Genotyping by Amplified Fragment Length Polymorphism Analysis Reveals Persistence and Recurrence of Infection with Streptococcus anginosus Group Organisms

Abstract

Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius, commonly referred to as the Streptococcus anginosus group (SAG), are commensal organisms known for their propensity to cause purulent infections which are difficult to eradicate. In this study, we determined the genetic similarities between SAG isolates consecutively recovered from single patients to assess the duration of infection or colonization. A total of 97 SAG isolates recovered from 30 patients were included; 65 (67.0%) of the isolates were abscess related. The isolates were identified by the 16S rRNA reverse line blot hybridization assay as S. anginosus (n ‫؍‬ 34), S. constellatus (n ‫؍‬ 55), and S. intermedius (n ‫؍‬ 8). Amplified fragment length polymorphism (AFLP) analysis of the SAG isolates produced discriminatory and reproducible patterns. Consecutive SAG isolates with identical AFLP types were found in 27 of 30 (90.0%) patients, and consecutive isolates with only a single AFLP type were demonstrated in 21 (70.0%) patients. The median delay between the times of recovery of the first and last isolates of identical AFLP types from each patient was 36 days, and this delay extended for more than 1 year in patients with both colonizing and abscess-related SAG isolates. In six bacteremic patients, paired blood and nonblood SAG isolates showed identical AFLP types. Streptococcus anginosus, Streptococcus constellatus, andStreptococcus intermedius are commonly referred to as the Streptococcus milleri group, recently designated the Streptococcus anginosus group (SAG) (10). SAG strains are known for their association with purulent infections that occur after local disruption of the mucosal barrier, such as in cases of ulceration, perforation, inflammation, or surgery (6, 14). These infections often cause significant morbidity and may require repeat drainage procedures (6). In our collection of consecutive clinical SAG isolates, we observed successive isolates from patients with persistent or recurrent infections. Although biochemical and serological data pointed to a close similarity of at least some of the isolates recovered from single patients, information on relatedness at the genetic level was lacking. To study the genetic similarities between these successive SAG isolates, we used amplified fragment length polymorphism (AFLP) analysis (19). MATERIALS AND METHODSBacterial strains. SAG isolates were consecutively collected from clinical specimens routinely submitted for culture to the Medical Microbiology Department of the University Hospital Maastricht, a 600-bed tertiary-care hospital. Culture, isolation, and identification to the SAG level have been described previously (7). Species identification was performed by the 16S rRNA reverse line blot hybridization assay. The previously described S. intermedius non-exclusive human hemolytic strains were assigned to the species S. constellatus (8), and the isolates within the S. anginosus species with different 16S rRNA groups were grouped together (9). Consecutively obtained ...

Development of an Ex Vivo Coculture System to Model Pulpal Infection by Streptococcus anginosus Group Bacteria

“…37% were found to contain strains from the SAG with the vast majority being S. anginosus strains. It has also been shown, using Amplified Fragment Length Polymorphism analysis, that SAG isolated from the blood and oral abscesses in the same patient are identical, suggesting that infection may be capable of spreading from oral abscesses to other sites in the body (Jacobs et al 2003). The importance of pulpal infections to patient health may be underestimated but studies such as this emphasise the need for effective treatments to limit bacterial spread.…”

Empiema pleural por Streptococcus grupo anginosus en un preescolar y revisión de la literatura: Case report and review

“…Streptococcus grupo anginosus fue aislado en 29% de las muestras de abscesos del SNC, en 20% de muestras de abscesos dentales, en 19,5% de muestras provenientes de infecciones intraabdominales, en 14% de abscesos peritonsilares, en 7,3% de empiemas y abscesos pulmonares, en 1,4% de las endocarditis infecciosas y en 0,1% de las bacteriemias en el periodo estudiado. En esta serie de casos no se observó mortalidad y de los 6 pacientes que presentaron infección pulmonar, la duración promedio del tratamiento antimicrobiano fue de 42 días, lo que concuerda con estudios que revelan dificultad de erradicación bacteriana y la necesidad de tratamientos prolongados [12][13][14][15] . De las especies de Streptococcus grupo anginosus, se ha observado que S. intermedius es más frecuentemente aislado en infecciones del SNC, S. constellatus en infecciones pulmonares y S. anginosus en bacteriemias, infecciones intestinales y genitales 16 .…”

Real-time monitoring of the adherence of Streptococcus anginosus group bacteria to extracellular matrix decorin and biglycan proteoglycans in biofilm formation

“…However, SAG members are frequently isolated from a range of clinical sites, including liver and brain abscesses, infective endocarditis and infections of the gastrointestinal and genitourinary tract. Whilst present in low numbers in dental plaque, SAGs are frequently isolated from polymicrobial infections; they are predominant components of a number of orofacial infections, including dento-alveolar and periodontal abscesses, and are frequently associated with failed root canal treatment (Jacobs et al, 2003;LedezmaRasillo et al, 2010;Lewis et al, 1986;Schuman and Turner, 1999;Siqueira et al, 2002;Okayama et al, 2005;Whiley et al, 1992). It has been proposed that SAGs are present early in the pathogenic process and may actually initiate infection, thereafter preparing the environment for subsequent colonisation by anaerobic species (Aderhold et al, 1981;Gossling, 1988;Nagashima et al, 1999;Shinzato and Saito, 1994).…”

“…There is evidence that the binding to these cell surface receptors may result in host cell responses, including intracellular signalling, influencing host cell survival, promotion of antimicrobial peptide synthesis and initiation of the inflammatory response (Baron et al, 2009;Hoepelman and Tuomanen, 1992;Jockusch et al, 1995;Wang et al, 2011), and thus they may be significant in the establishment of infection. Although still in their infancy, these studies have led to suggested options for therapeutic strategies related to the elucidation of microbe/PG interactions (Baron et al, 2009;Hoepelman and Tuomanen, 1992;Jockusch et al, 1995). Interactions with GAGs associated with decorin and biglycan, CS and DS, have been demonstrated for species Streptococcus pyogenes (Frick et al, 2003), Streptococcus uberis (Almeida et al, 1999a,b;Almeida et al, 2003) and Streptococcus pneumonia (Tonnaer et al, 2006).…”