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Fernando DD, Mounsey KE, Bernigaud C, Surve N, Estrada Chávez GE, Hay RJ, Currie BJ, Chosidow O, Fischer K. Scabies. Nat Rev Dis Primers 2024; 10:74. [PMID: 39362885 DOI: 10.1038/s41572-024-00552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 10/05/2024]
Abstract
Scabies is one of the most common and highest-burden skin diseases globally. Estimates suggest that >200 million people worldwide have scabies at any one time, with an annual prevalence of 455 million people, with children in impoverished and overcrowded settings being the most affected. Scabies infection is highly contagious and leads to considerable morbidity. Secondary bacterial infections are common and can cause severe health complications, including sepsis or necrotizing soft-tissue infection, renal damage and rheumatic heart disease. There is no vaccine or preventive treatment against scabies and, for the past 30 years, only few broad-spectrum antiparasitic drugs (mainly topical permethrin and oral ivermectin) have been widely available. Treatment failure is common because drugs have short half-lives and do not kill all developmental stages of the scabies parasite. At least two consecutive treatments are needed, which is difficult to achieve in resource-poor and itinerant populations. Another key issue is the lack of a practical, rapid, cheap and accurate diagnostic tool for the timely detection of scabies, which could prevent the cycle of exacerbation and disease persistence in communities. Scabies control will require a multifaceted approach, aided by improved diagnostics and surveillance, new treatments, and increased public awareness.
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Affiliation(s)
- Deepani D Fernando
- Scabies Laboratory, Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Kate E Mounsey
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Charlotte Bernigaud
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Nuzhat Surve
- Department of Microbiology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, India
| | - Guadalupe E Estrada Chávez
- State Institute of Cancer "Dr. Arturo Beltrán Ortega", Faculty of Medicine, Universidad Autónoma de Guerrero, Community Dermatology Mexico, Acapulco, Guerrero, Mexico
| | - Roderick J Hay
- St Johns Institute of Dermatology, King's College London, London, UK
| | - Bart J Currie
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Olivier Chosidow
- Hôpital Universitaire La Pitié-Salpêtrière, AP-HP, Paris, France
| | - Katja Fischer
- Scabies Laboratory, Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
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2
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Lorenz N, McGregor R, Whitcombe AL, Sharma P, Ramiah C, Middleton F, Baker MG, Martin WJ, Wilson NJ, Chung AW, Moreland NJ. An acute rheumatic fever immune signature comprising inflammatory markers, IgG3, and Streptococcus pyogenes-specific antibodies. iScience 2024; 27:110558. [PMID: 39184444 PMCID: PMC11342286 DOI: 10.1016/j.isci.2024.110558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 08/27/2024] Open
Abstract
Understanding the immune profile of acute rheumatic fever (ARF), a serious post-infectious sequelae of Streptococcal pyogenes (group A Streptococcus [GAS]), could inform disease pathogenesis and management. Circulating cytokines, immunoglobulins, and complement were analyzed in participants with first-episode ARF, swab-positive GAS pharyngitis and matched healthy controls. A striking elevation of total IgG3 was observed in ARF (90% > clinical reference range for normal). ARF was also associated with an inflammatory triad with significant correlations between interleukin-6, C-reactive protein, and complement C4 absent in controls. Quantification of GAS-specific antibody responses revealed that subclass polarization was remarkably consistent across the disease spectrum; conserved protein antigens polarized to IgG1, while M-protein responses polarized to IgG3 in all groups. However, the magnitude of responses was significantly higher in ARF. Taken together, these findings emphasize the association of exaggerated GAS antibody responses, IgG3, and inflammatory cytokines in ARF and suggest IgG3 testing could beneficially augment clinical diagnosis.
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Affiliation(s)
- Natalie Lorenz
- School of Medical Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Alana L. Whitcombe
- School of Medical Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Prachi Sharma
- School of Medical Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Ciara Ramiah
- School of Medical Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Francis Middleton
- School of Medical Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Michael G. Baker
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | - Nigel J. Wilson
- Starship Children’s Hospital, Health New Zealand – Te Whatu Ora, Auckland, New Zealand
| | - Amy W. Chung
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Nicole J. Moreland
- School of Medical Science, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
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3
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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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4
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Lacey JA, Bennett J, James TB, Hines BS, Chen T, Lee D, Sika-Paotonu D, Anderson A, Harwood M, Tong SY, Baker MG, Williamson DA, Moreland NJ. A worldwide population of Streptococcus pyogenes strains circulating among school-aged children in Auckland, New Zealand: a genomic epidemiology analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 42:100964. [PMID: 38035130 PMCID: PMC10684382 DOI: 10.1016/j.lanwpc.2023.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/20/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023]
Abstract
Background Acute rheumatic fever (ARF) is a serious post-infectious sequala of Group A Streptococcus (GAS, Streptococcus pyogenes). In New Zealand (NZ) ARF is a major cause of health inequity. This study describes the genomic analysis of GAS isolates associated with childhood skin and throat infections in Auckland NZ. Methods Isolates (n = 469) collected between March 2018 and October 2019 from the throats and skin of children (5-14 years) underwent whole genomic sequencing. Equal representation across three ethnic groups was ensured through sample quotas with isolates obtained from Indigenous Māori (n = 157, 33%), NZ European/Other (n = 149, 32%) and Pacific Peoples children (n = 163, 35%). Using in silico techniques isolates were classified, assessed for diversity, and examined for distribution differences between groups. Comparisons were also made with GAS strains identified globally. Findings Genomic analysis revealed a diverse population consisting of 65 distinct sequence clusters. These sequence clusters spanned 49 emm-types, with 11 emm-types comprised of several, distinct sequence clusters. There is evidence of multiple global introductions of different lineages into the population, as well as local clonal expansion. The M1UK lineage comprised 35% of all emm1 isolates. Interpretation The GAS population was characterized by a high diversity of strains, resembling patterns observed in low- and middle-income countries. However, strains associated with outbreaks and antimicrobial resistance commonly found in high-income countries were also observed. This unique combination poses challenges for vaccine development, disease management and control. Funding The work was supported by the Health Research Council of New Zealand (HRC), award number 16/005.
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Affiliation(s)
- Jake A. Lacey
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Bennett
- The Department of Public Health, University of Otago, Wellington, New Zealand
- The Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Taylah B. James
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Benjamin S. Hines
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Tiffany Chen
- Department of Molecular Medicine and Pathology, School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Darren Lee
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Anneka Anderson
- Te Kupenga Hauora Māori, The University of Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Healthcare, The University of Auckland, Auckland, New Zealand
| | - Steven Y.C. Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael G. Baker
- The Department of Public Health, University of Otago, Wellington, New Zealand
- The Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Deborah A. Williamson
- Department of Infectious Diseases at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Nicole J. Moreland
- The Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
- Department of Molecular Medicine and Pathology, School of Medical Sciences, The University of Auckland, Auckland, New Zealand
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5
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Acute Rheumatic Fever and Rheumatic Heart Disease: Highlighting the Role of Group A Streptococcus in the Global Burden of Cardiovascular Disease. Pathogens 2022; 11:pathogens11050496. [PMID: 35631018 PMCID: PMC9145486 DOI: 10.3390/pathogens11050496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/27/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023] Open
Abstract
Group A Streptococcus (GAS) causes superficial and invasive infections and immune mediated post-infectious sequalae (including acute rheumatic fever/rheumatic heart disease). Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are important determinants of global cardiovascular morbidity and mortality. ARF is a multiorgan inflammatory disease that is triggered by GAS infection that activates the innate immune system. In susceptible hosts the response against GAS elicits autoimmune reactions targeting the heart, joints, brain, skin, and subcutaneous tissue. Repeated episodes of ARF—undetected, subclinical, or diagnosed—may progressively lead to RHD, unless prevented by periodic administration of penicillin. The recently modified Duckett Jones criteria with stratification by population risk remains relevant for the diagnosis of ARF and includes subclinical carditis detected by echocardiography as a major criterion. Chronic RHD is defined by valve regurgitation and/or stenosis that presents with complications such as arrhythmias, systemic embolism, infective endocarditis, pulmonary hypertension, heart failure, and death. RHD predominantly affects children, adolescents, and young adults in LMICs. National programs with compulsory notification of ARF/RHD are needed to highlight the role of GAS in the global burden of cardiovascular disease and to allow prioritisation of these diseases aimed at reducing health inequalities and to achieve universal health coverage.
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6
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Whitcombe AL, McGregor R, Bennett J, Gurney JK, Williamson DA, Baker MG, Moreland NJ. OUP accepted manuscript. J Infect Dis 2022; 226:167-176. [PMID: 35134931 PMCID: PMC9373162 DOI: 10.1093/infdis/jiac043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Group A Streptococcus (GAS) causes superficial pharyngitis and skin infections as well as serious autoimmune sequelae such as acute rheumatic fever (ARF) and subsequent rheumatic heart disease. ARF pathogenesis remains poorly understood. Immune priming by repeated GAS infections is thought to trigger ARF, and there is growing evidence for the role of skin infections in this process. Methods We utilized our recently developed 8-plex immunoassay, comprising antigens used in clinical serology for diagnosis of ARF (SLO, DNase B, SpnA), and 5 conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD, Group A carbohydrate), to characterize antibody responses in sera from New Zealand children with a range of clinically diagnosed GAS disease: ARF (n = 79), GAS-positive pharyngitis (n = 94), GAS-positive skin infection (n = 51), and matched healthy controls (n = 90). Results The magnitude and breadth of antibodies in ARF was very high, giving rise to a distinct serological profile. An average of 6.5 antigen-specific reactivities per individual was observed in ARF, compared to 4.2 in skin infections and 3.3 in pharyngitis. Conclusions ARF patients have a unique serological profile, which may be the result of repeated precursor pharyngitis and skin infections that progressively boost antibody breadth and magnitude.
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Affiliation(s)
- Alana L Whitcombe
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah A Williamson
- University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J Moreland
- Correspondence: Nicole J. Moreland, BSc, PhD, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand ()
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7
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Lorenz N, Ho TKC, McGregor R, Davies MR, Williamson DA, Gurney JK, Smeesters PR, Baker MG, Moreland NJ. Serological Profiling of Group A Streptococcus Infections in Acute Rheumatic Fever. Clin Infect Dis 2021; 73:2322-2325. [PMID: 33639619 DOI: 10.1093/cid/ciab180] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 01/28/2023] Open
Abstract
Rheumatic fever is a serious post-infectious sequela of group A Streptococcus (GAS). Prior GAS exposures were mapped in sera using a large panel of M-type specific peptides. Rheumatic fever patients had serological evidence of significantly more GAS exposures than matched controls suggesting immune priming by repeat infections contributes to pathogenesis.
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Affiliation(s)
- Natalie Lorenz
- School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand
| | - Timothy K C Ho
- School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand
| | - Mark R Davies
- Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Deborah A Williamson
- Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Pierre R Smeesters
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Michael G Baker
- Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand.,Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J Moreland
- School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, Auckland, New Zealand
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8
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Wiegele S, McKinnon E, Wyber R, Noonan K. Protocol for the systematic review of the epidemiology of superficial Streptococcal A infections (skin and throat) in Australia. PLoS One 2021; 16:e0255789. [PMID: 34379660 PMCID: PMC8357163 DOI: 10.1371/journal.pone.0255789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/16/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We have produced a protocol for the comprehensive systematic review of the current literature around superficial group A Streptococcal infections in Australia. METHODS MEDLINE, Scopus, EMBASE, Web of Science, Global Health, Cochrane, CINAHL databases and the gray literature will be methodically and thoroughly searched for studies relating to the epidemiology of superficial group A Streptococcal infections between the years 1970 and 2019. Data will be extracted to present in the follow up systematic review. CONCLUSION A rigorous and well-organised search of the current literature will be performed to determine the current and evolving epidemiology of superficial group A Streptococcal infections in Australia.
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Affiliation(s)
- Sophie Wiegele
- Clinical Medicine, Perth Children’s Hospital, Perth, Western Australia, Australia
| | | | - Rosemary Wyber
- Research, Telethon Kid’s Institute, Perth, Western Australia, Australia
| | - Katharine Noonan
- Research, Telethon Kid’s Institute, Perth, Western Australia, Australia
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9
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Pilapitiya DH, Harris PWR, Hanson-Manful P, McGregor R, Kowalczyk R, Raynes JM, Carlton LH, Dobson RCJ, Baker MG, Brimble M, Lukomski S, Moreland NJ. Antibody responses to collagen peptides and streptococcal collagen-like 1 proteins in acute rheumatic fever patients. Pathog Dis 2021; 79:6311134. [PMID: 34185083 DOI: 10.1093/femspd/ftab033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/26/2021] [Indexed: 11/13/2022] Open
Abstract
Acute rheumatic fever (ARF) is a serious post-infectious immune sequelae of Group A streptococcus (GAS). Pathogenesis remains poorly understood, including the events associated with collagen autoantibody generation. GAS express streptococcal collagen-like proteins (Scl) that contain a collagenous domain resembling human collagen. Here, the relationship between antibody reactivity to GAS Scl proteins and human collagen in ARF was investigated. Serum IgG specific for a representative Scl protein (Scl1.1) together with collagen-I and collagen-IV mimetic peptides were quantified in ARF patients (n = 36) and healthy matched controls (n = 36). Reactivity to Scl1.1 was significantly elevated in ARF compared to controls (P < 0.0001) and this was mapped to the collagen-like region of the protein, rather than the N-terminal non-collagenous region. Reactivity to collagen-1 and collagen-IV peptides was also significantly elevated in ARF cases (P < 0.001). However, there was no correlation between Scl1.1 and collagen peptide antibody binding, and hierarchical clustering of ARF cases by IgG reactivity showed two distinct clusters, with Scl1.1 antigens in one and collagen peptides in the other, demonstrating that collagen autoantibodies are not immunologically related to those targeting Scl1.1. Thus, anti-collagen antibodies in ARF appear to be generated as part of the autoreactivity process, independent of any mimicry with GAS collagen-like proteins.
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Affiliation(s)
- Devaki H Pilapitiya
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Paul W R Harris
- School of Chemical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand.,School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Paulina Hanson-Manful
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Renata Kowalczyk
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Jeremy M Raynes
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Lauren H Carlton
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Renwick C J Dobson
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand.,Biomolecular Interaction Centre and School of Biological Sciences, University of Canterbury, Christchurch, New Zealand.,Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Michael G Baker
- Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand.,Department of Public Health, University of Otago, Wellington, New Zealand
| | - Margaret Brimble
- School of Chemical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Slawomir Lukomski
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Nicole J Moreland
- School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Maurice Wilkins Centre for Biodiscovery, The University of Auckland, Auckland, New Zealand
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10
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Wyber R, Wade V, Anderson A, Schreiber Y, Saginur R, Brown A, Carapetis J. Rheumatic heart disease in Indigenous young peoples. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:437-446. [PMID: 33705693 DOI: 10.1016/s2352-4642(20)30308-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 01/17/2023]
Abstract
Indigenous children and young peoples live with an inequitable burden of acute rheumatic fever and rheumatic heart disease. In this Review, we focus on the epidemiological burden and lived experience of these conditions for Indigenous young peoples in Australia, New Zealand, and Canada. We outline the direct and indirect drivers of rheumatic heart disease risk and their mitigation. Specifically, we identify the opportunities and limitations of predominantly biomedical approaches to the primary, secondary, and tertiary prevention of disease among Indigenous peoples. We explain why these biomedical approaches must be coupled with decolonising approaches to address the underlying cause of disease. Initiatives underway to reduce acute rheumatic fever and rheumatic heart disease in Australia, New Zealand, and Canada are reviewed to identify how an Indigenous rights-based approach could contribute to elimination of rheumatic heart disease and global disease control goals.
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Affiliation(s)
- Rosemary Wyber
- The George Institute for Global Health, Newtown, NSW, Australia.
| | - Vicki Wade
- RHDAustralia, Menzies School of Health Research, Darwin, NT, Australia
| | - Anneka Anderson
- Tomaiora Research Group, University of Auckland, Auckland, New Zealand
| | - Yoko Schreiber
- Section of Infectious Diseases, University of Manitoba, Clinical Sciences Division, Northern Ontario School of Medicine, ON, Canada
| | | | - Alex Brown
- South Australian Health and Medical Research Institute, University of Adelaide, SA, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth Children's Hospital, Perth, WA, Australia
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11
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de Crombrugghe G, Baroux N, Botteaux A, Moreland NJ, Williamson DA, Steer AC, Smeesters PR. The Limitations of the Rheumatogenic Concept for Group A Streptococcus: Systematic Review and Genetic Analysis. Clin Infect Dis 2021; 70:1453-1460. [PMID: 31334754 DOI: 10.1093/cid/ciz425] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/20/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The concept that a minority of group A streptococcus (GAS) emm types are more "rheumatogenic" than others has been widely disseminated. We aimed to provide a comprehensive list of acute rheumatic fever-associated GAS isolates and assess the presence of associated rheumatogenic motifs. METHODS Articles reporting GAS emm-type or emm-type-specific antibody responses associated with rheumatic fever were identified from 1 January 1944 to 31 July 2018. The revised Jones criteria were used to define rheumatic fever with a maximum period of 4 weeks between disease onset and microbiological characterization. A database of 175 representative M-protein sequences was used to analyze the protein diversity of rheumatic fever-associated strains in a phylogenetic tree and to identify the presence of 10 previously recognized rheumatogenic motifs. RESULTS We included 411 cases of rheumatic fever, for which microbiological characterization identified 73 different emm types associated with the disease. The classic rheumatogenic emm types represented only 12.3% of the 73 emm types and were responsible for 31.6% of the 411 clinical cases. Rheumatic fever-associated emm types were disseminated throughout the phylogeny, suggesting they belong to various genetic backgrounds. Rheumatic fever-associated motifs were present in only 15.1% of the rheumatic fever-associated emm types and only 24.8% of clinical cases. CONCLUSIONS The concept of rheumatogenicity should be extended to include strains other than those classically described. Our results highlight significant knowledge gaps in the understanding of rheumatic fever pathogenesis and suggest that a GAS vaccine candidate should offer broad coverage against a variety of GAS genetic variants in order to protect against this serious sequela.
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Affiliation(s)
- Gabrielle de Crombrugghe
- Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium
- Molecular Bacteriology Laboratory, Université libre de Bruxelles, Brussels, Belgium
| | - Noemie Baroux
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Anne Botteaux
- Molecular Bacteriology Laboratory, Université libre de Bruxelles, Brussels, Belgium
| | - Nicole J Moreland
- Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne, Australia
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Centre for International Child Health, University of Melbourne, Australia
| | - Pierre R Smeesters
- Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium
- Molecular Bacteriology Laboratory, Université libre de Bruxelles, Brussels, Belgium
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Centre for International Child Health, University of Melbourne, Australia
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12
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Taiaroa G, Matalavea B, Tafuna'i M, Lacey JA, Price DJ, Isaia L, Leaupepe H, Viali S, Lee D, Gorrie CL, Williamson DA, Jack S. Scabies and impetigo in Samoa: A school-based clinical and molecular epidemiological study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 6:100081. [PMID: 34327410 PMCID: PMC8315614 DOI: 10.1016/j.lanwpc.2020.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 10/29/2022]
Abstract
Background Common infections of the skin such as impetigo and scabies represent a large burden of disease globally, being particularly prevalent in tropical and resource-limited settings. Efforts to address these infections through mass drug administrations have recently been shown as efficacious and safe. In Samoa, a Pacific Island nation, there is a marked lack of epidemiological data for these neglected tropical diseases, or appreciation of their drivers in this setting. Methods An observational, cross-sectional survey of children aged between 4 and 15 years attending primary schools in rural areas of Upolu Island, Samoa was carried out to assess the prevalence of impetigo and scabies in schoolchildren residing in rural Samoa, integrated with descriptive epidemiological and microbial genomic data. A phylogenetic assessment of local Staphylococcus aureus isolated from Samoan schoolchildren was performed to estimate putative community transmission. Findings In this survey, the prevalence of impetigo observed in Samoan schoolchildren was one of the highest described globally (57•1%, 95% CI [53•8-60•5%], 476/833). Associations between active impetigo and age and gender were noted, with younger children and males more commonly affected (aOR2•8 [1•8-4•7]and aOR1•8 [1•3-2•5], respectively). The prevalence of scabies was similar to that seen in other South Pacific island countries (14•4%, 95% CI [12•2-17•0%], 120/833). Transmission of S. aureus was predicted, primarily between those children attending the same school. Carriage of S. pyogenes was notably low, with pharyngeal carriage observed in less than 2% of schoolchildren, consistent with earlier studies from Samoa. Interpretation This study describes a considerable burden of disease attributed to impetigo and scabies in Samoa. These findings will be valuable in addressing the public health challenge posed by these conditions, providing baseline prevalence data and highlighting practical strategies to reduce transmission of relevant microbes and parasites in this setting. Tala Tomua O a'afiaga o le pa'u i fa'ama'i o le po'u (impetigo) ma le utu o le pa'u (scabies), ua tele naua le fanau ua maua ai i le pasefika, ma le lalolagi atoa. O fuafuaga vaai mamao ma polokalame e fofoina ai nei faafitauli, e aofia ai le inumaga o fualaau e tapeina ai nei fa'ama'i, ua aliali mai ai e mafai ona faatamaia nei fa'ama'i. E le o tele ni tusitusiga ma faamaumauga i totonu o Samoa, pe ta'atele nei fa'amai o le pa'u pe leai. Ona o le le faatauaina o nei fa'ama'i, e le o iloa fo'i ni mafuaga ma nisi tulaga e faateleina ai nei fa'ama'i o le pa'u i Samoa. Faatinoina o le suesuega O le suesuega faasaenisi i le fanau aoga i le va o le 4 ma le 15 tausaga o loo ao'oga i le tulaga lua i nisi o nu'u i tua i Upolu, na faatinoina ai suesuega lea, ia suesueina ai le aotelega ma fainumera o le fanau ua maua i fa'ama'I o le po'u (impetigo) ma le utu o le pa'u (scabies). O lenei foi suesuega, na fia iloa ai fo'i po'o a ituaiga siama eseese o loo maua i luga o pa'u ma tino o le fanau aoga, ina ia iloa ai foi auala ua pipisi ai nei siama mai le isi tamaitiiti i le isi, ona mafua ai lea o nei fa'ama'i o le pa'u. Tanuuga o le suesuega Ua faailoa mai i le suesuega, le ta'atele o le fa'ama'i o le po'u (impetigo) ua maua ai le fanau aoga (57%), i aoga na faia ai le suesuega. O se fainumera ua maualuga tele i le lalolagi atoa. E toatele atu nisi o le fanau laiti (younger) ma tama (male) e maua i le po'u nai lo isi tamaiti. O le fainumera o le utu o le pa'u (scabies) (14·4%) e tai tutusa lava ma isi motu o le Pasefika. O le feaveaina o le siama faapitoa (staph aureus) ua tupu lea i le fanau ua ao'oga i le aoga e tasi. E le toatele foi nisi o le fanau (2%) na maua i le siama faapitoa o le fa'ai (strep pyogenes) e ona mafua ai le fiva rumatika. O lenei fainumera ua tai tutusa ma suesuega faasaenisi na fai muamua i Samoa. Aotelega O le aotelega la o lenei suesuega faasaenisi, ua faailoaina mai ai le tele naua o le fa'ama'i o le pa'u, o po'u (impetigo) ma le utu o le pa'u (scabies) i Samoa nei. O nei foi suesuega o le a aoga tele ini polokalame ma ni fuafuaga mamao e fa'afoisia ai nei faafitauli i le soifua maloloina o le fanau i Samoa. O le a avea foi nei fainumera e faamaumauina mo le silafia e le atunuu ma le soifua maloloina, le ta'atele o nei fa'amai o le pa'u, mo le tapenaina o ni fofo talafeagai ise taimi o i luma, ina ia faaitiitina ai le pipisi o nei siami i fanau ao'oga i Samoa.
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Affiliation(s)
- George Taiaroa
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
| | - Ben Matalavea
- Faculty of Medicine, National University of Samoa, Apia, Samoa.,National Kidney Foundation of Samoa, Apia, Samoa
| | - Malama Tafuna'i
- Centre for Pacific Health, Division of Health Sciences, The University of Otago, Dunedin, New Zealand
| | - Jake A Lacey
- Doherty Department at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia
| | - David J Price
- Victorian Infectious Diseases Reference Laboratory Epidemiology Unit, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Lupeoletalalelei Isaia
- Tupua Tamasese Mea'ole National Hospital Laboratory, Samoa Ministry of Health, Apia, Samoa
| | - Hinauri Leaupepe
- Tupua Tamasese Mea'ole National Hospital Laboratory, Samoa Ministry of Health, Apia, Samoa
| | | | - Darren Lee
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Claire L Gorrie
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Deborah A Williamson
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Susan Jack
- Department of Preventive and Social Medicine, University of Otago, New Zealand.,Public Health Unit, Southern District Health Board, Dunedin, New Zealand
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13
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Norrby-Teglund A, Siemens N. Is It Time to Reconsider the Group A Streptococcal Rheumatogenic Concept? Clin Infect Dis 2020; 70:1461-1462. [PMID: 31334751 DOI: 10.1093/cid/ciz427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 06/05/2019] [Indexed: 12/31/2022] Open
Affiliation(s)
- Anna Norrby-Teglund
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Nikolai Siemens
- Center for Functional Genomics of Microbes, Department of Molecular Genetics and Infection Biology, University of Greifswald, Germany
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14
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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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15
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Chung AW, Ho TKC, Hanson‐Manful P, Tritscheller S, Raynes JM, Whitcombe AL, Tay ML, McGregor R, Lorenz N, Oliver JR, Gurney JK, Print CG, Wilson NJ, Martin WJ, Williamson DA, Baker MG, Moreland NJ. Systems immunology reveals a linked IgG3–C4 response in patients with acute rheumatic fever. Immunol Cell Biol 2019; 98:12-21. [DOI: 10.1111/imcb.12298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/08/2019] [Accepted: 10/15/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Amy W Chung
- Peter Doherty Institute for Infection and Immunity University of Melbourne Melbourne VIC Australia
| | - Timothy KC Ho
- School of Medical Sciences University of Auckland Auckland New Zealand
| | - Paulina Hanson‐Manful
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | | | - Jeremy M Raynes
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Alana L Whitcombe
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Mei Lin Tay
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Reuben McGregor
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Natalie Lorenz
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | - Jane R Oliver
- Peter Doherty Institute for Infection and Immunity University of Melbourne Melbourne VIC Australia
- University of Otago Wellington New Zealand
| | | | - Cristin G Print
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
| | | | - William J Martin
- Science for Technological Innovation Science Challenge Callaghan Innovation Wellington New Zealand
| | - Deborah A Williamson
- Peter Doherty Institute for Infection and Immunity University of Melbourne Melbourne VIC Australia
| | | | - Nicole J Moreland
- School of Medical Sciences University of Auckland Auckland New Zealand
- Maurice Wilkins Centre for Biodiscovery University of Auckland Auckland New Zealand
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16
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Baker MG, Gurney J, Oliver J, Moreland NJ, Williamson DA, Pierse N, Wilson N, Merriman TR, Percival T, Murray C, Jackson C, Edwards R, Foster Page L, Chan Mow F, Chong A, Gribben B, Lennon D. Risk Factors for Acute Rheumatic Fever: Literature Review and Protocol for a Case-Control Study in New Zealand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4515. [PMID: 31731673 PMCID: PMC6888501 DOI: 10.3390/ijerph16224515] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease (RHD), have largely disappeared from high-income countries. However, in New Zealand (NZ), rates remain unacceptably high in indigenous Māori and Pacific populations. The goal of this study is to identify potentially modifiable risk factors for ARF to support effective disease prevention policies and programmes. A case-control design is used. Cases are those meeting the standard NZ case-definition for ARF, recruited within four weeks of hospitalisation for a first episode of ARF, aged less than 20 years, and residing in the North Island of NZ. This study aims to recruit at least 120 cases and 360 controls matched by age, ethnicity, gender, deprivation, district, and time period. For data collection, a comprehensive pre-tested questionnaire focussed on exposures during the four weeks prior to illness or interview will be used. Linked data include previous hospitalisations, dental records, and school characteristics. Specimen collection includes a throat swab (Group A Streptococcus), a nasal swab (Staphylococcus aureus), blood (vitamin D, ferritin, DNA for genetic testing, immune-profiling), and head hair (nicotine). A major strength of this study is its comprehensive focus covering organism, host and environmental factors. Having closely matched controls enables the examination of a wide range of specific environmental risk factors.
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Affiliation(s)
- Michael G Baker
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Jane Oliver
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Nicole J Moreland
- School of Medical Sciences, University of Auckland, Auckland 1010, New Zealand;
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne 3010, Australia;
| | - Nevil Pierse
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland District Health Board, Auckland 1023; New Zealand;
- Department of Paediatrics, University of Auckland, Auckland 1142, New Zealand;
| | - Tony R Merriman
- Biochemistry Department, University of Otago, Dunedin 9054, New Zealand;
| | - Teuila Percival
- School of Population Health, University of Auckland, Auckland 1142, New Zealand;
- KidzFirst Children’s Hospital, Auckland 1640, New Zealand;
| | - Colleen Murray
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand (L.F.P.)
| | - Catherine Jackson
- Auckland Regional Public Health Service, Auckland District Health Board, Auckland 0622, New Zealand;
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington 6021, New Zealand; (J.G.); (J.O.); (N.P.); (R.E.)
| | - Lyndie Foster Page
- Faculty of Dentistry, University of Otago, Dunedin 9054, New Zealand (L.F.P.)
| | | | - Angela Chong
- CBG Health Research Ltd, Auckland 0651, New Zealand; (A.C.); (B.G.)
| | - Barry Gribben
- CBG Health Research Ltd, Auckland 0651, New Zealand; (A.C.); (B.G.)
| | - Diana Lennon
- Department of Paediatrics, University of Auckland, Auckland 1142, New Zealand;
- KidzFirst Children’s Hospital, Auckland 1640, New Zealand;
- Starship Children’s Hospital, Auckland District Health Board, Auckland 1023, New Zealand
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17
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Nakauyaca AV, Ralph AP, Majoni WS, Kangaharan N. Case Report: Concurrent Rheumatic Fever and Acute Post-Streptococcal Glomerulonephritis in a High-Burden Setting. Am J Trop Med Hyg 2019; 101:1054-1057. [PMID: 31516109 PMCID: PMC6838557 DOI: 10.4269/ajtmh.18-0954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/29/2019] [Indexed: 01/23/2023] Open
Abstract
We report a case of acute rheumatic fever with severe pancarditis occurring simultaneously with probable acute post-streptococcal glomerulonephritis in a previously well, Australian Aboriginal, 29-year-old male. These autoimmune streptococcal sequelae are usually considered pathogenetically distinct, and concurrence has not previously been reported from this high-burden setting. We hypothesize that a single type of infecting group A Streptococcus (Strep A) triggered both autoimmune sequelae. Salient features included mitral and aortic regurgitation that worsened during the acute illness, painful pericarditis, and high troponin; severe acute kidney injury with oliguria, hematuria, and macroalbuminuria; reduced complement (C3); and elevated streptococcal serology. The case highlights important diagnostic and management challenges. It also illustrates the serious morbidity impact of the complications of Strep A.
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Affiliation(s)
- Anna V. Nakauyaca
- Division of Medicine, Department of General Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Flinders University Northern Territory Medical Program, Darwin, Northern Territory, Australia
| | - Anna P. Ralph
- Division of Medicine, Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - William S. Majoni
- Division of Medicine, Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Nadarajah Kangaharan
- Division of Medicine, Department of Cardiology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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18
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Giffard PM, Tong SYC, Holt DC, Ralph AP, Currie BJ. Concerns for efficacy of a 30-valent M-protein-based Streptococcus pyogenes vaccine in regions with high rates of rheumatic heart disease. PLoS Negl Trop Dis 2019; 13:e0007511. [PMID: 31269021 PMCID: PMC6634427 DOI: 10.1371/journal.pntd.0007511] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/16/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022] Open
Abstract
The prevalence of rheumatic heart disease (RHD) in the Aboriginal population of the Australian Northern Territory is high, and Streptococcus pyogenes skin infections likely contribute to this. A promising candidate S. pyogenes “30mer” vaccine is composed of 30 pharyngitis associated type-specific antigens from the S. pyogenes M protein. Cross opsonisation experiments suggest that 30mer vaccine protection may extend to non-cognate emm types. A new “emm cluster” scheme for classifying M protein is based on the full-length coding sequence, and correlates with functional and immunological properties, and anatomical tropism. Twenty-seven years of research in the Northern Territory has yielded 1810 S. pyogenes isolates with clinical and emm type data. The primary aim was to analyse these data with reference to the emm cluster scheme and cross opsonisation information, to inform estimation of 30mer vaccine efficacy in the Northern Territory. The isolates encompass 101 emm types. Variants of cluster A-C were enriched in throat isolates, and variants of emm cluster D enriched in skin isolates. Throat isolates were enriched for 30mer vaccine cognate emm types in comparison with skin isolates of which only 25% were vaccine emm types. While cross opsonisation data indicates potential for enhancing 30mer vaccine coverage, more than one third of skin isolates were within 38 emm types untested for cross opsonisation. Emm cluster D variants, in particular emm cluster D4, were not only all non-cognate with the vaccine, but were abundant and diverse, and less likely to be cross-opsonisation positive than other emm clusters. Long term persistence of many emm types in the study area was revealed. It was concluded that the 30mer vaccine efficacy in the Northern Territory will likely require both cross protection, and additional measures to elicit immunity against variants of emm cluster D. The bacterium Streptococcus pyogenes causes throat and skin infections. A danger from such infections is an immune response that attacks human heart tissue, leading to rheumatic heart disease, which is difficult to treat and potentially deadly. Disadvantaged populations such as the Indigenous people in remote tropical northern Australia have high burdens of S. pyogenes skin infection, and rheumatic heart disease. An effective vaccine would be a benefit, but none is approved for clinical use. We analysed data from 1810 S. pyogenes isolates from north Australia obtained over 28 years, to determine the potential of a previously described S. pyogenes vaccine candidate to be effective in this region. Only one quarter of the isolates from skin infections had a surface antigen corresponding to any one of the 30 antigen variants in the candidate vaccine. Previous work in animals indicates potential cross-protection from the vaccine against strains with mismatched antigens. However, even if this occurs in humans, protection against skin infection strains would likely remain compromised, unless there were additional components in the vaccine. Further studies on cross-protection are critical to defining the potential of this type of vaccine in populations burdened with S. pyogenes skin infections and rheumatic heart disease.
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Affiliation(s)
- Philip M. Giffard
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
- * E-mail:
| | - Steven Y. C. Tong
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah C. Holt
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Bart J. Currie
- Menzies School of Health Research, Division of Global and Tropical Health, Darwin, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
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19
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Jones S, Moreland NJ, Zancolli M, Raynes J, Loh JMS, Smeesters PR, Sriskandan S, Carapetis JR, Fraser JD, Goldblatt D. Development of an opsonophagocytic killing assay for group a streptococcus. Vaccine 2018; 36:3756-3763. [PMID: 29776751 DOI: 10.1016/j.vaccine.2018.05.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/17/2018] [Accepted: 05/11/2018] [Indexed: 10/14/2022]
Abstract
Group A Streptococcus (GAS) or Streptococcus pyogenes is responsible for an estimated 500,000 deaths worldwide each year. Protection against GAS infection is thought to be mediated by phagocytosis, enhanced by bacteria-specific antibody. There are no licenced GAS vaccines, despite many promising candidates in preclinical and early stage clinical development, the most advanced of which are based on the GAS M-protein. Vaccine progress has been hindered, in part, by the lack of a standardised functional assay suitable for vaccine evaluation. Current assays, developed over 50 years ago, rely on non-immune human whole blood as a source of neutrophils and complement. Variations in complement and neutrophil activity between donors result in variable data that is difficult to interpret. We have developed an opsonophagocytic killing assay (OPKA) for GAS that utilises dimethylformamide (DMF)-differentiated human promyelocytic leukemia cells (HL-60) as a source of neutrophils and baby rabbit complement, thus removing the major sources of variation in current assays. We have standardised the OPKA for several clinically relevant GAS strain types (emm1, emm6 and emm12) and have shown antibody-specific killing for each emm-type using M-protein specific rabbit antisera. Specificity was demonstrated by pre-incubation of the antisera with homologous M-protein antigens that blocked antibody-specific killing. Additional qualifications of the GAS OPKA, including the assessment of the accuracy, precision, linearity and the lower limit of quantification, were also performed. This GAS OPKA assay has the potential to provide a robust and reproducible platform to accelerate GAS vaccine development.
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Affiliation(s)
- Scott Jones
- Immunobiology, UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, 30 Guilford Street, London WC1N 1EH, United Kingdom.
| | - Nicole J Moreland
- Department of Molecular Medicine & Pathology, School of Medical Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Marta Zancolli
- Immunobiology, UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Jeremy Raynes
- Department of Molecular Medicine & Pathology, School of Medical Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Jacelyn M S Loh
- Department of Molecular Medicine & Pathology, School of Medical Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Pierre R Smeesters
- Molecular Bacteriology Laboratory, Universite ́ Libre de Bruxelles and Academic Children Hospital, Brussels, Belgium; Murdoch Children's Research Institute and University of Melbourne, Melbourne, Australia
| | - Shiranee Sriskandan
- Faculty of Medicine, Imperial College London, Commonwealth Building, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Perth, Australia
| | - John D Fraser
- Department of Molecular Medicine & Pathology, School of Medical Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - David Goldblatt
- Immunobiology, UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, 30 Guilford Street, London WC1N 1EH, United Kingdom
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20
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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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21
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Rheumatic Heart Disease Worldwide. J Am Coll Cardiol 2018; 72:1397-1416. [DOI: 10.1016/j.jacc.2018.06.063] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022]
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Abstract
Acute rheumatic fever is caused by an autoimmune response to throat infection with Streptococcus pyogenes. Cardiac involvement during acute rheumatic fever can result in rheumatic heart disease, which can cause heart failure and premature mortality. Poverty and household overcrowding are associated with an increased prevalence of acute rheumatic fever and rheumatic heart disease, both of which remain a public health problem in many low-income countries. Control efforts are hampered by the scarcity of accurate data on disease burden, and effective approaches to diagnosis, prevention, and treatment. The diagnosis of acute rheumatic fever is entirely clinical, without any laboratory gold standard, and no treatments have been shown to reduce progression to rheumatic heart disease. Prevention mainly relies on the prompt recognition and treatment of streptococcal pharyngitis, and avoidance of recurrent infection using long-term antibiotics. But evidence for the effectiveness of either approach is not strong. High-quality research is urgently needed to guide efforts to reduce acute rheumatic fever incidence and prevent progression to rheumatic heart disease.
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Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Luiza Guilherme
- Heart Institute (InCor), University of São Paulo, Institute for Investigation in Immunology, National Institute of Science and Technology, São Paulo, Brazil
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23
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Sekuloski S, Batzloff MR, Griffin P, Parsonage W, Elliott S, Hartas J, O’Rourke P, Marquart L, Pandey M, Rubin FA, Carapetis J, McCarthy J, Good MF. Evaluation of safety and immunogenicity of a group A streptococcus vaccine candidate (MJ8VAX) in a randomized clinical trial. PLoS One 2018; 13:e0198658. [PMID: 29965967 PMCID: PMC6028081 DOI: 10.1371/journal.pone.0198658] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 05/06/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Group A streptococcus (GAS) is a serious human pathogen that affects people of different ages and socio-economic levels. Although vaccination is potentially one of the most effective methods to control GAS infection and its sequelae, few prototype vaccines have been investigated in humans. In this study, we report the safety and immunogenicity of a novel acetylated peptide-protein conjugate vaccine candidate MJ8VAX (J8-DT), when delivered intramuscularly to healthy adults. METHODS A randomized, double-blinded, controlled Phase I clinical trial was conducted in 10 healthy adult participants. Participants were randomized 4:1 to receive the vaccine candidate (N = 8) or placebo (N = 2). A single dose of the vaccine candidate (MJ8VAX), contained 50 μg of peptide conjugate (J8-DT) adsorbed onto aluminium hydroxide and re-suspended in PBS in a total volume of 0.5 mL. Safety of the vaccine candidate was assessed by monitoring local and systemic adverse reactions following intramuscular administration. The immunogenicity of the vaccine was assessed by measuring the levels of peptide (anti-J8) and toxoid carrier (anti-DT)-specific antibodies in serum samples. RESULTS No serious adverse events were reported over 12 months of study. A total of 13 adverse events (AEs) were recorded, two of which were assessed to be associated with the vaccine. Both were mild in severity. No local reactogenicity was recorded in any of the participants. MJ8VAX was shown to be immunogenic, with increase in vaccine-specific antibodies in the participants who received the vaccine. The maximum level of vaccine-specific antibodies was detected at 28 days post immunization. The level of these antibodies decreased with time during follow-up. Participants who received the vaccine also had a corresponding increase in anti-DT serum antibodies. CONCLUSIONS Intramuscular administration of MJ8VAX was demonstrated to be safe and immunogenic. The presence of DT in the vaccine formulation resulted in a boost in the level of anti-DT antibodies. TRIAL REGISTRATION ACTRN12613000030774.
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Affiliation(s)
- Silvana Sekuloski
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Michael R. Batzloff
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Paul Griffin
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Q-Pharm Pty Ltd, Brisbane, Australia
- Department of Medicine and Infectious Diseases, Mater Hospital and Mater Medical Research Institute, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - William Parsonage
- Australian Centre for Health Service Innovation, Queensland University of Technology, Brisbane, Australia
| | | | - Jon Hartas
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Peter O’Rourke
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Louise Marquart
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Fran A. Rubin
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia and Perth Children’s Hospital, Perth, Australia
| | - James McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Michael F. Good
- The Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
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24
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Ozberk V, Pandey M, Good MF. Contribution of cryptic epitopes in designing a group A streptococcal vaccine. Hum Vaccin Immunother 2018; 14:2034-2052. [PMID: 29873591 PMCID: PMC6150013 DOI: 10.1080/21645515.2018.1462427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A successful vaccine needs to target multiple strains of an organism. Streptococcus pyogenes is an organism that utilizes antigenic strain variation as a successful defence mechanism to circumvent the host immune response. Despite numerous efforts, there is currently no vaccine available for this organism. Here we review and discuss the significant obstacles to vaccine development, with a focus on how cryptic epitopes may provide a strategy to circumvent the obstacles of antigenic variation.
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Affiliation(s)
- Victoria Ozberk
- a Griffith University, Institute for Glycomics , Gold Coast Campus, Queensland , Australia
| | - Manisha Pandey
- a Griffith University, Institute for Glycomics , Gold Coast Campus, Queensland , Australia
| | - Michael F Good
- a Griffith University, Institute for Glycomics , Gold Coast Campus, Queensland , Australia
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25
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Teatero S, McGeer A, Tyrrell GJ, Hoang L, Smadi H, Domingo MC, Levett PN, Finkelstein M, Dewar K, Plevneshi A, Athey TBT, Gubbay JB, Mulvey MR, Martin I, Demczuk W, Fittipaldi N. Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease. Open Forum Infect Dis 2018; 5:ofy085. [PMID: 29780850 DOI: 10.1093/ofid/ofy085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background The number of invasive group A Streptococcus (iGAS) infections due to hitherto extremely rare type emm74 strains has increased in several Canadian provinces since late 2015. We hypothesized that the cases recorded in the different provinces are linked and caused by strains of an emm74 clone that recently emerged and expanded explosively. Methods We analyzed both active and passive surveillance data for iGAS infections and used whole-genome sequencing to investigate the phylogenetic relationships of the emm74 strains responsible for these invasive infections country-wide. Results Genome analysis showed that highly clonal emm74 strains, genetically different from emm74 organisms previously circulating in Canada, were responsible for a country-wide epidemic of >160 invasive disease cases. The emerging clone belonged to multilocus sequence typing ST120. The analysis also revealed dissemination patterns of emm74 subclonal lineages across Canadian provinces. Clinical data analysis indicated that the emm74 epidemic disproportionally affected middle-aged or older male individuals. Homelessness, alcohol abuse, and intravenous drug usage were significantly associated with invasive emm74 infections. Conclusions In a period of 20 months, an emm74 GAS clone emerged and rapidly spread across several Canadian provinces located more than 4500 km apart, causing invasive infections primarily among disadvantaged persons.
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Affiliation(s)
- Sarah Teatero
- Public Health Ontario Laboratory, Toronto, ON, Canada
| | - Allison McGeer
- Sinai Health System, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregory J Tyrrell
- Alberta Provincial Laboratory for Public Health, and Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Hanan Smadi
- New Brunswick Department of Health, Communicable Disease and Control, Fredericton, NB, Canada
| | - Marc-Christian Domingo
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Ste-Anne de Bellevue, QC, Canada
| | - Paul N Levett
- Saskatchewan Disease Control Laboratory, Regina, SK, Canada
| | | | - Ken Dewar
- Genome Québec Innovation Centre, and McGill University, Montreal, QC, Canada
| | | | | | - Jonathan B Gubbay
- Public Health Ontario Laboratory, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Nahuel Fittipaldi
- Public Health Ontario Laboratory, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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27
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Raynes JM, Young PG, Proft T, Williamson DA, Baker EN, Moreland NJ. Protein adhesins as vaccine antigens for Group A Streptococcus. Pathog Dis 2018; 76:4919728. [DOI: 10.1093/femspd/fty016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/01/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- J M Raynes
- School of Medical Sciences, The University of Auckland, 85 Park Road, Auckland 1023, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
| | - P G Young
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
- School of Biological Sciences, University of Auckland, 5 Symonds Street, Auckland 1010, New Zealand
| | - T Proft
- School of Medical Sciences, The University of Auckland, 85 Park Road, Auckland 1023, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
| | - D A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - E N Baker
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
- School of Biological Sciences, University of Auckland, 5 Symonds Street, Auckland 1010, New Zealand
| | - N J Moreland
- School of Medical Sciences, The University of Auckland, 85 Park Road, Auckland 1023, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
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28
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Estimating the likely true changes in rheumatic fever incidence using two data sources. Epidemiol Infect 2017; 146:265-275. [PMID: 29208066 DOI: 10.1017/s0950268817002734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Acute rheumatic fever (ARF) continues to produce a significant burden of disease in New Zealand (NZ) Māori and Pacific peoples. Serious limitations in national surveillance data mean that accurate case totals cannot be generated. Given the changing epidemiology of ARF in NZ and the major national rheumatic fever prevention programme (2012-2017), we updated our previous likely true case number estimates using capture-recapture analyses. Aims were to estimate the likely true incidence of ARF in NZ and comment on the changing ability to detect cases. Data were obtained from national hospitalisation and notification databases. The Chapman Estimate partially adjusted for bias. An estimated 2342 likely true new cases arose from 1997 to 2015, giving a mean annual incidence of 2·9 per 100 000 (95% CI 2·5-3·5). Compared with the pre-intervention (2009-2011) baseline incidence (3·4 per 100 000, 95% CI 2·9-4·0), the likely true 2015 incidence declined 44%. Large gaps in data completeness are slowly closing. During the period 2012-2015, 723 cases were identified; 83·8% of notifications were matched to hospitalisation data, and 87·2% of hospitalisations matched to notifications. Despite this improvement, clinicians need to remain aware of the need to notify atypical patients. A possible unintended consequence of the national ARF prevention programme is increased misdiagnosis.
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29
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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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30
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May PJ, Bowen AC, Carapetis JR. The inequitable burden of group A streptococcal diseases in Indigenous Australians. Med J Aust 2017; 205:201-3. [PMID: 27581260 DOI: 10.5694/mja16.00400] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022]
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31
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Schödel F, Moreland NJ, Wittes JT, Mulholland K, Frazer I, Steer AC, Fraser JD, Carapetis J. Clinical development strategy for a candidate group A streptococcal vaccine. Vaccine 2017; 35:2007-2014. [DOI: 10.1016/j.vaccine.2017.02.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 12/30/2022]
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Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:15. [PMID: 28285457 PMCID: PMC5346434 DOI: 10.1007/s11936-017-0513-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OPINION STATEMENT Early recognition of group A streptococcal pharyngitis and appropriate management with benzathine penicillin using local clinical prediction rules together with validated rapi-strep testing when available should be incorporated in primary health care. A directed approach to the differential diagnosis of acute rheumatic fever now includes the concept of low-risk versus medium-to-high risk populations. Initiation of secondary prophylaxis and the establishment of early medium to long-term care plans is a key aspect of the management of ARF. It is a requirement to identify high-risk individuals with RHD such as those with heart failure, pregnant women, and those with severe disease and multiple valve involvement. As penicillin is the mainstay of primary and secondary prevention, further research into penicillin supply chains, alternate preparations and modes of delivery is required.
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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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34
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GURNEY JK, STANLEY J, BAKER MG, WILSON NJ, SARFATI D. Estimating the risk of acute rheumatic fever in New Zealand by age, ethnicity and deprivation. Epidemiol Infect 2016; 144:3058-3067. [PMID: 27311633 PMCID: PMC9150400 DOI: 10.1017/s0950268816001291] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/30/2016] [Accepted: 06/02/2016] [Indexed: 11/07/2022] Open
Abstract
In New Zealand, efforts to control acute rheumatic fever (ARF) and its sequelae have focused on school-age children in the poorest socioeconomic areas; however, it is unclear whether this approach is optimal given the strong association with demographic risk factors other than deprivation, especially ethnicity. The aim of this study was to estimate the stratum-specific risk of ARF by key sociodemographic characteristics. We used hospitalization and disease notification data to identify new cases of ARF between 2010 and 2013, and used population count data from the 2013 New Zealand Census as our denominator. Poisson logistic regression methods were used to estimate stratum-specific risk of ARF development. The likelihood of ARF development varied considerably by age, ethnicity and deprivation strata: while risk was greatest in Māori and Pacific children aged 10-14 years residing in the most extreme deprivation, both of these ethnic groups experienced elevated risk across a wide age range and across deprivation levels. Interventions that target populations based on deprivation will include the highest-risk strata, but they will also (a) include groups with very low risk of ARF, such as non-Māori/non-Pacific children; and (b) exclude groups with moderate risk of ARF, such as Māori and Pacific individuals living outside high deprivation areas.
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Affiliation(s)
- J. K. GURNEY
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - J. STANLEY
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - M. G. BAKER
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - N. J. WILSON
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - D. SARFATI
- Department of Public Health, University of Otago, Wellington, New Zealand
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35
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Raynes JM, Frost HRC, Williamson DA, Young PG, Baker EN, Steemson JD, Loh JM, Proft T, Dunbar PR, Atatoa Carr PE, Bell A, Moreland NJ. Serological Evidence of Immune Priming by Group A Streptococci in Patients with Acute Rheumatic Fever. Front Microbiol 2016; 7:1119. [PMID: 27499748 PMCID: PMC4957554 DOI: 10.3389/fmicb.2016.01119] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/05/2016] [Indexed: 01/08/2023] Open
Abstract
Acute rheumatic fever (ARF) is an autoimmune response to Group A Streptococcus (GAS) infection. Repeated GAS exposures are proposed to ‘prime’ the immune system for autoimmunity. This notion of immune-priming by multiple GAS infections was first postulated in the 1960s, but direct experimental evidence to support the hypothesis has been lacking. Here, we present novel methodology, based on antibody responses to GAS T-antigens, that enables previous GAS exposures to be mapped in patient sera. T-antigens are surface expressed, type specific antigens and GAS strains fall into 18 major clades or T-types. A panel of recombinant T-antigens was generated and immunoassays were performed in parallel with serum depletion experiments allowing type-specific T-antigen antibodies to be distinguished from cross-reactive antibodies. At least two distinct GAS exposures were detected in each of the ARF sera tested. Furthermore, no two sera had the same T-antigen reactivity profile suggesting that each patient was exposed to a unique series of GAS T-types prior to developing ARF. The methods have provided much-needed experimental evidence to substantiate the immune-priming hypothesis, and will facilitate further serological profiling studies that explore the multifaceted interactions between GAS and the host.
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Affiliation(s)
- Jeremy M Raynes
- School of Biological Sciences, University of AucklandAuckland, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, University of AucklandAuckland, New Zealand
| | - Hannah R C Frost
- School of Biological Sciences, University of Auckland Auckland, New Zealand
| | - Deborah A Williamson
- Maurice Wilkins Centre for Molecular Biodiscovery, University of AucklandAuckland, New Zealand; Institute of Environmental Science and ResearchWellington, New Zealand; The Peter Doherty Institute, University of MelbourneMelbourne, Australia
| | - Paul G Young
- School of Biological Sciences, University of AucklandAuckland, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, University of AucklandAuckland, New Zealand
| | - Edward N Baker
- School of Biological Sciences, University of AucklandAuckland, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, University of AucklandAuckland, New Zealand
| | - John D Steemson
- School of Biological Sciences, University of Auckland Auckland, New Zealand
| | - Jacelyn M Loh
- Maurice Wilkins Centre for Molecular Biodiscovery, University of AucklandAuckland, New Zealand; School of Medical Sciences, University of AucklandAuckland, New Zealand
| | - Thomas Proft
- Maurice Wilkins Centre for Molecular Biodiscovery, University of AucklandAuckland, New Zealand; School of Medical Sciences, University of AucklandAuckland, New Zealand
| | - P R Dunbar
- School of Biological Sciences, University of AucklandAuckland, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, University of AucklandAuckland, New Zealand
| | | | - Anita Bell
- Waikato District Health Board Hamilton, New Zealand
| | - Nicole J Moreland
- School of Biological Sciences, University of AucklandAuckland, New Zealand; Maurice Wilkins Centre for Molecular Biodiscovery, University of AucklandAuckland, New Zealand
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36
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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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37
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Carapetis JR, Beaton A, Cunningham MW, Guilherme L, Karthikeyan G, Mayosi BM, Sable C, Steer A, Wilson N, Wyber R, Zühlke L. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers 2016; 2:15084. [PMID: 27188830 PMCID: PMC5810582 DOI: 10.1038/nrdp.2015.84] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances - including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life - give cause for optimism that progress will be made in coming years against this neglected disease that affects populations around the world, but is a particular issue for those living in poverty.
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Affiliation(s)
- Jonathan R Carapetis
- Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Andrea Beaton
- Children's National Health System, Washington, District of Columbia, USA
| | - Madeleine W Cunningham
- Department of Microbiology and Immunology, Biomedical Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Luiza Guilherme
- Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute for Science and Technology, São Paulo, Brazil
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Craig Sable
- Children's National Health System, Washington, District of Columbia, USA
| | - Andrew Steer
- Department of Paediatrics, the University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Hospital, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Rosemary Wyber
- Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia
| | - Liesl Zühlke
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Department of Paediatric Cardiology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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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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