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Survey in Israel and Analytic Review

Yehuda Carmeli, MD; Jonathan M. Schapiro, MD; Dominique Neeman, MD; Amos M. Yinnon, MD; Michael Alkan, MD

Arch Intern Med. 1995;155(11):1170-1176.

Abstract
Background
Data concerning group C streptococcal bacteremia come mainly from case reports; thus, population-based studies from different geographic areas are needed to validate these findings.

Methods
Eight years of data on group C streptococcal infection in Israel and cases of bacteremia in five hospitals were reviewed. We compared data from our survey as well as from other population-based studies with multiple cases published as case reports.

Results
The organisms were isolated in 78 cases (excluding pharyngitis); 16 had bacteremia. Ten cases of bacteremia were reviewed in five hospitals; none of the patients reported exposure to animals, and nine had severe underlying diseases. The clinical syndromes included four cases of primary bacteremia, four cutaneous infections, and one case each of meningitis and pneumonia. There were two deaths, one patient underwent amputation of a toe, one had a stroke, and one had a relapse. We compared 80 cases published as case reports with 59 cases reported in five population-based studies from different countries. We found higher rates of underlying diseases, alcohol abuse, liver diseases, and cutaneous infections, and lower rates of exposure to animals or raw products, endovascular infections, and central nervous system infections in population-based studies. Morbidity and mortality were 20% to 30% each in both types of studies.

Conclusions
Group C streptococcal bacteremia affects patients with underlying diseases; exposure to animals is variable and less frequent than previously reported. Morbidity and mortality are high and probably reflect the patients' underlying state as well as the severity of the infection.

(Arch Intern Med. 1995;155:1170-1176)

Author Affiliations
From the Department of Medicine, Hadassah University Hospital Mount Scopus, Jerusalem, Israel (Dr Carmeli); Department of Medicine D, Beilinson Medical Center, Petach Tikva, Israel (Dr Schapiro); Infectious Diseases Unit, Hadassah University Hospital Ein Carem, Jerusalem (Dr Neeman); Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem (Dr Yinnon); and Infectious Diseases Unit, Soroka Medical Center, Beer Sheva, Israel (Dr Alkan). Dr Carmeli is now with the Division of Infectious Diseases, New England Deaconess Hospital, Boston, Mass.

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