Chapter 18 : Group C and Group G Streptococcal Infections: Epidemiologic and Clinical Aspects

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Group C and Group G Streptococcal Infections: Epidemiologic and Clinical Aspects, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816513/9781555813437_Chap18-1.gif /docserver/preview/fulltext/10.1128/9781555816513/9781555813437_Chap18-2.gif


Streptococci possessing Lancefield group C and G cell wall carbohydrates are heterogeneous in regard to biochemical reactions, hemolytic characteristics, predilection for host species, and clinical illnesses produced in humans and animals. These organisms are found as commensals in the throat, skin, and occasionally the female genitourinary tract, and their epidemiologic patterns and clinical manifestations reflect this distribution. This chapter focuses on the more common infections caused by subsp. , as well as on the few reported human cases caused by subsp. , subsp. , subsp. , and . Strains of these streptococci have been associated with infections of many body sites. Treatment with penicillin is adequate under most circumstances.

Citation: Baracco G, Bisno A. 2006. Group C and Group G Streptococcal Infections: Epidemiologic and Clinical Aspects, p 222-229. In Fischetti V, Novick R, Ferretti J, Portnoy D, Rood J (ed), Gram-Positive Pathogens, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816513.ch18

Key Concept Ranking

Cardiovascular Diseases
Respiratory Diseases
Toxic Shock Syndrome
Skin Infections
Streptococcus dysgalactiae
Streptococcus constellatus
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Aubry, P.,, T. M. Swor,, C. V. Lohr,, A. Tibary,, and G. M. Barrington. 2000. Septic orchitis in an alpaca. Can. Vet. J. 41:704706.
2. Auckenthaler, R.,, P. E. Hermans,, and J. A. Washington II. 1983. Group G streptococcal bacteremia: clinical study and review of the literature. Rev. Infect. Dis. 5:196204.
3. Baddour, L. M.,, and A. L. Bisno. 1985. Non-group A beta-hemolytic streptococcal cellulitis: association with venous and lymphatic compromise. Am. J. Med. 79:155159.
4. Balter, S.,, A. Benin,, S. W. Pinto,, L. M. Teixeira,, G. G. Alvim,, E. Luna,, D. Jackson,, L. Laclaire,, J. Elliott,, R. Facklam,, and A. Schuchat. 2000. Epidemic nephritis in Nova Serrana, Brazil. Lancet 355:17761780.
5. Barnham, M.,, T. J. Thornton,, and K. Lange. 1983. Nephritis caused by Streptococcus zooepidemicus (Lancefield group C). Lancet 1(8331):945948.
6. Benjamin, J. T.,, and V. A. J. Perriello. 1976. Pharyngitis due to group C hemolytic streptococci in children. J. Pediatr. 89:254256.
7. Bert, F.,, C. Branger,, B. Poutrel,, and N. Lambert- Zechovsky. 1997. Differentiation of human and animal strains of Streptococcus dysgalactiae by pulsed-field gel electrophoresis. FEMS Microbiol. Lett. 150:107112.
8. Bisno, A. L.,, and J. M. Gaviria. 1997. Murine model of recurrent group G streptococcal cellulitis: no evidence of protective immunity. Infect. Immun. 65:49264930.
9. Bisno, A. L.,, C. M. Collins,, and J. C. Turner. 1996. M proteins of group C streptococci isolated from patients with acute pharyngitis. J. Clin. Microbiol. 34:25112515.
10. Bradley, S. F.,, J. J. Gordon,, D. D. Baumgartner,, W. A. Marasco,, and C. A. Kauffman. 1991. Group C streptococcal bacteremia: analysis of 88 cases. Rev. Infect. Dis. 13:270280.
11. Brahmadathan, K. N.,, and G. Koshi. 1989. Importance of group G streptococci in human pyogenic infections. J. Trop. Med. Hyg. 92:3538.
12. Breiman, R. F.,, and F. J. Silverblatt. 1986. Systemic Streptococcus equi infection in a horse handler—a case of human strangles. West. J. Med. 145:385386.
13. Bronze, M. S.,, S. Whitby,, and D. R. Schaberg. 1997. Group G streptococcal arthritis: case report and review of the literature. Am. J. Med. Sci. 313:239243.
14. Carmeli, Y.,, and K. L. Ruoff. 1995. Report of cases of and taxonomic considerations for large-colony-forming Lancefield group C streptococcal bacteremia. J. Clin. Microbiol. 33:21142117.
15. Carmeli, Y.,, J. M. Schapiro,, D. Neeman,, A. M. Yinnon,, and M. Alkan. 1995. Streptococcal group C bacteremia: survey in Israel and analytical review. Arch. Intern. Med. 155:11701176.
16. Carstensen, H.,, C. Pers,, and O. Pryds. 1988. Group G streptococcal neonatal septicemia: two case reports and review of the literature. Scand. J. Infect. Dis. 20:407410.
17. Chalker, V. J.,, H. W. Brooks,, and J. Brownlie. 2003. The association of Streptococcus equi subsp. zooepidemicus with canine infectious respiratory disease. Vet. Microbiol. 95: 149156.
18. Cohen-Paradosu, R.,, J. Jaffe,, D. Lavi,, S. Grisariu-Greenzaid,, R. Nir-Paz,, L. Valinsky,, M. Dan-Goor,, C. Block,, B. Beall,, and A. Moses. 2004. Group G streptococcal bacteremia in Jerusalem. Emerg. Infect. Dis. 10: 14551460.
19. Collins, C. M.,, A. Kimura,, and A. L. Bisno. 1992. Group G streptococcal M protein exhibits structural features analogous to class I M protein of group A streptococci. Infect. Immun. 60:36893696.
20. Craven, D. E.,, A. I. Rixinger,, A. L. Bisno,, T. A. Goularte,, and W. R. McCabe. 1986. Bacteremia caused by group G streptococci in parenteral drug abusers: epidemiological and clinical aspects. J. Infect. Dis. 153:988992.
21. Duca, E.,, G. R. Teodorovici,, C. Radu,, A. Vita,, P. Talasman-Niculescu,, E. Bernescu,, C. Feldi,, and V. Rosca. 1969. A new nephritogenic streptococcus. J. Hyg. 67:691698.
22. Dyson, A. E.,, and S. E. Read. 1981. Group G streptococcal colonization and sepsis in neonates. J. Pediatr. 99:944947.
23.. Edwards, A. T.,, M. Roulson,, and M. J. Ironside. 1988. A milkborne outbreak of serious infection due to Streptococcus zooepidemicus (Lancefield group C). Epidemiol. Infect. 101:4351.
24. Efstratiou, A.,, G. Colman,, G. Hahn,, J. F. Timoney,, J. M. Boeufgras,, and D. Monget. 1994. Biochemical differences among human and animal streptococci of Lancefield group C or group G. J. Med. Microbiol. 41:145148.
25. Facklam, R. 2002. What happened to the streptococci: overview of taxonomic and nomenclature changes. Clin. Microbiol. Rev. 15:613630.
26. Faix, R. G.,, E. I. Soskolne,, and R. E. Schumacher. 1997. Group C streptococcal infection in a term newborn infant. J. Perinatol. 17:7982.
27. Galloway, A.,, I. Noel,, A. Efstratiou,, E. Saint,, and D. R. White. 1994. An outbreak of group C streptococcal infection in a maternity unit. J. Hosp. Infect. 28:3137.
28. Gaviria, J. M.,, and A. L. Bisno,. 2000. Group C and G streptococci, p. 238254. In E. L. Kaplan, and D. L. Stevens (ed.), Streptococcal Infections. Oxford University Press, New York, N.Y.
29. Gerber, M. A.,, M. F. Randolph,, N. J. Martin,, M. F. Rizkallah,, P. P. Cleary,, E. L. Kaplan,, and E. M. Ayoub. 1991. Community-wide outbreak of group G streptococcal pharyngitis. Pediatrics 87:598603.
30. Gonzalez Teran, B.,, M. P. Roiz,, J. T. Ruiz,, J. Rosas,, and J. Calvo-Alen. 2001. Acute bacterial arthritis caused by group C streptococci. Semin. Arthritis Rheum. 31:4351.
31. Guliye, A. Y.,, C. Van Creveld,, and R. Yagil. 2002. Detection of subclinical mastitis in dromedary camels (Camelus dromedarius) using somatic cell counts and the N-acetylbeta-D-glucosaminidase test. Trop. Anim. Health Prod. 34:95104.
32. Harrington, D. J.,, I. C. Sutcliffe,, and N. Chanter. 2002. The molecular basis of Streptococcus equi infection and disease. Microbes Infect. 4:501510.
33. Hashikawa, S.,, Y. Iinuma,, M. Furushita,, T. Ohkura,, T. Nada,, K. Torii,, T. Hasegawa,, and M. Ohta. 2004. Characterization of group C and G streptococcal strains that cause streptococcal toxic shock syndrome. J. Clin. Microbiol. 42:186192.
34. Hewson, J.,, and C. K. Cebra. 2001. Peritonitis in a llama caused by Streptococcus equi subsp. zooepidemicus. Can. Vet. J. 42:465467.
35. Hill, H. R.,, G. G. Caldwell,, E. Wilson,, D. Hager,, and R. A. Zimmerman. 1969. Epidemic of pharyngitis due to streptococci of Lancefield group G. Lancet 2(616):371374.
36. Igwe, E. I.,, P. L. Shewmaker,, R. R. Facklam,, M. M. Farley,, C. Van Beneden,, and B. Beall. 2003. Identification of superantigen genes speM, ssa, and smeZ in invasive strains of beta-hemolytic group C and G streptococci recovered from humans. FEMS Microbiol. Lett. 229:259264.
37. Kalia, A.,, and D. E. Bessen. 2003. Presence of streptococcal pyrogenic exotoxin A and C genes in human isolates of group G streptococci. FEMS Microbiol. Lett. 219:291295.
38. Kataja, J.,, H. Seppala,, M. Skurnik,, H. Sarkkinen,, and P. Huovinen. 1998. Different erythromycin resistance mechanisms in group C and group G streptococci. Antimicrob. Agents Chemother. 42:14931494.
39. Keiser, P.,, and W. Campbell. 1992. “Toxic strep syndrome” associated with group C streptococcus. Arch. Intern. Med. 152:882883.
40. Korman, T. M.,, A. Boers,, T. M. Gooding,, N. Curtis,, and K. Visvanathan. 2004. Fatal case of toxic shock-like syndrome due to group C streptococcus associated with superantigen exotoxin. J. Clin. Microbiol. 42:28662869.
41. Kugi, M.,, H. Tojo,, I. Haraga,, T. Takata,, K. Handa,, and K. Tanaka. 1998. Toxic shock-like syndrome caused by group G Streptococcus. J. Infect. 37:308309.
42. Lam, K.,, and A. S. Bayer. 1983. Serious infections due to group G streptococci: report of 15 cases with in vitro-in vivo correlations. Am. J. Med. 75:561570.
43. Lefort, A.,, O. Lortholary,, P. Casassus,, C. Selton-Suty,, L. Guillevin,, and J. L. Mainardi. 2002. Comparison between adult endocarditis due to beta-hemolytic streptococci (serogroups A, B, C, and G) and Streptococcus milleri: a multicenter study in France. Arch. Intern. Med. 162:24502456.
44. Liu, C. E.,, T. N. Jang,, F. D. Wang,, L. S. Wang,, and C. Y. Liu. 1995. Invasive group G streptococcal infections: a review of 37 cases. Zhonghua Yi Xue Za Zhi (Taipei) 56:173178.
45. McCue, J. D. 1982. Group G streptococcal pharyngitis: analysis of an outbreak at a college. JAMA 248:13331336.
46. McKeage, M. J.,, M. W. Humble,, and R. B. Morrison. 1990. Streptococcus zooepidemicus cellulitis and bacteremia in a renal transplant recipient. Aust. N. Z. J. Med. 20:177178.
47. Molina, J. M.,, C. Leport,, A. Bure,, M. Wolff,, C. Michon,, and J. L. Vilde. 1991. Clinical and bacterial features of infections caused by Streptococcus milleri. Scand. J. Infect. Dis. 23:659666.
48. Nakata, M. M.,, J. H. Silvers,, and L. George. 1983. Group G streptococcal arthritis. Arch. Intern. Med. 143:13281330.
49. Natoli, S.,, C. Fimiani,, N. Faglieri,, L. Laurenzi,, A. Calamaro,, A. M. Frasca,, and E. Arcuri. 1996. Toxic shock syndrome due to group C streptococci. A case report. Intensive Care Med. 22:985989.
50. Nohlgard, C.,, A. Bjorklind,, and H. Hammar. 1992. Group G streptococcal infections on a dermatological ward. Acta Derm. Venereol. 72:128130.
51. Packe, G. E.,, D. F. Smith,, T. M. S. Reid,, and C. C. Smith. 1991. Group G streptococcal bacteremia—a review of thirteen cases of grampian. Scott. Med. J. 36:4244.
52. Pinto, S. W.,, R. Sesso,, E. Vasconcelos,, Y. J. Watanabe,, and A. M. Pansute. 2001. Follow-up of patients with epidemic poststreptococcal glomerulonephritis. Am. J. Kidney Dis. 38:249255.
53. Portnoy, D.,, J. Prentis,, and G. K. Richards. 1981. Penicillin tolerance of human isolates of group C streptococci. Antimicrob. Agents Chemother. 20:235238.
54. Quinn, R. J. M.,, A. F. Hallett,, P. C. Appelbaum,, and R. C. Cooper. 1978. Meningitis caused by Streptococcus dysgalactiae in a preterm infant. Am. J. Clin. Pathol. 70:948950.
55. Rider, M. A.,, and J. C. McGregor. 1994. Group G streptococcus—an emerging cause of graft loss? Br. J. Plast. Surg. 47:346348.
56. Rolston, K. V.,, J. L. LeFrock,, and R. F. Schell. 1982. Activity of nine antimicrobial agents against Lancefield group C and group G streptococci. Antimicrob. Agents Chemother. 22:930932.
57. Rolston, K. V. I.,, P. H. Chandrasekar,, and J. L. LeFrock. 1984. Antimicrobial tolerance in group C and group G streptococci. J. Antimicrob. Chemother. 13:389392.
58. Ruoff, K. L.,, and A. L. Bisno,. 2005. Classification of streptococci, p. 23602362. In G. L. Mandell,, R. Dolin,, and J. E. Bennett (ed.), Principles and Practice of Infectious Diseases. Churchill Livingstone, Philadelphia, Pa.
59. Ruoff, K. L.,, L. J. Kunz,, and M. J. Ferraro. 1985. Occurrence of Streptococcus milleri among beta-hemolytic streptococci isolated from clinical specimens. J. Clin. Microbiol. 22:149151.
60. Sachse, S.,, P. Seidel,, D. Gerlach,, E. Gunther,, J. Rodel,, E. Straube,, and K. H. Schmidt. 2002. Superantigen-like gene(s) in human pathogenic Streptococcus dysgalactiae, subsp. equisimilis: genomic localization of the gene encoding streptococcal pyrogenic exotoxin G (speG(dys)). FEMS Immunol. Med. Microbiol. 34:159167.
61. Salata, R. A.,, P. I. Lerner,, D. M. Shlaes,, K. V. Gopalakrishna,, and E. Wolinsky. 1989. Infections due to Lancefield group C streptococci. Medicine 68:225239.
62. Schattner, A.,, and K. L. Vosti. 1998. Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine 77:122139.
63. Singh, K. P.,, A. Morris,, S. D. Lang,, D. M. MacCulloch,, and D. A. Bremner. 1988. Clinically significant Streptococcus anginosus (Streptococcus milleri) infections: a review of 186 cases. N. Z. Med. J. 101:813816.
64. Smith, K. C.,, A. S. Blunden,, K. E. Whitwell,, K. A. Dunn,, and A. D. Wales. 2003. A survey of equine abortion, stillbirth and neonatal death in the UK from 1988 to 1997. Equine Vet. J. 35:496501.
65. Smyth, E. G.,, A. P. Pallett,, and R. N. Davidson. 1988. Group G streptococcal endocarditis: two cases reports, a review of the literature and recommendations for treatment. J. Infect. 16:169176.
66. Stevens, D. L.,, S. Yan,, and A. E. Bryant. 1993. Penicillin- binding protein expression at different growth stages determines penicillin efficacy in vitro and in vivo: an explanation for the inoculum effect. J. Infect. Dis. 167:14011405.
67. Stryker, W. S.,, D. W. Fraser,, and R. R. Facklam. 1982. Foodborne outbreak of group G streptococcal pharyngitis. Am. J. Epidemiol. 116:533540.
68. Teare, E. L.,, R. D. Smithson,, A. Efstratiou,, W. R. Devenish,, and N. D. Noah. 1989. An outbreak of puerperal fever caused by group C streptococci. J. Hosp. Infect. 13: 337347.
69. Tee, W. S.,, P. K. Lieu,, and C. C. Ngan. 2002. Epidemiology of beta-haemolytic group G streptococcal bacteraemia in Singapore (1996 to 1998). Ann. Acad. Med. Singapore 31:8691.
70. Turner, J. C.,, G. F. Hayden,, D. Kiselica,, J. Lohr,, C. F. Fishburne,, and D. Murren. 1990. Association of group C beta-hemolytic streptococci with endemic pharyngitis among college students. JAMA 264:26442647.
71. Turner, J. C.,, F. G. Hayden,, M. C. Lobo,, C. E. Ramirez,, and D. Murren. 1997. Epidemiologic evidence for Lancefield group C beta-hemolytic streptococci as a cause of exudative pharyngitis in college students. J. Clin. Microbiol. 35:14.
72. Vartian, C.,, P. I. Lerner,, D. M. Shlaes,, and K. V. Gopalakrishna. 1985. Infections due to Lancefield group G streptococci. Medicine 64:7588.
73. Venezio, F. R.,, R. M. Gullberg,, G. O. Westenfelder,, J. P. Phair,, and F. V. Cook. 1986. Group G streptococcal endocarditis and bacteremia. Am. J. Med. 81:2934.
74. Vieira, V. V.,, L. M. Teixeira,, V. Zahner,, H. Momen,, R. R. Facklam,, A. G. Steigerwalt,, D. J. Brenner,, and A. C. Castro. 1998. Genetic relationships among the different phenotypes of Streptococcus dysgalactiae strains. Int. J. Syst. Bacteriol. 48(Pt. 4):12311243.
75. Wagner, J. G.,, P. M. Schlievert,, A. P. Assimacopoulos,, J. A. Stoehr,, P. J. Carson,, and K. Komadina. 1996. Acute group G streptococcal myositis associated with streptococcal toxic shock syndrome: case report and review. Clin. Infect. Dis. 23:11591163.
76. Watsky, K. L.,, N. Kollisch,, and P. Densen. 1985. Group G streptococcal bacteremia: the clinical experience at Boston University Medical Center and a critical review of the literature. Arch. Intern. Med. 145:5861.
77. Weightman, N. C.,, M. R. Barnham,, and M. Dove. 2004. Streptococcus milleri group bacteraemia in North Yorkshire, England (1989-2000). Indian J. Med. Res. 119(Suppl):164167.
78. Woo, P. C.,, J. L. Teng,, S. K. Lau,, P. N. Lum,, K. W. Leung,, K. L. Wong,, K. W. Li,, K. C. Lam,, and K. Y. Yuen. 2003. Analysis of a viridans group strain reveals a case of bacteremia due to Lancefield group G alpha-hemolytic Streptococcus dysgalactiae subsp. equisimilis in a patient with pyomyositis and reactive arthritis. J. Clin. Microbiol. 41:613618.
79. Woo, P. C.,, A. P. To,, H. Tse,, S. K. Lau,, and K. Y. Yuen. 2003.Clinicalandmolecularepidemiologyoferythromycinresistant beta-hemolytic Lancefield group G streptococci causing bacteremia. J. Clin. Microbiol. 41:51885191.
80. Woo, P. C.,, H. Tse,, K. M. Chan,, S. K. Lau,, A. M. Fung,, K. T. Yip,, D. M. Tam,, K. H. Ng,, T. L. Que,, and K. Y. Yuen. 2004. “Streptococcus milleri” endocarditis caused by Streptococcus anginosus. Diagn. Microbiol. Infect. Dis. 48:8188.
81. Yuen, K. Y.,, W. H. Seto,, C. H. Choi,, W. Ng,, S. W. Ho,, and P. Y. Chau. 1990. Streptococcus zooepidemicus (Lancefield group C) septicaemia in Hong Kong. J. Infect. 21:241250.


Generic image for table

Human and animal streptococci expressing Lancefield C and G cell-wall antigens

Reprinted from reference with permission of Elsevier.

Isolates with the group A antigen have also been described.

Citation: Baracco G, Bisno A. 2006. Group C and Group G Streptococcal Infections: Epidemiologic and Clinical Aspects, p 222-229. In Fischetti V, Novick R, Ferretti J, Portnoy D, Rood J (ed), Gram-Positive Pathogens, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816513.ch18

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error