An apparent worldwide resurgence of invasive group A Streptococcus (GAS) infections remains unexplained. However, we recently demonstrated in mice that when an otherwise nonlethal intranasal GAS infection is preceded by a nonlethal influenza A virus (IAV) infection, induction of lethal invasive GAS infections is often the result. In the present study, we established several isogenic mutants from a GAS isolate and evaluated several virulence factors as candidates responsible for the induction of invasive GAS infections. Disruption of the synthesis of the capsule, Mga, streptolysin O, streptolysin S, or streptococcal pyrogenic exotoxin B of GAS significantly reduced mortality among mice superinfected with IAV and a mutant. In addition, the number of GAS organisms adhering to IAV-infected alveolar epithelial cells was markedly reduced with the capsuledepleted mutant, although this was not the case with the other mutants. Wild-type GAS was found to bind directly to IAV particles, whereas the nonencapsulated mutant showed much less ability to bind. These results suggest that the capsule plays a key role in the invasion of host tissues by GAS following superinfection with IAV and GAS.Streptococcus pyogenes (group A Streptococcus [GAS]) is known to be the cause of such diseases as uncomplicated pharyngitis, impetigo, and acute rheumatic fever (10). In addition, severe invasive GAS infections, leading to a wide range of diverse diseases that include acute respiratory distress syndrome, renal failure, streptococcal toxic shock syndrome, sepsis, and cellulitis, have been reported in North America, Europe, and Japan (4,23,30,35,41). GAS invades the host via the upper respiratory tract or injured skin surfaces (10). Although many invasive GAS isolates are reportedly of the M1 or M3 serotype, which produce streptococcal pyrogenic exotoxin A (10), the reasons for the recent emergence, or reemergence, of invasive GAS infections remain unknown.Statistically, the incidence of GAS infections is highest in winter, when influenza epidemics are common (5,12,28). In that regard, we recently used a mouse model to show that superinfection with influenza A virus (IAV) and GAS applied intranasally causes a lethal GAS infection that affects various tissues and organs of the host (32). In that study, GAS organisms adhered to the surface of IAV-infected alveolar epithelial cells of superinfected mice, although no GAS adhered to epithelial cells of mice infected with GAS alone. Moreover, our electron microscopic observations confirmed that GAS organisms bind directly to IAV particles on the cell surfaces. Taken together, these results suggest that IAV infection plays a key role in the enhanced internalization of GAS by alveolar epithelial cells, resulting in the emergence of sepsis and other invasive GAS diseases. Beyond this, however, little is known about the mechanisms via which invasive IAV-GAS superinfections occur.Ashbaugh et al. (3) established a murine model of human necrotizing fasciitis and concluded that the GAS hyaluronic acid ca...