Bacteriological profile of biliary tract infections in adults undergoing interventional biliopancreatic endoscopy.

Rhamno-oligosaccharide-based glycoconjugates as promising vaccine candidates against Group A Streptococcus.

From random care to randomized clinical trials of patients with invasive streptococcal infections—research prioritisation and areas of equipoise

BackgroundGroup A Streptococcus causes pediatric infections from mild to severe forms. Since late 2022, invasive cases have increased in Europe, possibly due to reduced post-COVID-19 immunity, more respiratory virus circulation, and emergence of virulent strains.MethodsA retrospective, multicenter observational study was conducted in twelve Italian pediatric Hospitals, including patients under 18 years hospitalized with invasive or severe Group A Streptococcus infection. Data were anonymized and analyzed to identify factors associated with Pediatric Intensive Care Unit (PICU) admission and discharge with sequelae or death.ResultsSeventy-five children with invasive or severe Group A Streptococcus infection were included; the majority (69.3%) were aged 2–10 years. Invasive Group A Streptococcus (iGAS) infection accounted for 58.7% (n = 44) and severe GAS (sGAS) infection for 41.3% (n = 31) of cases. Pediatric Intensive Care Unit admission was required in 45.3% (n = 34) of the entire patient cohort, in this subgroup viral coinfection (OR 5.684, p = 0.003), sepsis/septic shock (OR 4.406, p = 0.003), iGAS diagnosis (OR 4.153, p = 0.005), and procalcitonin (PCT) > 0.5 ng/mL (OR 7.105, p = 0.019) were independently associated with admission; the use of corticosteroids (OR 4.641, p = 0.003) and intravenous immunoglobulin (IVIG) (OR 16.667, p = 0.003) was also significantly more frequent.All patients received empirical β-lactam antibiotics; anti-toxin therapy was administered in 47 patients (62.7%): clindamycin (49.3%), linezolid (16.0%), and rifampicin (1.3%). Mechanical ventilation was required in 24.0% (n = 18), and 49.3% (n = 37) underwent surgery. Post-infectious sequelae occurred in 20.0% (n = 15) and four children died, mostly due to streptococcal toxic shock syndrome.ConclusionPediatric invasive group A streptococcal infection continues to pose a significant clinical challenge, with notable rates of morbidity and mortality, underscoring the need for early recognition and close monitoring of high-risk patients. A widespread use of adjunctive therapies was documented. Continued surveillance and robust clinical research are essential to optimize management strategies and improve patient outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13052-025-02103-7.

Group B Streptococcus (GBS) is a major cause of infant meningitis, often requiring intensive care. The molecular determinants of severe disease (meningitis/Intensive Care Unit (ICU) admission) remain unclear. Although late-onset disease (LOD) and very late-onset disease (VLOD) appear clinically similar, their genomic distinctions are not well described. We characterized invasive GBS isolates from 87 patients at Boston Children's Hospital over 15 years using whole-genome sequencing. Isolate diversity was compared with global samples. We assessed vaccine coverage, antimicrobial resistance, and the relationships between clinical features or pathogen virulence factors and disease severity or age of onset using regression models adjusted for population structure and multiple testing. Of the 87 patients, 44.3% required ICU care and 18.6% had meningitis. Five serotypes and six clonal complexes were identified, with hypervirulent clones CC17/cpsIII and CC23/cpsIa predominating. All isolates contained candidate polysaccharide conjugate and/or protein vaccine targets and were susceptible to penicillin and vancomycin; 38% were erythromycin-resistant and 29% clindamycin-resistant. ICU admission correlated with specific hematologic abnormalities, but meningitis did not. No known virulence factors were associated with ICU admission or meningitis. LOD and VLOD isolates showed no major genomic differences, though the PI-2A1 pilus gene was more frequent in VLOD. Invasive GBS disease in infants frequently results in ICU admission and meningitis, yet no pathogen genomic features predicted these outcomes highlighting the likelihood of host response factors in determining outcomes. The similar clinical and genomic profiles of LOD and VLOD suggest their current classification may be arbitrary, with implications for surveillance and management.

BackgroundThere is no consensus on the antibiotic course or type of surgical treatment in streptococcal periprosthetic-joint infections (PJIs). We aimed to compare the treatment failure rate at 2 years of PJIs caused by streptococci to PJIs caused by other pathogens and identify factors associated with failure.MethodsIt was a single-center retrospective cohort study conducted between 2009 and 2019. We included all patients aged ≥ 18 years undergoing treatment for hip or knee PJI with a 2-year follow-up. We analyzed the treatment failure rate at 2 years of streptococcal PJIs versus PJIs caused by other pathogens with failure defined as a non-successful treatment using the Delphi-based international multidisciplinary consensus of success. We also analyzed factors associated with failure including streptococcal etiology and type of treatment.ResultsWe included 404 patients; 62 (15%) had a streptococcal PJI, of which 14 (23%) exhibited treatment failure at 2 years. The treatment failure rate was similar to that for PJIs caused by other pathogens (21%, 71/342) (P = 0.78). Streptococci were not associated with failure (OR = 1.55, 95% CI 0.62–3.89, P = 0.35). However, Streptococcus dysgalactiae (OR = 9.45, 95% CI 1.37–65.46, P = 0.02) and debridement, antibiotics and implant retention (DAIR) (OR = 9.31, 95% CI 1.80–48.20, P = 0.008) were associated with failure among patients with a streptococcal PJI.ConclusionsThe treatment failure rate of streptococcal PJIs was similar to that for PJIs caused by other pathogens. However, Streptococcus dysgalactiae and DAIR were factors associated with failure among patients with a streptococcal PJI. Our results suggest that streptococcal PJIs, especially Streptococcus dysgalactiae PJIs, should be surgically treated more aggressively with an implant exchange.

Acute rheumatic fever (ARF) and associated rheumatic heart disease are serious sequelae of a Group A Streptococcus (GAS/Strep A) infection. Autoantibodies are thought to contribute to pathogenesis, with deeper exploration of the autoantibody repertoire needed to improve mechanistic understanding and identify new biomarkers. Phage immunoprecipitation and Sequencing (PhIP-Seq) with the HuScan library (>250,000 overlapping 90-mer peptides spanning the human proteome) was utilised to analyse autoreactivity in sera from children with ARF, uncomplicated Strep A pharyngitis and matched healthy controls. A global proteome-wide increase in autoantigen reactivity was observed in ARF, as was marked heterogeneity between patients. Public epitopes, common between individuals with ARF were rare, and comprised < 1% of all enriched peptides. Differential analysis identified both novel and previously identified ARF autoantigens, including PPP1R12B, a myosin phosphatase complex regulatory subunit expressed in cardiac muscle, and members of the collagen-protein family, respectively. Pathway analysis found antigens from the disease-relevant processes encompassing sarcomere and heart-morphogenesis were targeted. In sum, PhIP-Seq has substantially expanded the spectrum of autoantigens in ARF, and reveals the rarity of public epitopes in the disease. It provides further support for the role of epitope spreading in pathogenesis and has identified PPP1R12B as a novel, enriched autoantigen.

Soil health is a critical factor in ensuring sustainable agricultural practices, particularly in maize production. Consequently, the objective of this paper was to assess the Physicochemical and Microbiological Properties of Soil from a Research Farm in Ilorin, Kwara State, Nigeria using appropriate standard methods. The results of the analysis revealed that the mean values of pH (H2O), pH (KCL) and E.C are 5.15, 4.9, and 11.62 respectively. In term of salinity, the soil is strongly saline. The mean values of Organic Matter, Nitrogen, available Phosphorous, Potassium, Sodium, calcium and magnesium are 2.32, 0.6 5.64, 2.045, 0.0045, 1.075 and 1.05 respectively. The mean value of the Exchangeable acidity is 1.26. The result reveals low pH, high salinity and insufficient nutrient levels. The mean value of Nitrogen is also below the critical threshold value of 1.5%. However, the levels of calcium and magnesium are adequate. In term of soil texture, the soil in the area is classified as sandy soil. The result of the microbiological analysis reveals that the mean values of Pseudomonas spp, Eschericihia spp, Nitrosococuuc sp and Listeria sp are 17.475,43.15, 69.5 and 77.5 respectively while mean values of Streptococcus spp, protein sp and Musor spp are 2.32, 53.1 and 14.99 respectively. The result reveals that the bacteria population and the fungi species are low despite its high organic content. Therefore, to address these issues, appropriate soil management such as application of organic amendments and fertilizers are essential for improving the soil health and enhancing crop yield.

BackgroundInterleukin-6 (IL-6) plays a crucial role in inflammation and immune defense; however, its intracellular trafficking and the mechanisms regulating its expression remain poorly understood.MethodsWe investigated epithelial cell responses to poly(dA:dT) stimulation and group A Streptococcus infection, using depletion and overexpression assays, NF-κB readouts, proteomics, co-immunoprecipitation, immunofluorescence imaging, and analysis of necrotizing soft tissue infection transcriptomes.ResultsTBC1D9, a Rab GTPase-activating protein, selectively regulates IL-6: its depletion reduced IL-6 mRNA and protein levels without broadly affecting other pro-inflammatory cytokines. TBC1D9 maintained basal p65 phosphorylation but was dispensable for stimulus-induced NF-κB activation, supporting the idea that homeostatic NF-κB signaling is necessary for constitutive IL-6 transcription. Proteomics identified Rab29 as a TBC1D9 partner; co-immunoprecipitation showed preferential interaction with GTP-dependent Rab29, and the two proteins co-localized following stimulation and infection. Rab29 overexpression inhibited NF-κB activation and IL-6 production, while Rab29 deficiency increased both, opposing TBC1D9’s effect. Necrotizing soft tissue infection patients’ datasets showed upregulation of TBC1D9 and IL-6-related pathways, revealing their clinical relevance.ConclusionThe TBC1D9–Rab29 axis connects GTPase signaling and membrane trafficking to specifically regulate IL-6 in epithelial cells, revealing a non-traditional mechanism for modulating inflammation and a potential target in IL-6-driven diseases.

Pteleopsis habeensis (Aubrev ex Keay), which belongs to the family Combretaceae, is known as Lalen giwa in Hausa language in northern part of Nigeria of Sub Saharan Africa. The area of distribution of Pteleopsis habeensis is restricted to only a few regions: the Bandiagara escarpments in Mali (with the plant population possibly extending into Burkina Faso), the Akosombo and Bui regions in Ghana, and the Yankari Game Reserve and it immediate surroundings in Nigeria. The shrub is use for the treatment of malaria fever, stomach ache, Aphrodisiac and in the destruction of tumours. The leaves of Pteleopsis habeensis were collected from faculty of pharmacy medicinal plant garden University of Maiduguri Borno, Nigeria, in March 2020. The plant was authenticated at the department of biological sciences, University of Maiduguri Borno, Nigeria. Phytochemical screening of crude leaf extract of Pteleopsis habeensis revealed the presence of alkaloids, flavonoids, tannins, triterpinoids, steroids and cardiac glycosides. The crude leaf Methanol and n-Butanol extracts of Pteleopsis habeensis exhibited antimicrobial activities against Escherichia coli, Pseudomonas aeroginosa, Staphylococcus aureus, Streptococcus spp and the fungus Candida albican using disc diffusion method and broth dilution methods. The fungus Candida albican, showed the highest sensitivity to methanol extract with zone of inhibition 14 mm at 100mg/ml compared to it sensitivity to n-Butanol extract with zone of inhibition 10mm at 100mg/ml. The Minimum Inhibitory concentration is 12.5mg/ml for Methanol extract and 25mg/ml for n-Butanol extract. The evaluation of the antioxidant activity of the n-Butanol and Methanol crude extracts was carried out in vitro through the radical model DPPH, and the antioxidant capacity of the two extracts was measured based on their Percentage scavenging activity and IC50 concentration which corresponds to the concentration of the extracts capable of reducing the initial DPPH absorbance by 50%. The DPPH Assay showed high free radical scavenging activity of the extract that is comparable to Ascorbic acid. The percentage scarvenging activity of Methanol extract was higher than that of the n-Butanol extract in the DPPH assay. This study has therefore showed that Pteleopsis habeensis crude leaf extracts contains phytochemicals, has antioxidant and antimicrobial activity, hence a potential source of a candidate drug whose bioactive constituents can be isolated for pharmaceutical use.

Background Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are characterized by the abrupt onset of neuropsychiatric symptoms temporally linked to Group A β-hemolytic Streptococcus infection. The condition remains diagnostically challenging due to overlapping features with other autoimmune and psychiatric disorders, absence of definitive biomarkers, and variable infectious histories. Objective To describe a diagnostically complex case of PANDAS in a preadolescent girl presenting with concurrent choreiform movements, acute psychosis, and subclinical valvular changes. Case A 12-year-6-month-old previously healthy girl developed sudden-onset involuntary dance-like movements and acute psychiatric symptoms, including auditory hallucinations and bizarre delusions. Neurological examination revealed chorea without focal deficits. Echocardiography showed mild mitral and tricuspid regurgitation. Anti Streptolysin O (ASTO) test was positive, but other Laboratory markers of inflammation were normal. The temporal clustering of symptoms, subtle cardiac findings, positive ASTO test and exclusion of alternative diagnoses supported a working diagnosis of PANDAS. Management included antipsychotic, benzodiazepine, and anticonvulsant therapy, with referral for tertiary evaluation and potential immunomodulation. Conclusion This case emphasizes the importance of early recognition of PANDAS in children with abrupt neuropsychiatric and motor symptom onset, the necessity of thorough differential diagnosis, and the value of multidisciplinary care in optimizing outcomes.

Recognizing Guttate Psoriasis in Primary Care: A Pediatric Case Report Following a Streptococcal Pharyngitis Infection.

Rheumatic heart disease is a chronic valvular disorder resulting from acute rheumatic fever, predominantly affecting the mitral valve and characterized by progressive fibrotic thickening. Although the initial insult is driven by autoimmune responses triggered by Group A Streptococcus infection, the sustained progression of valvular fibrosis involves a complex interplay of persistent immune activation, chronic inflammation, and, critically, long-term mechanical stress. Mechanical forces arising from altered hemodynamics and structural valve deformation perpetuate valvular interstitial cell activation, endothelial-to-mesenchymal transition, and extracellular matrix remodeling, thereby driving fibrosis even after acute inflammation resolves. Current therapeutic options to halt or reverse mitral valve fibrosis are limited, with surgical repair or replacement remaining the primary interventions for advanced disease. Advancing mechanistic understanding through physiologically relevant models, coupled with early diagnostic strategies and multitargeted antifibrotic approaches, holds promise for preserving valve function. Integrating molecular insights with scalable public health measures may ultimately mitigate the global burden of rheumatic heart disease and improve outcomes for affected populations.

We sought to characterize the sixth most common finding in our neuroimmunological laboratory practice (tissue assay-observed unclassified neural antibodies [UNAs]), combining protein microarray and phage immunoprecipitation sequencing (PhIP-Seq). Patient specimens (258; 133 serums; 125 CSF) meeting UNA criteria were profiled; October 2022-September 2023. Top-ranking candidate antigens were validated in silico, by dual-staining confocal microscopy, and ≥ 1 protein-specific assay. Clinical data were reviewed. Among 21 patients, 11 autoantibodies were characterized (serum, 19; CSF, all 9 available). Autoantigens were CACNA1I, 1; CAMK2B, 2; CLIP2, 1; FMN2, 2; MAP1A, 2; MAP2, 5; NECAB1, 1; SNAP91, 3; SRCIN1, 1; SYNJ1, 1; SYT3, 2. Analytical validation was by confocal TIIFA (all), western blot (10/10 available), and cell-based assay (5/5 performed). Clinical accompaniments were: encephalitis, 6; brainstem encephalitis, 2; encephalomyelitis, 2; cerebellar ataxia, 2; longitudinally extensive transverse myelitis (LETM), 2; sensory neuronopathy, 1; peripheral neuropathy, 4, and movement disorders, 2. Inflammatory MRI abnormalities were identified in 5/16 patients (31%) with CNS disorders: T2 signal change (2), LETM (2), leptomeningeal enhancement (1). Seven of 8 (88%) had inflammatory CSF (pleocytosis, 5 [median 25.5 cells, range 7-294]; elevated IgG index/synthesis rate, 4; CSF-exclusive oligoclonal bands, 4). Six had paraneoplastic causation (lung cancer, 2; other, 4); 3 were postinfectious (1 each of COVID-19, HSV-1, and post-Group A streptococcal infection). Of 9 immunotherapy-treated patients, 5 improved. UNAs are partly accounted for by a repertoire of diverse mostly intracellular synaptic antigens. Their characterization is expedited by protein arrays and PhIPSeq. Further individual studies are needed to assess them as disease biomarkers.

Although acute rheumatic fever (ARF) is a preventable condition, it continues to be diagnosed in Far North Queensland, Australia. Enhanced primary prevention is necessary to reduce the local burden of ARF and rheumatic heart disease. In this retrospective clinical audit, all cases of definite ARF in the remote Torres Strait and Cape York region of Far North Queensland between January 2020 and December 2024 were examined. Clinical records were reviewed to identify and characterize any healthcare presentations of individuals during the 6 weeks preceding their ARF diagnosis. Of 67 individuals with definite ARF 65 (97%) identified as First Nations Australians; 43/67 (64%) did not present for any healthcare in the 6 weeks preceding their diagnosis; and a further 10/67 (15%) presented for healthcare that was unrelated to group A Streptococcus (Strep A) infection. Overall, a possible Strep A infection (skin infection or sore throat) was identified in 14/67 (21%) patients; 9/67 (13%) patients presented with skin infections, and 5/67 (7%) presented with sore throats. Of these, 5/14 (36%) received appropriate antibiotic treatment. Most individuals with definite ARF in this remote region of Australia do not present for healthcare before their diagnosis; however, there remain opportunities for the primary prevention of ARF among those who do. Culturally considered health promotion, opportunistic screening, and improved recognition and treatment of Strep A infection are critical for reducing ARF incidence in this region of Australia. It is also important to define the contribution of asymptomatic Strep A infections to the pathogenesis of ARF.

Introduction: Sydenham chorea (SC) is a form of acquired chorea of childhood and is linked to Acute Rheumatic Fever (ARF), which is an autoimmune response to infection with Group A Streptococcus (GAS). Historically called St Vitus Dance, SC is reported in some patients with ARF and forms part of the major criteria for ARF in the Jones Criteria. Case Presentation: A 12 years old female presented with 10-day history involuntary movements. She suffered sudden, involuntary, irregular twitching of the right upper, lower limbs and facial mouthing or grimacing. She developed irritability, restlessness, easy crying, anger over minor events, deteriorating handwriting and slurring of speech. A thorough history was taken from patient and family, it was discovered that she had recurrent episodes of sore throat in the last one year, last episode being 1.5 months before the onset of chorea. Her throat infections were never treated by a qualified doctor. Physical examination revealed spooning sign of the hands, milkmaid grip sign, pronator sign of the arms and darting tongue sign. Tonsillar hypertrophy grade I was also noted. Pansystolic murmur was present over apex, 2D Echo was performed which showed moderate MR and mild AR, LVEF was 65%. Blood work showed highly elevated Anti Streptolysin O levels of &gt;650 IU/ml. MRI of the brain didn’t detect any abnormality. Based on the history and findings, a diagnosis of Acute Rheumatic Fever with Sydenham chorea and valvular heart disease was made. The patient was started on Phenoxymethyl Penicillin, Carbamazepine and Pantoprazole after which her choreiform movements started to ameliorate significantly. Discussion: Despite progress in earlier diagnosis and treatment of streptococcal infection, Sydenham Chorea is still an essential feature of acute rheumatic fever in developing nations. The exact pathophysiology of SC hasn’t been understood, various theories have been suggested for the same. Most accepted theory of SC is an autoimmune one, which occurs in response to the group A streptococcal infection. These antibodies are created against streptococcal antigens and react with neuronal protein tissues particularly in the basal ganglia that account for choreiform movements made by SC patients. Carditis is another severe manifestation of ARF. The cardiac lesion frequently encountered in ARF is mitral regurgitation, aortic regurgitation is the other frequently observed valvular disease.

Acute tonsillitis is one of the most common diseases in adults and accounts for a significant proportion of primary care visits. Objective: to conduct a comparative analysis of clinical features and rapid diagnostic results in different age groups in order to improve the diagnosis and treatment. Participants and Methods: 69 patients with clinical signs of acute tonsillitis were examined and divided into three age groups according to the WHO classification: the 1st group (18 – 44 years, n=25), the 2nd group (45 – 59 years, n=24), and the 3rd (60+ years, n=20). Rapid immunochromatographic tests were used to confirm the diagnosis and identify the presence of Streptococcus pyogenes, adenoviruses, respiratory syncytial virus (RSV), influenza A and B viruses, and SARS-CoV-2. Clinical assessment was performed using the Centor/McIsaac scale, a visual analogue scale to assess pain, and an analysis of the patient’s medical history. Results: The aetiology of the disease was established in 80% of cases. Viral infections were prevalent in all groups, with adenoviruses (25-28%) and RSV (12-20.8%) being the most common. Group A β-haemolytic streptococcus was detected in only 7.2% of cases overall, with significant variation in frequency between groups: 16% in the 18–44 age group versus 0–4.2% in older groups. SARS-CoV-2 was exclusively detected in middle-aged and elderly patients (up to 10%), showing an increasing trend with age. Clinical analysis revealed a statistically significant tendency for the disease to progress more severely in elderly patients, as evidenced by higher Centor scores (p&lt;0.05) and more intense pain when swallowing. A notable finding was the significantly higher frequency of antibiotic prescriptions for patients aged 60 and over prior to examination (16.6%), compared to younger age groups (4.0–4.2%, p = 0.017), suggesting potential overuse. Conclusion: The data indicate that there are age-related differences in the aetiology and clinical course of acute tonsillitis. In young people, streptococcal infection with typical symptoms is predominant, whereas in older people, viral and mixed forms predominate. The excessive use of antibiotics in older patients highlights the need for age-specific approaches to diagnosis and treatment.

Background: Rheumatic heart disease (RHD) continues to impose a significant public health burden globally,primarily as a sequela of untreated or recurrent streptococcal infections. Despite being preventable, RHD remains endemic in low- and middle-income countries.India, with its vast and diverse population, has emerged as a global hub for RHD, contributing a disproportionate share of the worldwide burden. Methods: We used the Global Burden of Disease Study 2021 framework to estimate RHD prevalence, mortality, and disability-adjusted life years (DALYs) among all age groups in India from 1990 to 2021. Temporal trends were assessed using total percentage change(TPC). Subnational patterns were examined across states and union territories. Age-specific incidence and YLDs per 100,000 population were reported.Gender-based disparities were also evaluated. Result: In 2021,India accounted for 19.17% of global rheumatic heart disease(RHD) prevalence(10.5 million out of 54.7 million cases), 44.46% of total global RHD deaths, and 42.79% of global DALYs. From 1990 to 2021, the total percentage change (TPC) in prevalence increased by 85% (95% UI: 80%–89%), while deaths rose by 20% (95% UI: 6%–49%). At the sub-national level, the greatest rise in TPC of incidence was observed in Meghalaya (109%), followed by Bihar (104%) and Uttar Pradesh (95%). In contrast, Goa and Kerala experienced declines of 9% and 17%, respectively. Regarding mortality, Manipur reported the highest increase in deaths (78%), followed by the Union Territories (64%), Meghalaya (58%), and Uttar Pradesh (49%). By age, the highest incidence rate in 2021 was recorded in the 20–24 years group at 110 (63–176) per 100,000, closely followed by 15–19 years at 109 per 100,000. For YLDs, the 30–34 years age group had the highest rate of 61 (37–96) per 100,000, followed by 25–29 years at 61 (36–96). Gender-wise, women experienced a disproportionately higher rise in RHD burden over the past three decades. The TPC in incidence (56% vs. 55%), deaths (39% vs. 2%), and YLDs (86% vs. 78%)—highlighting a disproportionately higher burden in women from 1990-2021. Conclusion: India bears the highest localized burden of RHD globally, with widening subnational and gender disparities. Despite declining trends in some states, the growing burden in others—especially among young adults and women—underscores the urgent need for targeted prevention, early diagnosis, and streptococcal infection control strategies across high-risk regions.

Introduction: Endovascular stents are commonly used for vascular access in patients undergoing hemodialysis. While these devices are generally safe, rare but serious complications such as stent migration and associated endocarditis can occur. Migration into cardiac chambers has been reported, often requiring surgical intervention due to the high risk of valvular damage. Case presentation: A 71-year-old male with a medical history of end-stage kidney disease on dialysis and hyperlipidemia, presented with fevers and shortness of breath. On presentation vital signs were notable for tachycardia. Sepsis was suspected, and blood cultures grew Streptococcus gallolyticus, and subsequently started on Ceftriaxone. Echocardiogram revealed a large, migrated endovascular stent in the right atrium, measuring approximately 6 cm × 1.4 cm. Stent appeared to be attached to the anterior leaflet of the tricuspid valve. Left ventricular function ejection fraction was 55%. No vegetations or pericardial effusion were appreciated. Patient reported undergoing an uncomplicated creation of the left arm fistula with vascular stent approximately two years prior. Percutaneous retrieval was attempted twice unsuccessfully. Later, his course was complicated by cardiac tamponade requiring pericardiocentesis, with drainage of approximately 550 mL of sanguineous fluid. This complication was suspected due to myocardial microperforation during the attempted stent retrieval. Following hemodynamic stabilization, the patient underwent cardiac surgery with successful removal of the migrated stent and bioprosthetic tricuspid valve replacement. He then completed a full course of antibiotics for bacteremia and was discharged to a physical rehabilitation facility. Discussion: Stent migration into the heart is a rare but potentially life-threatening complication. It’s commonly associated with improper sizing, placement, or vessel wall degradation over time. Once in the cardiac chambers, stents can cause mechanical damage, serve as a nidus for infection, and impair valvular function. While percutaneous retrieval is typically the first-line approach, surgical intervention is often necessary when complications like tamponade or valve involvement occur. This case calls attention to the importance of long-term monitoring of intravascular devices, especially in patients with dialysis access, and highlights the need and importance for multidisciplinary management when complications arise.

ABSTRACT Background Several European countries have reported a rise in invasive Group A Streptococcus (GAS) infections, particularly linked to the toxigenic emm1 sublineage M1UK. In Germany, historical molecular data are limited due to the absence of systematic molecular surveillance. Methods We performed whole-genome sequencing (WGS) on 189 invasive Streptococcus pyogenes isolates collected between January 1, 2015, and May 31, 2023, at University Medical Center Carl Gustav Carus, TU Dresden. Clinical data were extracted from patient records. M1UK sublineage identification was based on 27 characteristic single nucleotide polymorphisms (SNPs). A Bayesian coalescent analysis estimated the evolutionary timescales of the M1UK clade in Germany. Results The most common emm type was emm1 (34%, 64/189), followed by emm12, emm4, and emm89. Of the 64 emm1 isolates, 31 (48%) were M1UK. No significant associations were found between clinical outcomes and M1UK or M1global genotypes. Although a post-pandemic shift favouring M1UK was observed, our analysis indicates that M1UK had already been circulating in Germany by 2017. The estimated most recent common ancestor dates to 2012 (95% highest posterior density: 2009–2015), with a stable effective population size over time. Conclusion Our findings confirm the pre-pandemic circulation of M1UK in Germany. While the clinical impact of M1UK remains unclear, integrating clinical data with high-resolution molecular surveillance may improve early detection of emerging high-risk clones.