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Bessen DE, Beall BW, Hayes A, Huang W, DiChiara JM, Velusamy S, Tettelin H, Jolley KA, Fallon JT, Chochua S, Alobaidallah MSA, Higgs C, Barnett TC, Steemson JT, Proft T, Davies MR. Recombinational exchange of M-fibril and T-pilus genes generates extensive cell surface diversity in the global group A Streptococcus population. mBio 2024; 15:e0069324. [PMID: 38587426 PMCID: PMC11078000 DOI: 10.1128/mbio.00693-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Among genes present in all group A streptococci (GAS), those encoding M-fibril and T-pilus proteins display the highest levels of sequence diversity, giving rise to the two primary serological typing schemes historically used to define strain. A new genotyping scheme for the pilin adhesin and backbone genes is developed and, when combined with emm typing, provides an account of the global GAS strain population. Cluster analysis based on nucleotide sequence similarity assigns most T-serotypes to discrete pilin backbone sequence clusters, yet the established T-types correspond to only half the clusters. The major pilin adhesin and backbone sequence clusters yield 98 unique combinations, defined as "pilin types." Numerous horizontal transfer events that involve pilin or emm genes generate extensive antigenic and functional diversity on the bacterial cell surface and lead to the emergence of new strains. Inferred pilin genotypes applied to a meta-analysis of global population-based collections of pharyngitis and impetigo isolates reveal highly significant associations between pilin genotypes and GAS infection at distinct ecological niches, consistent with a role for pilin gene products in adaptive evolution. Integration of emm and pilin typing into open-access online tools (pubmlst.org) ensures broad utility for end-users wanting to determine the architecture of M-fibril and T-pilus genes from genome assemblies.IMPORTANCEPrecision in defining the variant forms of infectious agents is critical to understanding their population biology and the epidemiology of associated diseases. Group A Streptococcus (GAS) is a global pathogen that causes a wide range of diseases and displays a highly diverse cell surface due to the antigenic heterogeneity of M-fibril and T-pilus proteins which also act as virulence factors of varied functions. emm genotyping is well-established and highly utilized, but there is no counterpart for pilin genes. A global GAS collection provides the basis for a comprehensive pilin typing scheme, and online tools for determining emm and pilin genotypes are developed. Application of these tools reveals the expansion of structural-functional diversity among GAS via horizontal gene transfer, as evidenced by unique combinations of surface protein genes. Pilin and emm genotype correlations with superficial throat vs skin infection provide new insights on the molecular determinants underlying key ecological and epidemiological trends.
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Affiliation(s)
- Debra E. Bessen
- Department of Pathology, Microbiology, and Immunology, New York Medical College, Valhalla, New York, USA
| | - Bernard W. Beall
- Respiratory Disease Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
- Eagle Global Scientific, LLC, Atlanta, Georgia, USA
| | - Andrew Hayes
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Weihua Huang
- Department of Pathology, Microbiology, and Immunology, New York Medical College, Valhalla, New York, USA
- Department of Pathology, Brody School of Medicine, Eastern Carolina University, Greenville, North Carolina, USA
| | - Jeanne M. DiChiara
- Department of Pathology, Microbiology, and Immunology, New York Medical College, Valhalla, New York, USA
| | - Srinivasan Velusamy
- Respiratory Disease Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Hervé Tettelin
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Keith A. Jolley
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - John T. Fallon
- Department of Pathology, Microbiology, and Immunology, New York Medical College, Valhalla, New York, USA
- Department of Pathology, Brody School of Medicine, Eastern Carolina University, Greenville, North Carolina, USA
| | - Sopio Chochua
- Respiratory Disease Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mosaed S. A. Alobaidallah
- Department of Pathology, Microbiology, and Immunology, New York Medical College, Valhalla, New York, USA
| | - Charlie Higgs
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Timothy C. Barnett
- The Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - John T. Steemson
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Thomas Proft
- School of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Smeesters PR, de Crombrugghe G, Tsoi SK, Leclercq C, Baker C, Osowicki J, Verhoeven C, Botteaux A, Steer AC. Global Streptococcus pyogenes strain diversity, disease associations, and implications for vaccine development: a systematic review. THE LANCET. MICROBE 2024; 5:e181-e193. [PMID: 38070538 DOI: 10.1016/s2666-5247(23)00318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 02/12/2024]
Abstract
The high strain diversity of Streptococcus pyogenes serves as a major obstacle to vaccine development against this leading global pathogen. We did a systematic review of studies in PubMed, MEDLINE, and Embase that reported the global distribution of S pyogenes emm-types and emm-clusters from Jan 1, 1990, to Feb 23, 2023. 212 datasets were included from 55 countries, encompassing 74 468 bacterial isolates belonging to 211 emm-types. Globally, an inverse correlation was observed between strain diversity and the UNDP Human Development Index (HDI; r=-0·72; p<0·0001), which remained consistent upon subanalysis by global region and site of infection. Greater strain diversity was associated with a lower HDI, suggesting the role of social determinants in diseases caused by S pyogenes. We used a population-weighted analysis to adjust for the disproportionate number of epidemiological studies from high-income countries and identified 15 key representative isolates as vaccine targets. Strong strain type associations were observed between the site of infection (invasive, skin, and throat) and several streptococcal lineages. In conclusion, the development of a truly global vaccine to reduce the immense burden of diseases caused by S pyogenes should consider the multidimensional diversity of the pathogen, including its social and environmental context, and not merely its geographical distribution.
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Affiliation(s)
- Pierre R Smeesters
- Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université Libre de Bruxelles, Brussels, Belgium; Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - Gabrielle de Crombrugghe
- Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Shu Ki Tsoi
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Céline Leclercq
- Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium
| | - Ciara Baker
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Joshua Osowicki
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Caroline Verhoeven
- Laboratoire d'enseignement des Mathématiques, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Botteaux
- Molecular Bacteriology Laboratory, European Plotkin Institute for Vaccinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
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3
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Boeddha NP, Atkins L, de Groot R, Driessen G, Hazelzet J, Zenz W, Carrol ED, Anderson ST, Martinon-Torres F, Agyeman PKA, Galassini R, Herberg J, Levin M, Schlapbach LJ, Emonts M. Group A streptococcal disease in paediatric inpatients: a European perspective. Eur J Pediatr 2023; 182:697-706. [PMID: 36449079 PMCID: PMC9709363 DOI: 10.1007/s00431-022-04718-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
Group A streptococcal (GAS) disease shows increasing incidence worldwide. We characterised children admitted with GAS infection to European hospitals and studied risk factors for severity and disability. This is a prospective, multicentre, cohort study (embedded in EUCLIDS and the Swiss Pediatric Sepsis Study) including 320 children, aged 1 month to 18 years, admitted with GAS infection to 41 hospitals in 6 European countries from 2012 to 2016. Demographic, clinical, microbiological and outcome data were collected. A total of 195 (61%) patients had sepsis. Two hundred thirty-six (74%) patients had GAS detected from a normally sterile site. The most common infection sites were the lower respiratory tract (LRTI) (22%), skin and soft tissue (SSTI) (23%) and bone and joint (19%). Compared to patients not admitted to PICU, patients admitted to PICU more commonly had LRTI (39 vs 8%), infection without a focus (22 vs 8%) and intracranial infection (9 vs 3%); less commonly had SSTI and bone and joint infections (p < 0.001); and were younger (median 40 (IQR 21-83) vs 56 (IQR 36-85) months, p = 0.01). Six PICU patients (2%) died. Sequelae at discharge from hospital were largely limited to patients admitted to PICU (29 vs 3%, p < 0.001; 12% overall) and included neurodisability, amputation, skin grafts, hearing loss and need for surgery. More patients were recruited in winter and spring (p < 0.001). CONCLUSION In an era of observed marked reduction in vaccine-preventable infections, GAS infection requiring hospital admission is still associated with significant severe disease in younger children, and short- and long-term morbidity. Further advances are required in the prevention and early recognition of GAS disease. WHAT IS KNOWN • Despite temporal and geographical variability, there is an increase of incidence of infection with group A streptococci. However, data on the epidemiology of group A streptococcal infections in European children is limited. WHAT IS NEW • In a large, prospective cohort of children with community-acquired bacterial infection requiring hospitalisation in Europe, GAS was the most frequent pathogen, with 12% disability at discharge, and 2% mortality in patients with GAS infection. • In children with GAS sepsis, IVIG was used in only 4.6% of patients and clindamycin in 29% of patients.
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Affiliation(s)
- Navin P Boeddha
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Pediatrics, Maasstad Hospital, Rotterdam, the Netherlands
| | - Lucy Atkins
- Paediatric Immunology, Infectious Diseases & Allergy Dept., Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, RVI, Clinical Resources Building, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK
| | - Ronald de Groot
- Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Department of Pediatrics, Radboud Institute of Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - Gertjan Driessen
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Paediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jan Hazelzet
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Werner Zenz
- Department of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Enitan D Carrol
- Institute of Infection, Veterinary and Ecological Sciences Global Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases Section, Pediatrics Department, Santiago de Compostela, Spain
| | - Philipp K A Agyeman
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rachel Galassini
- Section of Paediatrics Division of Infectious Disease, Imperial College of London, London, UK
| | - Jethro Herberg
- Section of Paediatrics Division of Infectious Disease, Imperial College of London, London, UK
| | - Michael Levin
- Section of Paediatrics Division of Infectious Disease, Imperial College of London, London, UK
| | - Luregn J Schlapbach
- Neonatal and Pediatric Intensive Care Unit, University Children`s Hospital Zürich and Children`s Research Center, Zurich, Switzerland
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy Dept., Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, RVI, Clinical Resources Building, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK.
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK.
- NIHR Newcastle Biomedical Research Centre Based at Newcastle Upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle Upon Tyne, UK.
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4
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Dunne EM, Hutton S, Peterson E, Blackstock AJ, Hahn CG, Turner K, Carter KK. Increasing Incidence of Invasive Group A Streptococcus Disease, Idaho, USA, 2008-2019. Emerg Infect Dis 2022; 28:1785-1795. [PMID: 35997313 PMCID: PMC9423907 DOI: 10.3201/eid2809.212129] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated invasive group A Streptococcus epidemiology in Idaho, USA, during 2008–2019 using surveillance data, medical record review, and emm (M protein gene) typing results. Incidence increased from 1.04 to 4.76 cases/100,000 persons during 2008–2019. emm 1, 12, 28, 11, and 4 were the most common types, and 2 outbreaks were identified. We examined changes in distribution of clinical syndrome, patient demographics, and risk factors by comparing 2008–2013 baseline with 2014–2019 data. Incidence was higher among all age groups during 2014–2019. Streptococcal toxic shock syndrome increased from 0% to 6.4% of cases (p = 0.02). We identified no differences in distribution of demographic or risk factors between periods. Results indicated that invasive group A Streptococcus is increasing among the general population of Idaho. Ongoing surveillance of state-level invasive group A Streptococcus cases could help identify outbreaks, track regional trends in incidence, and monitor circulating emm types.
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Cho YN, Park SE, Cho EY, Cho HK, Park JY, Kang HM, Yun KW, Choi EH, Lee H. Distribution of emm genotypes in group A streptococcus isolates of Korean children from 2012 to 2019. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:671-677. [PMID: 35624007 DOI: 10.1016/j.jmii.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/18/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Changes in the epidemiology of group A streptococcus (GAS) infection is related to emm genotype. We studied the distribution of emm genotypes and their antibiotic susceptibility among Korean children. METHODS Isolates from children with GAS infection between 2012 and 2019 were collected. emm typing and cluster analysis was performed according to the Centers for Disease Control emm cluster classification. Antimicrobial susceptibility was tested using the E-test and resistance genes were analyzed for macrolide resistant phenotypes. RESULTS Among 169 GAS isolates, 115 were from children with scarlet fever. Among invasive isolates, emm1 (6/22, 27.3%), emm12 (4/22, 18.2%), and emm4 (4/22, 18.2%) were most common. In scarlet fever, although emm4 (38/115, 33.0%) was the most prevalent throughout the study period, emm4 was replaced by emm3 (28/90, 31.1%) during an outbreak in 2017-2018. Among all isolates, only 2 (1.2%) exhibited erythromycin resistance and harbored both ermA and ermB genes. CONCLUSIONS In this analysis of GAS isolated from Korean children, emm1 was the most prevalent in invasive infection. In scarlet fever, emm4 was prevalent throughout the study period, with an increase in emm3 during 2017-2018. GAS isolates during 2012-2019 demonstrated low erythromycin resistance.
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Affiliation(s)
- You Na Cho
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Republic of Korea
| | - Eun Young Cho
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hye Kyung Cho
- Department of Pediatrics, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyun-Mi Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Rafei R, Al Iaali R, Osman M, Dabboussi F, Hamze M. A global snapshot on the prevalent macrolide-resistant emm types of Group A Streptococcus worldwide, their phenotypes and their resistance marker genotypes during the last two decades: A systematic review. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 99:105258. [PMID: 35219865 DOI: 10.1016/j.meegid.2022.105258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 12/29/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Watchful epidemiological surveillance of macrolide-resistant Group A Streptococcus (MRGAS) clones is important owing to the evolutionary and epidemiological dynamic of GAS. Meanwhile, data on the global distribution of MRGAS emm types according to macrolide resistance phenotypes and genotypes are scant and need to be updated. For this, the present systematic review analyses a global set of extensively characterized MRGAS isolates from patients of diverse ages and clinical presentations over approximately two decades (2000 to 2020) and recaps the peculiar epidemiological features of the dominant MRGAS clones. Based on the inclusion and exclusion criteria, 53 articles (3593 macrolide-resistant and 15,951 susceptible isolates) distributed over 23 countries were dissected with a predominance of high-income countries over low-income ones. Although macrolide resistance in GAS is highly variable in different countries, its within-GAS distribution seems not to be random. emm pattern E, 13 major emm types (emm12, 4, 28, 77, 75, 11, 22, 92, 58, 60, 94, 63, 114) and 4 emm clusters (A-C4, E1, E6, and E2) were significantly associated with macrolide resistance. emm patterns A-C and D, 14 major emm types (emm89, 3, 6, 2, 44, 82, 87, 118, 5, 49, 81, 59, 227, 78) and 3 well-defined emm clusters (A-C5, E3, and D4) were significantly associated with macrolide susceptibility. Scrutinizing the tendency of each MRGAS emm type to be significantly associated with specific macrolide resistance phenotype or genotype, interesting vignettes are also unveiled. The 30-valent vaccine covers ~95% of MRGAS isolates. The presented data urge the importance of comprehensive nationwide sustained surveillance of MRGAS circulating clones particularly in Low and Middle income countries where sampling bias is high and GAS epidemiology is obfuscated and needs to be demystified.
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Affiliation(s)
- Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
| | - Rayane Al Iaali
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon; Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14850, USA
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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7
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Jabang S, Erhart A, Darboe S, Baldeh AK, Delforge V, Watson G, Foster-Nyarko E, Salaudeen R, Lawal B, Mackenzie G, Botteaux A, Antonio M, Smeesters PR. Molecular Epidemiology of Group A Streptococcus Infections in The Gambia. Vaccines (Basel) 2021; 9:124. [PMID: 33557233 PMCID: PMC7913941 DOI: 10.3390/vaccines9020124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022] Open
Abstract
Molecular epidemiological data on Group A Streptococcus (GAS) infection in Africa is scarce. We characterized the emm-types and emm-clusters of 433 stored clinical GAS isolates from The Gambia collected between 2004 and 2018. To reduce the potential for strain mistyping, we used a newly published primer for emm-typing. There was considerable strain diversity, highlighting the need for vaccine development offering broad strain protection.
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Affiliation(s)
- Sona Jabang
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Annette Erhart
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Saffiatou Darboe
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Aru-Kumba Baldeh
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Valerie Delforge
- Laboratoire de Génétique et Physiologie Bactérienne, IBMM, Université Libre de Bruxelles, 12 Rue des Professeurs Jenner et Brachet, 6041 Gosselies, Belgium; (V.D.); (A.B.); (P.R.S.)
| | - Gabriella Watson
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
- Southampton University Hospital, Southampton SO16 6YD, UK
| | - Ebenezer Foster-Nyarko
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Bolarinde Lawal
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Anne Botteaux
- Laboratoire de Génétique et Physiologie Bactérienne, IBMM, Université Libre de Bruxelles, 12 Rue des Professeurs Jenner et Brachet, 6041 Gosselies, Belgium; (V.D.); (A.B.); (P.R.S.)
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul 273, The Gambia; (S.J.); (S.D.); (A.-K.B.); (G.W.); (E.F.-N.); (R.S.); (B.L.); (G.M.); (M.A.)
| | - Pierre R. Smeesters
- Laboratoire de Génétique et Physiologie Bactérienne, IBMM, Université Libre de Bruxelles, 12 Rue des Professeurs Jenner et Brachet, 6041 Gosselies, Belgium; (V.D.); (A.B.); (P.R.S.)
- Department of Pediatrics, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, 1050 Brussels, Belgium
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Boukthir S, Moullec S, Cariou ME, Meygret A, Morcet J, Faili A, Kayal S. A prospective survey of Streptococcus pyogenes infections in French Brittany from 2009 to 2017: Comprehensive dynamic of new emergent emm genotypes. PLoS One 2020; 15:e0244063. [PMID: 33332468 PMCID: PMC7746304 DOI: 10.1371/journal.pone.0244063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022] Open
Abstract
Streptococcus pyogenes or group A Streptococcus (GAS) causes diseases ranging from uncomplicated pharyngitis to life-threatening infections. It has complex epidemiology driven by the diversity, the temporal and geographical fluctuations of the circulating strains. Despite the global burden of GAS diseases, there is currently no available vaccination strategy against GAS infections. This study, based on a longitudinal population survey, aimed to understand the dynamic of GAS emm types and to give leads to better recognition of underlying mechanisms for the emergence of successful clones. From 2009 to 2017, we conducted a systematic culture-based diagnosis of GAS infections in a French Brittany population with a prospective recovery of clinical data. The epidemiological analysis was performed using emm typing combined with the structural and functional cluster-typing system for all the recovered strains. Risk factors for the invasiveness, identified by univariate analysis, were computed in a multiple logistic regression analysis, and the only independent risk factor remaining in the model was the age (OR for the entire range [CI95%] = 6.35 [3.63, 11.10]; p<0.0001). Among the 61 different emm types identified, the most prevalent were emm28 (16%), emm89 (15%), emm1 (14%), and emm4 (8%), which accounted for more than 50% of circulating strains. During the study period, five genotypes identified as emm44, 66, 75, 83, 87 emerged successively and belonged to clusters D4, E2, E3, and E6 that were different from those gathering “Prevalent” emm types (clusters A-C3 to 5, E1 and E4). We previously reported significant genetic modifications for emm44, 66, 83 and 75 types resulting possibly from a short adaptive evolution. Herein we additionally observed that the emergence of a new genotype could occur in a susceptible population having specific risk factors or probably lacking a naturally-acquired cluster-specific immune cross-protection. Among emergent emm types, emm75 and emm87 tend to become prevalent with a stable annual incidence and the risk of a clonal expansion have to be considered.
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Affiliation(s)
- Sarrah Boukthir
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France
- Inserm, CIC 1414, Rennes, France
- Université Rennes 1, Faculté de Médecine, Rennes, France
| | - Séverine Moullec
- Inserm, CIC 1414, Rennes, France
- Université Rennes 1, Faculté de Médecine, Rennes, France
| | | | - Alexandra Meygret
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France
- Université Rennes 1, Faculté de Médecine, Rennes, France
| | - Jeff Morcet
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France
- Inserm, CIC 1414, Rennes, France
| | - Ahmad Faili
- Inserm, CIC 1414, Rennes, France
- Université Rennes 1, Faculté de Pharmacie, Rennes, France
| | - Samer Kayal
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France
- Inserm, CIC 1414, Rennes, France
- Université Rennes 1, Faculté de Médecine, Rennes, France
- * E-mail:
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Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal emm Clusters in Africa To Inform Vaccine Development. mSphere 2020; 5:5/4/e00429-20. [PMID: 32669471 PMCID: PMC7364215 DOI: 10.1128/msphere.00429-20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Low vaccine coverage is of grave public health concern, particularly in developing countries where epidemiological data are often absent. To inform vaccine development for group A Streptococcus (GAS), we report on the epidemiology of the M protein emm clusters from GAS infections in Africa, where GAS-related illnesses and their sequelae, including rheumatic fever and rheumatic heart disease, are of a high burden. This first report of emm clusters across the continent indicates a high probably of coverage by the M protein-based vaccine currently undergoing testing were an emm-cluster based approach to be used. An emm-cluster based system was proposed as a standard typing scheme to facilitate and enhance future studies of group A Streptococcus (GAS) epidemiological surveillance, M protein function, and vaccine development strategies. We provide an evidence-based distribution of GAS emm clusters in Africa and assess the potential coverage of the new 30-valent vaccine in terms of an emm cluster-based approach. Two reviewers independently assessed studies retrieved from a comprehensive search and extracted relevant data. Meta-analyses were performed (random-effects model) to aggregate emm cluster prevalence estimates. Eight studies (n = 1,595 isolates) revealed the predominant emm clusters as E6 (18%; 95% confidence interval [CI], 12.6% to 24.0%), followed by E3 (14%; 95% CI, 11.2% to 17.4%) and E4 (13%; 95% CI, 9.5% to 16.0%). There was negligible variation in emm clusters with regard to regions, age, and socioeconomic status across the continent. Considering an emm cluster-based vaccine strategy, which assumes cross-protection within clusters, the 30-valent vaccine currently in clinical development would provide hypothetical coverage to 80.3% of isolates in Africa. This systematic review indicates the most predominant GAS emm cluster in Africa is E6 followed by E3, E4, and D4. The current 30-valent vaccine would provide considerable coverage across the diversity of emm cluster types in Africa. Future efforts could be directed toward estimating the overall potential coverage of the new 30-valent vaccine based on cross-opsonization studies with representative panels of GAS isolates from populations at highest risk for GAS diseases. IMPORTANCE Low vaccine coverage is of grave public health concern, particularly in developing countries where epidemiological data are often absent. To inform vaccine development for group A Streptococcus (GAS), we report on the epidemiology of the M protein emm clusters from GAS infections in Africa, where GAS-related illnesses and their sequelae, including rheumatic fever and rheumatic heart disease, are of a high burden. This first report of emm clusters across the continent indicates a high probably of coverage by the M protein-based vaccine currently undergoing testing were an emm-cluster based approach to be used.
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10
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The emm-Cluster Typing System. Methods Mol Biol 2020. [PMID: 32430811 DOI: 10.1007/978-1-0716-0467-0_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
emm-cluster typing system allows to classify most Streptococcus pyogenes variants into 48 different emm clusters. The system correlates nicely with the host serum binding capacities of the M proteins and has been used in epidemiological surveys, strain selection, and vaccine development. Here we describe the allocation of the emm cluster based on the emm-typing defining region.
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11
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Grivea IN, Syrogiannopoulos GA, Michoula AN, Gazeti G, Malli E, Tsilipounidaki K, Fouzas S, Anthracopoulos MB, Petinaki E. emm Types and clusters and macrolide resistance of pediatric group A streptococcal isolates in Central Greece during 2011-2017. PLoS One 2020; 15:e0232777. [PMID: 32379802 PMCID: PMC7205280 DOI: 10.1371/journal.pone.0232777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
Background The surveillance of emm types and macrolide susceptibility of group A streptococcus (GAS) in various areas and time periods enhances the understanding of the epidemiology of GAS infections and may guide treatment strategies and the formulation of type-specific vaccines. Greece has emerged as a country with high macrolide use. However, studies suggest a gradual reduction in macrolide consumption after 2007. Methods During a 7-year period (2011–2017), 604 GAS isolates were recovered from consecutive children presenting with pharyngeal or nonpharyngeal infections in Central Greece; 517 viable isolates underwent molecular analysis, including emm typing. Results Isolates belonged to 20 different emm types (in decreasing order of prevalence: 1, 89, 4, 12, 28, 3, 75 and 6, accounting for 88.2% of total isolates). The emm types comprised 10 emm clusters (five most common clusters: E4, A-C3, E1, A-C4 and A-C5). The emm89 isolates were acapsular (‘new clade‘). Overall macrolide resistance rate was 15.4%, and cMLSB emerged as the predominant resistance phenotype (56.4%). The lowest annual resistance rates occurred in 2014 (13.1%), 2016 (5.5%) and 2017(8.0%) (P for trend = 0.002). Consumption of macrolide/lincosamide/streptogramin B declined by 22.6% during 2011–2017. Macrolide resistance and emm28 and emm77 types were associated (both P<0.001). The most frequently identified genetic lineages of macrolide-resistant GAS included emm28/ST52, emm77/ST63, emm12/ST36, emm89/ST101 and emm4/ST39. We estimated that 98.8% of the isolates belonged to emm types incorporated into a novel 30-valent M protein vaccine. Conclusions In Central Greece during 2011–2017, the acapsular emm89 isolates comprised the second most prevalent type. Susceptibility testing and molecular analyses revealed decreasing GAS macrolide resistance rates, which may be attributed to the reduction in the consumption of macrolides and/or the reduced circulation of macrolide-resistant clones in recent years. Such data may provide valuable baseline information in targeting therapeutic intervention and the formulation of type-specific GAS vaccines.
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Affiliation(s)
- Ioanna N. Grivea
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - George A. Syrogiannopoulos
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
- * E-mail:
| | - Aspasia N. Michoula
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Georgia Gazeti
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Ergina Malli
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Katerina Tsilipounidaki
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Patras, Rion-Patras, Greece
| | - Michael B. Anthracopoulos
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Patras, Rion-Patras, Greece
| | - Efthymia Petinaki
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
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12
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Analysis of Global Collection of Group A Streptococcus Genomes Reveals that the Majority Encode a Trio of M and M-Like Proteins. mSphere 2020; 5:5/1/e00806-19. [PMID: 31915226 PMCID: PMC6952200 DOI: 10.1128/msphere.00806-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
While the GAS M protein has been the leading vaccine target for decades, the bacteria encode many other virulence factors of interest for vaccine development. In this work, we show that emm-like genes are encoded in a remarkable majority of GAS genomes and expressed at a level similar to that for the emm gene. In collaboration with the U.S. Centers for Disease Control, we developed molecular definitions of the different emm and emm-like gene families. This clarification should abrogate mistyping of strains, especially in the area of whole-genome typing. We have also updated the emm-typing collection by removing emm-like gene sequences and provided in-depth analysis of Mrp and Enn protein sequence structure and diversity. The core Mga (multiple gene activator) regulon of group A Streptococcus (GAS) contains genes encoding proteins involved in adhesion and immune evasion. While all GAS genomes contain genes for Mga and C5a peptidase, the intervening genes encoding M and M-like proteins vary between strains. The genetic make-up of the Mga regulon of GAS was characterized by utilizing a collection of 1,688 GAS genomes that are representative of the global GAS population. Sequence variations were examined with multiple alignments, and the expression of all core Mga regulon genes was examined by quantitative reverse transcription-PCR in a representative strain collection. In 85.2% of the sampled genomes, the Mga locus contained genes encoding Mga, Mrp, M, Enn, and C5a peptidase proteins. These isolates account for 53% of global infections. Only 9.1% of genomes did not contain either an mrp or an enn gene. The pairwise identity within Enn (68.6%) and Mrp (83.2%) protein sequences was higher than within M proteins (44.7%). Gene expression varied between strains tested, but high expression was recorded for all genes in at least one strain. Previous nomenclature issues were clarified with molecular gene definitions. Our findings support a shift in focus in the GAS research field to further consider the role of Mrp and Enn in virulence and vaccine development. IMPORTANCE While the GAS M protein has been the leading vaccine target for decades, the bacteria encode many other virulence factors of interest for vaccine development. In this work, we show that emm-like genes are encoded in a remarkable majority of GAS genomes and expressed at a level similar to that for the emm gene. In collaboration with the U.S. Centers for Disease Control, we developed molecular definitions of the different emm and emm-like gene families. This clarification should abrogate mistyping of strains, especially in the area of whole-genome typing. We have also updated the emm-typing collection by removing emm-like gene sequences and provided in-depth analysis of Mrp and Enn protein sequence structure and diversity.
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13
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Konrad P, Hufnagel M, Berner R, Toepfner N. Long-term, single-center surveillance of non-invasive group A streptococcal (GAS) infections, emm types and emm clusters. Eur J Clin Microbiol Infect Dis 2019; 39:273-280. [PMID: 31758439 DOI: 10.1007/s10096-019-03719-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
Group A streptococci (GAS) are among the most frequent pathogens in children. Many epidemiological studies focus on specific GAS infections (such as tonsillopharyngitis or invasive disease), on GAS carriers or on post-streptococcal sequelae. By comparison, reports on regional GAS characteristics, particularly circulating non-invasive GAS in Europe, are rare. In a monocentric study, all GAS isolated from pediatric patients at a tertiary care hospital over a 6-year period (2006-2012) were characterized. GAS emm types and clusters were determined. Associated patient data were analyzed. Five hundred sixty-six GAS strains were collected. GAS tonsillopharyngitis was most common (71.6%), followed by pyoderma (6.0%), otitis media (3.7%), perineal dermatitis (3.4%), and invasive infections (1.4%). Colonizing strains represented 13.6% of GAS. GAS emm12 was most prevalent among invasive and non-invasive isolates. Emm1, emm4, emm28, and emm89 were the most frequent non-invasive GAS strains. The emm E4 cluster was most common, followed by the A-C4, A-C3, and E1. Among the GAS infections, different emm types and clusters were identified, e.g., emm4 was more common among patients with scarlet fever. Three new emm subtypes were characterized: emm29.13, emm36.7, and emm75.5. This comprehensive review of a large, local GAS cohort points to the differences between and similarities among GAS genotypes and disease manifestations, while minimizing regional variations. Considerable deviation from previous epidemiological findings is described, especially regarding the frequent detection of emm1 and emm89 in non-invasive GAS infections. Periodic updates on molecular and epidemiological GAS characteristics are needed to track the multifaceted pathogenic potential of GAS.
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Affiliation(s)
- Peter Konrad
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany
| | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Reinhard Berner
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany.
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14
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Group A Streptococcus infections in children: from virulence to clinical management. Curr Opin Infect Dis 2019; 31:224-230. [PMID: 29601325 DOI: 10.1097/qco.0000000000000452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Recent findings have open new perspectives on group A Streptococcus (GAS) virulence understanding with special focus on the carrier stage and new hopes for an efficient vaccine against this important pathogen. RECENT FINDINGS Understanding of carriage state, transmission and role of virulence factors in invasive infections have been recently active research fields questioning the link between carriage and infections and highlighting the potential to prevent invasive diseases. New roles for already well known virulence factors, such as Streptolysin O, M protein or NAD(+)-glycohydrolase have been discovered. Immunological studies have also shown diversity in both clinical and immunological responses toward various GAS antigens raising questions, and hopes, for the development of an efficient global vaccine candidate. SUMMARY A greater understanding of GAS virulence strategies, and their associated clinical manifestations, may be obtained by shifting our research scope toward virulence determinant interactions and cooperation rather than focusing on individual virulence factor or specific strain characterization only.
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15
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Abraham T, Sistla S. Decoding the molecular epidemiology of group A streptococcus - an Indian perspective. J Med Microbiol 2019; 68:1059-1071. [PMID: 31192782 DOI: 10.1099/jmm.0.001018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Unlike western countries the knowledge of group A streptococcus (GAS) epidemiology in India remains patchy and incomplete. Typing is crucial for surveillance as well as in predicting the efficacy of multivalent M protein vaccine. The present study aimed to explore the emm types of 206 invasive and non-invasive GAS isolates from South India as well as reviewing all the published literature on GAS molecular epidemiology from India thereby generating a pan-Indian data to predict the conjectural coverage of the 30-valent M-protein vaccine in this population. METHODOLOGY emm typing and superantigen (SAg) profiling of GAS along with reviewing literatures on GAS molecular epidemiology from India. RESULTS This study revealed a high diversity of emm types with emm 63, 82, 183, 85, 92, 169, 42, 44, 106, 74, 12 being frequently encountered, belonging to twenty emm clusters. The pan-Indian data on prevalent emm types further supports our study findings with 135 emm different types. Six clusters dominated accounting for 80 % of the GAS isolates: E3(26 %), E6(20 %), E2(11 %), E4(10 %), D4(7 %), E1(6 %). No significant association was noted between emm types and the nature of infection (P≥0.05) while a few SAg profiles were significantly associated with certain emm types. Pan Indian data revealed that only 16 % of the emm types encountered were included in proposed 30-valent M protein based vaccine. CONCLUSION The coverage among the South Indian GAS isolates was 28.2 % which increased to only 46.6 % with the cross-opsonic effect, thus highlighting the importance of developing a specific multivalent vaccine including the prevalent emm types in India or considering the use of conserved C-repeat vaccines and non-M protein based vaccines.
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Affiliation(s)
- Tintu Abraham
- Department of Microbiology, JIPMER, Puducherry, India
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16
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Smeesters PR, Laho D, Beall B, Steer AC, Van Beneden CA. Seasonal, Geographic, and Temporal Trends of emm Clusters Associated With Invasive Group A Streptococcal Infections in US Multistate Surveillance. Clin Infect Dis 2019; 64:694-695. [PMID: 28184410 DOI: 10.1093/cid/ciw807] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pierre R Smeesters
- Department of Pediatrics, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium.,Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium.,Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Australia
| | - Delphine Laho
- Department of Pediatrics, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium.,Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Bernard Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. USA
| | - Andrew C Steer
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Chris A Van Beneden
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. USA
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17
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Nascimento BR, Beaton AZ. Fighting Rheumatic Heart Disease: What are the next moves? Rev Soc Bras Med Trop 2019; 52:e20190182. [DOI: 10.1590/0037-8682-0182-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
- Bruno Ramos Nascimento
- Universidade Federal de Minas Gerais, Brazil; Universidade Federal de Minas Gerais, Brazil
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18
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Frost HR, Sanderson-Smith M, Walker M, Botteaux A, Smeesters PR. Group A streptococcal M-like proteins: From pathogenesis to vaccine potential. FEMS Microbiol Rev 2018; 42:193-204. [PMID: 29228173 DOI: 10.1093/femsre/fux057] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022] Open
Abstract
M and M-like surface proteins from group A Streptococcus (GAS) act as virulence factors and have been used in multiple vaccine candidates. While the M protein has been extensively studied, the two genetically and functionally related M-like proteins, Mrp and Enn, although present in most streptococcal strains have been relatively less characterised. We compile the current state of knowledge for these two proteins, from discovery to recent studies on function and immunogenicity, using the M protein for comparison as a prototype of this family of proteins. We focus on the known interactions between M-like proteins and host ligand proteins, and analyse the genetic data supporting these interactions. We discuss known and possible functions of M-like proteins during GAS infections, and highlight knowledge gaps where further investigation is warranted.
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Affiliation(s)
- Hannah R Frost
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels 1070, Belgium.,Group A Streptococcus Research Group, Murdoch Children's Research Institute, Melbourne 3052, VIC, Australia
| | - Martina Sanderson-Smith
- Illawarra Health and Medical Research Institute and School of Biological Sciences, University of Wollongong, 2522, NSW, Australia
| | - Mark Walker
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia 4072, QLD, Australia
| | - Anne Botteaux
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels 1070, Belgium
| | - Pierre R Smeesters
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels 1070, Belgium.,Group A Streptococcus Research Group, Murdoch Children's Research Institute, Melbourne 3052, VIC, Australia.,Department of Pediatrics, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels 1020, Belgium.,Centre for International Child Health, University of Melbourne, Melbourne 3052, VIC, Australia
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19
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Bessen DE, Smeesters PR, Beall BW. Molecular Epidemiology, Ecology, and Evolution of Group A Streptococci. Microbiol Spectr 2018; 6. [PMID: 30191802 DOI: 10.1128/microbiolspec.cpp3-0009-2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Indexed: 12/27/2022] Open
Abstract
The clinico-epidemiological features of diseases caused by group A streptococci (GAS) is presented through the lens of the ecology, population genetics, and evolution of the organism. The serological targets of three typing schemes (M, T, SOF) are themselves GAS cell surface proteins that have a myriad of virulence functions and a diverse array of structural forms. Horizontal gene transfer expands the GAS antigenic cell surface repertoire by generating numerous combinations of M, T, and SOF antigens. However, horizontal gene transfer of the serotype determinant genes is not unconstrained, and therein lies a genetic organization that may signify adaptations to a narrow ecological niche, such as the primary tissue reservoirs of the human host. Adaptations may be further shaped by selection pressures such as herd immunity. Understanding the molecular evolution of GAS on multiple levels-short, intermediate, and long term-sheds insight on mechanisms of host-pathogen interactions, the emergence and spread of new clones, rational vaccine design, and public health interventions.
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Affiliation(s)
- Debra E Bessen
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY 10595
| | - Pierre R Smeesters
- Department of Pediatrics, Queen Fabiola Children's University Hospital, and Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, 1020, Belgium
| | - Bernard W Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333
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20
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Frost HR, Laho D, Sanderson-Smith ML, Licciardi P, Donath S, Curtis N, Kado J, Dale JB, Steer AC, Smeesters PR. Immune Cross-Opsonization Within emm Clusters Following Group A Streptococcus Skin Infection: Broadening the Scope of Type-Specific Immunity. Clin Infect Dis 2018; 65:1523-1531. [PMID: 29020160 PMCID: PMC7263703 DOI: 10.1093/cid/cix599] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/06/2017] [Indexed: 12/13/2022] Open
Abstract
Background Group AStreptococcus (GAS) skin infections are particularly prevalent in developing nations. The GAS M protein, by which strains are differentiated into >220 differentemm types, is immunogenic and elicits protective antibodies. A major obstacle for vaccine development has been the traditional understanding that immunity following infection is restricted to a singleemm type. However, recent evidence has led to the hypothesis of immune cross-reactivity betweenemm types. Methods We investigated the human serological response to GAS impetigo in Fijian schoolchildren, focusing on 3 majoremm clusters (E4, E6, and D4). Pre- and postinfection sera were assayed by enzyme-linked immunosorbent assay with N-terminal M peptides and bactericidal assays using the infecting-type strain,emm cluster–related strains, and nonrelated strains. Results Twenty of the 53 paired sera demonstrated a ≥4-fold increase in antibody titer against the infecting type. When tested against all cluster-related M peptides, we found that 9 of 17 (53%) paired sera had a ≥4-fold increase in antibody titer to cluster-related strains as well. When grouped by cluster, the mean change to cluster-relatedemm types in E4 and E6 was >4-fold (5.9-fold and 19.5-fold, respectively) but for D4 was 3.8-fold. The 17 paired sera were tested in bactericidal assays against selected cluster-related and nonrelated strains. While the responses were highly variable, numerous instances of cross-reactive killing were observed. Conclusions These data demonstrate that M type–specific and cross-reactive immune responses occur following skin infection. The cross-reactive immune responses frequently align withemm clusters, raising new opportunities to design multivalent vaccines with broad coverage.
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Affiliation(s)
- Hannah R Frost
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Molecular Bacteriology Laboratory
| | - Delphine Laho
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Pediatrics, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Martina L Sanderson-Smith
- Illawarra Health and Medical Research Institute and School of Biological Sciences, University of Wollongong
| | - Paul Licciardi
- Pneumococcal Research Group, Murdoch Childrens Research Institute, Melbourne.,Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, Australia
| | - Susan Donath
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, Australia
| | - Nigel Curtis
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, Australia
| | - Joseph Kado
- Department of Paediatrics, Colonial War Memorial Hospital.,College of Medicine, Nursing and Health Sciences, Fiji National University.,Fiji Rheumatic Heart Disease Control Program, Suva, Fiji
| | - James B Dale
- Medicine.,Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center.,Department of Veterans Affairs Medical Center, Memphis, Tennessee
| | - Andrew C Steer
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, Australia.,Centre for International Child Health, University of Melbourne, Australia
| | - Pierre R Smeesters
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Melbourne, Australia.,Molecular Bacteriology Laboratory.,Department of Pediatrics, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium.,Centre for International Child Health, University of Melbourne, Australia
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21
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Nascimento BR, Sable C, Nunes MCP, Diamantino AC, Oliveira KKB, Oliveira CM, Meira ZMA, Castilho SRT, Santos JPA, Rabelo LMM, Lauriano KCA, Carmo GAL, Tompsett A, Ribeiro ALP, Beaton AZ. Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study. J Am Heart Assoc 2018; 7:JAHA.117.008039. [PMID: 29444774 PMCID: PMC5850205 DOI: 10.1161/jaha.117.008039] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Considering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease (RHD), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent RHD in schoolchildren (aged 5–18 years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil. Methods and Results The PROVAR (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for RHD echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart Federation criteria. Compliance with study consent and prevalence were compared between different screening settings, and variables associated with RHD were analyzed. In 26 months, 12 048 students were screened in 52 public schools (n=10 901), 2 private schools (n=589), and 3 primary care centers (n=558). Median age was 12.9 years, and 55.4% were girls. Overall RHD prevalence was 4.0% borderline (n=486) and 0.5% definite (n=63), with statistically similar rates between public schools (4.6%), private schools (3.5%), and primary care centers (4.8%) (P=0.24). The percentage of informed consents signed was higher in primary care centers (84.4%) and private schools (66.9%) compared with public schools (38.7%) (P<0.001). Prevalence was higher in children ≥12 years (5.3% versus 3.1%; P<0.001) and girls (4.9% versus 4.0%; P=0.02). Only age (odds ratio, 1.12; 95% confidence interval, 1.09–1.17; P<0.001) was independently associated with RHD. Conclusions RHD screening in primary care centers seems to achieve higher coverage rates. Prevalence among schoolchildren is significantly high, with rates higher than expected in private schools of high‐income areas. These data are important for the formulation of public policies to confront RHD.
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Affiliation(s)
- Bruno R Nascimento
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil .,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Craig Sable
- Children's National Health System, Washington, DC
| | - Maria Carmo P Nunes
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriana C Diamantino
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Kaciane K B Oliveira
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Cassio M Oliveira
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Zilda Maria A Meira
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra Regina T Castilho
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Júlia P A Santos
- School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Letícia Maria M Rabelo
- School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Karlla C A Lauriano
- School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gabriel A L Carmo
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Antonio Luiz P Ribeiro
- Division of Cardiology and Cardiovascular Surgery and Telehealth Center - Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,School of Medicine - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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22
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Dougherty S, Beaton A, Nascimento BR, Zühlke LJ, Khorsandi M, Wilson N. Prevention and control of rheumatic heart disease: Overcoming core challenges in resource-poor environments. Ann Pediatr Cardiol 2018; 11:68-78. [PMID: 29440834 PMCID: PMC5803981 DOI: 10.4103/apc.apc_135_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rheumatic heart disease (RHD) has long receded as a significant threat to public health in high-income countries. In low-resource settings, however, the specter of RHD remains unabated, as exemplified by recent data from the Global Burden of Diseases Study. There are many complex reasons for this ongoing global disparity, including inadequate data on disease burden, challenges in effective advocacy, ongoing poverty and inequality, and weak health systems, most of which predominantly affect developing nations. In this review, we discuss how each of these acts as a core challenge in RHD prevention and control. We then examine key lessons learnt from successful control programs in the past and highlight resources that have been developed to help create strong national RHD control programs.
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Affiliation(s)
- Scott Dougherty
- Department of Internal Medicine, Ministry of Health, Belau National Hospital, Koror, Republic of Palau
| | - Andrea Beaton
- Children's National Medical Center, Cardiology, Washington DC, USA
| | - Bruno R Nascimento
- Telehealth Center, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, South Africa
| | - Liesl J Zühlke
- Divisions of Paediatric Cardiology and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Maziar Khorsandi
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nigel Wilson
- Green Lane Paediatic and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, University of Auckland, Auckland, New Zealand
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23
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Ly AT, Noto JP, Walwyn OL, Tanz RR, Shulman ST, Kabat W, Bessen DE. Differences in SpeB protease activity among group A streptococci associated with superficial, invasive, and autoimmune disease. PLoS One 2017; 12:e0177784. [PMID: 28545045 PMCID: PMC5435240 DOI: 10.1371/journal.pone.0177784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/03/2017] [Indexed: 11/19/2022] Open
Abstract
The secreted cysteine proteinase SpeB is an important virulence factor of group A streptococci (GAS), whereby SpeB activity varies widely among strains. To establish the degree to which SpeB activity correlates with disease, GAS organisms were recovered from patients with pharyngitis, impetigo, invasive disease or acute rheumatic fever (ARF), and selected for analysis using rigorous sampling criteria; >300 GAS isolates were tested for SpeB activity by casein digestion assays, and each GAS isolate was scored as a SpeB-producer or non-producer. Highly significant statistical differences (p < 0.01) in SpeB production are observed between GAS recovered from patients with ARF (41.5% SpeB-non-producers) compared to pharyngitis (20.5%), invasive disease (16.7%), and impetigo (5.5%). SpeB activity differences between pharyngitis and impetigo isolates are also significant, whereas pharyngitis versus invasive isolates show no significant difference. The disproportionately greater number of SpeB-non-producers among ARF-associated isolates may indicate an altered transcriptional program for many rheumatogenic strains and/or a protective role for SpeB in GAS-triggered autoimmunity.
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Affiliation(s)
- Anhphan T. Ly
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, United States of America
| | - John P. Noto
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, United States of America
| | - Odaelys L. Walwyn
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, United States of America
| | - Robert R. Tanz
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, United States of America
| | - Stanford T. Shulman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, United States of America
| | - William Kabat
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, United States of America
| | - Debra E. Bessen
- Department of Microbiology and Immunology, New York Medical College, Valhalla, New York, United States of America
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24
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Comparative M-protein analysis of Streptococcus pyogenes from pharyngitis and skin infections in New Zealand: Implications for vaccine development. BMC Infect Dis 2016; 16:561. [PMID: 27733129 PMCID: PMC5062888 DOI: 10.1186/s12879-016-1891-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 10/01/2016] [Indexed: 02/04/2023] Open
Abstract
Background Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are responsible for a significant disease burden amongst Māori and Pacific populations in New Zealand (NZ). However, contemporary data are lacking regarding circulating group A Streptococcal (GAS) strains in NZ. Such information is important in guiding vaccine development. Methods GAS isolates from April to June 2015 were recovered from skin and pharyngeal samples from children living in areas of high social deprivation in Auckland, NZ, a significant proportion of which are Māori or Pacific. These children are among the highest risk group for developing ARF. Isolates were compared to concurrently collected pharyngeal isolates from Dunedin, NZ, where both the proportion of Māori and Pacific children and risk of developing ARF is low. Emm typing, emm cluster typing and theoretical coverage of the 30-valent vaccine candidate were undertaken as previously described. Results A high diversity of emm types and a high proportion of emm-pattern D and cluster D4 isolates were detected amongst both skin and pharyngeal isolates in children at high risk of ARF. Pharyngeal isolates from children at low risk of ARF within the same country were significantly less diverse, less likely to be emm pattern D, and more likely to be theoretically covered by the 30-valent M protein vaccine. Conclusions The high proportion of emm pattern D GAS strains amongst skin and pharyngeal isolates from children at high risk of ARF raises further questions about the role of skin infection in ARF pathogenesis. Emm types and emm clusters differed considerably between ARF endemic and non-endemic settings, even within the same country. This difference should be taken into account for vaccine development. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1891-6) contains supplementary material, which is available to authorized users.
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25
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Imperi M, Pittiglio V, D'Avenio G, Gherardi G, Ciammaruconi A, Lista F, Pourcel C, Baldassarri L, Creti R. A new genotyping scheme based on MLVA for inter-laboratory surveillance of Streptococcus pyogenes. J Microbiol Methods 2016; 127:176-181. [PMID: 27302039 DOI: 10.1016/j.mimet.2016.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
A newly developed MLVA seven-loci scheme for Streptococcus pyogenes is described. The method can be successfully applied by using both agarose gel with visual inspections of bands and Lab on Chip technology. The potential of the present MLVA has been tested on a collection of 100 clinical GAS strains representing the most common emm types found in high-income countries plus 18 published gap-free genomes, in comparison to PFGE and MLST. The MLVA analysis defined 30 MLVA types with ten out of the considered 15 emm types exhibiting multiple and specific MLVA types. In only one occasion the same MLVA profile was shared between isolates belonging to two different emm types. A robust congruency between the methods was observed, with MLVA discriminating within clonal complexes as defined by PFGE or MLST. This new MLVA scheme can be adopted as a quick, low-cost and reliable typing method to track the short-term diffusion of GAS clones in inter-laboratory-based surveillance.
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Affiliation(s)
- Monica Imperi
- Dept. of Infectious, Parasitic and Immune-mediated Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Valentina Pittiglio
- Health Corps Italian Army, Department of Molecular Biology, Immunology and Experimental Medicine, Army Medical and Veterinary Research Center, Rome, Italy
| | - Giuseppe D'Avenio
- Dept. of Technology and Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Andrea Ciammaruconi
- Health Corps Italian Army, Department of Molecular Biology, Immunology and Experimental Medicine, Army Medical and Veterinary Research Center, Rome, Italy
| | - Florigio Lista
- Health Corps Italian Army, Department of Molecular Biology, Immunology and Experimental Medicine, Army Medical and Veterinary Research Center, Rome, Italy
| | - Christine Pourcel
- I2BC, CNRS, Université Paris Sud, Université Paris-Saclay, Orsay, France
| | - Lucilla Baldassarri
- Dept. of Infectious, Parasitic and Immune-mediated Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Creti
- Dept. of Infectious, Parasitic and Immune-mediated Disease, Istituto Superiore di Sanità, Rome, Italy.
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26
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Tuerlinckx D, Gueulette E, Loens K, Goossens H, Smeesters PR. Group A streptococcal meningitis: emm type distribution and theoretical vaccine coverage in children. Acta Clin Belg 2016; 71:138-41. [PMID: 26319426 DOI: 10.1179/2295333715y.0000000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
As group A Streptococcus (GAS) meningitis is seldom reported in children, emm-type distribution data are scare. We report eight cases of GAS meningitis in Belgium (2008-2013) and compare molecular characteristics of our strains with a further 55 cases previously reported with their corresponding emm-types. emm1 type was the most frequent (24%) followed by emm6 (11%), emm12 (11%) and emm3 (6%). Together these four emm-types accounted for 52% of the cases, while the rest of the cases are due to 24 different emm-types. These 28 emm-types associated with GAS meningitis belonged to 16 different emm-clusters suggesting that there is no propensity for particular emm-types or emm-cluster to cause meningitis. Theoretical coverage of the 30-valent vaccine candidate would be 77.8% (49/63 isolates) among children with GAS meningitis.
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Affiliation(s)
- David Tuerlinckx
- a CHU Dinant-Godinne , Service de Pédiatrie, Université Catholique de Louvain , Yvoir , Belgium
| | | | - Katherine Loens
- c Department of Microbiology , University Hospital Antwerp , Belgium
| | - Herman Goossens
- c Department of Microbiology , University Hospital Antwerp , Belgium
| | - Pierre Robert Smeesters
- d Group A Streptococcus Research Group , Murdoch Childrens Research Institute , Melbourne , VIC , Australia
- e Centre for International Child Health , University of Melbourne , VIC , Australia
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27
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Bessen DE. Tissue tropisms in group A Streptococcus: what virulence factors distinguish pharyngitis from impetigo strains? Curr Opin Infect Dis 2016; 29:295-303. [PMID: 26895573 PMCID: PMC5373551 DOI: 10.1097/qco.0000000000000262] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Group A streptococci (GAS) are a common cause of pharyngitis and impetigo, and distinct throat strains and skin strains have been long recognized. This review aims to describe recent advances in molecular differences between throat and skin strains, and the pathogenic mechanisms used by virulence factors that may distinguish between these two groups. RECENT FINDINGS Recent findings include a new typing scheme for GAS strains based on sequence clusters of genes encoding the entire surface-exposed portion of M protein; correlations between emm-based typing schemes, clinical disease and surface adhesins; covalent bond formation mediated by GAS pili and other adhesins in binding to host ligands; a key role for superantigens in oropharyngeal infection via binding major histocompatibility complex class II antigen; and migration of GAS-specific Th17 cells from the upper respiratory tract to the brain, which may be relevant to autoimmune sequelae. SUMMARY The gap between molecular markers of disease (correlation) and virulence mechanisms (causation) in the establishment of tissue tropisms for GAS infection currently remains wide, but the gap also continues to narrow. Whole genome sequencing combined with mutant construction and improvements in animal models for oropharyngeal infection by GAS may help pave the way for new discoveries.
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Affiliation(s)
- Debra E Bessen
- Department of Microbiology and Immunology, New York Medical College, New York, USA
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28
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Frost HR, Tsoi SK, Baker CA, Laho D, Sanderson-Smith ML, Steer AC, Smeesters PR. Validation of an automated colony counting system for group A Streptococcus. BMC Res Notes 2016; 9:72. [PMID: 26856815 PMCID: PMC4745170 DOI: 10.1186/s13104-016-1875-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 01/19/2016] [Indexed: 01/06/2023] Open
Abstract
Background The practice of counting bacterial colony forming units on agar plates has long been used as a method to estimate the concentration of live bacteria in culture. However, due to the laborious and potentially error prone nature of this measurement technique, an alternative method is desirable. Recent technologic advancements have facilitated the development of automated colony counting systems, which reduce errors introduced during the manual counting process and recording of information. An additional benefit is the significant reduction in time taken to analyse colony counting data. Whilst automated counting procedures have been validated for a number of microorganisms, the process has not been successful for all bacteria due to the requirement for a relatively high contrast between bacterial colonies and growth medium. The purpose of this study was to validate an automated counting system for use with group A Streptococcus (GAS). Results Methods: Twenty-one different GAS strains, representative of major emm-types, were selected for assessment. In order to introduce the required contrast for automated counting, 2,3,5-triphenyl-2H-tetrazolium chloride (TTC) dye was added to Todd–Hewitt broth with yeast extract (THY) agar. Growth on THY agar with TTC was compared with growth on blood agar and THY agar to ensure the dye was not detrimental to bacterial growth. Automated colony counts using a ProtoCOL 3 instrument were compared with manual counting to confirm accuracy over the stages of the growth cycle (latent, mid-log and stationary phases) and in a number of different assays. The average percentage differences between plating and counting methods were analysed using the Bland–Altman method. Conclusions Results: A percentage difference of ±10 % was determined as the cut-off for a critical difference between plating and counting methods. All strains measured had an average difference of less than 10 % when plated on THY agar with TTC. This consistency was also observed over all phases of the growth cycle and when plated in blood following bactericidal assays. Agreement between these methods suggest the use of an automated colony counting technique for GAS will significantly reduce time spent counting bacteria to enable a more efficient and accurate measurement of bacteria concentration in culture. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-1875-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H R Frost
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia. .,Laboratoire de Bactériologie Moléculaire, Université Libre de Bruxelles, Brussels, Belgium.
| | - S K Tsoi
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.
| | - C A Baker
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.
| | - D Laho
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.
| | - M L Sanderson-Smith
- Illawarra Health and Medical Research Institute and School of Biological Sciences, University of Wollongong, Wollongong, Australia.
| | - A C Steer
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia. .,Centre for International Child Health, University of Melbourne, Melbourne, Australia. .,Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Australia.
| | - P R Smeesters
- Group A Streptococcus Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Melbourne, VIC, 3052, Australia. .,Illawarra Health and Medical Research Institute and School of Biological Sciences, University of Wollongong, Wollongong, Australia. .,Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Australia.
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29
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Abstract
Epidemiological data regarding group A streptococcal (GAS) infections in South East Asia are scarce with no information from Laos. We characterized emm types, emm clusters and the antibiotic resistance profile of 124 GAS isolates recovered in Laos during 2004-2013. Most strains were recovered from skin and invasive infections (76% and 19%, respectively). Thirty-four emm types were identified as belonging to 12 emm clusters and no novel emm types were identified. No significant differences were observed in the distribution of emm types or emm clusters according to age or site of recovery (skin or invasive infections). There was moderate strain diversity in this country but considerable differences in emm-type distribution between Laos, Thailand and Cambodia. Vaccine coverage was high for the J8 vaccine candidate. The theoretical coverage for the 30-valent vaccine candidate needs further investigation. Antibiotic resistance was moderate to erythromycin and chloramphenicol (8% and 7%, respectively) and low to ofloxacin (<1%).
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30
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Sheel M, Moreland NJ, Fraser JD, Carapetis J. Development of Group A streptococcal vaccines: an unmet global health need. Expert Rev Vaccines 2015; 15:227-38. [DOI: 10.1586/14760584.2016.1116946] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Meru Sheel
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Nicole J Moreland
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - John D Fraser
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Princess Margaret Hospital for Children, Perth, Australia
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31
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Epidemiology Analysis of Streptococcus pyogenes in a Hospital in Southern Taiwan by Use of the Updated emm Cluster Typing System. J Clin Microbiol 2015; 54:157-62. [PMID: 26560544 DOI: 10.1128/jcm.02089-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/05/2015] [Indexed: 12/14/2022] Open
Abstract
emm typing is the most widely used molecular typing method for the human pathogen Streptococcus pyogenes (group A streptococcus [GAS]). emm typing is based on a small variable region of the emm gene; however, the emm cluster typing system defines GAS types according to the nearly complete sequence of the emm gene. Therefore, emm cluster typing is considered to provide more information regarding the functional and structural properties of M proteins in different emm types of GAS. In the present study, 677 isolates collected between 1994 and 2008 in a hospital in southern Taiwan were analyzed by the emm cluster typing system. emm clusters A-C4, E1, E6, and A-C3 were the most prevalent emm cluster types and accounted for 67.4% of total isolates. emm clusters A-C4 and E1 were associated with noninvasive diseases, whereas E6 was significantly associated with both invasive and noninvasive manifestations. In addition, emm clusters D4, E2, and E3 were significantly associated with invasive manifestations. Furthermore, we found that the functional properties of M protein, including low fibrinogen-binding and high IgG-binding activities, were correlated significantly with invasive manifestations. In summary, the present study provides updated epidemiological information on GAS emm cluster types in southern Taiwan.
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32
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M-Protein Analysis of Streptococcus pyogenes Isolates Associated with Acute Rheumatic Fever in New Zealand. J Clin Microbiol 2015; 53:3618-20. [PMID: 26292296 DOI: 10.1128/jcm.02129-15] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 11/20/2022] Open
Abstract
We applied an emm cluster typing system to group A Streptococcus strains in New Zealand, including those associated with acute rheumatic fever (ARF). We observed few so-called rheumatogenic emm types but found a high proportion of emm types previously associated with pyoderma, further suggesting a role for skin infection in ARF.
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33
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Correlates of Protection for M Protein-Based Vaccines against Group A Streptococcus. J Immunol Res 2015; 2015:167089. [PMID: 26101780 PMCID: PMC4458553 DOI: 10.1155/2015/167089] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/28/2015] [Accepted: 05/03/2015] [Indexed: 11/17/2022] Open
Abstract
Group A streptococcus (GAS) is known to cause a broad spectrum of illness, from pharyngitis and impetigo, to autoimmune sequelae such as rheumatic heart disease, and invasive diseases. It is a significant cause of infectious disease morbidity and mortality worldwide, but no efficacious vaccine is currently available. Progress in GAS vaccine development has been hindered by a number of obstacles, including a lack of standardization in immunoassays and the need to define human correlates of protection. In this review, we have examined the current immunoassays used in both GAS and other organisms, and explored the various challenges in their implementation in order to propose potential future directions to identify a correlate of protection and facilitate the development of M protein-based vaccines, which are currently the main GAS vaccine candidates.
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Streptococcus pyogenes emm Types and Clusters during a 7-Year Period (2007 to 2013) in Pharyngeal and Nonpharyngeal Pediatric Isolates. J Clin Microbiol 2015; 53:2015-21. [PMID: 25878351 DOI: 10.1128/jcm.00301-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/07/2015] [Indexed: 01/10/2023] Open
Abstract
Group A streptococcus (GAS) is an important cause of morbidity and mortality worldwide. Surveillance of emm types has important implications, as it can provide baseline information for possible implementation of vaccination. A total of 1,349 GAS pediatric isolates were collected during a 7-year period (2007 to 2013); emm typing was completed for 1,282 pharyngeal (84%) or nonpharyngeal (16%) isolates, and emm clusters and temporal changes were analyzed. Thirty-five different emm types, including 14 subtypes, were identified. The most prevalent emm types identified were 1 (16.7%), 12 (13.6%), 77 (10.9%), 4 (10.8%), 28 (10.4%), 6 (6.8%), 3 (6.6%), and 89 (6.6%), accounting for 82.3% of total isolates. Rheumatogenic emm types comprised 16.3% of total isolates. The emm types 12, 4, and 77 were more prevalent among pharyngeal isolates, and the emm types 1, 89, 6, 75, and 11 were more prevalent among nonpharyngeal isolates. The emm types identified belonged to 13 emm clusters, and the 8 most prevalent clusters comprised 97% of all isolates. There were statistically significant decreases in the prevalence of emm types 12, 4, 5, and 61 and increases in the prevalence of emm types 89, 75, and 11, compared with the period 2001 to 2006. The proposed 30-valent GAS vaccine, which is currently in preclinical studies, encompasses 97.2% of the emm types detected in our study and 97.4% of the erythromycin-resistant strains. In addition, it includes 93.3% of the emm types involved in bacteremia. A much greater diversity of GAS emm types was identified in our area than described previously. Seasonal fluctuations and the introduction of new emm types were observed. Continuous surveillance of emm types is needed in order to evaluate the possible benefits of an M protein-based GAS vaccine.
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Cohen R, Levy C, Bonacorsi S, Wollner A, Koskas M, Jung C, Béchet S, Chalumeau M, Cohen J, Bidet P. Diagnostic accuracy of clinical symptoms and rapid diagnostic test in group A streptococcal perianal infections in children. Clin Infect Dis 2014; 60:267-70. [PMID: 25313248 DOI: 10.1093/cid/ciu794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
From 2009 to 2014, we prospectively enrolled 132 children with perianal infections. The presentation of painful defecation, anal fissures, and macroscopic blood in stools was highly suggestive of group A streptococcal perianal infection (probability 83.3%). We found a high sensitivity of a group A streptococcal rapid diagnostic testing (98%) but relatively low specificity (72.8%).
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Affiliation(s)
- Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés Clinical Research Center, Centre Hospitalier Intercommunal de Créteil Association Française de Pédiatrie Ambulatoire Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés Clinical Research Center, Centre Hospitalier Intercommunal de Créteil Association Française de Pédiatrie Ambulatoire
| | - Stéphane Bonacorsi
- Université Paris Diderot, Sorbonne Paris Cité Service de Microbiologie, Hôpital Robert-Debré
| | - Alain Wollner
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés
| | - Marc Koskas
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés
| | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Créteil
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés
| | - Martin Chalumeau
- Department of Pediatrics, Necker-Enfants-Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, France
| | - Jérémie Cohen
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, France
| | - Philippe Bidet
- Université Paris Diderot, Sorbonne Paris Cité Service de Microbiologie, Hôpital Robert-Debré
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