A case of suspected transmission of group A Streptococcus from a dead body with streptococcal toxic shock syndrome to an autopsy worker.

Autopsy workers are known to be at risk of contracting various infectious diseases from dead bodies. However, infections caused by group A Streptococcus (GAS, Streptococcus pyogenes) are rarely reported and often overlooked despite their potential severity. GAS infections can lead to serious complications, including streptococcal toxic shock syndrome (STSS). In this study, we conducted genetic analyses to identify the source of GAS bacteremia in a worker who conducted an autopsy on an individual who had developed STSS from GAS. GAS strains from the dead body and autopsy worker were analyzed using polymerase chain reaction (PCR) for five major streptococcal pyrogenic exotoxin (SPE) genes (speA, speB, speC, speF, and ssa) and M protein (emm) typing by sequencing. Multilocus sequence typing (MLST) was performed to analyze seven housekeeping genes (gki, gtr, murI, mutS, recP, xpt, and yqiL) by PCR and sequencing. Both GAS strains were positive for speB and speF, negative for speA, speC, and ssa, and classified as emm81.0 and sequence type 117. This is the first report to demonstrate homology between GAS strains from a dead body and autopsy worker using the M-protein type, SPE gene expression, and MLST analysis. Although the autopsy was conducted in a controlled environment with appropriate personal protective equipment, including N95 masks, GAS contact transmission may have occurred during other handling procedures, such body transportation. These findings emphasize the need for stringent precautionary measures when handling dead bodies and their specimens, considering the risk of infection at any time.