A high number of periocular group A streptococci (GAS) with Necrotizing Soft Tissue Infection in 2023
Author: Peter Toft
Base Hospital / Institution: Rigshospitalet, Denmark
ePoster presentation
Abstract ID: 24-204
Purpose
To report an unusually high number of periocular group A streptococci (GAS) in Copenhagen in the post-Covid era.
Methods
Review of records from patients admitted to the University Hospital in Copenhagen, Rigshospitalet with periocular soft tissue infections caused by GAS during the period of January 2023 to February 2024.
Results
A total of 12 patients with periocular GAS infection were admitted. Median age was 70 years (6-84) years. 7 were females.
All patients presented with erythema and edema of eyelids of one (9 pts.) or two eyes (3 pts.). Clinically, the infection behaved in an invasive manner in all pts. spreading rapidly to the surrounding tissues making the patients unable to open the affected eye(s). 6 pts. had post septal spread affecting eye motility. None had emphysema.
GAS was detected in blood cultures in 2 cases and in eyelid tissue samples in 3 cases, thereby classifying these 5 cases as invasive GAS infections. In the remaining 7 cases, GAS was detected in swabs from the eyelid and classified as non-invasive infection.
All patients were initially treated with clindamycin and meropenem. 6 pts. had surgical debridement of necrotic ulcers. Histology showed necrosis and inflammation in all confirming the clinical diagnosis of Necrotizing Soft Tissue Infection.
3 pts. needed mechanical ventilation, 3 pts. needed pressure support to avoid septic shock, one pt. needed hemodialysis for one week, 3 pts. were treated with hyperbaric oxygenation. 2 pts. have permanently reduced visual acuity in one eye due to post septal infection and optic neuropathy. One patient died.
Conclusion
In the years before 2023, periocular GAS with signs of systemic infection was a very rare encounter at Rigshospitalet with less than one patient a year on average. Data from the Danish Microbiology database covering all specialties in Denmark shows an increase in the incidence of invasive and non-invasive GAS by a factor of approx. 20 from January 2021 to January 2023. Not all patients with GAS in the periocular region need surgical debridement.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Jesper Skovlund | Jørgensen | Rigshospitalet, Denmark |
| Anne Katrine | Wiencke | Rigshospitalet, Denmark |
| Michaela | Tinggaard | Rigshospitalet, Denmark |
