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Affiliation(s)
- Diego O Andrey
- a Service of Infectious Diseases, Department of Medical Specialties , Geneva University Hospitals & University of Geneva Medical School , Geneva , Switzerland
| | - Klara M Posfay-Barbe
- b Pediatric Infectious Diseases Unit, Department of Pediatrics , Geneva University Hospitals & University of Geneva Medical School , Geneva , Switzerland
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Scarlet fever is caused by a limited number of Streptococcus pyogenes lineages and is associated with the exotoxin genes ssa, speA and speC. Pediatr Infect Dis J 2014; 33:306-10. [PMID: 24168973 DOI: 10.1097/inf.0000000000000088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several outbreaks of scarlet fever caused by Streptococcus pyogenes were recently reported. Scarlet fever is historically considered a toxin-mediated disease, dependent on the production of the exotoxins SpeA and SpeC, but a strict association between scarlet fever and these exotoxins is not always detected. The aims of this study were to characterize the scarlet fever bacterial isolates recovered from patients in a Lisbon hospital and to identify any distinctive characteristics of such isolates. METHODS We characterized a collection of 303 pharyngeal S. pyogenes collected between 2002 and 2008. One-hundred and one were isolated from scarlet fever patients and 202 were associated to a diagnosis of tonsillo-pharyngitis. Isolates were characterized by T and emm typing, pulsed field gel electrophoresis profiling and superantigen gene profiling. RESULTS The diversity of the scarlet fever isolates was lower than that of the pharyngitis isolates. Specific lineages of emm87, emm4 and emm3 were overrepresented in scarlet fever isolates but only 1 pulsed field gel electrophoresis major lineage was significantly associated with scarlet fever. Multivariate analysis indicated associations of ssa, speA and speC with scarlet fever. CONCLUSIONS In nonoutbreak conditions, scarlet fever is caused by a number of distinct genetic lineages. The lower diversity of these isolates and the association with specific exotoxin genes indicates that some lineages are more prone to cause this presentation than others even in nonoutbreak conditions.
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Liang Y, Liu X, Chang H, Ji L, Huang G, Fu Z, Zheng Y, Wang L, Li C, Shen Y, Yu S, Yao K, Ma L, Shen X, Yang Y. Epidemiological and molecular characteristics of clinical isolates of Streptococcus pyogenes collected between 2005 and 2008 from Chinese children. J Med Microbiol 2012; 61:975-983. [PMID: 22442290 DOI: 10.1099/jmm.0.042309-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yunmei Liang
- Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, PR China
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Xiaorong Liu
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Hesheng Chang
- Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, PR China
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Lili Ji
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Guoying Huang
- Children’s Hospital of Fudan University, Shanghai 200040, PR China
| | - Zhou Fu
- Chongqing Children’s Hospital Affiliated to Chongqing Medical University, Chongqing 400015, PR China
| | - Yuejie Zheng
- Shenzhen Children’s Hospital, Shenzhen 518035, PR China
| | - Libo Wang
- Children’s Hospital of Fudan University, Shanghai 200040, PR China
| | - Chengrong Li
- Shenzhen Children’s Hospital, Shenzhen 518035, PR China
| | - Ying Shen
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Sangjie Yu
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Kaihu Yao
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Lin Ma
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Xuzhuang Shen
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
| | - Yonghong Yang
- Beijing Children’s Hospital Affiliated to Capital Medical University, Beijing 100045, PR China
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Hsieh YC, Huang YC. Scarlet fever outbreak in Hong Kong, 2011. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:409-11. [DOI: 10.1016/j.jmii.2011.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Willems RJL, Hanage WP, Bessen DE, Feil EJ. Population biology of Gram-positive pathogens: high-risk clones for dissemination of antibiotic resistance. FEMS Microbiol Rev 2011; 35:872-900. [PMID: 21658083 DOI: 10.1111/j.1574-6976.2011.00284.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Infections caused by multiresistant Gram-positive bacteria represent a major health burden in the community as well as in hospitalized patients. Staphylococcus aureus, Enterococcus faecalis and Enterococcus faecium are well-known pathogens of hospitalized patients, frequently linked with resistance against multiple antibiotics, compromising effective therapy. Streptococcus pneumoniae and Streptococcus pyogenes are important pathogens in the community and S. aureus has recently emerged as an important community-acquired pathogen. Population genetic studies reveal that recombination prevails as a driving force of genetic diversity in E. faecium, E. faecalis, S. pneumoniae and S. pyogenes, and thus, these species are weakly clonal. Although recombination has a relatively modest role driving the genetic variation of the core genome of S. aureus, the horizontal acquisition of resistance and virulence genes plays a key role in the emergence of new clinically relevant clones in this species. In this review, we discuss the population genetics of E. faecium, E. faecalis, S. pneumoniae, S. pyogenes and S. aureus. Knowledge of the population structure of these pathogens is not only highly relevant for (molecular) epidemiological research but also for identifying the genetic variation that underlies changes in clinical behaviour, to improve our understanding of the pathogenic behaviour of particular clones and to identify novel targets for vaccines or immunotherapy.
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Affiliation(s)
- Rob J L Willems
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Chiou CS, Wang YW, Chen PL, Wang WL, Wu PF, Wei HL. Association of the shuffling of Streptococcus pyogenes clones and the fluctuation of scarlet fever cases between 2000 and 2006 in central Taiwan. BMC Microbiol 2009; 9:115. [PMID: 19486515 PMCID: PMC2697166 DOI: 10.1186/1471-2180-9-115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 06/01/2009] [Indexed: 11/10/2022] Open
Abstract
Background The number of scarlet fever occurrences reported between 2000 and 2006 fluctuated considerably in central Taiwan and throughout the nation. Isolates of Streptococcus pyogenes were collected from scarlet fever patients in central Taiwan and were characterized by emm sequencing and a standardized pulsed-field gel electrophoresis (PFGE) method. National weekly report data were collected for investigating epidemiological trends. Results A total of 23 emm types were identified in 1,218 S. pyogenes isolates. The five most prevalent emm types were emm12 (50.4%), emm4 (23.2%), emm1 (16.4%), emm6 (3.8%) and emm22 (3.0%). PFGE analysis with SmaI suggested that, with a few exceptions, strains with a common emm type belonged to the same clone. There were two large emm12 clones, one with DNA resistant to cleavage by SmaI. Each prevalent emm clone had major PFGE strain(s) and many minor strains. Most of the minor strains emerged in the population and disappeared soon after. Even some major strains remained prevalent for only 2–3 years before declining. The large fluctuation of scarlet fever cases between 2000 and 2006 was associated with the shuffling of six prevalent emm clones. In 2003, the dramatic drop in scarlet fever cases in central Taiwan and throughout the whole country was associated with the occurrence of a severe acute respiratory syndrome (SARS) outbreak that occurred between late-February and mid-June in Taiwan. Conclusion The occurrences of scarlet fever in central Taiwan in 2000–2006 were primarily caused by five emm types, which accounted for 96.8% of the isolates collected. Most of the S. pyogenes strains (as defined by PFGE genotypes) emerged and lasted for only a few years. The fluctuation in the number of scarlet fever cases during the seven years can be primarily attributed to the shuffling of six prevalent emm clones and to the SARS outbreak in 2003.
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Affiliation(s)
- Chien-Shun Chiou
- The Central Region Laboratory, Center for Research and Diagnostics, Centers for Disease Control, Taichung City 40855, Taiwan.
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Abstract
Over the past decade, antimicrobial resistance has emerged as a major public-health crisis. Common bacterial pathogens in the community such as Streptococcus pneumoniae have become progressively more resistant to traditional antibiotics. Salmonella strains are beginning to show resistance to crucial fluoroquinolone drugs. Community outbreaks caused by a resistant form of Staphylococcus aureus, known as community-associated meticillin (formerly methicillin)-resistant Staphylococcus aureus, have caused serious morbidity and even deaths in previously healthy children and adults. To decrease the spread of such antimicrobial-resistant pathogens in the community, a greater understanding of their means of emergence and survival is needed.
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Affiliation(s)
- E Yoko Furuya
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians & Surgeons, 630 West 168th Street, New York, New York 10032, USA.
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Chiou CS, Liao TL, Wang TH, Chang HL, Liao JC, Li CC. Epidemiology and molecular characterization of Streptococcus pyogenes recovered from scarlet fever patients in central Taiwan from 1996 to 1999. J Clin Microbiol 2004; 42:3998-4006. [PMID: 15364982 PMCID: PMC516299 DOI: 10.1128/jcm.42.9.3998-4006.2004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
One hundred seventy-nine Streptococcus pyogenes isolates recovered from scarlet fever patients from 1996 to 1999 in central Taiwan were characterized by emm, Vir, and pulsed-field gel electrophoresis (PFGE) typing methods. The protocols for Vir and PFGE typing were standardized. A database of the DNA fingerprints for the isolates was established. Nine emm or emm-like genes, 19 Vir patterns, and 26 SmaI PFGE patterns were detected among the isolates. Among the three typing methods, PFGE was the most discriminatory. However, it could not completely replace Vir typing because some isolates with identical PFGE patterns could be further differentiated into several Vir patterns. The prevalent emm types were emm4 (n = 81 isolates [45%]), emm12 (n = 64 [36%]), emm1 (n = 14 [8%]), and emm22 (n = 13 [7%]). Some emm type isolates could be further differentiated into several emm-Vir-PFGE genotypes; however, only one genotype in each emm group was usually predominant. DNA from nine isolates was resistant to SmaI digestion. Further PFGE analysis with SgrAI showed that the SmaI digestion-resistant strains could be derived from indigenous strains by horizontal transfer of exogenous genetic material. The emergence of the new strains could have resulted in an increase in scarlet fever cases in central Taiwan since 2000. The emm sequences, Vir, and PFGE pattern database will serve as a basis for information for the long-term evolutionary study of local S. pyogenes strains.
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Affiliation(s)
- Chien-Shun Chiou
- The Central Branch Office, Center for Disease Control, 5F 20 Wen-Sin South 3rd Rd., Taichung City 408, Taiwan.
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Lau SKP, Woo PCY, Yim TC, To APC, Yuen KY. Molecular characterization of a strain of group a streptococcus isolated from a patient with a psoas abscess. J Clin Microbiol 2004; 41:4888-91. [PMID: 14532252 PMCID: PMC254351 DOI: 10.1128/jcm.41.10.4888-4891.2003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the first case of a primary group A streptococcus (GAS) psoas abscess in a 31-year-old woman. The psoas abscess was preceded by an episode of acute pharyngitis. The M-protein gene (emm) and streptolysin S structural gene (sagA) were present in the isolate, with no significant amino acid differences from previously described sequences of M1 GAS isolates. Multilocus sequence typing (MLST) showed that the isolate belonged to MLST sequence type (MLST-ST) 28, the predominant MLST-ST associated with invasive disease caused by M1 isolates.
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Affiliation(s)
- Susanna K P Lau
- Department of Microbiology, The University of Hong Kong, Hong Kong
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Banks DJ, Beres SB, Musser JM. The fundamental contribution of phages to GAS evolution, genome diversification and strain emergence. Trends Microbiol 2002; 10:515-21. [PMID: 12419616 DOI: 10.1016/s0966-842x(02)02461-7] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The human bacterial pathogen group A Streptococcus (GAS) causes many different diseases including pharyngitis, tonsillitis, impetigo, scarlet fever, streptococcal toxic shock syndrome, necrotizing fasciitis and myositis, and the post-infection sequelae glomerulonephritis and rheumatic fever. The frequency and severity of GAS infections increased in the 1980s and 1990s, but the cause of this increase is unknown. Recently, genome sequencing of serotype M1, M3 and M18 strains revealed many new proven or putative virulence factors that are encoded by phages or phage-like elements. Importantly, these genetic elements account for an unexpectedly large proportion of the difference in gene content between the three strains. These new genome-sequencing studies have provided evidence that temporally and geographically distinct epidemics, and the complex array of GAS clinical presentations, might be related in part to the acquisition or evolution of phage-encoded virulence factors. We anticipate that new phage-encoded virulence factors will be identified by sequencing the genomes of additional GAS strains, including organisms non-randomly associated with particular clinical syndromes.
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Affiliation(s)
- David J Banks
- Laboratory of Human Bacterial Pathogenesis, Rocky Mountain Laboratories, 903 South 4th Street, Hamilton, MT 59840, USA
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