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Invasive Group A Streptococcal Disease in The Netherlands: Evidence for a Protective Role of Anti-Exotoxin A Antibodies

Ellen M. Mascini, Margriet Jansze, Joop F. P. Schellekens, James M. Musser, Joop A. J. Faber, Liesbeth A. E. Verhoef-Verhage, Leo Schouls, Wijnanda J. van Leeuwen, Jan Verhoef and Hans van Dijk
The Journal of Infectious Diseases
Vol. 181, No. 2 (Feb., 2000), pp. 631-638
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/30110291
Page Count: 8
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Invasive Group A Streptococcal Disease in The Netherlands: Evidence for a Protective Role of Anti-Exotoxin A Antibodies
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Abstract

As part of a nationwide surveillance in The Netherlands during 1994-1997, 53 patients with invasive group A streptococcal (GAS) infections were evaluated for medical history, symptoms, and outcome. Patients' isolates were tested for the production of pyrogenic exotoxins A (SPE-A) and B (SPE-B). Acute-phase sera from all patients and convalescent sera from 12 patients were investigated for the presence of antibodies against SPE-A and SPE-B. Twentythree patients developed toxic shock-like syndrome and 16 died. Absence of antibodies against SPE-A and/or SPE-B was a risk factor for developing invasive streptococcal disease. Toxic shock and mortality were associated with a lack of anti-SPE-A antibodies (P <.025). Anti-SPE-A antibodies were found in convalescent sera from all patients infected by speA-positive isolates. Virtually all invasive speA-positive streptococci expressed SPE-A protein in vitro. Thus antibodies against SPE-A appeared vital for mediating the outcome of invasive GAS disease in this population.

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