Skip to content

Research at St Andrews

Molecular analysis of an outbreak of lethal postpartum sepsis caused by Streptococcus pyogenes

Research output: Contribution to journalArticle

DOI

Open Access permissions

Open

Author(s)

Claire E. Turner, Matthew Dryden, Matthew Thomas Geoffrey Holden, Frances J. Davies, Richard A. Lawrenson, Leili Farzaneh, Stephen D. Bentley, Androulla Efstratiou, Shiranee Sriskandan

School/Research organisations

Abstract

Sepsis is now the leading direct cause of maternal death in the United Kingdom, and Streptococcus pyogenes is the leading pathogen. We combined conventional and genomic analyses to define the duration and scale of a lethal outbreak. Two postpartum deaths caused by S. pyogenes occurred within 24 h; one was characterized by bacteremia and shock and the other by hemorrhagic pneumonia. The women gave birth within minutes of each other in the same maternity unit 2 days earlier. Seven additional infections in health care and household contacts were subsequently detected and treated. All cluster-associated S. pyogenes isolates were genotype emm1 and were initially indistinguishable from other United Kingdom emm1 isolates. Sequencing of the virulence gene sic revealed that all outbreak isolates had the same unique sic type. Genome sequencing confirmed that the cluster was caused by a unique S. pyogenes clone. Transmission between patients occurred on a single day and was associated with casual contact only. A single isolate from one patient demonstrated a sequence change in sic consistent with longer infection duration. Transmission to health care workers was traced to single clinical contacts with index cases. The last case was detected 18 days after the first case. Following enhanced surveillance, the outbreak isolate was not detected again. Mutations in bacterial regulatory genes played no detectable role in this outbreak, illustrating the intrinsic ability of emm1 S. pyogenes to spread while retaining virulence. This fast-moving outbreak highlights the potential of S. pyogenes to cause a range of diseases in the puerperium with rapid transmission, underlining the importance of immediate recognition and response by clinical infection and occupational health teams.

Close

Details

Original languageEnglish
Pages (from-to)2089-2095
Number of pages7
JournalJournal of Clinical Microbiology
Volume51
Issue number7
Early online date24 Apr 2012
DOIs
Publication statusPublished - Jul 2013

    Research areas

  • Group-a streptococcus, Complement-inhibiting protein, Health-care, Infections, Selection, Cariage, Disease, Gene, Surveillance, Prevention

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Genomic identification of cryptic susceptibility to penicillins and β-lactamase inhibitors in methicillin-resistant Staphylococcus aureus

    Harrison, E. M., Ba, X., Coll, F., Blane, B., Restif, O., Carvell, H., Köser, C. U., Jamrozy, D., Reuter, S., Lovering, A., Gleadall, N., Bellis, K. L., Uhlemann, A. C., Lowy, F. D., Massey, R. C., Grilo, I. R., Sobral, R., Larsen, J., Rhod Larsen, A., Vingsbo Lundberg, C. & 5 othersParkhill, J., Paterson, G. K., Holden, M. T. G., Peacock, S. J. & Holmes, M. A., 24 Jun 2019, In : Nature Microbiology. 15 p.

    Research output: Contribution to journalArticle

  2. Atlas of group A streptococcal vaccine candidates compiled using large-scale comparative genomics

    Davies, M. R., McIntyre, L., Mutreja, A., Lacey, J. A., Lees, J. A., Towers, R. J., Duchêne, S., Smeesters, P. R., Frost, H. R., Price, D. J., Holden, M. T. G., David, S., Giffard, P. M., Worthing, K. A., Seale, A. C., Berkley, J. A., Harris, S. R., Rivera-Hernandez, T., Berking, O., Cork, A. J. & 18 othersTorres, R. S. L. A., Lithgow, T., Strugnell, R. A., Bergmann, R., Nitsche-Schmitz, P., Chhatwal, G. S., Bentley, S. D., Fraser, J. D., Moreland, N. J., Carapetis, J. R., Steer, A. C., Parkhill, J., Saul, A., Williamson, D. A., Currie, B. J., Tong, S. Y. C., Dougan, G. & Walker, M. J., Jun 2019, In : Nature Genetics. 51, 6, p. 1035-1043

    Research output: Contribution to journalArticle

  3. Antimicrobial resistance in atopic dermatitis: need for an urgent rethink

    Harkins, C. P., Holden, M. T. G. & Irvine, A. D., Mar 2019, In : Annals of Allergy Asthma & Immunology. 122, 3, p. 236-240 5 p.

    Research output: Contribution to journalArticle

  4. Molecular epidemiology and expression of capsular polysaccharides in Staphylococcus aureus clinical isolates in the United States

    Mohamed, N., Timofeyeva, Y., Jamrozy, D., Rojas, E., Hao, L., Silmon de Monerri, N. C., Hawkins, J., Singh, G., Cai, B., Liberator, P., Sebastian, S., Donald, R. G. K., Scully, I. L., Jones, C. H., Creech, C. B., Thomsen, I., Parkhill, J., Peacock, S. J., Jansen, K. U., Holden, M. T. G. & 1 othersAnderson, A. S., 14 Jan 2019, In : PLoS ONE. 14, 1, 33 p., e0208356.

    Research output: Contribution to journalArticle

Related by journal

  1. Heat-inactivation renders sputum safe and preserves Mycobacterium tuberculosis RNA for downstream molecular tests

    Sabiiti, W., Azam, K., Esmeraldo, E., Bhatt, N., Rachow, A. & Gillespie, S. H., Mar 2019, In : Journal of Clinical Microbiology. 57, 4, 8 p., e01778-18.

    Research output: Contribution to journalArticle

  2. Molecular bacterial load assay (MBLA) concurs with culture on the NaOH-induced Mycobacterium tuberculosis loss of viability

    Mtafya, B., Sabiiti, W., Sabi, I., John, J., Sichone, E., Ntinginya, N. E. & Gillespie, S. H., 25 Jun 2019, In : Journal of Clinical Microbiology. 57, e01992-18.

    Research output: Contribution to journalArticle

  3. Development of a multilocus sequence typing scheme for the molecular typing of Mycoplasma pneumoniae

    Brown, R. J., Holden, M., Spiller, O. B. & Chalker, V. J., Oct 2015, In : Journal of Clinical Microbiology. 53, 10, p. 3195-3203

    Research output: Contribution to journalArticle

  4. Whole-genome sequencing confirms that Burkholderia pseudomallei multilocus sequence types common to both Cambodia and Australia are due to homoplasy

    De Smet, B., Sarovich, D. S., Price, E. P., Mayo, M., Theobald, V., Kham, C., Heng, S., Phe, T., Holden, M. T. G., Parkhill, J., Peacock, S. J., Spratt, B. G., Jacobs, J., Vandamme, P. & Currie, B. J., Jan 2015, In : Journal of Clinical Microbiology. 53, 1, p. 323-326

    Research output: Contribution to journalArticle

  5. Micro-evolution of Burkholderia pseudomallei during an acute infection

    Limmathurotsakul, D., Holden, M. T. G., Coupland, P., Price, E. P., Chantratita, N., Wuthiekanun, V., Amornchai, P., Parkhill, J. & Peacock, S. J., 2014, In : Journal of Clinical Microbiology.

    Research output: Contribution to journalArticle

ID: 74259738