Group A Streptococci from Carriage and Disease in Portugal: Evolution of Antimicrobial Resistance and T Antigenic Types During 2000–2002

Pires, Renato; Rolo, Dora; Gama-Norton, Leonor; Morais, Ana Jessyca Alves; Lito, Luı́s; Salgado, M J; Johansson, C.; Möllerberg, Gunnel; Henriques‐Normark, Birgitta; Gonçalo-Marques, José; Sanches, Ilda Santos

doi:10.1089/mdr.2005.11.360

Cited by 19 publications

(13 citation statements)

References 51 publications

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“…Some countries have a high proportion of mefA-positive isolates, whereas in other countries, erm genes dominate, leading to higher levels of clindamycin resistance. There is also temporal variation in the distribution of the mefAencoded and erm-encoded phenotypes within the same geographic region (496)(497)(498)(499)(500). Studies in Finland, Spain, and Italy have shown a strong correlation between macrolide usage and resistance of GAS (501)(502)(503).…”

Section: Resistance To Macrolidesmentioning

confidence: 99%

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

et al. 2014

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SUMMARY Streptococcus pyogenes , also known as group A Streptococcus (GAS), causes mild human infections such as pharyngitis and impetigo and serious infections such as necrotizing fasciitis and streptococcal toxic shock syndrome. Furthermore, repeated GAS infections may trigger autoimmune diseases, including acute poststreptococcal glomerulonephritis, acute rheumatic fever, and rheumatic heart disease. Combined, these diseases account for over half a million deaths per year globally. Genomic and molecular analyses have now characterized a large number of GAS virulence determinants, many of which exhibit overlap and redundancy in the processes of adhesion and colonization, innate immune resistance, and the capacity to facilitate tissue barrier degradation and spread within the human host. This improved understanding of the contribution of individual virulence determinants to the disease process has led to the formulation of models of GAS disease progression, which may lead to better treatment and intervention strategies. While GAS remains sensitive to all penicillins and cephalosporins, rising resistance to other antibiotics used in disease treatment is an increasing worldwide concern. Several GAS vaccine formulations that elicit protective immunity in animal models have shown promise in nonhuman primate and early-stage human trials. The development of a safe and efficacious commercial human vaccine for the prophylaxis of GAS disease remains a high priority.

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Section: Resistance To Macrolidesmentioning

confidence: 99%

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

et al. 2014

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“…A combination of a ␤-lactam and clindamycin is the recommended treatment for severe GAS disease (59). Addi-tionally, though tetracycline is not used in the treatment of GAS disease, the susceptibility of GAS to tetracycline seems to be highly variable between countries (26,32,38).…”

Section: Active Surveillance Of Invasive Group a Streptococcal (Gas) mentioning

confidence: 99%

Clinical and Epidemiological Aspects of Invasive Streptococcus pyogenes Infections in Denmark during 2003 and 2004

et al. 2008

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Active surveillance of invasive group A streptococcal (GAS) infections was conducted in Denmark during2003 and 2004 as a part of the Strep-EURO initiative. The main objective was to improve understanding of the epidemiology of invasive GAS disease in Denmark. During the 2 years, 278 cases were reported, corresponding to a mean annual incidence of 2.6 cases per 100,000 inhabitants. The vast majority of isolates, 253 (91%), were from blood, with the remaining 25 (9%) being from cerebrospinal fluid, joints, or other normally sterile sites. The mean case fatality rate (CFR) was 20%, with the rate being higher in patients more than 70 years of age (36.5%). For streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis the CFRs were 53% and 25%, respectively. Out of 16 T types recorded, three predominated: T28 (23%), T1 (22%), and the cluster T3/13/B3264 (14%). Among 29 different emm types, emm28 and emm1 accounted for 51% of strains, followed by emm3 (11%), emm89 (7%), and emm12 (5.5%). Low resistance rates were detected for macrolide-lincosamide-streptogramin B (MLS B ) antibiotics (3%) and tetracycline (8%); two isolates exhibited coresistance to tetracycline and macrolides. Of nine pyrogenic exotoxin (superantigen) genes examined, speA and speC were identified in 58% and 40% of the strains, respectively; either of the genes was present in all strains causing STSS. Most strains harbored speG (99%). ssa was present in 14% of the isolates only. In Denmark, as in comparable countries, GAS invasive disease shows a sustained, high endemicity, with involvement of both established and emerging streptococcal emm and T types.

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“…Previous studies have addressed specific questions regarding GAS infections in Portugal (12,15,19), but this is the largest and most detailed study of GAS invasive isolates from Portu- gal, allowing the characterization of the main lineages of S. pyogenes causing invasive disease. This study identified extensive diversity among GAS isolates, as attested by the high SIDs of all typing methodologies, that results in a lower potential coverage of GAS invasive infections in Portugal by a future 26-valent vaccine (69%) than that in the United States (11).…”

Section: Downloaded Frommentioning

confidence: 99%

Nonoutbreak Surveillance of Group A Streptococci Causing Invasive Disease in Portugal Identified Internationally Disseminated Clones among Members of a Genetically Heterogeneous Population

2007

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The typing of 160 invasive Streptococcus pyogenes isolates confirmed the importance of pulsed-field gel electrophoresis and multilocus sequence typing for defining clones. The results identified an extremely diverse population and highlighted the importance of both internationally disseminated and local clones not previously associated with invasive disease.A reemergence of invasive disease caused by Streptococcus pyogenes (a member of the group A streptococci [GAS]) has been noted since the late 1980s, both in North America and in Europe (3). This increase in the incidence of GAS infections has frequently been associated with specific clones, suggesting the possibility that the rise of particularly virulent clones is responsible for this reemergence. The identification of GAS clones in surveillance and epidemiological studies has frequently relied on serotyping using two variable surface antigens, the T antigen (T typing) and the M protein (M typing, or emm typing, as the protein is encoded by the emm gene) (3). Recent work suggests that emm typing alone is not sufficient to unambiguously identify GAS clones and that this method must be complemented with an analysis by either pulsed-field gel electrophoresis (PFGE) or multilocus sequence typing (MLST) (1). A total of 160 nonduplicate GAS isolates recovered from normally sterile sites (150 from blood, 7 from pleural fluid, and 3 from cerebrospinal fluid) were collected in 19 laboratories distributed throughout Portugal that were asked to submit all isolates between 2000 and 2005. The number of participating laboratories was not constant, and this variation was reflected in the number of isolates available in each of the study years Twelve different T serotypes (20) were identified, and 23 isolates (14%) were nontypeable (Simpson's index of diversity [SID] Ϯ 95% confidence interval [CI], 88.2% Ϯ 2.3%) (1), whereas 30 different emm types were identified (SID Ϯ 95% CI, 92.0% Ϯ 2.0%). The presence of genes encoding GAS pyrogenic toxins was studied by PCR (2, 9, 16, 18). As expected, the results confirmed the presence of the chromosomal genes speB and speF in all strains except one. Eleven different exotoxin gene profiles were identified (SID Ϯ 95% CI, 82.2% Ϯ 3.0%), but a significant fraction of the isolates (16%) were negative for all but the chromosomal genes ( Table 1).The dendrogram based on the PFGE profiles of SmaI-or Cfr9I-digested total DNA (1, 19) from the isolates identified 13 major clusters accounting for 86% of all isolates (SID Ϯ 95% CI, 92.0% Ϯ 2.1%) (Fig. 1). Among the 37 isolates characterized by MLST (5), four new alleles were identified and submitted to the S. pyogenes MLST database, namely, recP82, gki98, gtr73, and murI68, as well as seven new sequence types (STs; ST258 and ST406 to ST411) that are all single-locus variants of preexisting STs, except for ST258, which is a double-locus variant of three preexisting STs. The overall level of correspondence between PFGE clusters and emm types was high, with a Wallace coefficient of 0.890, meaning th...

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Group A Streptococci from Carriage and Disease in Portugal: Evolution of Antimicrobial Resistance and T Antigenic Types During 2000–2002

Cited by 19 publications

References 51 publications

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

Clinical and Epidemiological Aspects of Invasive Streptococcus pyogenes Infections in Denmark during 2003 and 2004

Nonoutbreak Surveillance of Group A Streptococci Causing Invasive Disease in Portugal Identified Internationally Disseminated Clones among Members of a Genetically Heterogeneous Population

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