ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
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).
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeInvasive 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.
methodsAnonymized 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.
resultsForty 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).
conclusionThis 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.
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