<?xml version="1.0" encoding="UTF-8"?><xml><records><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Nicolas Dauby</style></author><author><style face="normal" font="default" size="100%">Véronique Yvette Miendje Deyi</style></author><author><style face="normal" font="default" size="100%">Valérie Delforge</style></author><author><style face="normal" font="default" size="100%">Martiny, Delphine</style></author><author><style face="normal" font="default" size="100%">Leila Mekkaoui</style></author><author><style face="normal" font="default" size="100%">Hallin, Marie</style></author><author><style face="normal" font="default" size="100%">Romain Mahieu</style></author><author><style face="normal" font="default" size="100%">Nathalie Bossuyt</style></author><author><style face="normal" font="default" size="100%">Anne Botteaux</style></author><author><style face="normal" font="default" size="100%">Pierre R Smeesters</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Streptococcus pyogenes infections with limited emm-type diversity in the homeless population of Brussels, 2016-2018.</style></title><secondary-title><style face="normal" font="default" size="100%">Int J Infect Dis</style></secondary-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">Adult</style></keyword><keyword><style  face="normal" font="default" size="100%">Bacterial Outer Membrane Proteins</style></keyword><keyword><style  face="normal" font="default" size="100%">Belgium</style></keyword><keyword><style  face="normal" font="default" size="100%">Cluster Analysis</style></keyword><keyword><style  face="normal" font="default" size="100%">Female</style></keyword><keyword><style  face="normal" font="default" size="100%">Homeless Persons</style></keyword><keyword><style  face="normal" font="default" size="100%">Humans</style></keyword><keyword><style  face="normal" font="default" size="100%">Male</style></keyword><keyword><style  face="normal" font="default" size="100%">middle aged</style></keyword><keyword><style  face="normal" font="default" size="100%">Skin Diseases, Infectious</style></keyword><keyword><style  face="normal" font="default" size="100%">Streptococcal Infections</style></keyword><keyword><style  face="normal" font="default" size="100%">Streptococcus pyogenes</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2019</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2019 Apr</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">81</style></volume><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;&lt;b&gt;OBJECTIVES: &lt;/b&gt;The aim was to characterize the clinical features, outcomes, and strain diversity of laboratory-confirmed Streptococcus pyogenes (group A Streptococcus, GAS) infections among inpatients hospitalized at a tertiary level hospital in Brussels, Belgium, according to the patients' housing status (homeless vs. not homeless).&lt;/p&gt;

&lt;p&gt;&lt;b&gt;METHODS: &lt;/b&gt;Between August 2016 and January 2018, all patients hospitalized with a laboratory-confirmed GAS infection were prospectively enrolled and risk factors were recorded. GAS strains were characterized using emm-typing and emm-clustering in both inpatients and outpatients. Analyses were performed according to homelessness status.&lt;/p&gt;

&lt;p&gt;&lt;b&gt;RESULTS: &lt;/b&gt;During the study period, 48% (28/58) of adults hospitalized with a GAS infection at the tertiary hospital were homeless. The estimated incidence rate was 100 times higher for homeless persons. Skin abscesses were more frequent in the homeless group (21.4% vs. 3.3%) and mortality was high (10.7%). Limited emm-type diversity was found in this group, with four emm-types (64, 77, 83, and 101) accounting for 76.1% of the infections, and the majority of these emm-types belonged to the D4 emm-cluster. Pooled analyses of inpatient and outpatient strains indicated lower diversity in the homeless group.&lt;/p&gt;

&lt;p&gt;&lt;b&gt;CONCLUSIONS: &lt;/b&gt;The homeless are disproportionately affected by GAS and have a higher rate of abscesses and high mortality. The lower emm-type diversity and preferential infection with four emm-types likely reflects endemic circulation of GAS in this population. Preventive strategies are warranted in this fragile population.&lt;/p&gt;
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