Rapid Emergence of
            <i>emm84</i>
            among Invasive
            <i>Streptococcus pyogenes</i>
            Infections in Finland

Siljander, Tuula; Lyytikäinen, Outi; Vähäkuopus, Susanna; Säilä, Petrus; Jalava, Jari; Vuopio‐Varkila, Jaana

doi:10.1128/jcm.01663-08

Cited by 10 publications

(6 citation statements)

References 30 publications

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“…In our material, all combinations of STs and emm types (Table 1) This was also reflected in a recently published study from Finland, where a rapid emergence of emm-84 strains and a decrease of the highly prevalent emm-28 strains were experienced (50).…”

Section: Discussionsupporting

confidence: 55%

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Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

et al. 2010

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To investigate the epidemiological patterns and genetic characteristics of disease caused by group A Streptococcus (GAS), all available isolates from invasive cases in Norway during 2006 to 2007 (262 isolates) were subjected to antimicrobial susceptibility testing, T serotyping, emm typing, and multilocus sequence typing and screened for known streptococcal pyrogenic exotoxin (Spe) genes, smeZ, and ssa. The average incidence rate was 3.1 cases per 100,000 individuals. The most prevalent sequence types (STs) were STs 52, 28, and 334. In association with emm types 28, 77, and 87, the serotype T-28 comprised 24.8% of the strains. emm types 28, 1, and 82 were dominating. In 2007, a sharp increase in the number of emm-6 strains was noted. All strains were sensitive to penicillin and quinupristin-dalfopristin, while 3.4% and 6.1% of the strains were resistant to macrolides and tetracycline, respectively. Furthermore, the emm-6 strains had intermediate susceptibility to ofloxacin. Isolates displayed a wide variety of gene profiles, as shown by the presence or absence of the Spe genes, smeZ, and ssa, but 48% of the isolates fell into one of three profiles. In most cases, an emm type was restricted to one gene profile. Although the incidence decreased during this study, invasive GAS disease still has a high endemic rate, with involvement of both established and emerging emm types displaying variability in virulence gene profiles as well as differences in gender and age group preferences.

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Section: Discussionsupporting

confidence: 55%

“…The most prominent difference was seen in Finland, where 45% of the strains were emm-28 strains (29). Recently, Finland also reported a rapid change in genotype prevalence caused by the previously uncommon emm type 84 during 2005 to 2007 (50).…”

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confidence: 94%

Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

et al. 2010

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“…We have to remember that our observations are based on very small numbers (3-23 cases per month). During the study, we did not detect any major outbreaks (within time/region/emm type), except for a small increase in cases caused by type emm84 (Siljander et al 2009. J Clin Microbiol 47:477-480).…”

Section: Specific Commentsmentioning

confidence: 71%

Epidemiology, outcome and emm types of invasive group A streptococcal infections in Finland

Siljander

Lyytikäinen

Vähäkuopus

et al. 2010

Eur J Clin Microbiol Infect Dis

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In 2006, Finnish nationwide surveillance showed an increase of invasive group A streptococcal (iGAS) disease and clinicians were alarmed by severe disease manifestations, prompting the investigation of recent trends and outcome for iGAS. A case of iGAS was defined as Streptococcus pyogenes isolated from blood or cerebrospinal fluid. Cases during 1998-2007 and isolates during 2004-2007 were included. Case-patients' 7-day outcome was available for 2004-2007. Isolates were emm typed. A total of 1,318 cases of iGAS were identified. The average annual incidence was 2.5/100,000 population. The rate was higher in males than females in persons aged 45-64 years, but lower in persons aged 25-34 years. The annual incidence was highest in 2007 (3.9/100,000). Occasional peaks occurred during midwinter and midsummer. The most common emm types were 28 (21%), 1 (16%), 84 (10%), 75 (7%) and 89 (6%). During 2004-2007, emm1 replaced emm28 as the most predominant type. The overall case fatality was 8%. Cases with emm1 were associated with high case fatality (14% vs. 8% in other types; p < 0.02); that of emm28 infections was 2% (p < 0.01). Changes in emm type prevalence influenced incidence and case fatality. Differences in age- and sex-specific incidence and seasonal patterns suggest variations in predisposing factors and underlying conditions.

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“…In Finland, during past decades, in addition to emm89 strains, these periodic fluctuations were associated with peaks of disease activity caused by emm 1 [8, 33, 34], emm 28 [8, 11], emm 84 [35], and emm 33 [11, 36] strains. For decades, the reasons behind fluctuations in emm type distribution were considered to be primarily associated with the spread of distinct emm types in immunological naive populations.…”

Section: Discussionmentioning

confidence: 99%

Genomic Characteristics Behind the Spread of Bacteremic Group AStreptococcusTypeemm89 in Finland, 2004–2014

et al. 2016

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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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Rapid Emergence of emm84 among Invasive Streptococcus pyogenes Infections in Finland

Cited by 10 publications

References 30 publications

Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

Epidemiology, outcome and emm types of invasive group A streptococcal infections in Finland

Genomic Characteristics Behind the Spread of Bacteremic Group AStreptococcusTypeemm89 in Finland, 2004–2014

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