The Ministry of National Health reports on the epidemiological situation of Streptococcus Pyogenes (also known as group A Streptococcus), a Gram-positive bacterium which is the most common cause of acute pharyngitis and skin infections such as impetigo, cellulitis and dengue fever.

After an alert was issued by this portfolio in December 2022 due to the increase in cases of invasive disease due to group A Streptococcus in countries in the European region, the occurrence of cases in Uruguay and in various Argentinian jurisdictions, Streptococcus pyogenes was included in mandatory national level event notification and surveillance protocols intensive care is designed to help understand the reasons for changes in epidemiological patterns of occurrence of these events.

As of November 6, 2023, 487 cases of invasive Streptococcus pyogenes infection were reported to the National Health Surveillance System (SNVS 2.0) across the country, of which 78 were fatal cases. Nearly half of S. pyogenes cases occurred in children under 16 years of age (241 cases, equivalent to 49.5%), while 38.5% of fatal cases occurred in children under 16 years of age, and the rest were spread throughout the world. all age groups.

On the other hand, although dengue fever is not part of the mandatory notifiable events, an outbreak of any etiology is a notifiable event. In this context, in October 2023, an outbreak of dengue fever was reported at an educational institution in the province of Santa Fe, with 5 associated cases, none of which required hospitalization and all of them progressed well. Diagnosis is made through a sample of pharyngeal exudate.

Genomic surveillance

Health teams’ awareness of the timely issuance of alerts allows the detection and recording of cases to the National Health Surveillance System in 2023. In successive reports published in the National Epidemiology Bulletin (BEN) Epidemiology Week (SE) 26 and 31, the national epidemiological situation was updated and warnings were given about the detection of the M1UK clone in Argentina and the discovery of 7 cases with the M1 sublineage having acquired mobile genetic elements encoding the superantigenic toxin SpeC, distinct from the recently emerged M1UK (England) and M1DK (Denmark) strains.

In document SE31, it was emphasized that these findings do not change current recommendations regarding early diagnosis and timely and adequate treatment of S. pyogenes infections, and the findings were re-disseminated.

Based on these findings, collaboration is underway between the National Reference Laboratory, the Epidemiology Directorate and jurisdictions to implement complementary non-invasive surveillance of diseases caused by S. pyogenes with the aim of analyzing possible relationships between the emerging clones. and an increase in cases this year. In July 2023, Instructions for notification of S. Pyogenes in SNVS 2.0 and notification sheets for OTHER INVASIVE INFECTIONS (events where invasive infections by group A Streptococcus are monitored) were published, available at:

https://bancos.salud.gob.ar/recurso/instructivo-para-la-notificacion-de-s-pyogenes-en-el-snvs-20

https://bancos.salud.gob.ar/recurso/otras-infecciones-invasivas-inmunoprevenibles-y-otras

S.pyogenes is included as a mandatory notification event within the framework of the surveillance awareness policy based on the Pan American Health Organization warning. Although previously such events could be notified in the National Surveillance System, actions aimed at standardizing the surveillance and notification of invasive diseases due to S.pyogenes, increasing awareness among health teams and the epidemiological and laboratory fields, led to the development of a systematic registry. across the country.

However, thanks to these efforts, health teams detected a higher incidence of invasive disease due to this pathogen, including fatal cases reflected in the notification. The detection of hypervirulent clones for the first time in Argentina, which have been registered in other countries, may partly explain the high incidence and mortality, but more evidence needs to be generated, which the national team is working on and is undertaking. province.

Recommendations for residents

Symptoms of pharyngitis are sore throat, fever, headache, stomach ache, nausea and vomiting, redness of the pharynx and tonsils, bad breath, enlarged lymph nodes in the neck.

The most common symptoms of dengue fever are redness, sore throat; fever (38.3°C or higher); red rash with sandpaper texture; dark red skin in the folds of the armpits, elbows and groin; a whitish coating on the tongue or the back of the throat; “raspberry” tongue; headache; nausea or vomiting; swollen glands; body aches.

If some of these symptoms are present, it is important to avoid self-treatment with antibiotics and consult a doctor for a timely diagnosis. In case of receiving a medical indication for antibiotic treatment, it is important to complete the regimen (adhere to the indicated dose and schedule, do not shorten or abandon treatment early), because inappropriate use of antibiotics increases bacterial resistance, a fact that threatens their effectiveness in the future.

Sick people should avoid going to public places (work, school) and limit household contacts. In addition, it is important to wash your hands frequently, not share personal items (cutlery, glasses, towels, etc.) and provide adequate and regular ventilation of the environment.