Disease caused by group A streptococci (GAS) in tropical regions often takes the form of impetigo, whereas pharyngitis tends to predominate in temperate zones. GAS derived from asymptomatic throat infections and pyoderma lesions of rural Aboriginal Australians were evaluated for phylogenetic distant emm genes, which represent ecological markers for tissue site preference. On the basis of the percentage of total isolates from a given tissue, emm pattern A-C organisms exhibited a stronger predilection for the throat, whereas pattern D organisms preferred the skin. Only 16% of isolates collected by active surveillance displayed pattern A-C, which reflects the low incidence of oropharyngeal infection. Importantly, most (70%) pattern A-C organisms were isolated from skin sores, despite their innate tendency to infect the throat. Combined with findings from nontropical populations, analysis of the data supports the hypothesis that GAS tissue preferences are genetically predetermined and that host risk factors for infection strongly influence the differential reproduction of individual clones.

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In group A streptococci, genetic markers for principal tissue reservoir are located within emm genes, which encode surface proteins that have a role in virulence. A worldwide collection of 160 isolates was evaluated for two traits: chromosomal emm gene markers for tissue tropism (designated patterns A-E), and bacteriophage-associated genes (speA and speC) encoding pyrogenic exotoxins. The speA and speC alleles of organisms harboring the emm marker for a pharyngeal reservoir (pattern A-C) differ from spe alleles that predominate in organisms with the emm marker for impetigo (pattern D). However, organisms that display the emm marker for both tissue sites (pattern E) are not intermediate for the distribution of either speA or speC alleles, but instead resemble pattern A-C isolates for speA and pattern D strains for speC. Statistically significant nonrandom associations between exotoxin alleles and emm patterns were observed but cannot be readily explained by niche separation alone.