Table 3.
Clinical Syndromes and Case-Fatality Rates in Case Patients With Invasive Group A Streptococcus Infections by Age Group, 2005–2012
| Syndromea | Case Patient Age Group | P Valueb | |||
|---|---|---|---|---|---|
|
| |||||
| All Ages (n = 9557) | <10 y (n = 955) | 10–64 y (n = 5752) (Reference) | ≥65 y (n = 2850) | ||
| Septic shockc | <.001 | ||||
| Case patients, No. (%) | 677 (13.7) | 22 (4.6) | 434 (14.8) | 221 (14.5) | |
| CFR (CFR for sole syndrome), %d | 33.8 (45.0) | 13.6 (60.0) | 29.7 (38.8) | 43.4 (55.8) | |
|
| |||||
| STSSe | <.001 | ||||
| Case patients, No. (%) | 381 (4.0) | 28 (2.9) | 265 (4.6) | 88 (3.1) | |
| CFR (CFR for sole syndrome), % | 25.7 (37.9) | 0 (0) | 23.4 (32.8) | 40.9 (70.0) | |
|
| |||||
| NFe | <.001 | ||||
| Case patients, No. (%) | 641 (6.7) | 7 (0.7) | 499 (8.7) | 135 (4.7) | |
| CFR (CFR for sole syndrome), % | 20.8 (29.0) | 0 (0) | 16.3 (21.9) | 38.5 (42.9) | |
|
| |||||
| Meningitis or CNS infection | <.001 | ||||
| Case patients, No. (%) | 110 (1.2) | 30 (3.1) | 62 (1.1) | 18 (0.6) | |
| CFR (CFR for sole syndrome), % | 23.6 (26.9) | 26.7 (35.3) | 21.0 (20.0) | 27.8 (30.0) | |
|
| |||||
| Pneumonia | <.001 | ||||
| Case patients, No. (%) | 1509 (15.8) | 150 (15.7) | 819 (14.2) | 540 (19.0) | |
| CFR (CFR for sole syndrome), % | 18.8 (17.7) | 4.7 (4.4) | 15.5 (13.8) | 27.8 (27.9) | |
|
| |||||
| Bacteremia | <.001 | ||||
| Case patients, No. (%) | 2383 (24.9) | 277 (29.0) | 1306 (22.7) | 800 (28.1) | |
| CFR (CFR for sole syndrome), % | 14.3 (14.4) | 4.7 (4.7) | 11.9 (11.9) | 21.9 (21.9) | |
|
| |||||
| Abdominal or peritoneal infection | <.001 | ||||
| Case patients, No. (%) | 190 (2.0) | 21 (2.2) | 151 (2.6) | 18 (0.6) | |
| CFR (CFR for sole syndrome), % | 14.7 (11.5) | 4.8 (8.3) | 15.9 (11.0) | 16.7 (18.2) | |
|
| |||||
| SSTIf | <.001 | ||||
| Case patients, No. (%) | 3890 (40.7) | 210 (22.0) | 2390 (41.6) | 1290 (45.3) | |
| CFR (CFR for sole syndrome), % | 7.3 (4.8) | 0 (0) | 5.5 (3.0) | 11.7 (8.3) | |
|
| |||||
| Septic arthritis | <.001 | ||||
| Case patients, No. (%) | 980 (10.3) | 138 (14.5) | 661 (11.5) | 181 (6.4) | |
| CFR (CFR for sole syndrome), % | 3.9 (3.5) | 0 (0) | 3.3 (3.5) | 8.8 (7.5) | |
|
| |||||
| Abscess | <.001 | ||||
| Case patients, No. (%) | 576 (6.0) | 109 (11.4) | 384 (6.7) | 83 (2.9) | |
| CFR (CFR for sole syndrome), % | 1.6 (0) | 0 (0) | 1.6 (0) | 3.6 (0) | |
|
| |||||
| Osteomyelitis | <.001 | ||||
| Case patients, No. (%) | 430 (4.5) | 72 (7.5) | 271 (4.7) | 87 (3.1) | |
| CFR (CFR for sole syndrome), % | 3.7 (1.3) | 0 (0) | 4.1 (2.1) | 5.8 (0) | |
|
| |||||
| Pregnancy-related infectiong | NA | ||||
| Case patients, No. (%) | NA | NA | 246 (20.1) | NA | |
| CFR (CFR for sole syndrome), % | NA | NA | 2.5 (1.1) | NA | |
|
| |||||
| Endocarditis or pericarditis | .02 | ||||
| Case patients, No. (%) | 131 (1.4) | 6 (0.6) | 93 (1.6) | 32 (1.1) | |
| CFR (CFR for sole syndrome), % | 7.6 (6.0) | 16.7 (25.0) | 4.3 (6.1) | 15.6 (0) | |
|
| |||||
| Epiglottitis or otitis media | <.001 | ||||
| Case patients, No. (%) | 128 (1.3) | 38 (4.0) | 61 (1.1) | 29 (1.0) | |
| CFR (CFR for sole syndrome), % | 3.9 (0) | 0 (0) | 4.9 (0) | 6.9 (0) | |
|
| |||||
| Otherh | <.001 | ||||
| Case patients, No. (%) | 39 (0.4) | 27 (2.8) | 12 (0.2) | 0 (0) | |
| CFR (CFR for sole syndrome), % | 2.6 (2.6) | 0 (0) | 8.3 (8.3) | NA | |
Abbreviations: CFR, case-fatality rate; CNS, central nervous system; NA, not applicable; NF, necrotizing fasciitis; SSTI, skin and soft-tissue infection; STSS, streptococcal toxic shock syndrome.
Case patients may have had >1 syndrome, with the exception of bacteremia without a source. Clinical syndromes, such as cutaneous and/or soft-tissue infection and pneumonia, had to be accompanied by recovery of an isolate from a normally sterile site or specimen, such as blood, to meet case definitions (except for NF and STSS). A total of 2214 case patients had >1 syndrome. For 9 patients, the outcome was missing, including 5 with bacteremia, 4 with cutaneous infection, and 1 each with NF, pneumonia, abscess, and osteomyelitis.
Comparison by age category of the proportion of invasive GAS infections attributable to a particular syndrome, determined with χ2 test, using the value for the 10–64-year age range as the referent and P < .05 the cutoff for significance.
The variable “septic shock” was added in 2009 (denominator, n = 4941).
Parenthetical values are CFRs for case patients in whom the specified syndrome was the only syndrome present.
A total of 73 case patients (0.8%) presented with both STSS and NF (combined CFR, 27.4%).
SSTI includes cellulitis, infected ulcers, erysipelas, wound infections, phlebitis/thrombophlebitis, lymphangitis, lymphadenitis, bursitis without a GAS-positive joint fluid culture, and gangrene; excludes NF.
For women aged 15–44 years; infections include endometritis (n = 82), septic abortion (n = 11), chorioamnionitis (n = 8), and puerperal sepsis (n = 33).
Other includes hemolytic uremic syndrome (n = 1), unknown syndromes (n = 14), and other syndromes (n = 24).