One hundred and three Streptococcus pyogenes isolates recovered mainly from streptococcal throat infections in Lebanon were characterized by emm and PFGE typing. Thirty-three emm types and subtypes were detected among the isolates. PFGE was more discriminatory as a typing method. The prevalent emm types were emm1 (12.6 %), emm22 (8.7 %), emm28 (7.7 %), emm88 (7.7 %) and emm4 (6.8 %) and all isolates were susceptible to vancomycin and penicillin G. Ten per cent of the isolates were resistant to erythromycin and 3 % were resistant to erythromycin and clindamycin, showing the macrolide-lincosamide-streptogramin B phenotype. The emm sequences and PFGE pattern database that were generated in this study will serve as a basis for information for long-term evolutionary and epidemiological studies of local S. pyogenes recovered not only in Lebanon, but also in neighbouring countries.
INTRODUCTIONStreptococcus pyogenes is one of the most clinically important Gram-positive pathogens. S. pyogenes causes disease states that vary between mild sore throat to the flesh-eating disease necrotizing fasciitis. S. pyogenes causes, other than the acute diseases, a set of severe post-disease sequelae such as rheumatic fever and post-streptococcal glomerulonephritis (Yoonim et al., 2005).The successful nature of S. pyogenes as a pathogen relates to its wide array of virulence factors, be they secreted or cell bound. S. pyogenes strains express a multitude of genes coding for DNases, antibiotic resistance and the highly virulent superantigens that cause streptococcal toxic shock syndrome in addition to other nonsuppurative sequelae (Aziz & Kotb, 2008). S. pyogenes also exhibits C5a peptidase, streptolysin O and streptolysin S activity, which aid in streptococcal cytotoxicity and virulence (Sagar et al., 2008). The S. pyogenes M protein is probably the most notorious virulence factor that this micro-organism possesses. It is a fibrillar cell wall protein that aids in adherence to human cells and prevention of opsonophagocytosis. This protein, due to molecular mimicry within protein sequences found in human tissues, is implicated in rheumatic fever (Guilherme et al., 2006). S. pyogenes emm typing has become one of the best approaches used in molecular typing of this microorganism. Many methods have been exploited to best type S. pyogenes, such as 16S rRNA gene sequencing (Stanley et al., 1995), restriction fragment length polymorphism analysis (Desai et al., 1999), random amplified polymorphic DNA analysis (Seppälä et al., 1994) and PFGE (Chiou et al., 2004). However, sequencing-based emm typing by the use of oligonucleotides that target the Nterminus of the M-protein coding gene remains the most practical method of S. pyogenes typing (Beall et al., 2000). The reason behind this is that the gene coding for the group A Streptococcus M protein contains a hypervariable 59 region that is subject to many single nucleotide polymorphisms, which serves as the basis for emm typing S. pyogenes isolates (Yoonim et al., 2005).To our knowledge, this ...