Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1993 Jun;52(6):483–487. doi: 10.1136/ard.52.6.483

Beta haemolytic streptococci and musculoskeletal sepsis in adults.

C Deighton 1
PMCID: PMC1005078  PMID: 8323404

Abstract

Lancefield group A streptococci (GAS) account for 3-17% cases of septic arthritis, but other beta haemolytic streptococci (BHS) (groups B, C, and G) are being increasingly implicated. Epidemiological evidence suggests that the increase of BHS sepsis in adults is a true increase and not simply a reflection of better reporting. While underlying predisposing disease and old age are common concomitants of BHS sepsis, some subjects with devastating disease have been young and healthy. This is particularly the case for highly virulent M1 serotypes of GAS, where a toxic shock-like syndrome has led to a number of deaths in young adults in the United Kingdom and elsewhere. Musculoskeletal features, such as myalgias, painful swollen limbs, myositis, and fasciitis, are important features of this condition, so that rheumatologists may be involved in management. Group C and G musculoskeletal sepsis remains uncommon, with a high prevalence of underlying predisposing disease, or pre-existing arthritis in the septic joint. Group B BHS septic disease appears to be increasing in incidence. Musculoskeletal sepsis with these organisms usually takes place in subjects with other diseases, but healthy subjects have not been spared. Multiple septic foci and a rapidly destructive arthritis are not uncommon, and a recently described extra-articular feature is potentially blinding metastatic endophthalmitis. Clinicians need to be aware of an apparently increasing incidence of BHS musculoskeletal sepsis in adults so that early identification can lead to aggressive management in these potentially fatal infections.

Full text

PDF
483

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnham M. Invasive streptococcal infections in the era before the acquired immune deficiency syndrome: a 10 years' compilation of patients with streptococcal bacteraemia in North Yorkshire. J Infect. 1989 May;18(3):231–248. doi: 10.1016/s0163-4453(89)80059-3. [DOI] [PubMed] [Google Scholar]
  2. Bayer A. S., Chow A. W., Anthony B. F., Guze L. B. Serious infections in adults due to group B streptococci. Clinical and serotypic characterization. Am J Med. 1976 Oct;61(4):498–503. doi: 10.1016/0002-9343(76)90329-6. [DOI] [PubMed] [Google Scholar]
  3. Belani K., Schlievert P. M., Kaplan E. L., Ferrieri P. Association of exotoxin-producing group A streptococci and severe disease in children. Pediatr Infect Dis J. 1991 May;10(5):351–354. doi: 10.1097/00006454-199105000-00001. [DOI] [PubMed] [Google Scholar]
  4. Bisno A. L. Group A streptococcal infections and acute rheumatic fever. N Engl J Med. 1991 Sep 12;325(11):783–793. doi: 10.1056/NEJM199109123251106. [DOI] [PubMed] [Google Scholar]
  5. Burkert T., Watanakunakorn C. Group G streptococcus septic arthritis and osteomyelitis: report and literature review. J Rheumatol. 1991 Jun;18(6):904–907. [PubMed] [Google Scholar]
  6. Cone L. A., Woodard D. R., Schlievert P. M., Tomory G. S. Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med. 1987 Jul 16;317(3):146–149. doi: 10.1056/NEJM198707163170305. [DOI] [PubMed] [Google Scholar]
  7. Cooper C., Cawley M. I. Bacterial arthritis in an English health district: a 10 year review. Ann Rheum Dis. 1986 Jun;45(6):458–463. doi: 10.1136/ard.45.6.458. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Eykyn S. J., Young S. E., Cookson B. D. Increased community-acquired septicaemic infection with group B streptococci in adults. Lancet. 1991 Aug 17;338(8764):446–446. doi: 10.1016/0140-6736(91)91069-7. [DOI] [PubMed] [Google Scholar]
  9. Falk J. A., Fleischman J. L., Zabriskie J. B., Falk R. E. A study of HL-A antigen phenotype in rheumatic fever and rheumatic heart disease patients. Tissue Antigens. 1973;3(3):173–178. doi: 10.1111/j.1399-0039.1973.tb00991.x. [DOI] [PubMed] [Google Scholar]
  10. Farber B. P., Weinbaum D. L., Dummer J. S. Metastatic bacterial endophthalmitis. Arch Intern Med. 1985 Jan;145(1):62–64. [PubMed] [Google Scholar]
  11. Garcia-Kutzbach A., Masi A. T. Acute infectious agent arthritis (IAA): a detailed comparison of proved gonococcal and other blood-borne bacterial arthritis. J Rheumatol. 1974 Mar;1(1):93–101. [PubMed] [Google Scholar]
  12. Gaunt P. N., Seal D. V. Group G streptococcal infection of joints and joint prostheses. J Infect. 1986 Sep;13(2):115–123. doi: 10.1016/s0163-4453(86)92785-4. [DOI] [PubMed] [Google Scholar]
  13. Gaworzewska E., Colman G. Changes in the pattern of infection caused by Streptococcus pyogenes. Epidemiol Infect. 1988 Apr;100(2):257–269. doi: 10.1017/s095026880006739x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ghoneim A. T., Cooke E. M. Serious infection caused by group C streptococci. J Clin Pathol. 1980 Feb;33(2):188–190. doi: 10.1136/jcp.33.2.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Goldenberg D. L., Reed J. I. Bacterial arthritis. N Engl J Med. 1985 Mar 21;312(12):764–771. doi: 10.1056/NEJM198503213121206. [DOI] [PubMed] [Google Scholar]
  16. Hable K. A., Horstmeier C., Wold A. D., Washington J. A., 2nd Group A -hemolytic streptococcemia. Bacteriologic and clinical study of 44 cases. Mayo Clin Proc. 1973 May;48(5):336–339. [PubMed] [Google Scholar]
  17. Hallas G. The production of pyrogenic exotoxins by group A streptococci. J Hyg (Lond) 1985 Aug;95(1):47–57. doi: 10.1017/s0022172400062276. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hartmann L. C., Nauseef W. M. Group B streptococcal polyarthritis complicating hemophilia B. Acta Haematol. 1990;84(2):95–97. doi: 10.1159/000205036. [DOI] [PubMed] [Google Scholar]
  19. Hayward G. W. Infective endocarditis: a changing disease. II. Br Med J. 1973 Jun 30;2(5869):764–766. doi: 10.1136/bmj.2.5869.764. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ike R. W. Septic arthritis due to group C streptococcus: report and review of the literature. J Rheumatol. 1990 Sep;17(9):1230–1236. [PubMed] [Google Scholar]
  21. Kelly P. J., Martin W. J., Coventry M. B. Bacterial (suppurative) arthritis in the adult. J Bone Joint Surg Am. 1970 Dec;52(8):1595–1602. [PubMed] [Google Scholar]
  22. Krisher K., Cunningham M. W. Myosin: a link between streptococci and heart. Science. 1985 Jan 25;227(4685):413–415. doi: 10.1126/science.2578225. [DOI] [PubMed] [Google Scholar]
  23. Laster A. J., Michels M. L. Group B streptococcal arthritis in adults. Am J Med. 1984 May;76(5):910–915. doi: 10.1016/0002-9343(84)91008-8. [DOI] [PubMed] [Google Scholar]
  24. Marrack P., Kappler J. The staphylococcal enterotoxins and their relatives. Science. 1990 May 11;248(4956):705–711. doi: 10.1126/science.2185544. [DOI] [PubMed] [Google Scholar]
  25. Mohr D. N., Feist D. J., Washington J. A., 2nd, Hermans P. E. Infections due to group C streptococci in man. Am J Med. 1979 Mar;66(3):450–456. doi: 10.1016/0002-9343(79)91067-2. [DOI] [PubMed] [Google Scholar]
  26. Ortel T. L., Kallianos J., Gallis H. A. Group C streptococcal arthritis: case report and review. Rev Infect Dis. 1990 Sep-Oct;12(5):829–837. doi: 10.1093/clinids/12.5.829. [DOI] [PubMed] [Google Scholar]
  27. Parker M. T., Ball L. C. Streptococci and aerococci associated with systemic infection in man. J Med Microbiol. 1976 Aug;9(3):275–302. doi: 10.1099/00222615-9-3-275. [DOI] [PubMed] [Google Scholar]
  28. Parker M. T. Perinatal and neonatal infections: infections with group-B streptococci. J Antimicrob Chemother. 1979 May;5 (Suppl A):27–37. doi: 10.1093/jac/5.supplement_a.27. [DOI] [PubMed] [Google Scholar]
  29. Pischel K. D., Weisman M. H., Cone R. O. Unique features of group B streptococcal arthritis in adults. Arch Intern Med. 1985 Jan;145(1):97–102. [PubMed] [Google Scholar]
  30. Pischel K. D., Weisman M. H., Cone R. O. Unique features of group B streptococcal arthritis in adults. Arch Intern Med. 1985 Jan;145(1):97–102. [PubMed] [Google Scholar]
  31. Rady M., Turner P. G., Ross E. R. Group G streptococcal septic arthritis. Br J Clin Pract. 1990 Jul;44(7):287–289. [PubMed] [Google Scholar]
  32. Schwartz B., Facklam R. R., Breiman R. F. Changing epidemiology of group A streptococcal infection in the USA. Lancet. 1990 Nov 10;336(8724):1167–1171. doi: 10.1016/0140-6736(90)92777-f. [DOI] [PubMed] [Google Scholar]
  33. Schwartz B., Schuchat A., Oxtoby M. J., Cochi S. L., Hightower A., Broome C. V. Invasive group B streptococcal disease in adults. A population-based study in metropolitan Atlanta. JAMA. 1991 Aug 28;266(8):1112–1114. [PubMed] [Google Scholar]
  34. Sharp J. T., Lidsky M. D., Duffy J., Duncan M. W. Infectious arthritis. Arch Intern Med. 1979 Oct;139(10):1125–1130. [PubMed] [Google Scholar]
  35. Shaunak S., Wendon J., Monteil M., Gordon A. M. Septic scarlet fever due to Streptococcus pyogenes cellulitis. Q J Med. 1988 Nov;69(259):921–925. [PubMed] [Google Scholar]
  36. Small C. B., Slater L. N., Lowy F. D., Small R. D., Salvati E. A., Casey J. I. Group B streptococcal arthritis in adults. Am J Med. 1984 Mar;76(3):367–375. doi: 10.1016/0002-9343(84)90653-3. [DOI] [PubMed] [Google Scholar]
  37. Sobrino J., Bosch X., Wennberg P., Villalta J., Grau J. M. Septic arthritis secondary to group C streptococcus typed as Streptococcus equisimilis. J Rheumatol. 1991 Mar;18(3):485–486. [PubMed] [Google Scholar]
  38. Spencer R. C. Blood cultures: where do we stand? J Clin Pathol. 1988 Jun;41(6):668–670. doi: 10.1136/jcp.41.6.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Tabatabai M. F., Sapico F. L., Canawati H. N., Harley H. A. Sternoclavicular joint infection with group B streptococcus. J Rheumatol. 1986 Apr;13(2):466–466. [PubMed] [Google Scholar]
  40. Vartian C., Lerner P. I., Shlaes D. M., Gopalakrishna K. V. Infections due to Lancefield group G streptococci. Medicine (Baltimore) 1985 Mar;64(2):75–88. doi: 10.1097/00005792-198503000-00001. [DOI] [PubMed] [Google Scholar]
  41. Walling D. M., Kaelin W. G., Jr Pyomyositis in patients with diabetes mellitus. Rev Infect Dis. 1991 Sep-Oct;13(5):797–802. doi: 10.1093/clinids/13.5.797. [DOI] [PubMed] [Google Scholar]
  42. Wannamaker L. W. Changes and changing concepts in the biology of group A streptococci and in the epidemiology of streptococcal infections. Rev Infect Dis. 1979 Nov-Dec;1(6):967–975. doi: 10.1093/clinids/1.6.967. [DOI] [PubMed] [Google Scholar]
  43. Watsky K. L., Kollisch N., Densen P. Group G streptococcal bacteremia. The clinical experience at Boston University Medical Center and a critical review of the literature. Arch Intern Med. 1985 Jan;145(1):58–61. doi: 10.1001/archinte.145.1.58. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES