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Rampersadh K, Salie MT, Engel KC, Moodley C, Zühlke LJ, Engel ME. Presence of Group A streptococcus frequently assayed virulence genes in invasive disease: a systematic review and meta-analysis. Front Cell Infect Microbiol 2024; 14:1337861. [PMID: 39055978 PMCID: PMC11270091 DOI: 10.3389/fcimb.2024.1337861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/18/2024] [Indexed: 07/28/2024] Open
Abstract
Introduction It is currently unclear what the role of Group A streptococcus (GAS) virulence factors (VFs) is in contributing to the invasive potential of GAS. This work investigated the evidence for the association of GAS VFs with invasive disease. Methods We employed a broad search strategy for studies reporting the presence of GAS VFs in invasive and non-invasive GAS disease. Data were independently extracted by two reviewers, quality assessed, and meta-analyzed using Stata®. Results A total of 32 studies reported on 45 putative virulence factors [invasive (n = 3,236); non-invasive (n = 5,218)], characterized by polymerase chain reaction (PCR) (n = 30) and whole-genome sequencing (WGS) (n = 2). The risk of bias was rated as low and moderate, in 23 and 9 studies, respectively. Meta-,analyses of high-quality studies (n = 23) revealed a significant association of speM [OR, 1.64 (95%CI, 1.06; 2.52)] with invasive infection. Meta-analysis of WGS studies demonstrated a significant association of hasA [OR, 1.91 (95%CI, 1.36; 2.67)] and speG [OR, 2.83 (95%CI, 1.63; 4.92)] with invasive GAS (iGAS). Meta-analysis of PCR studies indicated a significant association of speA [OR, 1.59 (95%CI, 1.10; 2.30)] and speK [OR, 2.95 (95%CI, 1.81; 4.80)] with invasive infection. A significant inverse association was observed between prtf1 [OR, 0.42 (95%CI, 0.20; 0.87)] and invasive infection. Conclusion This systematic review and genomic meta-analysis provides evidence of a statistically significant association with invasive infection for the hasA gene, while smeZ, ssa, pnga3, sda1, sic, and NaDase show statistically significantly inverse associations with invasive infection. SpeA, speK, and speG are associated with GAS virulence; however, it is unclear if they are markers of invasive infection. This work could possibly aid in developing preventative strategies.
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Affiliation(s)
- Kimona Rampersadh
- AFROStrep Research Group, Department of Medicine and Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - M. Taariq Salie
- AFROStrep Research Group, Department of Medicine and Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Kelin C. Engel
- AFROStrep Research Group, Department of Medicine and Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Clinton Moodley
- Department of Pathology, Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- The National Health Laboratory Service, Microbiology, Groote Schuur Hospital, Cape Town, South Africa
| | - Liesl J. Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, Parrow Valley, Cape Town, South Africa
| | - Mark E. Engel
- AFROStrep Research Group, Department of Medicine and Cape Heart Institute, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council, Parrow Valley, Cape Town, South Africa
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Mangioni D, Fox V, Saltini P, Lombardi A, Bussini L, Carella F, Cariani L, Comelli A, Matinato C, Muscatello A, Teri A, Terranova L, Cento V, Carloni S, Bartoletti M, Alteri C, Bandera A. Increase in invasive group A streptococcal infections in Milan, Italy: a genomic and clinical characterization. Front Microbiol 2024; 14:1287522. [PMID: 38274761 PMCID: PMC10808429 DOI: 10.3389/fmicb.2023.1287522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024] Open
Abstract
Background Group A Streptococcus (GAS) causes multiple clinical manifestations, including invasive (iGAS) or even life-threatening (severe-iGAS) infections. After the drop in cases during COVID-19 pandemic, in 2022 a sharp increase of GAS was reported globally. Methods GAS strains collected in 09/2022-03/2023 in two university hospitals in Milan, Italy were retrospectively analyzed. Clinical/epidemiological data were combined with whole-genome sequencing to: (i) define resistome/virulome, (ii) identify putative transmission chains, (iii) explore associations between emm-types and clinical severity. Results Twenty-eight isolates were available, 19/28 (67.9%) from adults and 9/28 (32.1%) from pediatric population. The criteria for iGAS were met by 19/28 cases (67.9%), of which 11/19 (39.3%) met the further criteria for severe-iGAS. Pediatric cases were mainly non-invasive infections (8/9, 88.9%), adult cases were iGAS and severe-iGAS in 18/19 (94.7%) and 10/19 (52.6%), respectively. Thirteen emm-types were detected, the most prevalent being emm1 and emm12 (6/28 strains each, 21.4%). Single nucleotide polymorphism (SNP) analysis of emm1.0 and emm12.0 strains revealed pairwise SNP distance always >10, inconsistent with unique transmission chains. Emm12.0-type, found to almost exclusively carry virulence factors speH and speI, was mainly detected in children and in no-iGAS infections (55.6 vs. 5.3%, p = 0.007 and 66.7 vs. 0.0%, p < 0.001, respectively), while emm1.0-type was mainly detected in severe-iGAS (0.0 vs. 45.5%, p = 0.045). Conclusions This study showed that multiple emm-types contributed to a 2022/2023 GAS infection increase in two hospitals in Milan, with no evidence of direct transmission chains. Specific emm-types could be associated with disease severity or invasiveness. Overall, these results support the integration of classical epidemiological studies with genomic investigation to appropriately manage severe infections and improve surveillance.
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Affiliation(s)
- Davide Mangioni
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Valeria Fox
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Paola Saltini
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Linda Bussini
- Infectious Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesco Carella
- Infectious Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Lisa Cariani
- Microbiology Laboratory, Clinical Pathology, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Agnese Comelli
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Caterina Matinato
- Microbiology Laboratory, Clinical Pathology, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Teri
- Microbiology Laboratory, Clinical Pathology, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Leonardo Terranova
- Respiratory Unit and Adult Cystic Fibrosis Center, Department of Internal Medicine, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Cento
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Microbiology and Virology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Sara Carloni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Italy
| | - Michele Bartoletti
- Infectious Disease Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Claudia Alteri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
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Gouveia C, Bajanca-Lavado MP, Mamede R, Araújo Carvalho A, Rodrigues F, Melo-Cristino J, Ramirez M, Friães A. Sustained increase of paediatric invasive Streptococcus pyogenes infections dominated by M1 UK and diverse emm12 isolates, Portugal, September 2022 to May 2023. Euro Surveill 2023; 28:2300427. [PMID: 37676143 PMCID: PMC10486195 DOI: 10.2807/1560-7917.es.2023.28.36.2300427] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/07/2023] [Indexed: 09/08/2023] Open
Abstract
Since autumn 2022, observed numbers of paediatric invasive group A Streptococcus infections in Portugal (n = 89) were higher than in pre-COVID-19 seasons. Between September 2022 and May 2023, the dominant diagnoses were pneumonia (25/79), mostly with empyema (20/25), and sepsis (22/79). A number of cases required admission to intensive care (27/79) and surgery (35/79), and the case fatality rate was 5.1% (4/79). Genomic sequencing (n = 55) revealed multiple genetic lineages, dominated by the M1UK sublineage (26/55) and more diverse emm12 isolates (12/55).
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Affiliation(s)
- Catarina Gouveia
- Infectious Diseases Unit, Pediatric Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Maria Paula Bajanca-Lavado
- Laboratório Nacional de Referência a Infeções Respiratórias a Agentes Bacterianos, Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Rafael Mamede
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Araújo Carvalho
- Infectious Diseases Unit, Pediatric Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fernanda Rodrigues
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Melo-Cristino
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mario Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Friães
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Li H, Zhou L, Zhao Y, Ma L, Zhang H, Liu Y, Liu X, Hu J. Epidemiological analysis of Group A streptococcus infection diseases among children in Beijing, China under COVID-19 pandemic. BMC Pediatr 2023; 23:76. [PMID: 36782167 PMCID: PMC9923647 DOI: 10.1186/s12887-023-03885-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Group A streptococcus is human-restricted gram-positive pathogen, responsible for various clinical presentations from mild epidermis infections to life threatened invasive diseases. Under COVID-19 pandemic,. the characteristics of the epidemic strains of GAS could be different. PURPOSE To investigate epidemiological and molecular features of isolates from GAS infections among children in Beijing, China between January 2020 and December 2021. Antimicrobial susceptibility profiling was performed based on Cinical Laboratory Sandards Institute. Distribution of macrolide-resistance genes, emm types, and superantigens was examined by polymerase chain reaction. RESULTS 114 GAS isolates were collected which were frequent resistance against erythromycin (94.74%), followed by clindamycin (92.98%), tetracycline (87.72%). Emm12 (46.49%), emm1 (25.44%) were dominant emm types. Distribution of ermB, ermA, and mefA gene was 93.85%, 2.63%, and 14.04%, respectively. Frequent superantigenes identified were smeZ (97.39%), speG (95.65%), and speC (92.17%). Emm1 strains possessed smeZ, ssa, and speC, while emm12 possessed smeZ, ssa, speG, and speC. Erythromycin resistance was predominantly mediated by ermB. Scarlet fever strains harbored smeZ (98.81%), speC (94.05%). Impetigo strains harbored smeZ (88.98%), ssa (88.89%), and speC (88.89%). Psoriasis strains harbored smeZ (100%). CONCLUSIONS Under COVID-19 pandemic, our collections of GAS infection cutaneous diseases decreased dramatically. Epidemiological analysis of GAS infections among children during COVID-19 pandemic was not significantly different from our previous study. There was a correlation among emm, superantigen gene and disease manifestations. Long-term surveillance and investigation of emm types and superantigens of GAS prevalence are imperative.
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Affiliation(s)
- Hongxin Li
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China.
| | - Lin Zhou
- grid.459434.bDepartment of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Yong Zhao
- grid.414252.40000 0004 1761 8894Department of Reproductive Medicine, Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Lijuan Ma
- grid.459434.bDepartment of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Haihua Zhang
- grid.459434.bDepartment of Dermatology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Yan Liu
- grid.459434.bDepartment of Dermatology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Xiaoyan Liu
- grid.459434.bDepartment of Dermatology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Jin Hu
- grid.459434.bDepartment of Dermatology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
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Kızılyıldırım S, Köksal F, Güneri CÖ. Distribution of emm, superantigen and other virulence genotypes and detection of phylogenetic relationships in group A streptococcal isolates. Acta Microbiol Immunol Hung 2022; 69:290-296. [PMID: 36370368 DOI: 10.1556/030.2022.01740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
Group A streptococci are important pathogens with various virulence factors, such as M protein, superantigens, hemolysins, deoxyribonuclease, and proteases. The aims of this study are to investigate the detection of emm genotypes and other virulence genes, such as SAgs, DNase, protease, antibiotic resistance, and phylogenetic relationships in GAS strains isolated from clinical samples.Test strains were obtained from Çukurova University Balcalı Hospital and regional hospitals in Adana province. The M proteins were detected by sequence analysis of emm genes. SAgs and other virulence gene profiles were determined using the Multiplex-PCR method. The antibiotic susceptibility of the isolates was performed by the disc diffusion method and evaluated according to CLSI criteria. The PFGE method was used to determine the clonal relationship between the strains.The emm gene was positive in 86 isolates. The most common emm genotypes were emm28 (22%), emm1 (18.6%), emm12 (13.9%), and emm3 (11.6%). Also, the most common virulence genes were speG (58.1%), speC (56.9%), sdaB (53.4%), and mac (53.4%). The rates of resistance to erythromycin, clindamycin, levofloxacin, ciprofloxacin and telithromycin were 19.8%, 16.3%, 4.7%, 3.5%, and 3.5%, respectively.As a result, additional regional studies on the detection and prevalence of GAS virulence factors in Turkey are required. We believe that this study will provide valuable information for epidemiological studies on emm sequences, Sags, and other virulence factors of Streptococcus pyogenes in Turkey.
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Affiliation(s)
- Suna Kızılyıldırım
- 1Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Süleyman Demirel, 32260, Isparta, Turkey
| | - Fatih Köksal
- 2Department of Medical Microbiology, Faculty of Medical, University of Çukurova, 01380, Adana, Turkey
| | - Cansu Önlen Güneri
- 3Department of Medical Microbiology, Gulhane Vocational School of Health Services, University of Sağlık Bilimleri, 06010, Ankara, Turkey
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Berbel D, González-Díaz A, López de Egea G, Càmara J, Ardanuy C. An Overview of Macrolide Resistance in Streptococci: Prevalence, Mobile Elements and Dynamics. Microorganisms 2022; 10:2316. [PMID: 36557569 PMCID: PMC9783990 DOI: 10.3390/microorganisms10122316] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Streptococcal infections are usually treated with beta-lactam antibiotics, but, in case of allergic patients or reduced antibiotic susceptibility, macrolides and fluoroquinolones are the main alternatives. This work focuses on studying macrolide resistance rates, genetic associated determinants and antibiotic consumption data in Spain, Europe and also on a global scale. Macrolide resistance (MR) determinants, such as ribosomal methylases (erm(B), erm(TR), erm(T)) or active antibiotic efflux pumps and ribosomal protectors (mef(A/E)-mrs(D)), are differently distributed worldwide and associated with different clonal lineages and mobile genetic elements. MR rates vary together depending on clonal dynamics and on antibiotic consumption applying selective pressure. Among Streptococcus, higher MR rates are found in the viridans group, Streptococcus pneumoniae and Streptococcus agalactiae, and lower MR rates are described in Streptococcus pyogenes. When considering different geographic areas, higher resistance rates are usually found in East-Asian countries and milder or lower in the US and Europe. Unfortunately, the availability of data varies also between countries; it is scarce in low- and middle- income countries from Africa and South America. Thus, surveillance studies of macrolide resistance rates and the resistance determinants involved should be promoted to complete global knowledge among macrolide resistance dynamics.
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Affiliation(s)
- Dàmaris Berbel
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Aida González-Díaz
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Guillem López de Egea
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Jordi Càmara
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Carmen Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, 08007 Barcelona, Spain
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7
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Hirose Y, Kolesinski P, Hiraoka M, Uchiyama S, Zurich RH, Kumaraswamy M, Bjanes E, Ghosh P, Kawabata S, Nizet V. Contribution of Streptococcus pyogenes M87 protein to innate immune resistance and virulence. Microb Pathog 2022; 169:105636. [PMID: 35724830 PMCID: PMC9878354 DOI: 10.1016/j.micpath.2022.105636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/16/2022] [Accepted: 06/10/2022] [Indexed: 01/29/2023]
Abstract
Streptococcus pyogenes is a pre-eminent human pathogen, and classified by the hypervariable sequence of the emm gene encoding the cell surface M protein. Among a diversity of M/emm types, the prevalence of the M/emm87 strain has been steadily increasing in invasive S. pyogenes infections. Although M protein is the major virulence factor for globally disseminated M/emm1 strain, it is unclear if or how the corresponding M protein of M/emm87 strain (M87 protein) functions as a virulence factor. Here, we use targeted mutagenesis to show that the M87 protein contributes to bacterial resistance to neutrophil and whole blood killing and promotes the release of mature IL-1β from macrophages. While deletion of emm87 did not influence epithelial cell adherence and nasal colonization, it significantly reduced S. pyogenes-induced mortality and bacterial loads in a murine systemic infection model. Our data suggest that emm87 is involved in pathogenesis by modulating the interaction between S. pyogenes and innate immune cells.
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Affiliation(s)
- Yujiro Hirose
- Department of Oral and Molecular Microbiology, Osaka University Graduate School of Dentistry, Suita, Osaka 5650871, Japan,Department of Pediatrics, University of California at San Diego, La Jolla, California 92093, USA
| | - Piotr Kolesinski
- Department of Chemistry and Biochemistry, University of California at San Diego, La Jolla, California 92093, USA
| | - Masanobu Hiraoka
- Department of Pediatrics, University of California at San Diego, La Jolla, California 92093, USA,Department of Otorhinolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Wakayama 6418509, Japan
| | - Satoshi Uchiyama
- Department of Pediatrics, University of California at San Diego, La Jolla, California 92093, USA
| | - Raymond H. Zurich
- Department of Pediatrics, University of California at San Diego, La Jolla, California 92093, USA
| | - Monika Kumaraswamy
- Department of Medicine, University of California at San Diego, La Jolla, California 92093, USA,Infectious Diseases Section, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Elisabet Bjanes
- Department of Pediatrics, University of California at San Diego, La Jolla, California 92093, USA
| | - Partho Ghosh
- Department of Chemistry and Biochemistry, University of California at San Diego, La Jolla, California 92093, USA
| | - Shigetada Kawabata
- Department of Oral and Molecular Microbiology, Osaka University Graduate School of Dentistry, Suita, Osaka 5650871, Japan,Correspondence: Victor Nizet, , TEL: +18585347408, Shigetada Kawabata, , TEL: +81668792896
| | - Victor Nizet
- Department of Pediatrics, University of California at San Diego, La Jolla, California 92093, USA,Skaggs School of Pharmaceutical Sciences, University of California at San Diego, La Jolla, California 92093, USA,Correspondence: Victor Nizet, , TEL: +18585347408, Shigetada Kawabata, , TEL: +81668792896
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Araújo NJS, Macêdo MJF, de Morais LP, da Cunha FAB, de Matos YMLS, de Almeida RS, Braga MFBM, Coutinho HDM. Control of arboviruses vectors using biological control by Wolbachia pipientis: a short review. Arch Microbiol 2022; 204:376. [PMID: 35678877 DOI: 10.1007/s00203-022-02983-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
The number of arbovirus cases has increased in recent years, demonstrating a need for investing in effective control actions. Among these actions, are strategies using biological control vectors, a field where Wolbachia pipientis has shown itself as useful. Wolbachia pipientis, an obligatory intracellular Gram-negative bacteria, which parasites arthropods naturally or through laboratory-induced infections, is capable of manipulating the reproduction of its host. A systematic literature review gathering studies on this bacteria over last 10 years (2007-2021) was performed given its important role in the reduction of insect disease vectors. 111 articles were found, from which 78 were used in this study. Information on the Wolbachia biology, mechanism of action and potential for the biological control of insect disease vectors was gathered. The present study may contribute to the knowledge surrounding the bacterium, as well as stimulate the production of other studies with the same theme.
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Affiliation(s)
- Nara Juliana Santos Araújo
- Programa de Residência em Saúde Coletiva, Universidade Regional de Cariri-URCA, Regional University of Cariri, Crato, Ceará, 63105-000, Brazil
| | - Márcia Jordana Ferreira Macêdo
- Programa de Residência em Saúde Coletiva, Universidade Regional de Cariri-URCA, Regional University of Cariri, Crato, Ceará, 63105-000, Brazil
| | - Luís Pereira de Morais
- Programa de Residência em Saúde Coletiva, Universidade Regional de Cariri-URCA, Regional University of Cariri, Crato, Ceará, 63105-000, Brazil
| | - Francisco Assis Bezerra da Cunha
- Programa de Residência em Saúde Coletiva, Universidade Regional de Cariri-URCA, Regional University of Cariri, Crato, Ceará, 63105-000, Brazil.,Laboratório de Bioprospecção do Semiárido, Universidade Regional de Cariri-URCA, Crato, Ceará, Brazil
| | | | - Ray Silva de Almeida
- Laboratório de Microbiologia e Biologia Molecular, Universidade Regional de Cariri-URCA, Crato, Ceará, Brazil
| | | | - Henrique Douglas Melo Coutinho
- Programa de Residência em Saúde Coletiva, Universidade Regional de Cariri-URCA, Regional University of Cariri, Crato, Ceará, 63105-000, Brazil. .,Laboratório de Microbiologia e Biologia Molecular, Universidade Regional de Cariri-URCA, Crato, Ceará, Brazil.
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Annotated Whole-Genome Multilocus Sequence Typing Schema for Scalable High-Resolution Typing of Streptococcus pyogenes. J Clin Microbiol 2022; 60:e0031522. [DOI: 10.1128/jcm.00315-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Streptococcus pyogenes
is a major human pathogen with high genetic diversity, largely created by recombination and horizontal gene transfer, making it difficult to use single nucleotide polymorphism (SNP)-based genome-wide analyses for surveillance. Using a gene-by-gene approach on 208 complete genomes of
S. pyogenes
, a novel whole-genome multilocus sequence typing (wgMLST) schema was developed, comprising 3,044 target loci.
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10
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Rafei R, Al Iaali R, Osman M, Dabboussi F, Hamze M. A global snapshot on the prevalent macrolide-resistant emm types of Group A Streptococcus worldwide, their phenotypes and their resistance marker genotypes during the last two decades: A systematic review. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 99:105258. [PMID: 35219865 DOI: 10.1016/j.meegid.2022.105258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 12/29/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Watchful epidemiological surveillance of macrolide-resistant Group A Streptococcus (MRGAS) clones is important owing to the evolutionary and epidemiological dynamic of GAS. Meanwhile, data on the global distribution of MRGAS emm types according to macrolide resistance phenotypes and genotypes are scant and need to be updated. For this, the present systematic review analyses a global set of extensively characterized MRGAS isolates from patients of diverse ages and clinical presentations over approximately two decades (2000 to 2020) and recaps the peculiar epidemiological features of the dominant MRGAS clones. Based on the inclusion and exclusion criteria, 53 articles (3593 macrolide-resistant and 15,951 susceptible isolates) distributed over 23 countries were dissected with a predominance of high-income countries over low-income ones. Although macrolide resistance in GAS is highly variable in different countries, its within-GAS distribution seems not to be random. emm pattern E, 13 major emm types (emm12, 4, 28, 77, 75, 11, 22, 92, 58, 60, 94, 63, 114) and 4 emm clusters (A-C4, E1, E6, and E2) were significantly associated with macrolide resistance. emm patterns A-C and D, 14 major emm types (emm89, 3, 6, 2, 44, 82, 87, 118, 5, 49, 81, 59, 227, 78) and 3 well-defined emm clusters (A-C5, E3, and D4) were significantly associated with macrolide susceptibility. Scrutinizing the tendency of each MRGAS emm type to be significantly associated with specific macrolide resistance phenotype or genotype, interesting vignettes are also unveiled. The 30-valent vaccine covers ~95% of MRGAS isolates. The presented data urge the importance of comprehensive nationwide sustained surveillance of MRGAS circulating clones particularly in Low and Middle income countries where sampling bias is high and GAS epidemiology is obfuscated and needs to be demystified.
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Affiliation(s)
- Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
| | - Rayane Al Iaali
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon; Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14850, USA
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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11
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Li H, Zhou L, Zhao Y, Ma L, Liu X, Hu J. Molecular epidemiology and antimicrobial resistance of group a streptococcus recovered from patients in Beijing, China. BMC Infect Dis 2020; 20:507. [PMID: 32660436 PMCID: PMC7359455 DOI: 10.1186/s12879-020-05241-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern. The objective of this study was to investigate the molecular epidemiological characteristics and antimicrobial resistance of GAS isolates from patients in Children's Hospital in Beijing. METHODS From 2016 to 2017, pharyngeal swab samples were collected from the outpatients in Children's Hospital, Capital Institute of Pediatrics, who were diagnosed with scarlet fever. Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes (ermB, ermA, mefA), emm (M protein-coding gene) typing, and superantigens (SAg) gene profiling were examined by polymerase chain reaction (PCR). RESULTS A total of 297 GAS isolates were collected. The susceptibility of the isolates to penicillin, ceftriaxone, and levofloxacin was 100%. The resistance rate to erythromycin and clindamycin was 98.3 and 96.6%, respectively. The dominant emm types were emm12 (65.32%), emm1 (27.61%), emm75 (2.69%), and emm89 (1.35%). Of the 297 isolates, 290 (97.64%) carried the ermB gene, and 5 (1.68%) carried the mefA gene, while none carried the ermA gene. The most common superantigen genes identified from GAS isolates were smeZ (96.97%), speC (92.59%), speG (91.58%), ssa (85.52%), speI (54.55%), speH (52.19%), and speA (34.34%). Isolates with the genotype emm1 possessed speA, speC, speG, speJ, speM, ssa, and smeZ, while emm12 possessed speC, speG, speH, speI, speM, ssa, and smeZ superantigens. CONCLUSIONS The prevalent strain of GAS isolates in Beijing has a high resistance rate to macrolides; however, penicillin can still be the preferred antibiotic for treatment. Erythromycin resistance was predominantly mediated by ermB. The common emm types were emm12 and emm1. There was a correlation between emm and the superantigen gene. Thus, long-term monitoring and investigation of the emm types and superantigen genes of GAS prevalence are imperative.
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Affiliation(s)
- Hongxin Li
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China.
| | - Lin Zhou
- Department of Clinical Laboratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Yong Zhao
- The Sixth Medical Centre of PLA, General Hospital, Beijing, 100048, China
| | - Lijuan Ma
- Department of Clinical Laboratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Xiaoyan Liu
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Jin Hu
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China.
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12
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Changes in emm types and superantigen gene content of Streptococcus pyogenes causing invasive infections in Portugal. Sci Rep 2019; 9:18051. [PMID: 31792274 PMCID: PMC6888849 DOI: 10.1038/s41598-019-54409-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022] Open
Abstract
Fluctuations in the clonal composition of Group A Streptococcus (GAS) have been associated with the emergence of successful lineages and with upsurges of invasive infections (iGAS). This study aimed at identifying changes in the clones causing iGAS in Portugal. Antimicrobial susceptibility testing, emm typing and superantigen (SAg) gene profiling were performed for 381 iGAS isolates from 2010-2015. Macrolide resistance decreased to 4%, accompanied by the disappearance of the M phenotype and an increase of the iMLSB phenotype. The dominant emm types were: emm1 (28%), emm89 (11%), emm3 (9%), emm12 (8%), and emm6 (7%). There were no significant changes in the prevalence of individual emm types, emm clusters, or SAg profiles when comparing to 2006-2009, although an overall increasing trend was recorded during 2000-2015 for emm1, emm75, and emm87. Short-term increases in the prevalence of emm3, emm6, and emm75 may have been driven by concomitant SAg profile changes observed within these emm types, or reflect the emergence of novel genomic variants of the same emm types carrying different SAgs.
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13
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Bencardino D, Di Luca MC, Petrelli D, Prenna M, Vitali LA. High virulence gene diversity in Streptococcus pyogenes isolated in Central Italy. PeerJ 2019; 7:e6613. [PMID: 30918759 PMCID: PMC6431245 DOI: 10.7717/peerj.6613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/13/2019] [Indexed: 12/26/2022] Open
Abstract
Globally, Streptococcus pyogenes poses a continuous burden on human health, causing both self-limiting and life-threatening diseases. Therefore, studying the profile of virulence genes and their combinations is essential to monitor the epidemiology and pathogenic potential of this important species. Thus, the aim of this study was to analyze related genetic features of clinical strains collected in Italy in 2012 in order to obtain a valid picture of their virulence profile that could be compared to similar studies made in other countries approximately in the same period. We conducted emm typing and fibronectin-collagen-T antigen (FCT) region typing in 122 Streptococcus pyogenes strains. Furthermore, several additional virulence genes were screened by polymerase chain reaction. We found correlations between emm types and FCT region profiles. emm1 strains were mainly associated with FCT2 and FCT6, while emm89 and emm12 strains were associated with FCT4. FCT5 was mainly represented in emm4, emm6, and emm75 strains. Significantly, we defined subtypes for each FCT type based on the differences in single and double loci compared to the reference scheme used for the classification of the FCT region. In addition, new FCT-region variants with differences in multiple loci were also recorded. Cluster analysis based on virulence gene profiling showed a non-random distribution within each emm type. This study added new data to existing studies conducted worldwide and revealed new variability scores in circulating Streptococcus pyogenes strains and new assortments in well-established virulence gene signatures.
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Affiliation(s)
- Daniela Bencardino
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Maria Chiara Di Luca
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Dezemona Petrelli
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Manuela Prenna
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
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14
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Pato C, Melo-Cristino J, Ramirez M, Friães A. Streptococcus pyogenes Causing Skin and Soft Tissue Infections Are Enriched in the Recently Emerged emm89 Clade 3 and Are Not Associated With Abrogation of CovRS. Front Microbiol 2018; 9:2372. [PMID: 30356787 PMCID: PMC6189468 DOI: 10.3389/fmicb.2018.02372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022] Open
Abstract
Although skin and soft tissue infections (SSTI) are the most common focal infections associated with invasive disease caused by Streptococcus pyogenes (Lancefield Group A streptococci - GAS), there is scarce information on the characteristics of isolates recovered from SSTI in temperate-climate regions. In this study, 320 GAS isolated from SSTI in Portugal were characterized by multiple typing methods and tested for antimicrobial susceptibility and SpeB activity. The covRS and ropB genes of isolates with no detectable SpeB activity were sequenced. The antimicrobial susceptibility profile was similar to that of previously characterized isolates from invasive infections (iGAS), presenting a decreasing trend in macrolide resistance. However, the clonal composition of SSTI between 2005 and 2009 was significantly different from that of contemporary iGAS. Overall, iGAS were associated with emm1 and emm3, while SSTI were associated with emm89, the dominant emm type among SSTI (19%). Within emm89, SSTI were only significantly associated with isolates lacking the hasABC locus, suggesting that the recently emerged emm89 clade 3 may have an increased potential to cause SSTI. Reflecting these associations between emm type and disease presentation, there were also differences in the distribution of emm clusters, sequence types, and superantigen gene profiles between SSTI and iGAS. According to the predicted ability of each emm cluster to interact with host proteins, iGAS were associated with the ability to bind fibrinogen and albumin, whereas SSTI isolates were associated with the ability to bind C4BP, IgA, and IgG. SpeB activity was absent in 79 isolates (25%), in line with the proportion previously observed among iGAS. Null covS and ropB alleles (predicted to eliminate protein function) were detected in 10 (3%) and 12 (4%) isolates, corresponding to an underrepresentation of mutations impairing CovRS function in SSTI relative to iGAS. Overall, these results indicate that the isolates responsible for SSTI are genetically distinct from those recovered from normally sterile sites, supporting a role for mutations impairing CovRS activity specifically in invasive infection and suggesting that this role relies on a differential regulation of other virulence factors besides SpeB.
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Affiliation(s)
- Catarina Pato
- Author Affiliations: Centro Hospitalar do Barlavento Algarvio; Centro Hospitalar de Entre Douro e Vouga; Centro Hospitalar de Leiria; Centro Hospitalar de Vila Nova de Gaia/Espinho; Centro Hospitalar do Alto Ave; Centro Hospitalar do Porto; Centro Hospitalar da Póvoa do Varzim/Vila do Conde; Hospital Central do Funchal; Centro Hospitalar de Lisboa Central; Centro Hospitalar Lisboa Norte; Centro Hospitalar Lisboa Ocidental; Centro Hospitalar do Baixo Vouga; Hospital de Vila Real; Hospitais da Universidade de Coimbra; Hospital de Cascais; Hospital de São João, Porto; Hospital de Braga; Hospital de Santa Luzia, Elvas; Hospital dos SAMS, Lisboa; Hospital Dr. Fernando da Fonseca, Amadora/Sintra; Hospital do Espírito Santo, Évora; Hospital Garcia de Orta, Almada; Hospital Pedro Hispano, Matosinhos; Unidade Local de Saúde do Baixo Alentejo, Beja.,Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - José Melo-Cristino
- Author Affiliations: Centro Hospitalar do Barlavento Algarvio; Centro Hospitalar de Entre Douro e Vouga; Centro Hospitalar de Leiria; Centro Hospitalar de Vila Nova de Gaia/Espinho; Centro Hospitalar do Alto Ave; Centro Hospitalar do Porto; Centro Hospitalar da Póvoa do Varzim/Vila do Conde; Hospital Central do Funchal; Centro Hospitalar de Lisboa Central; Centro Hospitalar Lisboa Norte; Centro Hospitalar Lisboa Ocidental; Centro Hospitalar do Baixo Vouga; Hospital de Vila Real; Hospitais da Universidade de Coimbra; Hospital de Cascais; Hospital de São João, Porto; Hospital de Braga; Hospital de Santa Luzia, Elvas; Hospital dos SAMS, Lisboa; Hospital Dr. Fernando da Fonseca, Amadora/Sintra; Hospital do Espírito Santo, Évora; Hospital Garcia de Orta, Almada; Hospital Pedro Hispano, Matosinhos; Unidade Local de Saúde do Baixo Alentejo, Beja.,Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - Mario Ramirez
- Author Affiliations: Centro Hospitalar do Barlavento Algarvio; Centro Hospitalar de Entre Douro e Vouga; Centro Hospitalar de Leiria; Centro Hospitalar de Vila Nova de Gaia/Espinho; Centro Hospitalar do Alto Ave; Centro Hospitalar do Porto; Centro Hospitalar da Póvoa do Varzim/Vila do Conde; Hospital Central do Funchal; Centro Hospitalar de Lisboa Central; Centro Hospitalar Lisboa Norte; Centro Hospitalar Lisboa Ocidental; Centro Hospitalar do Baixo Vouga; Hospital de Vila Real; Hospitais da Universidade de Coimbra; Hospital de Cascais; Hospital de São João, Porto; Hospital de Braga; Hospital de Santa Luzia, Elvas; Hospital dos SAMS, Lisboa; Hospital Dr. Fernando da Fonseca, Amadora/Sintra; Hospital do Espírito Santo, Évora; Hospital Garcia de Orta, Almada; Hospital Pedro Hispano, Matosinhos; Unidade Local de Saúde do Baixo Alentejo, Beja.,Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Friães
- Author Affiliations: Centro Hospitalar do Barlavento Algarvio; Centro Hospitalar de Entre Douro e Vouga; Centro Hospitalar de Leiria; Centro Hospitalar de Vila Nova de Gaia/Espinho; Centro Hospitalar do Alto Ave; Centro Hospitalar do Porto; Centro Hospitalar da Póvoa do Varzim/Vila do Conde; Hospital Central do Funchal; Centro Hospitalar de Lisboa Central; Centro Hospitalar Lisboa Norte; Centro Hospitalar Lisboa Ocidental; Centro Hospitalar do Baixo Vouga; Hospital de Vila Real; Hospitais da Universidade de Coimbra; Hospital de Cascais; Hospital de São João, Porto; Hospital de Braga; Hospital de Santa Luzia, Elvas; Hospital dos SAMS, Lisboa; Hospital Dr. Fernando da Fonseca, Amadora/Sintra; Hospital do Espírito Santo, Évora; Hospital Garcia de Orta, Almada; Hospital Pedro Hispano, Matosinhos; Unidade Local de Saúde do Baixo Alentejo, Beja.,Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal
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15
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Epidemiology of an upsurge of invasive group A streptococcal infections in Ireland, 2012-2015. J Infect 2018; 77:183-190. [PMID: 29935196 DOI: 10.1016/j.jinf.2018.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Group A streptococcus (GAS) is responsible for mild to very severe disease. The epidemiology of an upsurge in invasive GAS (iGAS) infections in Ireland, 2012-2015 was investigated. METHODS Epidemiological typing of iGAS (n = 473) isolates was performed and compared to non-invasive (n = 517) isolates. Clinical data of notified iGAS was obtained from the national infectious disease information system. RESULTS Annual incidences of iGAS cases (n = 561) were 2.33-3.66 per 100,000 population. Bacteraemia was the most common clinical presentation (75%) followed by focus without bacteraemia (19%) and necrotizing faciitis (7%). Streptococcal toxic shock syndrome occurred in 19% of presentations. The main invasive emm types in rank order were emm1, emm3, emm28, emm12 and emm89 whereas emm4, emm28, emm3, emm12, emm89 and emm1 predominated in non-invasive infections. Invasive emm1 and emm3 showed annual fluctuations (15-48% and 4-37%, respectively) and predominated in most clinical presentations of iGAS. Superantigens speA, speG, speJ was associated with iGAS disease and, speC, speI and ssa with non-invasive infections. There was 4.3% erythromycin and 5.6% tetracycline resistance. The main resistant types were emm11, emm28 and emm77. CONCLUSIONS Cyclic increases in emm1 and emm3 occurred during the iGAS upsurge. Continued surveillance of GAS is therefore essential given the epidemiological changes that occur in a short time period.
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16
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Vuksanović P, Opavski N. Changes in macrolide resistance phenotype in pharyngeal group a streptococci isolates in children. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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17
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Beres SB, Olsen RJ, Ojeda Saavedra M, Ure R, Reynolds A, Lindsay DSJ, Smith AJ, Musser JM. Genome sequence analysis of emm89 Streptococcus pyogenes strains causing infections in Scotland, 2010-2016. J Med Microbiol 2017; 66:1765-1773. [PMID: 29099690 PMCID: PMC5845742 DOI: 10.1099/jmm.0.000622] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Strains of type emm89 Streptococcus pyogenes have recently increased in frequency as a cause of human infections in several countries in Europe and North America. This increase has been molecular epidemiologically linked with the emergence of a new genetically distinct clone, designated clade 3. We sought to extend our understanding of this epidemic behavior by the genetic characterization of type emm89 strains responsible in recent years for an increased frequency of infections in Scotland. Methodology We sequenced the genomes of a retrospective cohort of 122 emm89 strains recovered from patients with invasive and noninvasive infections throughout Scotland during 2010 to 2016. Results All but one of the 122 emm89 infection isolates are of the recently emerged epidemic clade 3 clonal lineage. The Scotland isolates are closely related to and not genetically distinct from recent emm89 strains from England, they constitute a single genetic population. Conclusions The clade 3 clone causes virtually all-contemporary emm89 infections in Scotland. These findings add Scotland to a growing list of countries of Europe and North America where, by whole genome sequencing, emm89 clade 3 strains have been demonstrated to be the cause of an ongoing epidemic of invasive infections and to be genetically related due to descent from a recent common progenitor.
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Affiliation(s)
- Stephen B Beres
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, and Houston Methodist Hospital, Houston, TX 77030, USA
| | - Randall J Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, and Houston Methodist Hospital, Houston, TX 77030, USA.,Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, NY 10021, USA
| | - Matthew Ojeda Saavedra
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, and Houston Methodist Hospital, Houston, TX 77030, USA
| | - Roisin Ure
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, New Lister Building, Glasgow, G31 2ER, Scotland, UK
| | - Arlene Reynolds
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, New Lister Building, Glasgow, G31 2ER, Scotland, UK
| | - Diane S J Lindsay
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, New Lister Building, Glasgow, G31 2ER, Scotland, UK
| | - Andrew J Smith
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, New Lister Building, Glasgow, G31 2ER, Scotland, UK.,College of Medical, Veterinary and Life Sciences, Glasgow Dental Hospital and School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, Scotland, UK
| | - James M Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, and Houston Methodist Hospital, Houston, TX 77030, USA.,Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, NY 10021, USA
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18
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Ksia S, Smaoui H, Hraoui M, Bouafsoun A, Boutiba-Ben Boubaker I, Kechrid A. Molecular Characteristics of Erythromycin-ResistantStreptococcus pyogenesStrains Isolated from Children Patients in Tunis, Tunisia. Microb Drug Resist 2017; 23:633-639. [DOI: 10.1089/mdr.2016.0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Sonia Ksia
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Hanen Smaoui
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Manel Hraoui
- LR99ES09 Laboratoire de Résistance aux Antimicrobiens, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Aida Bouafsoun
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Ihem Boutiba-Ben Boubaker
- LR99ES09 Laboratoire de Résistance aux Antimicrobiens, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Amel Kechrid
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
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19
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Randjelovic G, Otasevic S, Mladenovic-Antic S, Mladenovic V, Radovanovic-Velickovic R, Randjelovic M, Bogdanovic D. Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children. Pediatr Int 2017; 59:432-437. [PMID: 27638252 DOI: 10.1111/ped.13169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Streptococcus pyogenes (group A Streptococcus) is the etiological agent of perineal infection in children, consisting of perianal infection, vulvovaginitis and balanitis. If it is not properly diagnosed and treated, it can persist for many months and can cause severe complications. Furthermore, treatment with penicillin can be followed by failures and recurrences. METHODS We report here the prevalence of S. pyogenes isolates in genital tract specimens from girls (n = 1692) with symptoms of vulvovaginitis and from boys (n = 52) with balanitis in the municipality of Nis, Southeast-Serbia (the Western Balkans) in a 10 year period, and the seasonal distribution, patient age and sensitivity to bacitracin and antimicrobial drugs used in the treatment of streptococcal infection. RESULTS Streptococcal vulvovaginitis was diagnosed in 2.30% of examinees. Of those cases, 64.10% were detected from April to September, and it was most common (71.79%) in girls aged 3-7 years. Streptococcal balanitis was diagnosed in two instances: in a 4-year-old boy and in a 7-year-old boy. S. pyogenes strains resistant to bacitracin were identified in five girls. Two isolates with M phenotype and five isolates with cMLSB phenotype were identified. CONCLUSIONS Streptococcal vulvovaginitis was diagnosed less often in the present study, but it was still far more common than streptococcal balanitis in childhood. Bacitracin resistance of S. pyogenes strains should be taken into account in routine microbiological identification, and the detection of S. pyogenes isolates resistant to erythromycin requires surveillance in the present geographical territory.
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Affiliation(s)
- Gordana Randjelovic
- Faculty of Medicine, University of Nis, Niš, Serbia.,Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | - Suzana Otasevic
- Faculty of Medicine, University of Nis, Niš, Serbia.,Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | | | - Vesna Mladenovic
- Center of Microbiology, Public Health Institute Nis, Niš, Serbia
| | | | | | - Dragan Bogdanovic
- Center of Microbiology, Public Health Institute Nis, Niš, Serbia.,Department of Biomedical Sciences, State University of Novi Pazar, Novi Pazar, Serbia
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Viciani E, Montagnani F, Tordini G, Romano A, Salerni L, De Luca A, Ruggiero P, Manetti AGO. Prevalence of M75 Streptococcus pyogenes Strains Harboring slaA Gene in Patients Affected by Pediatric Obstructive Sleep Apnea Syndrome in Central Italy. Front Microbiol 2017; 8:294. [PMID: 28293224 PMCID: PMC5329643 DOI: 10.3389/fmicb.2017.00294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/13/2017] [Indexed: 11/13/2022] Open
Abstract
Recently we reported an association between pediatric obstructive sleep apnea syndrome (OSAS) and Group A streptococcus (GAS) sub-acute chronic tonsil colonization. We showed that GAS may contribute to tonsil hyperplasia via a streptolysin O (SLO)-dependent cysteinyl leukotrienes (CysLTs) production, which can trigger T and B cell proliferation. In the present study, we characterized the GAS strains isolated from pediatric OSAS patients in comparison with a panel of age and sex matched GAS strains unrelated to OSAS, but isolated in the same area and during the same period ranging from 2009 to 2013. We found that slaA gene, previously reported to be associated to CysLTs production pathway, was significantly associated to GAS OSAS strains. Moreover, the most numerous group (32%) of the GAS OSAS strains belonged to M75 type, and 6 out of 7 of these strains harbored the slaA gene. Multilocus Sequence Typing (MLST) experiments demonstrated that the clone emm75/ST49/ smeZ, slaA was associated to OSAS cases. In conclusion, we found an association between slaA gene and the GAS OSAS strains, and we showed that the clone emm75/ST49 harboring genes smeZ and slaA was exclusively isolated from patients affected by OSAS, thus suggesting that this genotype might be associated to the pathogenesis of OSAS, although further studies are needed to elucidate the possible role of SlaA in tonsil hypertrophy development.
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Affiliation(s)
- Elisa Viciani
- GSK Vaccines S.r.l.Siena, Italy; Host-Microbiota Interaction Team, Wellcome Trust Sanger InstituteCambridge, UK
| | - Francesca Montagnani
- Department of Medical Biotechnologies, University of SienaSiena, Italy; Hospital Department of Specialized and Internal Medicine, University Division of Infectious DiseasesSiena, Italy
| | - Giacinta Tordini
- Department of Medical Biotechnologies, University of Siena Siena, Italy
| | - Antonio Romano
- Clinica Otorinolaringoiatrica, Policlinico Universitario "Le Scotte" Siena, Italy
| | - Lorenzo Salerni
- Clinica Otorinolaringoiatrica, Policlinico Universitario "Le Scotte" Siena, Italy
| | - Andrea De Luca
- Department of Medical Biotechnologies, University of SienaSiena, Italy; Hospital Department of Specialized and Internal Medicine, University Division of Infectious DiseasesSiena, Italy
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Ranđelović G, Mladenović V, Mladenović- Antić S, Stojanović P, Ranđelović M, Stolić J. STREPTOCOCCUS PYOGENES AS THE CAUSE OF VULVOVAGINITIS IN ADULT WOMEN. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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22
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Latronico F, Nasser W, Puhakainen K, Ollgren J, Hyyryläinen HL, Beres SB, Lyytikäinen O, Jalava J, Musser JM, Vuopio J. Genomic Characteristics Behind the Spread of Bacteremic Group A Streptococcus Type emm89 in Finland, 2004-2014. J Infect Dis 2016; 214:1987-1995. [PMID: 27707808 PMCID: PMC5142090 DOI: 10.1093/infdis/jiw468] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/27/2016] [Indexed: 12/20/2022] Open
Abstract
Background. Many countries worldwide have reported increasing numbers of emm89 group A Streptococcus (GAS) infections during last decade. Pathogen genetic factors linked to this increase need assessment. Methods. We investigated epidemiological characteristics of emm89 GAS bacteremic infections, including 7-day and 30-day case-fatality rates, in Finland during 2004–2014 and linked them to whole-genome sequencing data obtained from corresponding strains. The Fisher exact test and exact logistic regression were used to compare differences between bacteremic infections due to emm89 GAS belonging to different genetic clades and subclades. Results. Out of 1928 cases of GAS bacteremic infection, 278 were caused by emm89 GAS. We identified 2 genetically distinct clades, arbitrarily designated clade 2 and clade 3. Both clades were present during 2004–2008, but clade 3 increased rapidly from 2009 onward. Six subclades (designated subclades A–F) were identified within clade 3, based on phylogenetic core genome analysis. The case-fatality rate differed significantly between subclades (P < .05), with subclade D having the highest 30-day estimated case-fatality rate (19% vs 3%–14%). Conclusions. A new emm89 clone, clade 3, emerged in 2009 and spread rapidly in Finland. Patients infected with certain subclades of clade 3 were significantly more likely to die. A specific polymerase chain reaction assay was developed to follow the spread of subclade D in 2015.
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Affiliation(s)
- Francesca Latronico
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki.,European Programme for Public Health Microbiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Waleed Nasser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Texas
| | - Kai Puhakainen
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki.,Department of Medical Microbiology and Immunology, University of Turku, Finland
| | - Jukka Ollgren
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki
| | | | - Stephen B Beres
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Texas
| | - Outi Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki
| | - Jari Jalava
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki
| | - James M Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Texas
| | - Jaana Vuopio
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki.,Department of Medical Microbiology and Immunology, University of Turku, Finland
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Emergence of the Same Successful Clade among Distinct Populations of emm89 Streptococcus pyogenes in Multiple Geographic Regions. mBio 2015; 6:e01780-15. [PMID: 26628724 PMCID: PMC4669383 DOI: 10.1128/mbio.01780-15] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Trading Capsule for Increased Cytotoxin Production: Contribution to Virulence of a Newly Emerged Clade of emm89 Streptococcus pyogenes. mBio 2015; 6:e01378-15. [PMID: 26443457 PMCID: PMC4611041 DOI: 10.1128/mbio.01378-15] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Strains of emm89 Streptococcus pyogenes have become one of the major causes of invasive infections worldwide in the last 10 years. We recently sequenced the genome of 1,125 emm89 strains and identified three major phylogenetic groups, designated clade 1, clade 2, and the epidemic clade 3. Epidemic clade 3 strains, which now cause the great majority of infections, have two distinct genetic features compared to clade 1 and clade 2 strains. First, all clade 3 organisms have a variant 3 nga promoter region pattern, which is associated with increased production of secreted cytolytic toxins SPN (S. pyogenes NADase) and SLO (streptolysin O). Second, all clade 3 strains lack the hasABC locus mediating hyaluronic acid capsule synthesis, whereas this locus is intact in clade 1 and clade 2 strains. We constructed isogenic mutant strains that produce different levels of SPN and SLO toxins and capsule (none, low, or high). Here we report that emm89 strains with elevated toxin production are significantly more virulent than low-toxin producers. Importantly, we also show that capsule production is dispensable for virulence in strains that already produce high levels of SPN and SLO. Our results provide new understanding about the molecular mechanisms contributing to the rapid emergence and molecular pathogenesis of epidemic clade 3 emm89 S. pyogenes. S. pyogenes (group A streptococcus [GAS]) causes pharyngitis (“strep throat”), necrotizing fasciitis, and other human infections. Serious infections caused by emm89 S. pyogenes strains have recently increased in frequency in many countries. Based on whole-genome sequence analysis of 1,125 strains recovered from patients on two continents, we discovered that a new emm89 clone, termed clade 3, has two distinct genetic features compared to its predecessors: (i) absence of the genes encoding antiphagocytic hyaluronic acid capsule virulence factor and (ii) increased production of the secreted cytolytic toxins SPN and SLO. emm89 S. pyogenes strains with the clade 3 phenotype (absence of capsule and high expression of SPN and SLO) are highly virulent in mice. These findings provide new understanding of how new virulent clones emerge and cause severe infections worldwide. This newfound knowledge of S. pyogenes virulence can be used to help understand future epidemics and conduct new translational research.
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Freschi de Barros S, De Amicis KM, Alencar R, Smeesters PR, Trunkel A, Postól E, Almeida Junior JN, Rossi F, Pignatari ACC, Kalil J, Guilherme L. Streptococcus pyogenes strains in Sao Paulo, Brazil: molecular characterization as a basis for StreptInCor coverage capacity analysis. BMC Infect Dis 2015; 15:308. [PMID: 26243278 PMCID: PMC4525746 DOI: 10.1186/s12879-015-1052-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/22/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Several human diseases are caused by Streptococcus pyogenes, ranging from common infections to autoimmunity. Characterization of the most prevalent strains worldwide is a useful tool for evaluating the coverage capacity of vaccines under development. In this study, a collection of S. pyogenes strains from Sao Paulo, Brazil, was analyzed to describe the diversity of strains and assess the vaccine coverage capacity of StreptInCor. METHODS Molecular epidemiology of S. pyogenes strains was performed by emm-genotyping the 229 isolates from different clinical sites, and PCR was used for superantigen profile analysis. The emm-pattern and tissue tropism for these M types were also predicted and compared based on the emm-cluster classification. RESULTS The strains were fit into 12 different emm-clusters, revealing a diverse phylogenetic origin and, consequently, different mechanisms of infection and escape of the host immune system. Forty-eight emm-types were distinguished in 229 samples, and the 10 most frequently observed types accounted for 69 % of all isolates, indicating a diverse profile of circulating strains comparable to other countries under development. A similar proportion of E and A-C emm-patterns were observed, whereas pattern D was less frequent, indicating that the strains of this collection primarily had a tissue tropism for the throat. In silico analysis of the coverage capacity of StreptInCor, an M protein-conserved regionally based vaccine candidate developed by our group, had a range of 94.5 % to 59.7 %, with a mean of 71.0 % identity between the vaccine antigen and the predicted amino acid sequence of the emm-types included here. CONCLUSIONS This is the first report of S. pyogenes strain characterization in Sao Paulo, one of the largest cities in the world; thus, the strain panel described here is a representative sample for vaccine coverage capacity analysis. Our results enabled evaluation of StreptInCor candidate vaccine coverage capacity against diverse M-types, indicating that the vaccine candidate likely would induce protection against the diverse strains worldwide.
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Affiliation(s)
- Samar Freschi de Barros
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Karine Marafigo De Amicis
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Raquel Alencar
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Pierre Robert Smeesters
- Laboratoire de Génétique et Physiologie Bactérienne, Institute de Biologie et de Médecine Moléculaires, Faculté des Sciences, Université Libre de Bruxelles, Bruxelles, 1050, Belgium.
- Murdoch Childrens Research Institute, Parkville, 3052, Australia.
| | - Ariel Trunkel
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Edilberto Postól
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - João Nóbrega Almeida Junior
- Microbiology Laboratory of Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | - Flavia Rossi
- Microbiology Laboratory of Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | | | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
- Clinical Immunology and Allergy Division, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
- Laboratory of Immunology, Clinical Hospital, Heart Institute (HC-FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
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Consequences of the variability of the CovRS and RopB regulators among Streptococcus pyogenes causing human infections. Sci Rep 2015; 5:12057. [PMID: 26174161 PMCID: PMC4502508 DOI: 10.1038/srep12057] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/05/2015] [Indexed: 11/08/2022] Open
Abstract
To evaluate the importance of covRS and ropB mutations in invasive disease caused by Group A Streptococci (GAS), we determined the sequence of the covRS and ropB genes of 191 isolates from invasive infections and pharyngitis, comprising a diverse set of emm types and multilocus sequence types. The production of SpeB and the activity of NAD glycohydrolase (NADase) and streptolysin S (SLS) were evaluated. The results support the acquisition of null covS alleles (predicted to eliminate protein function), resulting in downregulation of SpeB and upregulation of NADase and SLS, as a mechanism possibly contributing to higher invasiveness. Among the isolates tested, this mechanism was found to be uncommon (10% of invasive isolates) and was not more prevalent among clones with enhanced invasiveness (including M1T1) but occurred in diverse genetic backgrounds. In lineages such as emm64, these changes did not result in upregulation of NADase and SLS, highlighting the diversity of regulatory pathways in GAS. Despite abrogating SpeB production, null alleles in ropB were not associated with invasive infection. The covRS and ropB genes are under stabilising selection and no expansion of isolates carrying null alleles has been observed, suggesting that the presence of these regulators is important for overall fitness.
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Emergence of a New Highly Successful Acapsular Group A Streptococcus Clade of Genotype emm89 in the United Kingdom. mBio 2015; 6:e00622. [PMID: 26173696 PMCID: PMC4502227 DOI: 10.1128/mbio.00622-15] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Group A Streptococcus (GAS) genotype emm89 is increasingly recognized as a leading cause of disease worldwide, yet factors that underlie the success of this emm type are unknown. Surveillance identified a sustained nationwide increase in emm89 invasive GAS disease in the United Kingdom, prompting longitudinal investigation of this genotype. Whole-genome sequencing revealed a recent dramatic shift in the emm89 population with the emergence of a new clade that increased to dominance over previous emm89 variants. Temporal analysis indicated that the clade arose in the early 1990s but abruptly increased in prevalence in 2008, coinciding with an increased incidence of emm89 infections. Although standard variable typing regions (emm subtype, tee type, sof type, and multilocus sequence typing [MLST]) remained unchanged, uniquely the emergent clade had undergone six distinct regions of homologous recombination across the genome compared to the rest of the sequenced emm89 population. Two of these regions affected known virulence factors, the hyaluronic acid capsule and the toxins NADase and streptolysin O. Unexpectedly, and in contrast to the rest of the sequenced emm89 population, the emergent clade-associated strains were genetically acapsular, rendering them unable to produce the hyaluronic acid capsule. The emergent clade-associated strains had also acquired an NADase/streptolysin O locus nearly identical to that found in emm12 and modern emm1 strains but different from the rest of the sequenced emm89 population. The emergent clade-associated strains had enhanced expression of NADase and streptolysin O. The genome remodeling in the new clade variant and the resultant altered phenotype appear to have conferred a selective advantage over other emm89 variants and may explain the changes observed in emm89 GAS epidemiology. Sudden upsurges or epidemic waves are common features of group A streptococcal disease. Although the mechanisms behind such changes are largely unknown, they are often associated with an expansion of a single genotype within the population. Using whole-genome sequencing, we investigated a nationwide increase in invasive disease caused by the genotype emm89 in the United Kingdom. We identified a new clade variant that had recently emerged in the emm89 population after having undergone several core genomic recombination-related changes, two of which affected known virulence factors. An unusual finding of the new variant was the loss of the hyaluronic acid capsule, previously thought to be essential for causing invasive disease. A further genomic adaptation in the NADase/streptolysin O locus resulted in enhanced production of these toxins. Recombination-related genome remodeling is clearly an important mechanism in group A Streptococcus that can give rise to more successful and potentially more pathogenic variants.
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Silva-Costa C, Friães A, Ramirez M, Melo-Cristino J. Macrolide-resistant Streptococcus pyogenes: prevalence and treatment strategies. Expert Rev Anti Infect Ther 2015; 13:615-28. [PMID: 25746210 DOI: 10.1586/14787210.2015.1023292] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although penicillin remains the first-choice treatment for Streptococcus pyogenes infection, macrolides are important alternatives for allergic patients and lincosamides are recommended together with β-lactams in invasive infections. S. pyogenes may exhibit macrolide resistance because of active efflux (mef genes) or target modification (erm genes), the latter conferring cross resistance to lincosamides and streptogramin B. Worldwide, resistance is restricted to a limited number of genetic lineages, despite resistance genes being encoded on mobile genetic elements. For reasons that are not completely clear, resistance and the associated phenotypes are highly variable across countries. Although resistance remains high in several countries, particularly in Asia, an overall decreasing trend of resistance has been noted in recent years, mostly in Europe. This decrease is not always accompanied by declines in macrolide consumption, suggesting significant roles of other factors in determining the dynamics of macrolide-resistant clones. Continued surveillance is needed to obtain further insights into the forces governing macrolide resistance in S. pyogenes.
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Affiliation(s)
- Catarina Silva-Costa
- Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, Av. Prof. Egas Moniz, PT 1649-028 Lisboa, Portugal
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29
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Arêas GP, Schuab RBB, Neves FPG, Barros RR. Antimicrobial susceptibility patterns, emm type distribution and genetic diversity of Streptococcus pyogenes recovered in Brazil. Mem Inst Oswaldo Cruz 2014; 109:935-9. [PMID: 25410998 PMCID: PMC4296499 DOI: 10.1590/0074-0276140231] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022] Open
Abstract
Streptococcus pyogenes is responsible for a variety of infectious diseases and immunological complications. In this study, 91 isolates of S. pyogenes recovered from oropharynx secretions were submitted to antimicrobial susceptibility testing, emm typing and pulsed-field gel electrophoresis (PFGE) analysis. All isolates were susceptible to ceftriaxone, levofloxacin, penicillin G and vancomycin. Resistance to erythromycin and clindamycin was 15.4%, which is higher than previous reports from this area, while 20.9% of the isolates were not susceptible to tetracycline. The macrolide resistance phenotypes were cMLSB (10) and iMLSB (4). The ermB gene was predominant, followed by the ermA gene. Thirty-two emm types and subtypes were found, but five (emm1, emm4, emm12, emm22, emm81) were detected in 48% of the isolates. Three new emm subtypes were identified (emm1.74, emm58.14, emm76.7). There was a strong association between emm type and PFGE clustering. A variety of PFGE profiles as well as emm types were found among tetracycline and erythromycin-resistant isolates, demonstrating that antimicrobial resistant strains do not result from the expansion of one or a few clones. This study provides epidemiological data that contribute to the development of suitable strategies for the prevention and treatment of such infections in a poorly studied area.
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Affiliation(s)
| | | | | | - Rosana R Barros
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico,
Universidade Federal Fluminense, Niterói, RJ, Brasil
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Wajima T, Chiba N, Morozumi M, Shouji M, Sunaoshi K, Sugita K, Tajima T, Ubukata K. Prevalence of Macrolide Resistance Among Group A Streptococci Isolated from Pharyngotonsillitis. Microb Drug Resist 2014; 20:431-5. [DOI: 10.1089/mdr.2013.0213] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takeaki Wajima
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Naoko Chiba
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Michi Shouji
- Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | | | - Kayoko Sugita
- Department of Clinical Laboratories, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Tajima
- Department of Pediatrics, Hakujikai Memorial Hospital, Tokyo, Japan
| | - Kimiko Ubukata
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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Santagati M, Spanu T, Scillato M, Santangelo R, Cavallaro F, Arena V, Castiglione G, Falcone M, Venditti M, Stefani S. Rapidly fatal hemorrhagic pneumonia and group A Streptococcus serotype M1. Emerg Infect Dis 2014; 20:98-101. [PMID: 24520561 PMCID: PMC3884710 DOI: 10.3201/eid2001.130233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report 3 cases of fulminant hemorrhagic pneumonia in previously health patients. Sudden-onset hemoptysis and dyspnea developed; all 3 patients and died <12 h later of massive pulmonary bleeding, despite aggressive supportive care. Postmortem analysis showed that the illnesses were caused by group A Streptococcusemm1/sequence type 28 strains.
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32
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Streptococcal superantigens: categorization and clinical associations. Trends Mol Med 2013; 20:48-62. [PMID: 24210845 DOI: 10.1016/j.molmed.2013.10.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 10/01/2013] [Accepted: 10/08/2013] [Indexed: 01/01/2023]
Abstract
Superantigens are key virulence factors in the immunopathogenesis of invasive disease caused by group A streptococcus. These protein exotoxins have also been associated with severe group C and group G streptococcal infections. A number of novel streptococcal superantigens have recently been described with some resulting confusion in their classification. In addition to clarifying the nomenclature of streptococcal superantigens and proposing guidelines for their categorization, this review summarizes the evidence supporting their involvement in various clinical diseases including acute rheumatic fever.
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Wajima T, Morozumi M, Chiba N, Shouji M, Iwata S, Sakata H, Ubukata K. Associations of macrolide and fluoroquinolone resistance with molecular typing in Streptococcus pyogenes from invasive infections, 2010–2012. Int J Antimicrob Agents 2013; 42:447-9. [DOI: 10.1016/j.ijantimicag.2013.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 11/26/2022]
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Friães A, Lopes JP, Melo-Cristino J, Ramirez M. Changes in Streptococcus pyogenes causing invasive disease in Portugal: evidence for superantigen gene loss and acquisition. Int J Med Microbiol 2013; 303:505-13. [PMID: 23932912 DOI: 10.1016/j.ijmm.2013.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/26/2013] [Accepted: 07/10/2013] [Indexed: 01/10/2023] Open
Abstract
The emergence of highly virulent and successful Streptococcus pyogenes (group A streptococci - GAS) clones has been attributed to the exchange of virulence factors by lateral gene transfer mechanisms, which strongly contribute to genomic diversity. We characterized a collection of 191 GAS isolates recovered from normally sterile sites in Portugal during 2006-2009 and compared them to invasive isolates obtained during 2000-2005. Antimicrobial resistance rates did not change significantly between the two periods and were generally low. In 2006-2009, emm1, emm89, emm3, and emm6 represented 60% of the isolates. The chromosomally encoded superantigen (SAg) genes speG and smeZ were present in the majority (>90%) of the isolates, while speJ was found in only 45%. The phage encoded SAgs varied greatly in prevalence (2-53%). The distribution of emm types, pulsed-field gel electrophoresis profiling (PFGE) clusters, and SAg profiles changed significantly between the periods, although there were no statistically supported changes in the prevalence of individual types. While the macrolide susceptible clone emm1-T1-ST28 remained dominant (28%), there was a significant decrease in clonal diversity as indicated by both PFGE profiling and emm typing. This was accompanied by intra-clonal divergence of SAg profiles, which was statistically confirmed for isolates representing emm1, emm28, and emm44. This diversification was associated with the loss and acquisition of SAg genes, carried by phages and of chromosomal origin. These data suggest an ongoing genomic diversification of GAS invasive isolates in Portugal that may contribute to the persistence of clones with improved fitness or virulence.
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Affiliation(s)
- Ana Friães
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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