Kassandra Loewen1, Natalie Bocking2, Cai-Lei Matsumoto2, Mike Kirlew3, Len Kelly4. 1. Anishnaabe Bimaadiziwin Research Program and Sioux Lookout Local Education Group, Sioux Lookout, Ont. 2. Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont. 3. Northern Ontario School of Medicine, Sioux Lookout, Ont. 4. Anishnaabe Bimaadiziwin Research Program, Sioux Lookout, Ont.
Abstract
INTRODUCTION: High rates of invasive group A Streptococcus disease were suspected by clinicians in northwestern Ontario. Patients with sepsis were being encountered with bacteremia positive for group A Streptococcus. This study was designed to assess the incidence of invasive group A Streptococcus infection in the region and provide best-practice treatment information. METHODS: We performed a retrospective chart review at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) from 2009 to 2014 to examine rates of infection due to invasive group A Streptococcus and outcomes. All blood cultures from 2015 were also examined to calculate the relative rates of distinct pathogens responsible for cases of bacteremia. A literature review on this topic was performed, with attention to rural incidence where available and clinical practice guidelines. RESULTS: Invasive group A Streptococcus disease was diagnosed in 65 patients during the study period. Most (37 [57%]) had bacteremia without a clinical focus. Type 2 diabetes mellitus was a comorbid condition in 27 (42%) and skin conditions in 30 (46%). The case fatality rate was 4.6%. In 2015, group A Streptococcus accounted for 8% of all positive blood cultures from in- and outpatients in the catchment area. The calculated annual incidence rate of invasive group A Streptococcus infection was 37.2 cases per 100 000 population. CONCLUSION: Rural physicians may encounter group A Streptococcus bacteremia in their practice. The death rate associated with these infections can be as high as 20%, and patients require urgent treatment, typically with intravenous penicillin and clindamycin therapy. The rate of invasive group A Streptococcus infection in the predominantly First Nations population served by the SLMHC exceeded the Canadian rate eightfold and is comparable to rates observed in low-income countries and among Indigenous populations in Australia. This disparity may result from inadequate housing, overcrowding or limited access to clean water.
INTRODUCTION: High rates of invasive group A Streptococcus disease were suspected by clinicians in northwestern Ontario. Patients with sepsis were being encountered with bacteremia positive for group A Streptococcus. This study was designed to assess the incidence of invasive group A Streptococcus infection in the region and provide best-practice treatment information. METHODS: We performed a retrospective chart review at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) from 2009 to 2014 to examine rates of infection due to invasive group A Streptococcus and outcomes. All blood cultures from 2015 were also examined to calculate the relative rates of distinct pathogens responsible for cases of bacteremia. A literature review on this topic was performed, with attention to rural incidence where available and clinical practice guidelines. RESULTS: Invasive group A Streptococcus disease was diagnosed in 65 patients during the study period. Most (37 [57%]) had bacteremia without a clinical focus. Type 2 diabetes mellitus was a comorbid condition in 27 (42%) and skin conditions in 30 (46%). The case fatality rate was 4.6%. In 2015, group A Streptococcus accounted for 8% of all positive blood cultures from in- and outpatients in the catchment area. The calculated annual incidence rate of invasive group A Streptococcus infection was 37.2 cases per 100 000 population. CONCLUSION: Rural physicians may encounter group A Streptococcus bacteremia in their practice. The death rate associated with these infections can be as high as 20%, and patients require urgent treatment, typically with intravenous penicillin and clindamycin therapy. The rate of invasive group A Streptococcus infection in the predominantly First Nations population served by the SLMHC exceeded the Canadian rate eightfold and is comparable to rates observed in low-income countries and among Indigenous populations in Australia. This disparity may result from inadequate housing, overcrowding or limited access to clean water.
Authors: Grace Huang; Irene Martin; Raymond S Tsang; Walter H Demczuk; Gregory J Tyrrell; Y Anita Li; Catherine Dickson; Francesca Reyes-Domingo; Susan G Squires Journal: Can Commun Dis Rep Date: 2021-11-10