Strain Prevalence, Rather than Innate Virulence Potential, Is the Major Factor Responsible for an Increase in Serious Group A Streptococcus Infections

Rogers, Sarah; Commons, Robert J; Danchin, Margaret; Selvaraj, Gowri; Kelpie, Loraine; Curtis, Nigel; Robins-Browne, Roy M.; Carapetis, Jonathan R.

doi:10.1086/513875

Cited by 64 publications

(57 citation statements)

References 41 publications

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“…Together, these observations suggest that, rather than being isolated at constant rates, individual emm types and subtypes display features of epidemic behavior, constantly expanding and subsiding as a result of host immune selective pressure. The isolation frequency for emm types from different GAS diseases generally parallels their rate of asymptomatic carriage in the same population (57). However, there are significant associations of some emm types with particular disease manifestations ( Table 1).…”

Section: Epidemiology Of Gas Infectionsmentioning

confidence: 93%

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: Epidemiology Of Gas Infectionsmentioning

confidence: 93%

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

et al. 2014

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“…However, variation among serotypes explains only part of the variation in infection type [11,12,17], the residual typically being ascribed to variation among host individuals. Here we explore another factor that may contribute: bacterial epigenetic regulation of virulence.…”

Section: An Epigenetic Mechanism For Virulence Bistabilitymentioning

confidence: 99%

“…However, some GAS serotypes are biased towards a given infection type, which shows that the bacterium also plays a role in determining the type of infection. For example, the serotypes M1 and M12 are both able to cause all three types of infection, but M1 is overrepresented in symptomatic infections, whereas M12 is more prone to be asymptomatic [11,12]. Similarly, a large study performed at the Centers for Disease Control and Prevention (CDC) found that the M1 serotype was significantly associated with invasive infection, and M12 with noninvasive infection [13].…”

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confidence: 99%

To harm or not to harm? On the evolution and expression of virulence in group A streptococci

Waldetoft

Råberg

2014

Trends in Microbiology

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“…Although many GAS serotypes are capable of causing severe diseases, a few were more frequently isolated from patients with severe cases, e.g., M1, M3, M18, and M28 strains ( Table 2 in online Technical Appendix). However, whether those serotypes cause more severe disease because of their hypervirulence or because they were also the most prevalently isolated strains in the community at that time was not clear (11,12). These possibilities are not mutually exclusive, but in fact may be related.…”

Section: Resurgence Of Severe Invasive Streptococcal Diseases and Emementioning

confidence: 99%

Rise and Persistence of Global M1T1 Clone ofStreptococcus pyogenes

Aziz

Kotb²

2008

Emerg. Infect. Dis.

171

170

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The resurgence of severe invasive group A streptococcal infections in the 1980s is a typical example of the reemergence of an infectious disease. We found that this resurgence is a consequence of the diversifi cation of particular strains of the bacteria. Among these strains is a highly virulent subclone of serotype M1T1 that has exhibited unusual epidemiologic features and virulence, unlike all other streptococcal strains. This clonal strain, commonly isolated from both noninvasive and invasive infection cases, is most frequently associated with severe invasive diseases. Because of its unusual prevalence, global spread, and increased virulence, we investigated the unique features that likely confer its unusual properties. In doing so, we found that the increased virulence of this clonal strain can be attributed to its diversifi cation through phage mobilization and its ability to sense and adapt to different host environments; accordingly, the fi ttest members of this diverse bacterial community are selected to survive and invade host tissue.

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Strain Prevalence, Rather than Innate Virulence Potential, Is the Major Factor Responsible for an Increase in Serious Group A Streptococcus Infections

Cited by 64 publications

References 41 publications

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

To harm or not to harm? On the evolution and expression of virulence in group A streptococci

Rise and Persistence of Global M1T1 Clone ofStreptococcus pyogenes

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