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Purpose <p>Invasive <i>Streptococcus pyogenes</i> (iGAS) infections have risen globally since the COVID-19 pandemic. This study aimed to characterize clinical-pathological patterns in iGAS presenting as unexpected deaths and to evaluate the role of post-mortem microbiology alongside clinical and autopsy findings in determining cause of death.</p> Methods <p>Anonymized clinical, microbiological, and pathological (macroscopy and/or histopathology) data from fatal cases with positive <i>S. pyogenes</i> cultures, reported in four ESGFOR laboratories between September 2020 and May 2023, were reviewed.</p> Results <p>Forty cases were identified. Respiratory tract infection (<i>n</i> = 20) and sepsis/septic shock (<i>n</i> = 17) were the most frequent presentations. <i>S. pyogenes</i> was isolated primarily from blood (<i>n</i> = 26) and lung tissue (<i>n</i> = 30). In 37 cases with histopathology, acute inflammation was the predominant feature. <i>S. pyogenes</i> was judged the definite cause of death in 28 cases, contributory in 8, and probable in 2; in two cases, its role remained unclear. The <i>emm</i>-type 1 was strongly associated with the definite cause of death (12/13 cases).</p> Conclusion <p>This study highlights the importance and contribution of post-mortem microbiology and autopsy data in clarifying unexpected/unexplained deaths with a focus on <i>S. pyogenes</i>. Comprehensive autopsy, including post-mortem microbiology and histopathology findings, enabled determination of <i>S. pyogenes</i>’ role in 95% (38/40) of unexpected iGAS deaths. With this type of post-mortem investigation, one may come to new insights for these rapidly progressive and sometimes unexpected fatal infections. Standardized postmortem culture protocols in fatal sepsis cases and a European registry of fatal iGAS may help to better define clinical-pathological patterns of these rapidly progressive and sometimes unexpected fatal infections.</p>

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Fatal Streptococcus pyogenes infections in Spain, Turkey, UK and Belgium after pandemics: a comprehensive case series combining microbiology with autopsy findings. A study of the ESCMID study group for forensic and post-mortem microbiology (ESGFOR).

  • 期刊论文

  • 发表日期：

    2026年1月5日

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  • Veroniek Saegeman,
  • Amparo Fernandez-Rodriguez,
  • Nihan Ziyade,
  • Raquel Abad,
  • Marta C. Cohen

摘要

Purpose

Invasive Streptococcus pyogenes (iGAS) infections have risen globally since the COVID-19 pandemic. This study aimed to characterize clinical-pathological patterns in iGAS presenting as unexpected deaths and to evaluate the role of post-mortem microbiology alongside clinical and autopsy findings in determining cause of death.

Methods

Anonymized clinical, microbiological, and pathological (macroscopy and/or histopathology) data from fatal cases with positive S. pyogenes cultures, reported in four ESGFOR laboratories between September 2020 and May 2023, were reviewed.

Results

Forty cases were identified. Respiratory tract infection (n = 20) and sepsis/septic shock (n = 17) were the most frequent presentations. S. pyogenes was isolated primarily from blood (n = 26) and lung tissue (n = 30). In 37 cases with histopathology, acute inflammation was the predominant feature. S. pyogenes was judged the definite cause of death in 28 cases, contributory in 8, and probable in 2; in two cases, its role remained unclear. The emm-type 1 was strongly associated with the definite cause of death (12/13 cases).

Conclusion

This study highlights the importance and contribution of post-mortem microbiology and autopsy data in clarifying unexpected/unexplained deaths with a focus on S. pyogenes. Comprehensive autopsy, including post-mortem microbiology and histopathology findings, enabled determination of S. pyogenes’ role in 95% (38/40) of unexpected iGAS deaths. With this type of post-mortem investigation, one may come to new insights for these rapidly progressive and sometimes unexpected fatal infections. Standardized postmortem culture protocols in fatal sepsis cases and a European registry of fatal iGAS may help to better define clinical-pathological patterns of these rapidly progressive and sometimes unexpected fatal infections.