Acute abdomen due to group A streptococcus bacteremia caused by an isolate with a mutation in the csrS gene.

Masahiko Kaneko, Masaki Maruta, Hisaharu Shikata, Masakazu Hanayama, Tadayoshi Ikebe

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2015 Nov

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Streptococcus pyogenes (group A streptococcus) is an aerobic gram-positive coccus that causes infections ranging from non-invasive pharyngitis to severely invasive necrotizing fasciitis. Mutations in csrS/csrR and rgg, negative regulator genes of group A streptococcus, are crucial factors in the pathogenesis of streptococcal toxic shock syndrome, which is a severe, invasive infection characterized by sudden onset of shock and multiorgan failure, resulting in a high mortality rate. Here we present a case of group A streptococcal bacteremia in a 28-year-old Japanese woman with no relevant previous medical history. The patient developed progressive abdominal symptoms that may have been due to spontaneous bacterial peritonitis, followed by a state of shock, which did not fulfill the proposed criteria for streptococcal toxic shock. The isolate was found to harbor a mutation in the negative regulator csrS gene, whereas the csrR and rgg genes were intact. It was noteworthy that this strain carrying a csrS mutation had caused group A streptococcal bacteremia characterized by acute abdomen as the presenting symptom in a young individual who had been previously healthy. This case indicates that group A streptococcus with csrS mutations has potential virulence factors that are associated with the onset of group A streptococcal bacteremia that does not meet the diagnostic criteria for streptococcal toxic shock syndrome. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Citation

Masahiko Kaneko, Masaki Maruta, Hisaharu Shikata, Masakazu Hanayama, Tadayoshi Ikebe. Acute abdomen due to group A streptococcus bacteremia caused by an isolate with a mutation in the csrS gene. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 2015 Nov;21(11):816-9