Background: The numbers and characteristics of patients with invasive streptococcal disease co-occurring with COVID-19 have not been quantified and described at population level in any country.
Methods: Using patient-level data from national infectious disease surveillance, we linked test results for SARS-CoV-2 (first positive PCR) with microbiology results for sterile site specimens (blood, CSF, bone, joint, etc.) found to be positive for Groups A, B, C, or G Streptococcus during the period 01/03/2020 to 31/01/2022. Cases were classified according to the interval between bacterial and viral tests: 2-14 days for bacterial preceding viral infection, ±1 day for coincident infection, and 2-28 days for bacterial secondary to viral infection.
Results: We identified 343 cases of invasive pyogenic streptococcal infection preceding SARS-CoV-2 infection (A=69, B=89, C=89, G=96), 149 cases of coincident infection (A=39, B=58, C=29, G=23), and 160 cases of secondary infection (A=31, B=70, C=34, G=25), which represented 4.9% (652/13,283) of all invasive Group A, B, C, or G streptococcal infections. Invasive infections with SARS-CoV-2 were predominantly bacteraemia (90.0%, n=587), followed by lower respiratory tract (3.2%, n=21), joint (3.2%, n=21), and bone (2.0%, n=13). The median age of patients was 74 (IQR 57-85) years, lowest in group B cases (64, IQR 51-78 years); 43.7% of cases (n=285) were female. Median time from streptococcal to SARS-CoV-2 infection was 8 (IQR 5-11) days and from SARS-CoV-2 to streptococcal infection 11 (IQR 7-19.5) days.
Conclusions: Invasive infections with pyogenic streptococci preceding, coinciding with or following SARS-CoV-2 infection occurred mainly in older patients. The clinical severity and nosocomial or community origin of these cases requires further investigation.