{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T22:34:47Z","timestamp":1778711687489,"version":"3.51.4"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2009,10,2]],"date-time":"2009-10-02T00:00:00Z","timestamp":1254441600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2010,4]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Invasive group A streptococcal (GAS) disease is a condition of clinical and public health significance. We conducted epidemiological analyses to determine if the presence of gastrointestinal (GI) complaints (diarrhea and\/or vomiting) early in the course of invasive GAS disease is associated with either of two severe outcomes: GAS necrotizing fasciitis, or hospital mortality. Subjects were hospitalized for invasive GAS disease throughout the state of Florida, USA, during a 4-year period. Multiple imputation using the Markov chain Monte Carlo method was used to replace missing values with plausible values. Excluding cases with missing data resulted in a sample size of 138 invasive GAS patients (the complete subject analysis) while the imputed datasets contained 257 records. GI symptomatology within 48 h of hospital admission was not associated with hospital mortality in either the complete subject analysis [adjusted odds ratio (aOR) 0\u00b786, 95% confidence interval (CI) 0\u00b731\u20132\u00b739] or in the imputed datasets. GI symptoms were significantly associated with GAS necrotizing fasciitis in the complete subject analysis (aOR 4\u00b764, 95% CI 1\u00b718\u201318\u00b723) and in the imputed datasets but only in patients aged &lt;55 years. The common cause of GI symptoms and necrotizing fasciitis may be streptococcal exotoxins. Clinicians who are treating young individuals presumed to be in the early stages of invasive GAS disease should take note of GI symptoms and remain vigilant for the development of a GAS necrotizing soft-tissue infection.<\/jats:p>","DOI":"10.1017\/s0950268809990938","type":"journal-article","created":{"date-parts":[[2009,10,2]],"date-time":"2009-10-02T11:11:35Z","timestamp":1254481895000},"page":"534-541","source":"Crossref","is-referenced-by-count":3,"title":["Gastrointestinal symptomatology as a predictor of severe outcomes of invasive group A streptococcal infections"],"prefix":"10.1017","volume":"138","author":[{"given":"O. M.","family":"KHATEEB","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"OSBORNE","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Z. D.","family":"MULLA","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2009,10,2]]},"reference":[{"key":"S0950268809990938_ref013","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1152\/physrev.1995.75.3.561","article-title":"Modulation of epithelial permeability by extracellular macromolecules","volume":"75","author":"Lewis","year":"1995","journal-title":"Physiological Reviews"},{"key":"S0950268809990938_ref005","unstructured":"5. Mulla ZD .Invasive group A streptococcal infections in Florida: descriptive epidemiology and risk factors for hospital mortality. Ph.D. dissertation. 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Yuan YC . Multiple Imputation for Missing Data: Concepts and New Development, Proceedings of the Twenty-Fifth Annual SAS Users Group International Conference. Cary, North Carolina: SAS Institute, Inc., 2000, pp. 1410\u20131419."},{"key":"S0950268809990938_ref012","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2619"},{"key":"S0950268809990938_ref016","doi-asserted-by":"publisher","DOI":"10.1086\/432729"},{"key":"S0950268809990938_ref021","doi-asserted-by":"publisher","DOI":"10.3109\/10408419009105728"},{"key":"S0950268809990938_ref011","doi-asserted-by":"publisher","DOI":"10.1198\/0003130032314"},{"key":"S0950268809990938_ref015","doi-asserted-by":"publisher","DOI":"10.1172\/JCI117541"},{"key":"S0950268809990938_ref010","volume-title":"Missing Data. Sage University Papers Series on Quantitative Applications in the Social Sciences, 07\u2013136","author":"Allison","year":"2001"},{"key":"S0950268809990938_ref014","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1128\/JB.93.6.1825-1831.1967","article-title":"Effect of Streptococcus pyogenes on tissue cells","volume":"93","author":"Quinn","year":"1967","journal-title":"Journal of Bacteriology"},{"key":"S0950268809990938_ref007","doi-asserted-by":"publisher","DOI":"10.1002\/9781119013563"},{"key":"S0950268809990938_ref018","first-page":"203","volume-title":"Control of Communicable Diseases Manual","author":"Chin","year":"2000"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268809990938","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,5,22]],"date-time":"2020-05-22T19:23:31Z","timestamp":1590175411000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268809990938\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,10,2]]},"references-count":21,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2010,4]]}},"alternative-id":["S0950268809990938"],"URL":"https:\/\/doi.org\/10.1017\/s0950268809990938","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,10,2]]}}}