INTRODUCTION: Despite national guidelines and use of intrapartum antibiotic prophylaxis (IAP), Streptococcus agalactiae (group B streptococci (GBS)) is still a leading cause of morbidity and mortality in newborns in Europe and the United States. The European DEVANI (Design of a Vaccine Against Neonatal Infections) program assessed the neonatal GBS infection burden in Europe, the clinical characteristics of colonized women and microbiological data of GBS strains in colonized women and their infants with early-onset disease (EOD). METHODS: Overall, 1083 pregnant women with a GBS-positive culture result from eight European countries were included in the study. Clinical obstetrical information was collected by a standardized questionnaire. GBS strains were characterized by serological and molecular methods. RESULTS: Among GBS carriers included in this study after testing positive for GBS by vaginal or recto-vaginal sampling, 13.4% had at least one additional obstetrical risk factor for EOD. The five most common capsular types (i.e., Ia, Ib, II, III and V) comprised ~ 93% of GBS carried. Of the colonized women, 77.8% received any IAP, and in 49.5% the IAP was considered appropriate. In our cohort, nine neonates presented with GBS early-onset disease (EOD) with significant regional heterogeneity. CONCLUSIONS: Screening methods and IAP rates need to be harmonized across Europe in order to reduce the rates of EOD. The epidemiological data from eight different European countries provides important information for the development of a successful GBS vaccine.

• MeSH
• Antibiotic Prophylaxis MeSH
• Adult MeSH
• Pregnancy Complications, Infectious * epidemiology   microbiology   MeSH
• Humans MeSH
• Young Adult MeSH
• Infant, Newborn MeSH
• Carrier State epidemiology   microbiology   MeSH
• Streptococcus agalactiae * isolation & purification   classification   MeSH
• Streptococcal Infections * epidemiology   microbiology   prevention & control   MeSH
• Pregnancy MeSH
• Vagina microbiology   MeSH
• Infectious Disease Transmission, Vertical statistics & numerical data   prevention & control   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

BACKGROUND: Since 2022, an increasing number of invasive group A streptococcal (iGAS) infections have been reported, with increasing severity and lethality. We aimed to compare the frequency and characteristics of bacteraemic GAS infections in adults before and after the COVID-19 pandemic. METHODS: This was a retrospective observational study of adult patients with Streptococcus pyogenes bacteraemia in two periods, January 2017 to December 2019 and October 2022 to December 2023. Demographics, clinical presentation, antibiotic treatment, therapeutic response, complications and outcome were analysed. RESULTS: Thirty-five patients with Streptococcus pyogenes bacteraemia in the 3-year pre-pandemic group were compared with 36 patients in the 15-month post-pandemic group. The median ages in the pre-pandemic and post-pandemic groups were 65 (IQR = 28) and 64.5 (IQR = 31) years, respectively. The proportions of males and females in the pre-pandemic group were 69% and 31%, respectively, compared with 33% and 67%, respectively, in the post-pandemic group. Skin and soft tissue infections occurred in 77% and 53%, respectively (p = 0.032). Rare manifestations, such as pneumonia and meningitis, were diagnosed in the post-pandemic group. Septic shock was significantly less common in the pre-pandemic group, with rates of 26% vs. 56% (p = 0.011). Treatment response was good in 74% of the pre-pandemic group compared to 58% of the post-pandemic group (p = 0.155). Lethality was not significantly higher in the post-pandemic group (26% vs. 33%, p = 0.482) but the number of deaths per year was more than three times higher in the post-pandemic group. CONCLUSIONS: In the post-pandemic period, the frequency of bacteraemic GAS infections in adults increased significantly. A higher proportion of women, a decrease in the age of women and an increase in the age of men, rare clinical manifestations, poor response to therapy and increased severity and number of deaths were the new features of adult disease observed in the post-pandemic period.

• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Bacteremia * epidemiology   microbiology   drug therapy   MeSH
• COVID-19 * epidemiology   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Retrospective Studies MeSH
• SARS-CoV-2 MeSH
• Aged MeSH
• Streptococcus pyogenes * MeSH
• Streptococcal Infections * epidemiology   drug therapy   microbiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

Infective endocarditis (IE) is a life-threatening disease, with its mortality rate varying depending on the infectious agent. Streptococci are among the most common causes of infective endocarditis. However, Streptococcus vestibularis has rarely been associated with human infections, typically affecting patients with underlying conditions such as immunosuppressive diseases, valve replacement, rheumatic heart disease, and hemodialysis. We present the case of a 26-year-old man who presented with fever, unanticipated weight loss, and fatigue. Although no typical risk factors for infective endocarditis were identified at admission, transesophageal echocardiography revealed a bicuspid aortic valve with calcification, paravalvular aortic abscess formation, and vegetations on the anterior leaflet of the mitral valve. Blood cultures grew S. vestibularis, which was initially sensitive to benzylpenicillin but developed emergent resistance on the third day of the antibiotic treatment. Subsequently, ceftriaxone therapy was initiated, and blood cultures became sterile on day 10. The patient eventually underwent aortic valve replacement. We report the first known case of native aortic and mitral valve endocarditis caused by S. vestibularis, accompanied by a paravalvular abscess around the native aortic valve, in a patient who had no typical risk factors for infective endocarditis, except for a bicuspid aortic valve.

• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Aortic Valve Insufficiency * microbiology   surgery   MeSH
• Endocarditis, Bacterial * complications   diagnosis   drug therapy   microbiology   MeSH
• Bicuspid Aortic Valve Disease * complications   surgery   MeSH
• Third Generation Cephalosporins therapeutic use   MeSH
• Ceftriaxone therapeutic use   MeSH
• Heart Valve Prosthesis Implantation MeSH
• Adult MeSH
• Humans MeSH
• Mitral Valve * microbiology   MeSH
• Penicillin G therapeutic use   MeSH
• Penicillin Resistance MeSH
• Streptococcal Infections * complications   diagnosis   drug therapy   microbiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Parapharyngeal abscess in an infant is a very rare condition. We present the case of a 4-month-old girl with large masses on the neck's left side. Computed tomography showed an extensive parapharyngeal abscess. Left tonsillectomy was performed under general anesthesia from a transoral approach, followed by an incision and evacuation of the abscess from the parapharyngeal space. Microbiological analysis identified a massive occurrence of Streptococcus intermedius.

• MeSH
• Abscess * microbiology   surgery   MeSH
• Infant MeSH
• Humans MeSH
• Pharyngeal Diseases microbiology   surgery   MeSH
• Tomography, X-Ray Computed MeSH
• Parapharyngeal Space * surgery   diagnostic imaging   microbiology   MeSH
• Streptococcus intermedius isolation & purification   MeSH
• Streptococcal Infections * microbiology   surgery   MeSH
• Tonsillectomy MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

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• MeSH
• Genotyping Techniques MeSH
• Disease Notification MeSH
• Humans MeSH
• Streptococcus pyogenes * isolation & purification   pathogenicity   MeSH
• Streptococcal Infections * epidemiology   MeSH
• Age Factors MeSH
• Check Tag
• Humans MeSH
• Publication type
• Chart MeSH
• Geographicals
• Czech Republic MeSH

Cíle: Od prosince roku 2022 je pozorován v České republice zvýšený výskyt invazivního onemocnění způsobeného Streptococcus pyogenes s posunem klinické prezentace a věkové hranice postižených osob. Invazivní onemocnění se projevují ve srovnání s předchozími roky častěji u dětí do 18 let věku a dosud zdravých dospělých středního věku. Zvýšil se počet izolátů S. pyogenes získaných z primárně sterilních míst, jako je hemokultura, mozkomíšní mok, pleurální výpotek, kloubní punktát a sekční materiál. Rutinním stanovováním typu genu emm bylo zjištěno, že převažujícím emm typem S. pyogenes je emm1. V období od ledna 2023 do července 2023 46 % všech izolátů S. pyogenes z invazivních onemocnění odpovídalo typu emm1. Globálně rozšířená sublinie M1UK je charakterizována ve srovnání s historickými kmeny iGAS typu emm1 odlišnou expresí sedmi genů, mezi které patří i gen streptokokového pyrogenního toxinu A (speA). Cílem studie je stanovit, zda ve větší míře toxigenní sublinie M1UK je spojena se zvýšeným výskytem invazivního onemocnění v České republice. Metody: Celogenomová sekvenace 41 izolátů S. pyogenes izolovaných v České republice v letech 2018 a 2019 a od prosince 2022 do května 2023 od pacientů s invazivním onemocněním byla provedena přístrojem MiSeq (Illumina). Bioinformatická analýza byla provedena volně dostupnými online nástroji Bacterial and Viral Bioinformatics Resource Center. Výsledky: Na základě dat celogenomové sekvenace 41 izolátů S. pyogenes typu emm1 izolovaných od pacientů s invazivním infekčním onemocněním v období let 2018 a 2019 a od prosince 2022 do května 2023 bylo zjištěno, že mezi invazivními kmeny S. pyogenes typu emm1 převládá od prosince 2022 do května 2023 v České republice sublinie M1UK. Závěr: Důvod rozšíření sublinie M1UK v České republice na konci roku 2022 a v první polovině roku 2023 není zcela zřejmý, ale může být spojen se sníženou imunitou v souvislosti s omezeným přenosem GAS během lockdownů, zvláště u dětí. Dalším faktorem, který mohl přispět k vysokému výskytu invazivních infekčních onemocnění, je sezonní cirkulace respiračních virů.

Aims: Since December 2022, an increase in invasive disease caused by Streptococcus pyogenes has been observed in the Czech Republic, with a shift in the clinical presentation and age of patients. Unlike in previous years, invasive disease is more common in children and adolescents under 18 years of age and in previously healthy middle-aged adults. An increase has been noticed in the number of S. pyogenes isolates from primarily sterile sites such as haemoculture, cerebrospinal fluid, pleural effusion fluid, joint fluid, and postmortem specimens. Routine emm gene typing revealed emm1 to be the predominant emm type of S. pyogenes. Between January 2023 and July 2023, 46% of all S. pyogenes isolates from invasive cases were assigned to the emm1 type. The globally spread M1UK sublineage is characterized by differences in the expression of seven genes, including the streptococcal pyrogenic toxin A (speA) gene, compared to historical emm1 iGAS strains. The aim of this study is to determine whether the more toxigenic M1UK sublineage is associated with the increase in invasive disease in the Czech Republic. Methods: Whole genome sequencing of 41 S. pyogenes isolates from patients with invasive disease recovered in the Czech Republic in 2018 and 2019 and from December 2022 to May 2023 was performed using the MiSeq instrument (Illumina). Bioinformatics analysis was performed using freely available online tools the Bacterial and Viral Bioinformatics Resource Center. Results: Based on whole genome sequencing data of 41 emm1 isolates of S. pyogenes from patients with invasive infectious disease recovered in 2018 and 2019 and from December 2022 to May 2023, the M1UK sublineage was found to be predominant from December 2022 to May 2023. Conclusion: The reason for the spread of the M1UK sublineage in the Czech Republic late in 2022 and in the first half of 2023 is not entirely clear, but it may be related to reduced immunity due to limited GAS transmission during lockdowns, especially in children. Another factor that may have contributed to the high incidence of invasive infectious diseases is the seasonal circulation of respiratory viruses.

• MeSH
• Antigens, Bacterial MeSH
• Bacterial Proteins genetics   isolation & purification   MeSH
• Exotoxins MeSH
• Humans MeSH
• Bacterial Outer Membrane Proteins genetics   MeSH
• Whole Genome Sequencing MeSH
• Streptococcus pyogenes genetics   isolation & purification   MeSH
• Streptococcal Infections * epidemiology   microbiology   MeSH
• Superantigens MeSH
• Check Tag
• Humans MeSH
• Geographicals
• Czech Republic MeSH

Intrapartum antibiotic prophylaxis (IAP) is commonly used during C-section delivery and in Group B Streptococcus-positive women before vaginal delivery. Here, we primarily aimed to investigate the effect of IAP on the neonatal oral and fecal bacteriomes in the first week of life. In this preliminary study, maternal and neonatal oral swabs and neonatal fecal (meconium and transitional stool) swabs were selected from a pool of samples from healthy mother-neonate pairs participating in the pilot phase of CELSPAC: TNG during their hospital stay. The DNA was extracted and bacteriome profiles were determined by 16S rRNA amplicon sequencing (Illumina). In the final dataset, 33 mother-neonate pairs were exposed to antibiotics during C-section or vaginal delivery (cases; +IAP) and the vaginal delivery without IAP (controls, -IAP) took place in 33 mother-neonate pairs. Differences in alpha diversity (Shannon index, p=0.01) and bacterial composition (PERMANOVA, p<0.05) between the +IAP and -IAP groups were detected only in neonatal oral samples collected ≤48 h after birth. No significant differences between meconium bacteriomes of the +IAP and -IAP groups were observed (p>0.05). However, the IAP was associated with decreased alpha diversity (number of amplicon sequence variants, p<0.001), decreased relative abundances of the genera Bacteroides and Bifidobacterium, and increased relative abundances of genera Enterococcus and Rothia (q<0.01 for all of them) in transitional stool samples. The findings of this study suggest that exposure to IAP may significantly influence the early development of the neonatal oral and gut microbiomes. IAP affected the neonatal oral bacteriome in the first two days after birth as well as the neonatal fecal bacteriome in transitional stool samples. In addition, it highlights the necessity for further investigation into the potential long-term health impacts on children.

• MeSH
• Anti-Bacterial Agents * administration & dosage   MeSH
• Antibiotic Prophylaxis * methods   MeSH
• Bacteria genetics   classification   isolation & purification   drug effects   MeSH
• Cesarean Section MeSH
• Adult MeSH
• Feces * microbiology   MeSH
• Humans MeSH
• Meconium microbiology   MeSH
• Infant, Newborn MeSH
• RNA, Ribosomal, 16S genetics   MeSH
• Gastrointestinal Microbiome drug effects   MeSH
• Pregnancy MeSH
• Mouth * microbiology   MeSH
• Delivery, Obstetric MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

PURPOSE: Group B streptococcus (GBS) remains a leading cause of invasive disease, mainly sepsis and meningitis, in infants < 3 months of age and of mortality among neonates. This study, a major component of the European DEVANI project (Design of a Vaccine Against Neonatal Infections) describes clinical and important microbiological characteristics of neonatal GBS diseases. It quantifies the rate of antenatal screening and intrapartum antibiotic prophylaxis among cases and identifies risk factors associated with an adverse outcome. METHODS: Clinical and microbiological data from 153 invasive neonatal cases (82 early-onset [EOD], 71 late-onset disease [LOD] cases) were collected in eight European countries from mid-2008 to end-2010. RESULTS: Respiratory distress was the most frequent clinical sign at onset of EOD, while meningitis is found in > 30% of LOD. The study revealed that 59% of mothers of EOD cases had not received antenatal screening, whilst GBS was detected in 48.5% of screened cases. Meningitis was associated with an adverse outcome in LOD cases, while prematurity and the presence of cardiocirculatory symptoms were associated with an adverse outcome in EOD cases. Capsular-polysaccharide type III was the most frequent in both EOD and LOD cases with regional differences in the clonal complex distribution. CONCLUSIONS: Standardizing recommendations related to neonatal GBS disease and increasing compliance might improve clinical care and the prevention of GBS EOD. But even full adherence to antenatal screening would miss a relevant number of EOD cases, thus, the most promising prophylactic approach against GBS EOD and LOD would be a vaccine for maternal immunization.

• MeSH
• Antibiotic Prophylaxis adverse effects   MeSH
• Pregnancy Complications, Infectious * diagnosis   epidemiology   MeSH
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Streptococcus agalactiae MeSH
• Streptococcal Infections * diagnosis   epidemiology   prevention & control   MeSH
• Pregnancy MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

• MeSH
• Child MeSH
• Humans MeSH
• Streptococcus pyogenes pathogenicity   MeSH
• Streptococcal Infections * diagnosis   drug therapy   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Geographicals
• Czech Republic MeSH

Streptococcus pyogenes (streptokok skupiny A, GAS) může u dětí zapříčinit široké spektrum onemocnění, zejména faryngitidu a spálu. Méně často může způsobit závažné invazivní infekce, včetně nekrotizující fascitidy, pneumonie, sepse a syndromu streptokokového toxického šoku. Infekce GAS vyžadující hospitalizaci je u mladších dětí stále spojena se závažným onemocněním a krátkodobou i dlouhodobou morbiditou. Včasné rozpoznání onemocnění a okamžitá antibiotická léčba je dnes nejúčinnější prevencí vážné komplikace GAS infekce. U dětí do 10 let je míra výskytu infekce invazivním streptokokem skupiny A (iGAS) v letošním roce vyšší než v letech předcházejících pandemii covidu-19, ale podstatně vyšší než v posledních dvou letech. V posledním roce na základě hlášení o nárůstu infekcí dolních cest dýchacích u dětí, zejména empyému, probíhá systematický sběr dat jednotlivých případů, abychom infekci iGAS lépe porozuměli. Prezentujeme dvě děti předškolního věku se spálovou angínou, která byla komplikovaná pleuropneumonií a respiračním selháním.

Streptococcus pyogenes (group A streptococcus, GAS) causes a wide range of diseases in children, especially pharyngitis and scarlet fever. Less commonly, it can cause serious invasive infections, including necrotizing fasciitis, pneumonia, sepsis and streptococcal toxic shock syndrome. GAS infection requiring hospitalization is still associated with significant serious illness and short- and long-term morbidity in younger children. Early recognition of the disease and prompt antibiotic treatment is the most natural prevention of serious GAS complications today. In children under 10 years of age, the rate of infection with invasive GAS (iGAS) is higher than in the years preceding the COVID-19 pandemic, but significantly higher than in the last two years. In the last year, based on reports of an increase in lower respiratory tract infections in children, particularly empyema, systematic data collection of individual cases is underway to better understand iGAS. We present two preschool children with scarlet fever complicated by pleuropneumonia and respiratory failure.

• MeSH
• Respiratory Tract Infections etiology   drug therapy   classification   microbiology   MeSH
• Humans MeSH
• Morbidity MeSH
• Pleuropneumonia diagnosis   etiology   MeSH
• Child, Preschool MeSH
• Respiratory Insufficiency etiology   MeSH
• Scarlet Fever MeSH
• Streptococcus pyogenes * pathogenicity   MeSH
• Streptococcal Infections diagnosis   classification   microbiology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH