Site-Specific Manifestations of Invasive Group A Streptococcal Disease: Type Distribution and Corresponding Patterns of Virulence Determinants

Abstract

As part of a national surveillance program on invasive group A streptococci (GAS), isolates that caused specific manifestations of invasive GAS disease in The Netherlands were collected between 1992 and 1996. These site-specific GAS infections involved meningitis, arthritis, necrotizing fasciitis, and puerperal sepsis. An evaluation was performed to determine whether GAS virulence factors correlate with these different disease manifestations. PCRs were developed to detect 9 genes encoding exotoxins and 12 genes encoding fibronectin binding proteins. The genetic backgrounds of all isolates were determined by M genotyping and pulsed-field gel electrophoresis (PFGE) analysis. The predominant M types included M1, M2, M3, M4, M6, M9, M12, and M28. Most M types were associated with all manifestations of GAS disease. However, M2 was found exclusively in patients with puerperal sepsis, M6 predominated in patients with meningitis, and M12 predominated in patients with GAS arthritis. While characteristic gene profiles were detected in most M types, the resolution of detection of different gene profiles within M genotypes was enhanced by PFGE analysis, which clearly demonstrated the existence of some clonal lineages among invasive GAS isolates in The Netherlands. M1 isolates comprised a single clone carrying highly mitogenic toxin genes (speA, smeZ) and were associated with toxic shock-like syndrome. Toxin profiles were highly conserved among the most virulent strains, such as M1 and M3.

Reemergence of emm 1 and a Changed Superantigen Profile for Group A Streptococci Causing Invasive Infections: Results from a Nationwide Study

“…Two recent European studies investigated correlations between the severity of GAS infections and toxin profiles or genes encoding fibronectin binding protein and concluded that observed differences basically reflected the linkage to certain emm types (36,43). In accordance, we did not identify any of the SAg genes to be significantly associated with STSS or septic shock without STSS.…”

Genetic variation in group A streptococci

“…This was subsequently demonstrated to be due to the association of particular M1 and M3 strains in invasive disease cases in North America and Western Europe (Chatellier, et al, 2000, Cleary, et al, 1992. As some M-types that do not express these particular superantigen are capable of causing invasive disease (Chaussee, et al, 1996, Gorton, et al, 2005, Vlaminckx, et al, 2003) the presence of speA and speC is not the sole predictor of a strains capacity to cause invasive disease. Equally, the absence of these genes can not be used to infer a strain is non-invasive.…”

Group-A-streptococcal meningitis in a 7-year-old child - a rare pathogen in a non-immune compromised patient

“…In a Dutch study on emm types and GAS ABM, emm type 1.0 was one of three most prevalent types in 170 cases. 11 Once GAS is identifi ed as cause of ABM, examination of the ear, nose and throat is required, to rule out a GAS reservoir such as a mastoiditis, an abcess or a fi stula of the central nervous system. 6 The clinical course is, due to the relative low prevalence, less well known than that of other bacteria causing ABM.…”