1
|
Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P. Toxic Shock Syndrome: A Literature Review. Antibiotics (Basel) 2024; 13:96. [PMID: 38247655 PMCID: PMC10812596 DOI: 10.3390/antibiotics13010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in this review. Bacterial superantigenic exotoxins induces unconventional polyclonal lymphocyte activation, which leads to rapid shock, multiple organ failure syndrome, and death. The main described superantigenic exotoxins are toxic shock syndrome toxin-1 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes. Staphylococcal TSS can be menstrual or nonmenstrual. Streptococcal TSS is linked to a severe group A streptococcal infection and, most frequently, to a necrotizing soft tissue infection. Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. The interest of polyclonal intravenous immunoglobulin G administration as an adjunctive treatment for TSS requires further evaluation. Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease.
Collapse
Affiliation(s)
- Enora Atchade
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
| | - Christian De Tymowski
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- INSERM UMR 1149, Immunoreceptor and Renal Immunopathology, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Nathalie Grall
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- Bacteriology Department, Bichat Claude Bernard Hospital, AP-HP, Paris Cité University, 75018 Paris, France
- INSERM UMR 1137 Infection, Antimicrobials, Modelling, Evolution, 75018 Paris, France
| | - Sébastien Tanaka
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- INSERM, UMR 1188, Diabetes Atherothrombosis Réunion Océan Indien (DéTROI), la Réunion University, 97400 Saint-Denis de la Réunion, France
| | - Philippe Montravers
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- INSERM UMR 1152 ANR 10—LABX-17, Pathophysiology and Epidemiology of Respiratory Diseases, 75018 Paris, France
| |
Collapse
|
2
|
Plainvert C, Rosinski-Chupin I, Weckel A, Lambert C, Touak G, Sauvage E, Poyart C, Glaser P, Fouet A. A Novel CovS Variant Harbored by a Colonization Strain Reduces Streptococcus pyogenes Virulence. J Bacteriol 2023; 205:e0003923. [PMID: 36920220 PMCID: PMC10127592 DOI: 10.1128/jb.00039-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 03/16/2023] Open
Abstract
Streptococcus pyogenes, also known as group A Streptococcus, causes a wide variety of diseases ranging from mild noninvasive to severe invasive infections. To identify possible causes of colonization-to-invasive switches, we determined the genomic sequences of 10 isolates from five pairs each composed of an invasive strain and a carriage strain originating from five infectious clusters. Among them, one pair displayed a single-nucleotide difference in covS, encoding the sensor histidine kinase of the two-component CovRS system that controls the expression of 15% of the genome. In contrast to previously described cases where the invasive strains harbor nonfunctional CovS proteins, the carriage strain possessed the mutation covST115C, leading to the replacement of the tyrosine at position 39 by a histidine. The CovSY39H mutation affected the expression of the genes from the CovR regulon in a unique fashion. Genes usually overexpressed in covS mutant strains were underexpressed and vice versa. Furthermore, the covS mutant strain barely responded to the addition of the CovS-signaling compounds Mg2+ and LL-37. The variations in the accumulation of two virulence factors paralleled the transcription modifications. In addition, the covST115C mutant strain showed less survival than its wild-type counterpart in murine macrophages. Finally, in two murine models of infection, the covS mutant strain was less virulent than the wild-type strain. Our study suggests that the CovSY39H protein compromises CovS phosphatase activity and that this yields a noninvasive strain. IMPORTANCE Streptococcus pyogenes, also known as group A Streptococcus, causes a wide variety of diseases, leading to 517,000 deaths yearly. The two-component CovRS system, which responds to MgCl2 and the antimicrobial peptide LL-37, controls the expression of 15% of the genome. Invasive strains may harbor nonfunctional CovS sensor proteins that lead to the derepression of most virulence genes. We isolated a colonization strain that harbors a novel covS mutation. This mutant strain harbored a transcriptome profile opposite that of other covS mutant strains, barely responded to environmental signals, and was less virulent than the wild-type strain. This supports the importance of the derepression of the expression of most virulence genes, via mutations that impact the phosphorylation of the regulator CovR, for favoring S. pyogenes invasive infections.
Collapse
Affiliation(s)
- Céline Plainvert
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Service de Bactériologie, CNR des Streptocoques, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Isabelle Rosinski-Chupin
- Institut Pasteur, Ecologie et Evolution de la Résistance aux Antibiotiques, UMR3525, Paris, France
| | - Antonin Weckel
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Clara Lambert
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Gérald Touak
- Service de Bactériologie, CNR des Streptocoques, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Elisabeth Sauvage
- Institut Pasteur, Ecologie et Evolution de la Résistance aux Antibiotiques, UMR3525, Paris, France
| | - Claire Poyart
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Service de Bactériologie, CNR des Streptocoques, Hôpitaux Universitaires Paris Centre, Paris, France
| | - Philippe Glaser
- Institut Pasteur, Ecologie et Evolution de la Résistance aux Antibiotiques, UMR3525, Paris, France
| | - Agnès Fouet
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Service de Bactériologie, CNR des Streptocoques, Hôpitaux Universitaires Paris Centre, Paris, France
| |
Collapse
|
3
|
Hua C, Urbina T, Bosc R, Parks T, Sriskandan S, de Prost N, Chosidow O. Necrotising soft-tissue infections. THE LANCET. INFECTIOUS DISEASES 2023; 23:e81-e94. [PMID: 36252579 DOI: 10.1016/s1473-3099(22)00583-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022]
Abstract
The incidence of necrotising soft-tissue infections has increased during recent decades such that most physicians might see at least one case of these potentially life-threatening infections in their career. Despite advances in care, necrotising soft-tissue infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. In particular, failure to suspect necrotising soft-tissue infections, fuelled by poor awareness of the disease, promotes delays to first surgical debridement, amplifying disease severity and adverse outcomes. This Review will focus on practical approaches to management of necrotising soft-tissue infections including prompt recognition, initiation of specific management, exploratory surgery, and aftercare. Increased alertness and awareness for these infections should improve time to diagnosis and early referral to specialised centres, with improvement in the prognosis of necrotising soft-tissue infections.
Collapse
Affiliation(s)
- Camille Hua
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Créteil, France; Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris Est Créteil, Créteil, France; Groupe Infectiologie Dermatologique-Infections Sexuellement Transmissibles, Société Française de Dermatologie, Paris, France
| | - Tomas Urbina
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Bosc
- Service de Chirurgie Plastique, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Tom Parks
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Shiranee Sriskandan
- Department of Infectious Diseases, Imperial College London, London, UK; MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Créteil, France; CARMAS Research Group, UPEC-Université Paris-Est Créteil Val de Marne, Faculté de médecine de Créteil, Créteil, France
| | - Olivier Chosidow
- Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Créteil, France; Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Groupe Infectiologie Dermatologique-Infections Sexuellement Transmissibles, Société Française de Dermatologie, Paris, France; Research group Dynamyc, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France.
| |
Collapse
|
4
|
Thomson TN, Campbell PT, Gibney KB. The epidemiology of invasive group A streptococcal disease in Victoria, 2007-2017: an analysis of linked datasets. Aust N Z J Public Health 2022; 46:878-883. [PMID: 35980150 DOI: 10.1111/1753-6405.13290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the incidence and severity of invasive group A streptococcal disease (iGAS) in Victoria, Australia. METHODS Retrospective analysis of iGAS cases identified in linked datasets, 2007-2017: laboratory data from the Victorian Hospital Pathogen Surveillance Scheme; hospitalisation data from the Victorian Admitted Episodes Dataset; and deaths reported by the Australian Coordinating Registry. RESULTS There were 1,369 confirmed and 610 probable cases of iGAS identified from 2007 to 2017 in Victoria, Australia. The median annual incidence was 3.1 (range 2.4-5.2) per 100,000 population. The incidence was highest in 2017, with 5.2 (95%CI: 4.6-5.8) cases per 100,000 population. The median length of stay in hospital was 10 days, with 33.1% (578/1,744) of cases admitted to the intensive care unit, of whom 49.5% (286/578) were mechanically ventilated. The case fatality rate was 5.6% (110/1,979), reaching 13.5% (51/378) among those aged 75 years or older. CONCLUSIONS There was an increased incidence of iGAS in 2017 in Victoria, with substantial healthcare utilisation and a high case fatality rate among older Victorians. IMPLICATIONS FOR PUBLIC HEALTH These data support mandatory notification of iGAS, which will enable better characterisation of the disease, rapid identification of changes in epidemiology and targeted public health responses.
Collapse
Affiliation(s)
- Tilda Nell Thomson
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Patricia Therese Campbell
- Department of Infectious Diseases, University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, Victoria
| | - Katherine B Gibney
- The University of Melbourne and The Royal Melbourne Hospital, at The Peter Doherty Institute for Infection and Immunity, Victoria
| |
Collapse
|
5
|
Bouchiat C, Ginevra C, Benito Y, Gaillard T, Salord H, Dauwalder O, Laurent F, Vandenesch F. Improving the Diagnosis of Bacterial Infections: Evaluation of 16S rRNA Nanopore Metagenomics in Culture-Negative Samples. Front Microbiol 2022; 13:943441. [PMID: 35910644 PMCID: PMC9329087 DOI: 10.3389/fmicb.2022.943441] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
While 16S rRNA PCR-Sanger sequencing has paved the way for the diagnosis of culture-negative bacterial infections, it does not provide the composition of polymicrobial infections. We aimed to evaluate the performance of the Nanopore-based 16S rRNA metagenomic approach, using both partial and full-length amplification of the gene, and to explore its feasibility and suitability as a routine diagnostic tool for bacterial infections in a clinical laboratory. Thirty-one culture-negative clinical samples from mono- and polymicrobial infections based on Sanger-sequencing results were sequenced on MinION using both the in-house partial amplification and the Nanopore dedicated kit for the full-length amplification of the 16S rRNA gene. Contamination, background noise definition, bacterial identification, and time-effectiveness issues were addressed. Cost optimization was also investigated with the miniaturized version of the flow cell (Flongle). The partial 16S approach had a greater sensitivity compared to the full-length kit that detected bacterial DNA in only 24/31 (77.4%) samples. Setting a threshold of 1% of total reads overcame the background noise issue and eased the interpretation of clinical samples. Results were obtained within 1 day, discriminated polymicrobial samples, and gave accurate bacterial identifications compared to Sanger-based results. We also found that multiplexing and using Flongle flow cells was a cost-effective option. The results confirm that Nanopore technology is user-friendly as well as cost- and time-effective. They also indicate that 16S rRNA targeted metagenomics is a suitable approach to be implemented for the routine diagnosis of culture-negative samples in clinical laboratories.
Collapse
Affiliation(s)
- Coralie Bouchiat
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France
- Equipe Inserm U1111, Centre International de Recherche en Infectiologie, Université de Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
- *Correspondence: Coralie Bouchiat
| | - Christophe Ginevra
- Centre National de Référence des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Yvonne Benito
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France
| | - Tiphaine Gaillard
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France
- Laboratoire de biologie médicale, Hôpital d'Instruction des Armées Desgenettes, Service de Santé des Armées, Lyon, France
| | - Hélène Salord
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France
| | - Olivier Dauwalder
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France
- Equipe Inserm U1111, Centre International de Recherche en Infectiologie, Université de Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - François Vandenesch
- Laboratoire de Bactériologie, Institut des Agents Infectieux, Biologie Moléculaire, Hospices Civils de Lyon, Lyon, France
- Equipe Inserm U1111, Centre International de Recherche en Infectiologie, Université de Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| |
Collapse
|
6
|
Pawlowski A, Lannergård J, Gonzalez-Miro M, Cao D, Larsson S, Persson JJ, Kitson G, Darsley M, Rom AL, Hedegaard M, Fischer PB, Johansson-Lindbom B. A group B Streptococcus alpha-like protein subunit vaccine induces functionally active antibodies in humans targeting homotypic and heterotypic strains. Cell Rep Med 2022; 3:100511. [PMID: 35243418 PMCID: PMC8861819 DOI: 10.1016/j.xcrm.2022.100511] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/17/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022]
Abstract
Maternal vaccination is a promising strategy for preventing neonatal disease caused by group B Streptococcus. The safety and immunogenicity of the prototype vaccine GBS-NN, a fusion protein consisting of the N-terminal domains of the alpha-like proteins (Alp) αC and Rib, were recently evaluated favorably in healthy adult women in a phase 1 trial. Here we demonstrate robust immunoglobulin G (IgG) and immunoglobulin A (IgA) responses against αC and Rib, as well as against the heterotypic Alp family members Alp1–Alp3. IgA and heterotypic IgG responses are more variable between subjects and correlate with pre-existing immunity. Vaccine-induced IgG mediates opsonophagocytic killing and prevents bacterial invasion of epithelial cells. Like the vaccine-induced response, naturally acquired IgG against the vaccine domains is dominated by IgG1. Consistent with the high IgG1 cross-placental transfer rate, naturally acquired IgG against both domains reaches higher concentrations in neonatal than maternal blood, as assessed in a separate group of non-vaccinated pregnant women and their babies. GBS-NN subunit vaccine broadly elicits IgG1 to homotypic αC and Rib N-terminal domains IgA and heterotypic IgG responses occur in vaccinees with pre-existing immunity Abs mediate opsonophagocytic killing and prevent bacterial epithelial cell invasion IgG against αC-N and Rib-N is transferred efficiently across the placenta
Collapse
Affiliation(s)
| | - Jonas Lannergård
- Immunology Section, BMC D14, Lund University, 221 84 Lund, Sweden
| | | | - Duojia Cao
- Immunology Section, BMC D14, Lund University, 221 84 Lund, Sweden
| | - Sara Larsson
- Immunology Section, BMC D14, Lund University, 221 84 Lund, Sweden
| | - Jenny J Persson
- Immunology Section, BMC D14, Lund University, 221 84 Lund, Sweden
| | - Geoff Kitson
- Minervax A/S, Ole Maaløes Vej 3, 2200 Copenhagen N, Denmark
| | | | - Ane Lilleøre Rom
- Department of Obstetrics, the Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark.,The Research Unit for Women's and Children's Health, the Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Morten Hedegaard
- Department of Obstetrics, the Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Per B Fischer
- Minervax A/S, Ole Maaløes Vej 3, 2200 Copenhagen N, Denmark
| | - Bengt Johansson-Lindbom
- Immunology Section, BMC D14, Lund University, 221 84 Lund, Sweden.,Minervax A/S, Ole Maaløes Vej 3, 2200 Copenhagen N, Denmark
| |
Collapse
|
7
|
Yamaba Y, Takakuwa O, Ida C, Saito M, Kawae D, Yoshihara M, Kunii E, Imaeda K, Tatsuno I, Hasegawa T, Akita K. Streptococcal Toxic Shock Syndrome Induced by Group A Streptococcus with the emm28 Genotype That Developed after a Uterine Cancer Test. Intern Med 2021; 60:3481-3483. [PMID: 33994434 PMCID: PMC8627819 DOI: 10.2169/internalmedicine.6290-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 69-year-old woman without pre-existing disease visited our hospital due to general malaise, diarrhea, and arthralgia 3 days after a uterine cancer test. We diagnosed her with sepsis of unknown focus and started treatment immediately, but she died 20 hours after the first visit due to multi-organ failure and septic shock. Later, group A streptococcus was detected from the blood culture, and streptococcal toxic shock syndrome (STSS) was diagnosed. The strain had the emm28 genotype and a mutation in csrR with increased NADase activity. These virulence factors were considered to be related to STSS development in this patient.
Collapse
Affiliation(s)
- Yusuke Yamaba
- Department of Respiratory Medicine, Nagoya City University West Medical Center, Japan
| | - Osamu Takakuwa
- Department of Respiratory Medicine, Nagoya City University West Medical Center, Japan
- Department of Education and Research Center for Advanced Medicine, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Chiaki Ida
- Nagoya City University Medical School, Japan
| | - Manami Saito
- Department of Respiratory Medicine, Nagoya City University West Medical Center, Japan
| | - Daisuke Kawae
- Department of Respiratory Medicine, Nagoya City University West Medical Center, Japan
| | - Misuzu Yoshihara
- Department of Respiratory Medicine, Nagoya City University West Medical Center, Japan
| | - Eiji Kunii
- Department of Respiratory Medicine, Nagoya City University West Medical Center, Japan
| | - Kenro Imaeda
- Department of Endocrinology and Diabetes, Nagoya City University West Medical Center, Japan
| | - Ichiro Tatsuno
- Department of Bacteriology, Nagoya City University Graduate School of Medical Science, Japan
| | - Tadao Hasegawa
- Department of Bacteriology, Nagoya City University Graduate School of Medical Science, Japan
| | - Kenji Akita
- Department of Respiratory Medicine, Nagoya City University West Medical Center, Japan
| |
Collapse
|
8
|
Kuo CF, Chen WY, Yu HH, Tsai YH, Chang YC, Chang CP, Tsao N. IL-33/ST2 Axis Plays a Protective Effect in Streptococcus pyogenes Infection through Strengthening of the Innate Immunity. Int J Mol Sci 2021; 22:10566. [PMID: 34638904 PMCID: PMC8509005 DOI: 10.3390/ijms221910566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 12/21/2022] Open
Abstract
Group A Streptococcus (GAS) causes invasive human diseases with the cytokine storm. Interleukin-33 (IL-33)/suppression of tumorigenicity 2 (ST2) axis is known to drive TH2 response, while its effect on GAS infection is unclear. We used an air pouch model to examine the effect of the IL-33/ST2 axis on GAS-induced necrotizing fasciitis. GAS infection induced IL-33 expression in wild-type (WT) C57BL/6 mice, whereas the IL-33- and ST2-knockout mice had higher mortality rates, more severe skin lesions and higher bacterial loads in the air pouches than those of WT mice after infection. Surveys of infiltrating cells in the air pouch of GAS-infected mice at the early stage found that the number and cell viability of infiltrating cells in both gene knockout mice were lower than those of WT mice. The predominant effector cells in GAS-infected air pouches were neutrophils. Absence of the IL-33/ST2 axis enhanced the expression of inflammatory cytokines, but not TH1 or TH2 cytokines, in the air pouch after infection. Using in vitro assays, we found that the IL-33/ST2 axis not only enhanced neutrophil migration but also strengthened the bactericidal activity of both sera and neutrophils. These results suggest that the IL-33/ST2 axis provided the protective effect on GAS infection through enhancing the innate immunity.
Collapse
Affiliation(s)
- Chih-Feng Kuo
- School of Medicine, I-Shou University, Kaohsiung City 824005, Taiwan;
- Department of Nursing, College of Medicine, I-Shou University, Kaohsiung City 824005, Taiwan
| | - Wei-Yu Chen
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 833401, Taiwan;
| | - Hai-Han Yu
- Department of Biological Science and Technology, College of Medical Science and Technology, I-Shou University, Kaohsiung City 824005, Taiwan; (H.-H.Y.); (Y.-H.T.)
| | - Yu-Hsuan Tsai
- Department of Biological Science and Technology, College of Medical Science and Technology, I-Shou University, Kaohsiung City 824005, Taiwan; (H.-H.Y.); (Y.-H.T.)
| | - Ya-Chu Chang
- Department of Medical Laboratory Science, College of Medical Science and Technology, I-Shou University, Kaohsiung City 824005, Taiwan;
| | - Chih-Peng Chang
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan;
- The Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
| | - Nina Tsao
- Department of Biological Science and Technology, College of Medical Science and Technology, I-Shou University, Kaohsiung City 824005, Taiwan; (H.-H.Y.); (Y.-H.T.)
- Department of Medical Laboratory Science, College of Medical Science and Technology, I-Shou University, Kaohsiung City 824005, Taiwan;
| |
Collapse
|
9
|
Fay K, Onukwube J, Chochua S, Schaffner W, Cieslak P, Lynfield R, Muse A, Smelser C, Harrison LH, Farley M, Petit S, Alden N, Apostal M, Vagnone PS, Nanduri S, Beall B, Van Beneden CA. Patterns of antibiotic nonsusceptibility among invasive group A Streptococcus infections-United States, 2006-2017. Clin Infect Dis 2021; 73:1957-1964. [PMID: 34170310 DOI: 10.1093/cid/ciab575] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Treatment of severe group A streptococcal infections requires timely and appropriate antibiotic therapy. We describe the epidemiology of antimicrobial-resistant invasive group A streptococcal (iGAS) infections in the U.S. METHODS We analyzed population-based iGAS surveillance data at 10 U.S. sites from 2006-2017. Cases were defined as infection with GAS isolated from normally sterile sites or wounds in patients with necrotizing fasciitis or streptococcal toxic shock syndrome. GAS isolates were emm typed. Antimicrobial susceptibility was determined using broth microdilution or whole genome sequencing. We compared characteristics among patients infected with erythromycin nonsusceptible (EryNS) and clindamycin nonsusceptible (CliNS) strains to those with susceptible infections. We analyzed proportions of EryNS and CliNS among isolates by site, year, risk factors and emm type. RESULTS Overall, 17,179 iGAS cases were reported; 14.5% were EryNS. Among isolates tested for both inducible and constitutive CliNS (2011-2017), 14.6% were CliNS. Most (99.8%) CliNS isolates were EryNS. Resistance was highest in 2017 (EryNS: 22.8%; CliNS: 22.0%). All isolates were susceptible to beta-lactams. EryNS and CliNS infections were most frequent among persons aged 18-34 years and in persons residing in long-term care facilities, experiencing homelessness, incarcerated, or who injected drugs. Patterns varied by site. Patients with nonsusceptible infections were significantly less likely to die. Emm types with >30% EryNS or CliNS included: 77, 58, 11, 83, 92. CONCLUSION Increasing prevalence of EryNS and CliNS iGAS infections in the U.S. is predominantly due to expansion of several emm types. Clinicians should consider local resistance patterns when treating iGAS infections.
Collapse
Affiliation(s)
- Katherine Fay
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
| | | | - Sopio Chochua
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
| | | | - Paul Cieslak
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Alison Muse
- New York State Department of Health, Emerging Infections Program, Rochester, New York, USA
| | - Chad Smelser
- New Mexico Department of Health, Santa Fe, New Mexico, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Monica Farley
- Emerging Infections Program, Emory University, Atlanta, Georgia, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford Connecticut, USA
| | - Nisha Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | | | | | | | - Bernard Beall
- Respiratory Diseases Branch, CDC, Atlanta, Georgia, USA
| | | |
Collapse
|
10
|
Adigbli D, Rozen V, Darbar A, Janin P. Early intravenous immunoglobulin therapy for group A β-haemolytic streptococcal meningitis with toxic shock syndrome. BMJ Case Rep 2021; 14:e238472. [PMID: 33664027 PMCID: PMC7934773 DOI: 10.1136/bcr-2020-238472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 11/03/2022] Open
Abstract
A woman in her forties was transferred to a Sydney (Australia)-based tertiary hospital, following presentation to a regional hospital with group A Streptococcus (GAS) otomastoiditis; complicated by meningitis, venous sinus thrombosis, haemorrhagic cerebral infarction and subdural empyema. She rapidly deteriorated with profound cardiovascular collapse. Despite initiation of high dose vasoactive therapy, she remained shocked and developed multiorgan dysfunction syndrome. Early intravenous immunoglobulin therapy (140 g in two doses) was initiated as an adjunct to antimicrobial, surgical and supportive care for refractory streptococcal toxic shock syndrome. Over the course of a twelve-day intensive care unit stay she made good progress with de-escalation of her vasoactive supportive care and reversal of her organ injuries. She was subsequently discharged to ward-based care. At her three-month follow-up appointment she had significantly reduced neurological deficit. Five months following her presentation to hospital she had returned to full-time work.
Collapse
Affiliation(s)
- Derick Adigbli
- Intensive Care Unit, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Valerie Rozen
- Haematology, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Archie Darbar
- Microbiology, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Pierre Janin
- Intensive Care Unit, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| |
Collapse
|
11
|
Weckel A, Guilbert T, Lambert C, Plainvert C, Goffinet F, Poyart C, Méhats C, Fouet A. Streptococcus pyogenes infects human endometrium by limiting the innate immune response. J Clin Invest 2021; 131:130746. [PMID: 33320843 DOI: 10.1172/jci130746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/10/2020] [Indexed: 11/17/2022] Open
Abstract
Group A Streptococcus (GAS), a Gram-positive human-specific pathogen, yields 517,000 deaths annually worldwide, including 163,000 due to invasive infections and among them puerperal fever. Before efficient prophylactic measures were introduced, the mortality rate for mothers during childbirth was approximately 10%; puerperal fever still accounts for over 75,000 maternal deaths annually. Yet, little is known regarding the factors and mechanisms of GAS invasion and establishment in postpartum infection. We characterized the early steps of infection in an ex vivo infection model of the human decidua, the puerperal fever portal of entry. Coordinate analysis of GAS behavior and the immune response led us to demonstrate that (a) GAS growth was stimulated by tissue products; (b) GAS invaded tissue and killed approximately 50% of host cells within 2 hours, and these processes required SpeB protease and streptolysin O (SLO) activities, respectively; and (c) GAS impaired the tissue immune response. Immune impairment occurred both at the RNA level, with only partial induction of the innate immune response, and protein level, in an SLO- and SpeB-dependent manner. Our study indicates that efficient GAS invasion of the decidua and the restricted host immune response favored its propensity to develop rapid invasive infections in a gynecological-obstetrical context.
Collapse
Affiliation(s)
- Antonin Weckel
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Département Hospitalo-Universitaire Risk & Pregnancy, Port Royal Maternity, Paris, France
| | - Thomas Guilbert
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Clara Lambert
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Département Hospitalo-Universitaire Risk & Pregnancy, Port Royal Maternity, Paris, France
| | - Céline Plainvert
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Département Hospitalo-Universitaire Risk & Pregnancy, Port Royal Maternity, Paris, France.,Centre National de Référence des Streptocoques.,Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris
| | - François Goffinet
- Département Hospitalo-Universitaire Risk & Pregnancy, Port Royal Maternity, Paris, France.,Faculté de Médecine, Université Paris Descartes, and.,Service de Gynécologie Obstétrique I, Maternité Port Royal, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claire Poyart
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Département Hospitalo-Universitaire Risk & Pregnancy, Port Royal Maternity, Paris, France.,Centre National de Référence des Streptocoques.,Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris
| | - Céline Méhats
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Département Hospitalo-Universitaire Risk & Pregnancy, Port Royal Maternity, Paris, France
| | - Agnès Fouet
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Département Hospitalo-Universitaire Risk & Pregnancy, Port Royal Maternity, Paris, France.,Centre National de Référence des Streptocoques
| |
Collapse
|
12
|
Rafei R, Hawli M, Osman M, Khelissa S, Salloum T, Dabboussi F, Tokajian S, Hamze M. Molecular epidemiology of nonpharyngeal group A streptococci isolates in northern Lebanon. Future Microbiol 2020; 15:1555-1569. [PMID: 33236928 DOI: 10.2217/fmb-2020-0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: To characterize the epidemiology of group A Streptococcus (GAS) involved in nonpharyngeal infections sparingly addressed in Lebanon. Materials & methods: A collection of 63 nonpharyngeal GAS isolates recovered between 2010 and 2019 from northern Lebanon were analyzed through emm typing, virulence gene profiling, FCT typing and antibiotic susceptibility analysis. Results & conclusion: A total of 29 emm subtypes was detected, with emm1 being the most dominant. A great intraclonal divergence driven by the loss and gain of superantigens or by the structural variability within the FCT regions was unraveled. The resistance rates for erythromycin and tetracycline were 8 and 20.6%, respectively. The 30-valent vaccine coverage was 76%. This study evidences the complexity of the neglected GAS pathogen in Lebanon.
Collapse
Affiliation(s)
- Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| | - Malaik Hawli
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| | - Simon Khelissa
- Université de Lille, Centre National de la Recherche Scientifique, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centrale Lille, Unité Mixte de Recherche 8207 - Unité Matériaux et Transformations, Lille, 59000, France
| | - Tamara Salloum
- Department of Natural Sciences, School of Arts & Sciences, Lebanese American University, Byblos campus, Postal Box 36, Byblos, 1401, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| | - Sima Tokajian
- Department of Natural Sciences, School of Arts & Sciences, Lebanese American University, Byblos campus, Postal Box 36, Byblos, 1401, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, 1300, Lebanon
| |
Collapse
|
13
|
Eraso JM, Kachroo P, Olsen RJ, Beres SB, Zhu L, Badu T, Shannon S, Cantu CC, Saavedra MO, Kubiak SL, Porter AR, DeLeo FR, Musser JM. Genetic heterogeneity of the Spy1336/R28-Spy1337 virulence axis in Streptococcus pyogenes and effect on gene transcript levels and pathogenesis. PLoS One 2020; 15:e0229064. [PMID: 32214338 PMCID: PMC7098570 DOI: 10.1371/journal.pone.0229064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Streptococcus pyogenes is a strict human pathogen responsible for more than 700 million infections annually worldwide. Strains of serotype M28 S. pyogenes are typically among the five more abundant types causing invasive infections and pharyngitis in adults and children. Type M28 strains also have an unusual propensity to cause puerperal sepsis and neonatal disease. We recently discovered that a one-nucleotide indel in an intergenic homopolymeric tract located between genes Spy1336/R28 and Spy1337 altered virulence in a mouse model of infection. In the present study, we analyzed size variation in this homopolymeric tract and determined the extent of heterogeneity in the number of tandemly-repeated 79-amino acid domains in the coding region of Spy1336/R28 in large samples of strains recovered from humans with invasive infections. Both repeat sequence elements are highly polymorphic in natural populations of M28 strains. Variation in the homopolymeric tract results in (i) changes in transcript levels of Spy1336/R28 and Spy1337 in vitro, (ii) differences in virulence in a mouse model of necrotizing myositis, and (iii) global transcriptome changes as shown by RNAseq analysis of isogenic mutant strains. Variation in the number of tandem repeats in the coding sequence of Spy1336/R28 is responsible for size variation of R28 protein in natural populations. Isogenic mutant strains in which genes encoding R28 or transcriptional regulator Spy1337 are inactivated are significantly less virulent in a nonhuman primate model of necrotizing myositis. Our findings provide impetus for additional studies addressing the role of R28 and Spy1337 variation in pathogen-host interactions.
Collapse
Affiliation(s)
- Jesus M. Eraso
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Priyanka Kachroo
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Randall J. Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
- Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Stephen B. Beres
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Luchang Zhu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Traci Badu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Sydney Shannon
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Concepcion C. Cantu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Matthew Ojeda Saavedra
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Samantha L. Kubiak
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Adeline R. Porter
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
| | - Frank R. DeLeo
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
| | - James M. Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
- Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| |
Collapse
|
14
|
Matsue M, Ogura K, Sugiyama H, Miyoshi-Akiyama T, Takemori-Sakai Y, Iwata Y, Wada T, Okamoto S. Pathogenicity Characterization of Prevalent-Type Streptococcus dysgalactiae subsp. equisimilis Strains. Front Microbiol 2020; 11:97. [PMID: 32117127 PMCID: PMC7010647 DOI: 10.3389/fmicb.2020.00097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/17/2020] [Indexed: 12/26/2022] Open
Abstract
Streptococcus dysgalactiae subsp. equisimilis (SDSE) is an emerging human pathogen that causes severe invasive streptococcal diseases. Recent reports have shown that SDSE exhibits high pathogenicity with different mechanisms from that of Streptococcus pyogenes, although the two streptococci possess some common virulence factors such as streptolysin, streptokinase, and cell-binding proteins. To date, only a few studies have examined the variety of mechanisms expressing the pathogenicity of SDSE. Among nine SDSE clinical isolates sequenced in this study, we present in vitro and in vivo analyses of KNZ01 and KNZ03, whose emm and multilocus species types (MLSTs) are prevalent in Japan and other countries. For the comparison of pathogenicity, we also utilized the ATCC 12394 strain. The whole-genome analysis showed that KNZ03 and ATCC 12394 are categorized into an identical clonal complex by MLST and are phylogenetically close. However, the three strains exhibited different characteristics for pathogenicity in vitro; ATCC 12394 showed significant cytotoxicity to human keratinocytes and release of streptolysin O (SLO) compared to KNZ01 and KNZ03; KNZ03 exhibited significantly high hemolytic activity, but did not secrete SLO. KNZ01 and KNZ03 adhered to human keratinocytes at a higher rate than ATCC 12394; KNZ03 showed a higher rate of survival after a brief (30 min) incubation with human neutrophils compared to the other two strains; also, KNZ01 grew more rapidly in the presence of human serum. In vivo subcutaneous infection commonly resulted in ulcer formation in the three strains 7 days after infection. KNZ01-infected mice showed significant body weight loss 2 days after infection. Besides, on post-infection day 2, only KNZ01 remained in the cutaneous tissues of mice. Scanning electron microscopy analysis revealed that KNZ01 formed an extracellular structure (biofilm), which was probably composed of cell wall-anchoring proteins, in the presence of glucose and human serum. The extracellular structure of ATCC 12394 was also changed dramatically in response to culture conditions, whereas that of KNZ03 did not. Our study proposed that each SDSE strain possesses different virulence factors characteristics for mediating pathogenicity in humans.
Collapse
Affiliation(s)
- Miki Matsue
- Department of Clinical Laboratory Science, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kohei Ogura
- Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
| | - Hironori Sugiyama
- Division of Instrumental Analysis, Engineering and Technology Department, Kanazawa University, Kanazawa, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Shinjuku, Japan
| | - Yukiko Takemori-Sakai
- Division of Clinical Laboratory Medicine, Kanazawa University, Kanazawa, Japan.,Division of Infection Control, Kanazawa University, Kanazawa, Japan
| | - Yasunori Iwata
- Division of Infection Control, Kanazawa University, Kanazawa, Japan.,Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Takashi Wada
- Division of Clinical Laboratory Medicine, Kanazawa University, Kanazawa, Japan.,Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Shigefumi Okamoto
- Department of Clinical Laboratory Science, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
15
|
Kachroo P, Eraso JM, Olsen RJ, Zhu L, Kubiak SL, Pruitt L, Yerramilli P, Cantu CC, Ojeda Saavedra M, Pensar J, Corander J, Jenkins L, Kao L, Granillo A, Porter AR, DeLeo FR, Musser JM. New Pathogenesis Mechanisms and Translational Leads Identified by Multidimensional Analysis of Necrotizing Myositis in Primates. mBio 2020; 11:e03363-19. [PMID: 32071274 PMCID: PMC7029145 DOI: 10.1128/mbio.03363-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 01/08/2023] Open
Abstract
A fundamental goal of contemporary biomedical research is to understand the molecular basis of disease pathogenesis and exploit this information to develop targeted and more-effective therapies. Necrotizing myositis caused by the bacterial pathogen Streptococcus pyogenes is a devastating human infection with a high mortality rate and few successful therapeutic options. We used dual transcriptome sequencing (RNA-seq) to analyze the transcriptomes of S. pyogenes and host skeletal muscle recovered contemporaneously from infected nonhuman primates. The in vivo bacterial transcriptome was strikingly remodeled compared to organisms grown in vitro, with significant upregulation of genes contributing to virulence and altered regulation of metabolic genes. The transcriptome of muscle tissue from infected nonhuman primates (NHPs) differed significantly from that of mock-infected animals, due in part to substantial changes in genes contributing to inflammation and host defense processes. We discovered significant positive correlations between group A streptococcus (GAS) virulence factor transcripts and genes involved in the host immune response and inflammation. We also discovered significant correlations between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness, as assessed by previously conducted genome-wide transposon-directed insertion site sequencing (TraDIS). By integrating the bacterial RNA-seq data with the fitness data generated by TraDIS, we discovered five new pathogen genes, namely, S. pyogenes 0281 (Spy0281 [dahA]), ihk-irr, slr, isp, and ciaH, that contribute to necrotizing myositis and confirmed these findings using isogenic deletion-mutant strains. Taken together, our study results provide rich new information about the molecular events occurring in severe invasive infection of primate skeletal muscle that has extensive translational research implications.IMPORTANCE Necrotizing myositis caused by Streptococcus pyogenes has high morbidity and mortality rates and relatively few successful therapeutic options. In addition, there is no licensed human S. pyogenes vaccine. To gain enhanced understanding of the molecular basis of this infection, we employed a multidimensional analysis strategy that included dual RNA-seq and other data derived from experimental infection of nonhuman primates. The data were used to target five streptococcal genes for pathogenesis research, resulting in the unambiguous demonstration that these genes contribute to pathogen-host molecular interactions in necrotizing infections. We exploited fitness data derived from a recently conducted genome-wide transposon mutagenesis study to discover significant correlation between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness. Collectively, our findings have significant implications for translational research, potentially including vaccine efforts.
Collapse
Affiliation(s)
- Priyanka Kachroo
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Jesus M Eraso
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Randall J Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, USA
| | - Luchang Zhu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Samantha L Kubiak
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Layne Pruitt
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Prasanti Yerramilli
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Concepcion C Cantu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Matthew Ojeda Saavedra
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Johan Pensar
- Department of Mathematics and Statistics, Helsinki Institute of Information Technology, University of Helsinki, Helsinki, Finland
| | - Jukka Corander
- Department of Mathematics and Statistics, Helsinki Institute of Information Technology, University of Helsinki, Helsinki, Finland
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Leslie Jenkins
- Comparative Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA
| | - Lillian Kao
- Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Alejandro Granillo
- Department of Internal Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Adeline R Porter
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Frank R DeLeo
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - James M Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
16
|
Rafei R, Hawli M, Osman M, Dabboussi F, Hamze M. Distribution of emm types and macrolide resistance determinants among group A streptococci in the Middle East and North Africa region. J Glob Antimicrob Resist 2020; 22:334-348. [PMID: 32084609 DOI: 10.1016/j.jgar.2020.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of this review was to provide an updated scenario on the epidemiology of group A streptococci (GAS) in the Middle East and North Africa (MENA) region with a special spotlight on the most prevalent emmtypes and macrolide resistance profiles. METHODS This review briefly summarises the disease burden for GAS in the MENA region. RESULTS Whilst the burden of invasive GAS infections is difficult to assess in the MENA region, the GAS prevalence ranged from 2.5% up to 42.4% in pharyngitis patients and from 2.4% up to 35.4% in healthy carriers.emm1, emm12, emm89, emm4, emm28 and emm3were responsible for the major GAS burden in the MENA region. The coverage rate of the new M protein-based vaccine candidate (30-valent) varied from 42% to 100% according to the country. The rate of erythromycin resistance differed substantially between countries from low to moderate or high. CONCLUSION These data add more shreds of evidence on the neglected GAS burden in the MENA region. Systematic surveillance of invasive GAS infections along with molecular characterisation of GAS isolates are strongly recommended to track the trends of circulating clones and to evaluate the potential coverage of vaccine candidates.
Collapse
Affiliation(s)
- Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Malaik Hawli
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
| |
Collapse
|
17
|
Imamdad P, Miailhes P, Bosch A, Ferry T. Group A Streptococcus pleuropneumonia associated with toxic shock syndrome in a 64-year-old woman. BMJ Case Rep 2019; 12:12/5/e228369. [PMID: 31068344 DOI: 10.1136/bcr-2018-228369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Philippe Imamdad
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France
| | - Patrick Miailhes
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France
| | - Alexie Bosch
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
18
|
Fujiya Y, Hayakawa K, Gu Y, Yamamoto K, Mawatari M, Kutsuna S, Takeshita N, Kato Y, Kanagawa S, Ohmagari N. Age-related differences in clinical characteristics of invasive group G streptococcal infection: Comparison with group A and group B streptococcal infections. PLoS One 2019; 14:e0211786. [PMID: 30845149 PMCID: PMC6405256 DOI: 10.1371/journal.pone.0211786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose Invasive Group G streptococcal infection (iGGS) has increasingly been recognized as a cause of severe disease, mainly among elderly people with chronic illnesses. This study aimed to examine age-related differences in clinical characteristics of iGGS and describe its characteristics among very elderly individuals (≥80 years). Methods Fifty-four iGGS patients for whom detailed clinical information was available were identified from 2002 to 2014 in a tertiary care hospital in Japan. iGGS (n = 54) was compared with invasive Group A (iGAS; n = 17) and B streptococcal infection patients (iGBS; n = 52) based on patient age. Results The incidence of iGGS in our catchment area significantly increased during the study period. The prevalence of iGGS in the very elderly population was higher than that of iGAS or iGBS (p<0.001). Among iGGS patients, cardiovascular disease, chronic kidney disease, oxygen demand, and bacteremia with unknown focus of infection were more frequent in the very elderly population (p = 0.009, p = 0.02, p = 0.04, and p = 0.04, respectively). Altered mental status was present in half of iGGS patients aged ≥60 years (p = 0.03). In contrast, alcohol drinking and liver cirrhosis were significantly more frequent in patients with iGGS aged <60 years than in other age groups (p<0.001, p = 0.001, respectively). Levofloxacin resistance in GBS isolates was significantly more frequent among very elderly patients than among other age groups (p<0.001). Conclusions The burden of iGGS has been increasing in our catchment area. Different iGGS-associated clinical characteristics were found in each age group. Unclear and atypical clinical manifestations and syndromes were likely to be observed in very elderly patients. Alcohol drinking and liver cirrhosis may contribute to iGGS even in patients aged <60 years. Understanding these age-related differences could be helpful for optimal diagnosis and treatment.
Collapse
Affiliation(s)
- Yoshihiro Fujiya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
- * E-mail:
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Momoko Mawatari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shuzo Kanagawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
19
|
Integrated analysis of population genomics, transcriptomics and virulence provides novel insights into Streptococcus pyogenes pathogenesis. Nat Genet 2019; 51:548-559. [PMID: 30778225 DOI: 10.1038/s41588-018-0343-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/21/2018] [Indexed: 12/22/2022]
Abstract
Streptococcus pyogenes causes 700 million human infections annually worldwide, yet, despite a century of intensive effort, there is no licensed vaccine against this bacterium. Although a number of large-scale genomic studies of bacterial pathogens have been published, the relationships among the genome, transcriptome, and virulence in large bacterial populations remain poorly understood. We sequenced the genomes of 2,101 emm28 S. pyogenes invasive strains, from which we selected 492 phylogenetically diverse strains for transcriptome analysis and 50 strains for virulence assessment. Data integration provided a novel understanding of the virulence mechanisms of this model organism. Genome-wide association study, expression quantitative trait loci analysis, machine learning, and isogenic mutant strains identified and confirmed a one-nucleotide indel in an intergenic region that significantly alters global transcript profiles and ultimately virulence. The integrative strategy that we used is generally applicable to any microbe and may lead to new therapeutics for many human pathogens.
Collapse
|
20
|
Ogura N, Tomari K, Takayama T, Tonegawa N, Okawa T, Matsuoka T, Nakayashiro M, Matsumora T. Group A streptococcus endocarditis in children: 2 cases and a review of the literature. BMC Infect Dis 2019; 19:102. [PMID: 30704409 PMCID: PMC6357504 DOI: 10.1186/s12879-019-3736-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is defined as endocarditis caused by microorganisms (bacteria or fungi) involving either the heart or great vessels. The clinical course of IE can be complicated by cardiac dysfunction and bacterial embolization to virtually any organ. Staphylococcus aureus and viridans group streptococci are the most common causative organisms, whereas group A Streptococcus (GAS) is less common. Although some GAS serotypes have been associated with severe disease, there are few reports of IE associated with GAS serotypes. Here, we report two cases of GAS endocarditis and review the associated literature. CASE PRESENTATIONS Patient 1 was a previously healthy 14-year-old girl who developed bacteremia and disseminated intravascular coagulation secondary to left foot cellulitis. She was administered intravenous antibiotics. Two of three blood cultures grew Streptococcus pyogenes (T6 M6, emm6.104). Three days later, a new systolic ejection murmur was heard and echocardiography showed mitral regurgitation with mitral valve vegetation. Because of the resultant severity of the mitral regurgitation, she underwent mitral valve repair after 10 weeks of antibiotic treatment. Patient 2 was a 17-month old boy who presented with a fever. He had a history of spontaneous closure of a ventricular septal defect (VSD). He was started on intravenous antibiotics for possible bacteremia. Two consecutive blood cultures with an interval of more than 12 h grew S. pyogenes (T4 M4, emm4.0). Five days later, echocardiography showed vegetation on a membranous ventricular septal aneurysm. The patient responded well to antibiotics, and recovered fully with no complications. CONCLUSIONS Although both patients developed GAS endocarditis, patient 1 did not have any predisposing conditions for IE, and patient 2 had a only a low-risk predisposing condition, a VSD that had closed spontaneously at five months of age. We found twelve reports in the literature of GAS endocarditis with information on serotypes. All patients in these reports had GAS endocarditis caused by serotypes generally associated with milder infections, but no specific risk trends were identified. A greater accumulation of cases is necessary to more clearly elucidate the association between GAS IE and specific serotypes.
Collapse
Affiliation(s)
- Nao Ogura
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Kouki Tomari
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan.
| | - Tomotada Takayama
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Naoya Tonegawa
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Teppei Okawa
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Takashi Matsuoka
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| | - Mami Nakayashiro
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of Pediatric Cardiology, Okinawa, Japan
| | - Tsutomu Matsumora
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Department of General Pediatrics, Okinawa, Japan
| |
Collapse
|
21
|
Savoia P, Heininger U, Buettcher M. Streptococcus pyogenes Endocarditis Associated With Varicella-Case Report and Review of the Literature. Front Pediatr 2019; 7:500. [PMID: 31867295 PMCID: PMC6904297 DOI: 10.3389/fped.2019.00500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/19/2019] [Indexed: 01/29/2023] Open
Abstract
Infection with varicella zoster virus (VZV) is usually a benign and self-limiting disease. Serious complications by bacterial pathogens do occur, such as necrotising fasciitis (NF). One of the most important is Streptococcus pyogenes (or Group A Streptococcus, GAS), which colonizes epithelial surfaces, primarily of the throat and skin. In rare instances, varicella may also be associated with S. pyogenes endocarditis. Review of the literature reveals only 18 children with infective endocarditis (IE) caused by GAS since 1942. VZV as antecedent illness was found in five (28%). Fourteen (78%) had no pre-existing cardiac abnormalities. Death occurred in three (17%) children. Infective endocarditis with acute deterioration secondary to rupture of mitral valve chordae tendineae necessitating cardiac surgery has not been reported in the literature yet. We present this rare and instructive pediatric case and the results of a literature search on S. pyogenes endocarditis in children.
Collapse
Affiliation(s)
- Patrizia Savoia
- Paediatric Intensive Care and Neonatology, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Ulrich Heininger
- Department of Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland
| |
Collapse
|
22
|
Hertzog BB, Kaufman Y, Biswas D, Ravins M, Ambalavanan P, Wiener R, Angeli V, Chen SL, Hanski E. A Sub-population of Group A Streptococcus Elicits a Population-wide Production of Bacteriocins to Establish Dominance in the Host. Cell Host Microbe 2018; 23:312-323.e6. [PMID: 29544095 DOI: 10.1016/j.chom.2018.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/26/2017] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Abstract
Bacteria use quorum sensing (QS) to regulate gene expression. We identified a group A Streptococcus (GAS) strain possessing the QS system sil, which produces functional bacteriocins, through a sequential signaling pathway integrating host and bacterial signals. Host cells infected by GAS release asparagine (ASN), which is sensed by the bacteria to alter its gene expression and rate of proliferation. We show that upon ASN sensing, GAS upregulates expression of the QS autoinducer peptide SilCR. Initial SilCR expression activates the autoinduction cycle for further SilCR production. The autoinduction process propagates throughout the GAS population, resulting in bacteriocin production. Subcutaneous co-injection of mice with a bacteriocin-producing strain and the globally disseminated M1T1 GAS clone results in M1T1 killing within soft tissue. Thus, by sensing host signals, a fraction of a bacterial population can trigger an autoinduction mechanism mediated by QS, which acts on the entire bacterial community to outcompete other bacteria within the infection.
Collapse
Affiliation(s)
- Baruch B Hertzog
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research, Israel-Canada (IMRIC), The Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel
| | - Yael Kaufman
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research, Israel-Canada (IMRIC), The Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel
| | - Debabrata Biswas
- NUS-HUJ-CREATE Programme for Inflammation Research, Center for Research Excellence & Technological Enterprise (CREATE), Department of Microbiology and Immunology, National University of Singapore, Singapore 138602, Singapore
| | - Miriam Ravins
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research, Israel-Canada (IMRIC), The Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel
| | - Poornima Ambalavanan
- NUS-HUJ-CREATE Programme for Inflammation Research, Center for Research Excellence & Technological Enterprise (CREATE), Department of Microbiology and Immunology, National University of Singapore, Singapore 138602, Singapore
| | - Reuven Wiener
- Department of Biochemistry and Molecular Biology, The Institute for Medical Research, Israel-Canada (IMRIC), The Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel
| | - Veronique Angeli
- Department of Microbiology and Immunology, National University of Singapore; LSI Immunology Programme, National University of Singapore, Singapore 117456, Singapore
| | - Swaine L Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and Infectious Diseases Group, Genome Institute of Singapore, Singapore 119074, Singapore
| | - Emanuel Hanski
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research, Israel-Canada (IMRIC), The Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem 9112102, Israel; NUS-HUJ-CREATE Programme for Inflammation Research, Center for Research Excellence & Technological Enterprise (CREATE), Department of Microbiology and Immunology, National University of Singapore, Singapore 138602, Singapore.
| |
Collapse
|
23
|
Weckel A, Ahamada D, Bellais S, Méhats C, Plainvert C, Longo M, Poyart C, Fouet A. The N-terminal domain of the R28 protein promotes emm28 group A Streptococcus adhesion to host cells via direct binding to three integrins. J Biol Chem 2018; 293:16006-16018. [PMID: 30150299 DOI: 10.1074/jbc.ra118.004134] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/20/2018] [Indexed: 01/07/2023] Open
Abstract
Group A Streptococcus (GAS) is a human-specific pathogen responsible for a wide range of diseases, ranging from superficial to life-threatening invasive infections, including endometritis, and autoimmune sequelae. GAS strains express a vast repertoire of virulence factors that varies depending on the strain genotype, and many adhesin proteins that enable GAS to adhere to host cells are restricted to some genotypes. GAS emm28 is the third most prevalent genotype in invasive infections in France and is associated with gyneco-obstetrical infections. emm28 strains harbor R28, a cell wall-anchored surface protein that has previously been reported to promote adhesion to cervical epithelial cells. Here, using cellular and biochemical approaches, we sought to determine whether R28 supports adhesion also to other cells and to characterize its cognate receptor. We show that through its N-terminal domain, R28Nt, R28 promotes bacterial adhesion to both endometrial-epithelial and endometrial-stromal cells. R28Nt was further subdivided into two domains, and we found that both are involved in cell binding. R28Nt and both subdomains interacted directly with the laminin-binding α3β1, α6β1, and α6β4 integrins; interestingly, these bindings events did not require divalent cations. R28 is the first GAS adhesin reported to bind directly to integrins that are expressed in most epithelial cells. Finally, R28Nt also promoted binding to keratinocytes and pulmonary epithelial cells, suggesting that it may be involved in supporting the prevalence in invasive infections of the emm28 genotype.
Collapse
Affiliation(s)
- Antonin Weckel
- From the INSERM U1016, Institut Cochin.,CNRS UMR 8104, and.,Université Paris Descartes, UMR-S1016 Paris, France and
| | - Dorian Ahamada
- From the INSERM U1016, Institut Cochin.,CNRS UMR 8104, and.,Université Paris Descartes, UMR-S1016 Paris, France and
| | - Samuel Bellais
- From the INSERM U1016, Institut Cochin.,CNRS UMR 8104, and.,Université Paris Descartes, UMR-S1016 Paris, France and
| | - Céline Méhats
- From the INSERM U1016, Institut Cochin.,CNRS UMR 8104, and.,Université Paris Descartes, UMR-S1016 Paris, France and
| | - Céline Plainvert
- From the INSERM U1016, Institut Cochin.,CNRS UMR 8104, and.,Université Paris Descartes, UMR-S1016 Paris, France and.,the Centre National de Référence des Streptocoques and.,the Hôpitaux Universitaires Paris Centre, Institut Cochin, Assistance Publique Hôpitaux de Paris, 75014 Paris, France
| | - Magalie Longo
- From the INSERM U1016, Institut Cochin.,CNRS UMR 8104, and.,Université Paris Descartes, UMR-S1016 Paris, France and
| | - Claire Poyart
- From the INSERM U1016, Institut Cochin.,CNRS UMR 8104, and.,Université Paris Descartes, UMR-S1016 Paris, France and.,the Centre National de Référence des Streptocoques and.,the Hôpitaux Universitaires Paris Centre, Institut Cochin, Assistance Publique Hôpitaux de Paris, 75014 Paris, France
| | - Agnès Fouet
- From the INSERM U1016, Institut Cochin, .,CNRS UMR 8104, and.,Université Paris Descartes, UMR-S1016 Paris, France and.,the Centre National de Référence des Streptocoques and
| |
Collapse
|
24
|
Plainvert C, Longo M, Seringe E, Saintpierre B, Sauvage E, Ma L, Beghain J, Dmytruk N, Collobert G, Hernandez E, Manuel C, Astagneau P, Glaser P, Ariey F, Poyart C, Fouet A. A clone of the emergent Streptococcus pyogenes emm89 clade responsible for a large outbreak in a post-surgery oncology unit in France. Med Microbiol Immunol 2018; 207:287-296. [DOI: 10.1007/s00430-018-0546-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/25/2018] [Indexed: 02/08/2023]
|
25
|
Keller N, Andreoni F, Reiber C, Luethi-Schaller H, Schuepbach RA, Moch H, Marques Maggio E, Zinkernagel AS. Human Streptococcal Necrotizing Fasciitis Histopathology Mirrored in a Murine Model. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:1517-1523. [PMID: 29684366 DOI: 10.1016/j.ajpath.2018.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/13/2018] [Accepted: 03/26/2018] [Indexed: 11/25/2022]
Abstract
Streptococcal necrotizing fasciitis (NF) causes high morbidity and mortality despite state-of-the-art therapy. Low incidence and rapid disease progression, necessitating immediate initiation of therapy, have proven challenging aspects for setting up prospective randomized trials. This has resulted in little therapeutic progress over the past decade. The validation of reliable murine NF models to study both pathogenesis and optimized therapeutic regimens of streptococcal NF are thus essential. In this study, we characterized a murine NF model and compared the pathology with an in-depth tissue analysis of streptococcal NF in patients. We found that the streptococcal murine NF model closely reflected all histologic characteristics encountered in human streptococcal NF. This murine NF model helps understanding of human NF pathology better in a time-dependent manner and will allow studying novel therapeutic options in the future.
Collapse
Affiliation(s)
- Nadia Keller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Federica Andreoni
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Claudine Reiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Helga Luethi-Schaller
- Clinic of Preventive Dentistry, Periodontology and Cariology, Division of Oral Microbiology and Immunology, Center of Dental Medicine; University of Zurich, Zurich, Switzerland
| | | | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Ewerton Marques Maggio
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
| |
Collapse
|
26
|
Okamoto S, Nagase S. Pathogenic mechanisms of invasive group AStreptococcusinfections by influenza virus-group AStreptococcussuperinfection. Microbiol Immunol 2018; 62:141-149. [DOI: 10.1111/1348-0421.12577] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Shigefumi Okamoto
- Department of Laboratory Sciences; Faculty of Health Sciences, Kanazawa University; 5-11-80 Kodatsuno Kanazawa Ishikawa 920-0942 Japan
- Wellness Promotion Science Center, Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; 5-11-80 Kodatsuno Kanazawa Ishikawa 920-0942 Japan
| | - Satoshi Nagase
- Department of Laboratory Sciences; Faculty of Health Sciences, Kanazawa University; 5-11-80 Kodatsuno Kanazawa Ishikawa 920-0942 Japan
| |
Collapse
|
27
|
Gherardi G, Vitali LA, Creti R. Prevalent emm Types among Invasive GAS in Europe and North America since Year 2000. Front Public Health 2018; 6:59. [PMID: 29662874 PMCID: PMC5890186 DOI: 10.3389/fpubh.2018.00059] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Streptococcus pyogenes or group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections, from uncomplicated to more severe and invasive diseases with high mortality and morbidity. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern; for this purpose the M protein gene (emm) gene typing is the most widely used genotyping method, with more than 200 emm types recognized. Molecular epidemiological data have been also used for the development of GAS M protein-based vaccines. METHODS The aim of this paper was to provide an updated scenario of the most prevalent GAS emm types responsible for invasive infections in developed countries as Europe and North America (US and Canada), from 1st January 2000 to 31st May 2017. The search, performed in PubMed by the combined use of the terms ("emm") and ("invasive") retrieved 264 articles, of which 38 articles (31 from Europe and 7 from North America) met the inclusion criteria and were selected for this study. Additional five papers cited in the European articles but not retrieved by the search were included. RESULTS emm1 represented the dominant type in both Europe and North America, replaced by other emm types in only few occasions. The seven major emm types identified (emm1, emm28, emm89, emm3, emm12, emm4, and emm6) accounted for approximately 50-70% of the total isolates; less common emm types accounted for the remaining 30-50% of the cases. Most of the common emm types are included in either one or both the 26-valent and 30-valent vaccines, though some well-represented emm types found in Europe are not. CONCLUSION This study provided a picture of the prevalent emm types among invasive GAS (iGAS) in Europe and North America since the year 2000 onward. Continuous surveillance on the emm-type distribution among iGAS infections is strongly encouraged also to determine the potential coverage of the developing multivalent vaccines.
Collapse
Affiliation(s)
- Giovanni Gherardi
- Microbiology Unit, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | | | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| |
Collapse
|
28
|
Park DW, Kim SH, Park JW, Kim MJ, Cho SJ, Park HJ, Jung SH, Seo MH, Lee YS, Kim BH, Min H, Lee SY, Ha DR, Kim ES, Hong Y, Chung JK. Incidence and Characteristics of Scarlet Fever, South Korea, 2008-2015. Emerg Infect Dis 2018; 23:658-661. [PMID: 28322696 PMCID: PMC5367408 DOI: 10.3201/eid2304.160773] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The incidence rate for scarlet fever in South Korea is rising. During 2008–2015, we collected group A Streptococcus isolates and performed emm and exotoxin genotyping and disk-diffusion antimicrobial tests. Scarlet fever in South Korea was most closely associated with emm types emm4, emm28, emm1, and emm3. In 2015, tetracycline resistance started increasing.
Collapse
|
29
|
Javouhey E, Bolze PA, Jamen C, Lina G, Badiou C, Poyart C, Portefaix A, Tristan A, Laurent F, Bes M, Vandenesch F, Gilletand Y, Dauwalder O. Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort. Front Pediatr 2018; 6:360. [PMID: 30547021 PMCID: PMC6280580 DOI: 10.3389/fped.2018.00360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 11/05/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction: Toxic shock syndromes (TSS) are severe shocks due to staphylococcal or streptococcal infection that require specific treatments. The early recognition of these shocks is crucial to improve their outcomes. Objectives: The primary objective of this study was to compare characteristics and outcomes of staphylococcal and streptococcal TSS in children, in order to identify putative early clinical diagnostic criteria. Secondary objectives were to determine the toxin gene profiles of associated isolated strains and the relevance of measuring Vβ T-cell signatures to confirm the diagnosis. Study design: We performed a multicenter retrospective evaluation of clinical data, biological results, and treatment outcomes of children with a confirmed or probable case of staphylococcal or streptococcal TSS. Children were consecutively included if they were admitted to the pediatric intensive care units of Lyon (France), between January 2005 and July 2011. Results: Among the 30 analyzed children, 15 presented staphylococcal TSS and 15 streptococcal TSS. The most frequent origin of staphylococcal and streptococcal TSS was the lower respiratory tract (53%) and the genital tract (47%) respectively. Non-menstrual TSS syndrome cases presented more frequently with neurological alterations, and digestive signs were predominant in menstrual forms. Compared to Staphylococcal TSS, Streptococcal TSS presented with higher organ dysfunction scores (median Pediatric Index of Mortality 2 score 20.9 (4.1-100) vs. 1.7 (1.3-2.3), p = 0.001), required respiratory support more frequently (80 vs. 33%, p = 0.02), were intubated for a longer time (3 days (0.75-5) vs. 1 day (0-1.5), p = 0.006) and had a non-significant trend of higher, case-fatality rate (20 vs. 7%, p = 0.60). The lack of antitoxin therapy was associated with higher case-fatality rate (50 vs. 4%, p = 0.04). The Vβ repertoire measurements exhibited toxin dependent-alterations in accordance with the toxin gene profiles of isolated strains in both types of toxic shock syndromes. Regarding toxin gene profiles of isolated strains, 10/15 Staphylococcus aureus belonged to clonal complex (CC) 30 and 6/12 Streptococcus pyogenes were emm1 type suggesting clonal etiologies for both staphylococcal and streptococcal TSS. Conclusion: Despite the involvement of functionally similar toxins, staphylococcal and streptococcal TSS differed by their clinical signs, origin of infection and prognosis. The detection of Vβ profiles was useful to confirm the diagnosis of staphylococcal and streptococcal TSS and for the identification of involved toxins.
Collapse
Affiliation(s)
- Etienne Javouhey
- Pediatric Emergency and Critical Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Faculté de Médecine Lyon Est, Université de Lyon, Domaine de la Buire, Lyon, France
| | - Pierre-Adrien Bolze
- Service de Gynécologie et Obstétrique, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Claire Jamen
- Pediatric Emergency and Critical Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Gerard Lina
- Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Nord, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, Lyon, France
| | - Cédric Badiou
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, Lyon, France
| | - Claire Poyart
- Centre National de Références des Streptocoques - Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca, Assistance Publique Hôpitaux de Paris, Paris, France.,Institut Cochin Université Sorbonne Paris Descartes, Paris, France.,INSERM 1016, Institut Cochin, Paris, France.,CNRS, UMR8104, Institut Cochin, Paris, France
| | - Aurelie Portefaix
- Pediatric Emergency and Critical Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacotoxicologie, Hospices Civils de Lyon, Bron, France
| | - Anne Tristan
- Faculté de Médecine Lyon Est, Université de Lyon, Domaine de la Buire, Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Nord, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, Lyon, France
| | - Frédéric Laurent
- Faculté de Médecine Lyon Est, Université de Lyon, Domaine de la Buire, Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Nord, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, Lyon, France
| | - Michèle Bes
- Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, Lyon, France
| | - François Vandenesch
- Faculté de Médecine Lyon Est, Université de Lyon, Domaine de la Buire, Lyon, France.,Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Nord, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, Lyon, France
| | - Yves Gilletand
- Pediatric Emergency and Critical Care Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France.,Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, Lyon, France
| | - Olivier Dauwalder
- Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Bactériologie, Centre de Biologie et de Pathologie Nord, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, Lyon, France
| |
Collapse
|
30
|
Beres SB, Olsen RJ, Ojeda Saavedra M, Ure R, Reynolds A, Lindsay DSJ, Smith AJ, Musser JM. Genome sequence analysis of emm89 Streptococcus pyogenes strains causing infections in Scotland, 2010-2016. J Med Microbiol 2017; 66:1765-1773. [PMID: 29099690 PMCID: PMC5845742 DOI: 10.1099/jmm.0.000622] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Strains of type emm89 Streptococcus pyogenes have recently increased in frequency as a cause of human infections in several countries in Europe and North America. This increase has been molecular epidemiologically linked with the emergence of a new genetically distinct clone, designated clade 3. We sought to extend our understanding of this epidemic behavior by the genetic characterization of type emm89 strains responsible in recent years for an increased frequency of infections in Scotland. Methodology We sequenced the genomes of a retrospective cohort of 122 emm89 strains recovered from patients with invasive and noninvasive infections throughout Scotland during 2010 to 2016. Results All but one of the 122 emm89 infection isolates are of the recently emerged epidemic clade 3 clonal lineage. The Scotland isolates are closely related to and not genetically distinct from recent emm89 strains from England, they constitute a single genetic population. Conclusions The clade 3 clone causes virtually all-contemporary emm89 infections in Scotland. These findings add Scotland to a growing list of countries of Europe and North America where, by whole genome sequencing, emm89 clade 3 strains have been demonstrated to be the cause of an ongoing epidemic of invasive infections and to be genetically related due to descent from a recent common progenitor.
Collapse
Affiliation(s)
- Stephen B Beres
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, and Houston Methodist Hospital, Houston, TX 77030, USA
| | - Randall J Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, and Houston Methodist Hospital, Houston, TX 77030, USA.,Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, NY 10021, USA
| | - Matthew Ojeda Saavedra
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, and Houston Methodist Hospital, Houston, TX 77030, USA
| | - Roisin Ure
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, New Lister Building, Glasgow, G31 2ER, Scotland, UK
| | - Arlene Reynolds
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, New Lister Building, Glasgow, G31 2ER, Scotland, UK
| | - Diane S J Lindsay
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, New Lister Building, Glasgow, G31 2ER, Scotland, UK
| | - Andrew J Smith
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, New Lister Building, Glasgow, G31 2ER, Scotland, UK.,College of Medical, Veterinary and Life Sciences, Glasgow Dental Hospital and School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, Scotland, UK
| | - James M Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, and Houston Methodist Hospital, Houston, TX 77030, USA.,Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, NY 10021, USA
| |
Collapse
|
31
|
Reichert JC, Habild G, Simon P, Nöth U, Krümpelmann JB. Necrotizing streptococcal myositis of the upper extremity: a case report. BMC Res Notes 2017; 10:407. [PMID: 28807000 PMCID: PMC5556997 DOI: 10.1186/s13104-017-2743-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background Necrotizing myositis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the affected tissue. The myositis is often caused by toxin-producing, virulent bacteria such as group A β-hemolytic streptococcus and associated with severe systemic toxicity. It is rapidly fatal unless diagnosed promptly and treated aggressively. However, necrotizing myositis is often initially misdiagnosed as a more benign soft-tissue infection as such fulminant, invasive muscle infections are rare with no more than 30 cases reported over the last century. Case presentation We illustrate the case of a 74-year-old male Caucasian initially presenting with a progressing swelling and gradually oncoming pain of the upper right extremity. Rapidly, livid discolorations of the skin, blisters, hypoesthesia and severe pain resistant to analgesics treatment developed accompanied by disruption of the arterial blood flow. Due to a manifest compartment syndrome the patient was admitted to theater for fasciotomy of the arm. After multiple revision surgeries wound closure was achieved using a pedicled, fasciocutaneous parascapular flap and a free, ipsilateral anterolateral thigh flap. Microbiological analysis revealed group A β-hemolytic streptococcus, histology a bacterial interstitial myositis with necrotic muscular fibers. Conclusions A high degree of clinical suspicion is necessary to avert potentially disastrous consequences of necrotizing myositis. Timely diagnosis, broad-spectrum antibiotic therapy, and aggressive surgical debridement of affected tissue are keys to the treatment of this serious, often life-threatening infection.
Collapse
Affiliation(s)
- Johannes C Reichert
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany. .,Department of Orthopaedic Surgery, König-Ludwig-Haus, Center for Musculoskeletal Research, Julius-Maximilians-University, Brettreichstraße 11, 97074, Würzburg, Germany.
| | - Götz Habild
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Paul Simon
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Ulrich Nöth
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| | - Jan B Krümpelmann
- Department of Orthopaedic and Trauma Surgery, Ev. Waldkrankenhaus Spandau, Stadtrandstr. 555, 13589, Berlin, Germany
| |
Collapse
|
32
|
Group A streptococci infection. A systematic clinical review exemplified by cases from an obstetric department. Eur J Obstet Gynecol Reprod Biol 2017; 215:33-40. [DOI: 10.1016/j.ejogrb.2017.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/08/2017] [Accepted: 05/23/2017] [Indexed: 12/18/2022]
|
33
|
Imöhl M, Fitzner C, Perniciaro S, van der Linden M. Epidemiology and distribution of 10 superantigens among invasive Streptococcus pyogenes disease in Germany from 2009 to 2014. PLoS One 2017; 12:e0180757. [PMID: 28719668 PMCID: PMC5515411 DOI: 10.1371/journal.pone.0180757] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 06/21/2017] [Indexed: 11/18/2022] Open
Abstract
A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany. Invasive isolates (n = 719) were obtained between 2009 and 2014. Most isolates were obtained from blood (92.1%). The proportions of isolates from cerebrospinal fluid, pleural fluid, synovial fluid and peritoneal fluid were 3.9%, 1.8%, 1.7% and 0.6%, respectively. The most common emm types were emm 1 (31.8%), emm 28 (15.4%) and emm 89 (14.5%). The most common superantigen genes (speA, speC, speG, speH, speI, speJ, speK, speL, speM, ssa) identified from S. pyogenes were speG (92.1%), speJ (50.9%), and speC (42.0%). Significant associations of superantigen genes with underlying conditions or risks were observed in speG, speH, speJ, and speK. Significant associations between emm types or superantigen genes with clinical complications were observed in emm type 3 and in superantigen gene speA 1-3. Most frequent clinical manifestations included sepsis 59.4%, STSS 6.3%, meningitis 5.4%, and necrotizing fasciitis 5.0% (significantly associated with emm1).
Collapse
Affiliation(s)
- Matthias Imöhl
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
- * E-mail:
| | - Christina Fitzner
- Department of Medical Statistics, University Hospital (RWTH), Aachen, Germany
| | - Stephanie Perniciaro
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
| | - Mark van der Linden
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
| |
Collapse
|
34
|
Ksia S, Smaoui H, Hraoui M, Bouafsoun A, Boutiba-Ben Boubaker I, Kechrid A. Molecular Characteristics of Erythromycin-ResistantStreptococcus pyogenesStrains Isolated from Children Patients in Tunis, Tunisia. Microb Drug Resist 2017; 23:633-639. [DOI: 10.1089/mdr.2016.0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Sonia Ksia
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Hanen Smaoui
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Manel Hraoui
- LR99ES09 Laboratoire de Résistance aux Antimicrobiens, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Aida Bouafsoun
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Ihem Boutiba-Ben Boubaker
- LR99ES09 Laboratoire de Résistance aux Antimicrobiens, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Amel Kechrid
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| |
Collapse
|
35
|
Kuo CF, Tsao N, Hsieh IC, Lin YS, Wu JJ, Hung YT. Immunization with a streptococcal multiple-epitope recombinant protein protects mice against invasive group A streptococcal infection. PLoS One 2017; 12:e0174464. [PMID: 28355251 PMCID: PMC5371370 DOI: 10.1371/journal.pone.0174464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/09/2017] [Indexed: 12/11/2022] Open
Abstract
Streptococcus pyogenes (group A Streptococcus; GAS) causes clinical diseases, including pharyngitis, scarlet fever, impetigo, necrotizing fasciitis and streptococcal toxic shock syndrome. A number of group A streptococcus vaccine candidates have been developed, but only one 26-valent recombinant M protein vaccine has entered clinical trials. Differing from the design of a 26-valent recombinant M protein vaccine, we provide here a vaccination using the polyvalence epitope recombinant FSBM protein (rFSBM), which contains four different epitopes, including the fibronectin-binding repeats domain of streptococcal fibronectin binding protein Sfb1, the C-terminal immunogenic segment of streptolysin S, the C3-binding motif of streptococcal pyrogenic exotoxin B, and the C-terminal conserved segment of M protein. Vaccination with the rFSBM protein successfully prevented mortality and skin lesions caused by several emm strains of GAS infection. Anti-FSBM antibodies collected from the rFSBM-immunized mice were able to opsonize at least six emm strains and can neutralize the hemolytic activity of streptolysin S. Furthermore, the internalization of GAS into nonphagocytic cells is also reduced by anti-FSBM serum. These findings suggest that rFSBM can be applied as a vaccine candidate to prevent different emm strains of GAS infection.
Collapse
Affiliation(s)
- Chih-Feng Kuo
- Department of Nursing, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Nina Tsao
- Department of Biological Science and Technology, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Chen Hsieh
- Department of Biological Science and Technology, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yee-Shin Lin
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiunn-Jong Wu
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Biotechnology and Laboratory Science in Medicine, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ting Hung
- Department of Biological Science and Technology, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| |
Collapse
|
36
|
Blot M, de Curraize C, Salmon-Rousseau A, Gehin S, Bador J, Chavanet P, Neuwirth C, Piroth L, Amoureux L. Streptococcus pyogenes: an unusual cause of salpingitis. Case report and review of the literature. Infection 2017; 45:697-702. [PMID: 28283947 DOI: 10.1007/s15010-017-1003-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/27/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Streptococcus pyogenes can colonize genitourinary tract, but it is a rare cause of salpingitis. CASE REPORT We report a case of bilateral salpingitis due to Streptococcus pyogenes in a 34-year-old woman using an intra-uterine device and which occurred following a family history of recurrent S. pyogenes infections. We review 12 other cases reported in the literature, and discuss the pathophysiological mechanisms of this potentially life-threatening disease. CONCLUSION It is important to take into account consider Streptococcus pyogenes as a cause of acute salpingitis in the context of recent intra-familial Streptococcus pyogenes infections.
Collapse
Affiliation(s)
- Mathieu Blot
- Service de Maladies Infectieuses et Tropicales, CHU de Dijon, Dijon, France. .,Département d'Infectiologie, CHU, 14 rue Paul Gaffarel, 21079, Dijon Cedex, France.
| | | | | | - Sophie Gehin
- Département de Radiologie, CHU de Dijon, Dijon, France
| | - Julien Bador
- Laboratoire de Bactériologie, CHU de Dijon, Dijon, France
| | - Pascal Chavanet
- Service de Maladies Infectieuses et Tropicales, CHU de Dijon, Dijon, France
| | | | - Lionel Piroth
- Service de Maladies Infectieuses et Tropicales, CHU de Dijon, Dijon, France
| | - Lucie Amoureux
- Laboratoire de Bactériologie, CHU de Dijon, Dijon, France
| |
Collapse
|
37
|
Burlet E, HogenEsch H, Dunham A, Morefield G. Evaluation of the Potency, Neutralizing Antibody Response, and Stability of a Recombinant Fusion Protein Vaccine for Streptococcus pyogenes. AAPS JOURNAL 2017; 19:875-881. [DOI: 10.1208/s12248-017-0069-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/25/2017] [Indexed: 11/30/2022]
|
38
|
Teatero S, Coleman BL, Beres SB, Olsen RJ, Kandel C, Reynolds O, Athey TBT, Musser JM, McGeer A, Fittipaldi N. Rapid Emergence of a New Clone Impacts the Population at Risk and Increases the Incidence of Type emm89 Group A Streptococcus Invasive Disease. Open Forum Infect Dis 2017; 4:ofx042. [PMID: 28470020 PMCID: PMC5407211 DOI: 10.1093/ofid/ofx042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/02/2017] [Indexed: 12/02/2022] Open
Abstract
Background Invasive group A Streptococcus (iGAS) disease caused by type emm89 strains has been increasing worldwide, driven by the emergence of an epidemic clonal variant (clade 3 emm89). The clinical characteristics of patients with emm89 iGAS disease, and in particular with clade 3 emm89 iGAS disease, are poorly described. Methods We used population-based iGAS surveillance data collected in metropolitan Toronto, Ontario, Canada during the period 2000–2014. We sequenced the genomes of 105 emm89 isolates representing all emm89 iGAS disease cases in the area during the period and 138 temporally matched emm89 iGAS isolates collected elsewhere in Ontario. Results Clades 1 and 2 and clade O, a newly discovered emm89 genetic variant, caused most cases of emm89 iGAS disease in metropolitan Toronto before 2008. After rapid emergence of new clade 3, previously circulating clades were purged from the population and the incidence of emm89 iGAS disease significantly increased from 0.14 per 100000 in 2000–2007 to 0.22 per 100000 in 2008–2014. Overall, emm89 organisms caused significantly more arthritis but less necrotizing fasciitis than strains of the more common type emm1. Other clinical presentations were soft tissue and severe respiratory tract infections. Clinical outcomes did not differ significantly between emm89 clades overall. However, clade 3 emm89 iGAS disease was more common in youth and middle-aged individuals. Conclusions The rapid shift in emm89 iGAS strain genetics in metropolitan Toronto has resulted in a significant increase in the incidence of emm89 iGAS disease, with noticeably higher rates of clade 3 disease in younger patients.
Collapse
Affiliation(s)
| | - Brenda L Coleman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | - Stephen B Beres
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Randall J Olsen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Christopher Kandel
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | | | | | - James M Musser
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | - Nahuel Fittipaldi
- Public Health Ontario, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| |
Collapse
|
39
|
Latronico F, Nasser W, Puhakainen K, Ollgren J, Hyyryläinen HL, Beres SB, Lyytikäinen O, Jalava J, Musser JM, Vuopio J. Genomic Characteristics Behind the Spread of Bacteremic Group A Streptococcus Type emm89 in Finland, 2004-2014. J Infect Dis 2016; 214:1987-1995. [PMID: 27707808 PMCID: PMC5142090 DOI: 10.1093/infdis/jiw468] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/27/2016] [Indexed: 12/20/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Francesca Latronico
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki.,European Programme for Public Health Microbiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Waleed Nasser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Texas
| | - Kai Puhakainen
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki.,Department of Medical Microbiology and Immunology, University of Turku, Finland
| | - Jukka Ollgren
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki
| | | | - Stephen B Beres
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Texas
| | - Outi Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki
| | - Jari Jalava
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki
| | - James M Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Texas
| | - Jaana Vuopio
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki.,Department of Medical Microbiology and Immunology, University of Turku, Finland
| |
Collapse
|
40
|
Oppegaard O, Skrede S, Mylvaganam H, Kittang BR. Temporal trends of β-haemolytic streptococcal osteoarticular infections in western Norway. BMC Infect Dis 2016; 16:535. [PMID: 27716100 PMCID: PMC5050853 DOI: 10.1186/s12879-016-1874-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Beta-haemolytic streptococci are important contributors to the global burden of osteoarticular infections (OAI). Knowledge on the disease traits specific for streptococcal OAI, however, remains scarce. We wished to explore temporal trends of OAI caused by Group A Streptococci (GAS), Group B Streptococci (GBS) and Group C and G Streptococci (GCGS), and furthermore, to describe the associated host and pathogen characteristics. METHODS All cases of microbiologically verified β-haemolytic streptococcal OAI in Health Region Bergen, Norway, in the period 1999-2013 were retrospectively identified. Clinical data were extracted from medical records. Microbial isolates were submitted to antibiotic susceptibility testing and molecular typing. RESULTS A total of 24 GAS, 45 GBS and 42 GCGS acute OAI were identified. The cumulative incidence of GCGS OAI, but not GAS or GBS OAI, increased significantly from the first to the last 5-year period (IRR 5.7, p = 0.0003), with the annual incidence peaking at 1.9/100 000 in 2013. GAS OAI generally produced the most acute and severe clinical presentation, whereas GBS and GCGS predominantly affected the elderly, and were significantly associated with the presence of host risk factors of systemic and focal origin, respectively. CONCLUSIONS We found a significantly increasing incidence of GCGS OAI, likely related to the presence of host susceptibility factors, including prosthetic material and pre-existing joint disease. With an increasing application of therapeutic and diagnostic bone and joint procedures, the rising trend of OAI caused by GCGS is likely to continue. Sustained epidemiological attentiveness to GCGS seems warranted.
Collapse
Affiliation(s)
- Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway. .,Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Steinar Skrede
- Department of Medicine, Haukeland University Hospital, 5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Haima Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Bård Reiakvam Kittang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| |
Collapse
|
41
|
Golińska E, van der Linden M, Więcek G, Mikołajczyk D, Machul A, Samet A, Piórkowska A, Dorycka M, Heczko PB, Strus M. Virulence factors of Streptococcus pyogenes strains from women in peri-labor with invasive infections. Eur J Clin Microbiol Infect Dis 2016; 35:747-54. [PMID: 26873375 PMCID: PMC4840219 DOI: 10.1007/s10096-016-2593-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 10/24/2022]
Abstract
Invasive group A streptococcal (GAS) infections constitute an important epidemiological problem. Many cases occur in women during the postnatal period. The objective of this study was to evaluate the presence of the genes responsible for production of iron-chelating protein (perR) and superantigens (speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, smeZ, and ssa) in S. pyogenes strains isolated from invasive infections in women after delivery. Furthermore, this study sought to verify whether S. pyogenes strains show special phenotypic and genotypic (sla, spy1325) characteristics that may play a decisive role in adherence to the genital tract epithelium. Moreover, the emm-types and antibiotic susceptibility were determined. We tested 30 invasive S. pyogenes strains isolated from postpartum invasive infection and 37 GAS control strains isolated from the genital tracts of asymptomatic multiparous women. The majority of the tested strains were shown to express two types of emm genes (1 and 28), though emm -12, -28, -75 and -89 were uniquely expressed in the group of strains isolated from invasive infections. A significantly higher prevalence of perR in the strains from puerperal fever was shown. Significant differences were also found between the two groups with respect to the incidence of the genes related to adherence; GAS strains originating from women with sepsis/puerperal fever showed presence of these genes less frequently than those of the control group. Although differences in frequencies of the gene coding for various superantigens were noted between the compared groups of GAS strains, they were not significant.
Collapse
Affiliation(s)
- E Golińska
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - M van der Linden
- Institute of Microbiology, RWTH Aachen University, Faculty of Medicine and University Hospital, Aachen, Germany
| | - G Więcek
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - D Mikołajczyk
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - A Machul
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - A Samet
- Department of Clinical Microbiology, University Clinical Center in Gdansk, 7 Debinki Str., 80-952, Gdansk, Poland
| | - A Piórkowska
- Department of Clinical Microbiology, University Clinical Center in Gdansk, 7 Debinki Str., 80-952, Gdansk, Poland
| | - M Dorycka
- Microbiological Laboratory, Diagnostics Inc., Kracow Branch, Na Skarpie 66 axis, 31-913, Kracow, Poland
| | - P B Heczko
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - M Strus
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland.
| |
Collapse
|
42
|
Characterization of Streptococcus pyogenes isolates responsible for adult meningitis in France from 2003 to 2013. Diagn Microbiol Infect Dis 2016; 84:350-2. [DOI: 10.1016/j.diagmicrobio.2015.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/22/2022]
|
43
|
Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections. J Clin Microbiol 2016; 54:994-9. [PMID: 26818671 DOI: 10.1128/jcm.02516-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/20/2016] [Indexed: 02/03/2023] Open
Abstract
Rapid antigen detection tests (RADTs) for group A streptococci (GAS) are widely used for diagnosing acute pharyngitis, which has led to a considerable reduction in antibiotic prescriptions over the past decade. Beyond this intended use, their reassessment on invasive samples may be relevant in the management of life-threatening GAS infections. To this end, we evaluated the performances of three RADTs, culture, GAS PCR, and 16S rRNA gene PCR assays, and compared them with a composite gold standard (GAS-PCR assay and/or culture) for the diagnosis of severe GAS infection. A total of 192 specimens from deep-tissue (mostly normally sterile) sites enriched for 75 GAS-positive samples were enrolled in the study. The three evaluated RADTs showed sensitivities ranging from 88.0% to 94.7% versus 98.7% for GAS PCR, 84% for 16S rRNA gene PCR, and 77.3% for culture. The sensitivities of the ImmunoCardSTAT! Strep A test (Meridian Bioscience) and the NADAL Strep A strip (Nal Von Minden) were similar to that of GAS PCR (P= 0.25 and 0.03, respectively) and higher than that of culture (P= 0.001 and 0.006, respectively), whereas the SD Bioline Strep A test strip (Standard Diagnostics) showed a performance similar to that of culture (P= 0.02). The three RADTs detected 10 distinctemmtypes, including a predominance ofemm1 (33.3%),emm89 (10.6%), andemm12 (7.6%). No false-positive results were observed, leading to a specificity of 100% for all the evaluated RADTs. The GAS RADTs turned out to be sensitive, specific, and easy-to-use tools that may aid in the management of invasive GAS infections in 24/7 point-of-care laboratories by enabling early diagnosis and focused therapy.
Collapse
|
44
|
Watanabe S, Takemoto N, Ogura K, Miyoshi-Akiyama T. Severe invasive streptococcal infection by Streptococcus pyogenes
and Streptococcus dysgalactiae
subsp. equisimilis. Microbiol Immunol 2016; 60:1-9. [DOI: 10.1111/1348-0421.12334] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/15/2015] [Accepted: 10/29/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Shinya Watanabe
- Division of Bacteriology; Department of Infection and Immunity; School of Medicine; Jichi Medical University; 3311-1 Yakushiji Shimotsuke-shi Tochigi 329-0498
| | - Norihiko Takemoto
- Pathogenic Microbe Laboratory; Research Institute; National Center for Global Health and Medicine; 1-21-1 Toyama Shinjuku Tokyo 162-8655, Japan
| | - Kohei Ogura
- Pathogenic Microbe Laboratory; Research Institute; National Center for Global Health and Medicine; 1-21-1 Toyama Shinjuku Tokyo 162-8655, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory; Research Institute; National Center for Global Health and Medicine; 1-21-1 Toyama Shinjuku Tokyo 162-8655, Japan
| |
Collapse
|
45
|
Clustered Regularly Interspaced Short Palindromic Repeats Are emm Type-Specific in Highly Prevalent Group A Streptococci. PLoS One 2015; 10:e0145223. [PMID: 26710228 PMCID: PMC4692479 DOI: 10.1371/journal.pone.0145223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 11/30/2015] [Indexed: 12/20/2022] Open
Abstract
Clustered regularly interspaced short palindromic repeats (CRISPR) are the bacterial adaptive immune system against foreign nucleic acids. Given the variable nature of CRISPR, it could be a good marker for molecular epidemiology. Group A streptococcus is one of the major human pathogens. It has two CRISPR loci, including CRISPR01 and CRISPR02. The aim of this study was to analyze the distribution of CRISPR-associated gene cassettes (cas) and CRISPR arrays in highly prevalent emm types. The cas cassette and CRISPR array in two CRISPR loci were analyzed in a total of 332 strains, including emm1, emm3, emm4, emm12, and emm28 strains. The CRISPR type was defined by the spacer content of each CRISPR array. All strains had at least one cas cassette or CRISPR array. More than 90% of the spacers were found in one emm type, specifically. Comparing the consistency between emm and CRISPR types by Simpson’s index of diversity and the adjusted Wallace coefficient, CRISPR01 type was concordant to emm type, and CRISPR02 showed unidirectional congruence to emm type, suggesting that at least for the majority of isolates causing infection in high income countries, the emm type can be inferred from CRISPR analysis, which can further discriminate isolates sharing the same emm type.
Collapse
|
46
|
Dinis M, Plainvert C, Longo M, Guignot J, Gabriel C, Poyart C, Fouet A. Group A Streptococcus emm3 strains induce early macrophage cell death. Pathog Dis 2015; 74:ftv124. [PMID: 26702632 DOI: 10.1093/femspd/ftv124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2015] [Indexed: 01/05/2023] Open
Abstract
Group A Streptococcus (GAS) infections present high morbidity and mortality rates and consequently remain a significant health problem. The emm3 isolates induce more severe pathologies than all others. In this study, we tested, on a collection of invasive and non-invasive emm3 clinical isolates, whether in that genotype the invasive status of the strains affects the innate immune response. We show that phagocytosis is dependent on the invasiveness of the isolates. Interestingly, all emm3 isolates compromise macrophage integrity, already noticeable 1 h after infection. Inflammatory modulators (IL-6, TNF-α and IFN-β) are nevertheless detected during at least 6 h post-infection. This is a likely consequence of the macrophages not being all infected. The efficient and rapid induction of macrophage death could explain the virulence of the emm3 strains.
Collapse
Affiliation(s)
- Márcia Dinis
- INSERM U 1016, Institut Cochin, Unité FRM 'Barrières et Pathogènes' F-75014 Paris, France CNRS UMR 8104, F-75014 Paris, France Université Paris Descartes, Sorbonne Paris Cité, F-75014 Paris, France
| | - Céline Plainvert
- INSERM U 1016, Institut Cochin, Unité FRM 'Barrières et Pathogènes' F-75014 Paris, France CNRS UMR 8104, F-75014 Paris, France Université Paris Descartes, Sorbonne Paris Cité, F-75014 Paris, France Centre National de Référence des Streptocoques, F-75014 Paris, France Hôpitaux Universitaires Paris Centre, Assistance Publique Hôpitaux de Paris, F-75014 Paris, France
| | - Magalie Longo
- INSERM U 1016, Institut Cochin, Unité FRM 'Barrières et Pathogènes' F-75014 Paris, France CNRS UMR 8104, F-75014 Paris, France Université Paris Descartes, Sorbonne Paris Cité, F-75014 Paris, France
| | - Julie Guignot
- INSERM U 1016, Institut Cochin, Unité FRM 'Barrières et Pathogènes' F-75014 Paris, France CNRS UMR 8104, F-75014 Paris, France Université Paris Descartes, Sorbonne Paris Cité, F-75014 Paris, France
| | - Christelle Gabriel
- INSERM U 1016, Institut Cochin, Unité FRM 'Barrières et Pathogènes' F-75014 Paris, France CNRS UMR 8104, F-75014 Paris, France Université Paris Descartes, Sorbonne Paris Cité, F-75014 Paris, France
| | - Claire Poyart
- INSERM U 1016, Institut Cochin, Unité FRM 'Barrières et Pathogènes' F-75014 Paris, France CNRS UMR 8104, F-75014 Paris, France Université Paris Descartes, Sorbonne Paris Cité, F-75014 Paris, France Centre National de Référence des Streptocoques, F-75014 Paris, France Hôpitaux Universitaires Paris Centre, Assistance Publique Hôpitaux de Paris, F-75014 Paris, France
| | - Agnès Fouet
- INSERM U 1016, Institut Cochin, Unité FRM 'Barrières et Pathogènes' F-75014 Paris, France CNRS UMR 8104, F-75014 Paris, France Université Paris Descartes, Sorbonne Paris Cité, F-75014 Paris, France Centre National de Référence des Streptocoques, F-75014 Paris, France
| |
Collapse
|
47
|
Highly virulent M1 Streptococcus pyogenes isolates resistant to clindamycin. Med Mal Infect 2015; 45:470-4. [DOI: 10.1016/j.medmal.2015.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022]
|
48
|
Trading Capsule for Increased Cytotoxin Production: Contribution to Virulence of a Newly Emerged Clade of emm89 Streptococcus pyogenes. mBio 2015; 6:e01378-15. [PMID: 26443457 PMCID: PMC4611041 DOI: 10.1128/mbio.01378-15] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Strains of emm89 Streptococcus pyogenes have become one of the major causes of invasive infections worldwide in the last 10 years. We recently sequenced the genome of 1,125 emm89 strains and identified three major phylogenetic groups, designated clade 1, clade 2, and the epidemic clade 3. Epidemic clade 3 strains, which now cause the great majority of infections, have two distinct genetic features compared to clade 1 and clade 2 strains. First, all clade 3 organisms have a variant 3 nga promoter region pattern, which is associated with increased production of secreted cytolytic toxins SPN (S. pyogenes NADase) and SLO (streptolysin O). Second, all clade 3 strains lack the hasABC locus mediating hyaluronic acid capsule synthesis, whereas this locus is intact in clade 1 and clade 2 strains. We constructed isogenic mutant strains that produce different levels of SPN and SLO toxins and capsule (none, low, or high). Here we report that emm89 strains with elevated toxin production are significantly more virulent than low-toxin producers. Importantly, we also show that capsule production is dispensable for virulence in strains that already produce high levels of SPN and SLO. Our results provide new understanding about the molecular mechanisms contributing to the rapid emergence and molecular pathogenesis of epidemic clade 3 emm89 S. pyogenes. S. pyogenes (group A streptococcus [GAS]) causes pharyngitis (“strep throat”), necrotizing fasciitis, and other human infections. Serious infections caused by emm89 S. pyogenes strains have recently increased in frequency in many countries. Based on whole-genome sequence analysis of 1,125 strains recovered from patients on two continents, we discovered that a new emm89 clone, termed clade 3, has two distinct genetic features compared to its predecessors: (i) absence of the genes encoding antiphagocytic hyaluronic acid capsule virulence factor and (ii) increased production of the secreted cytolytic toxins SPN and SLO. emm89 S. pyogenes strains with the clade 3 phenotype (absence of capsule and high expression of SPN and SLO) are highly virulent in mice. These findings provide new understanding of how new virulent clones emerge and cause severe infections worldwide. This newfound knowledge of S. pyogenes virulence can be used to help understand future epidemics and conduct new translational research.
Collapse
|
49
|
Imöhl M, van der Linden M. Antimicrobial Susceptibility of Invasive Streptococcus pyogenes Isolates in Germany during 2003-2013. PLoS One 2015; 10:e0137313. [PMID: 26340445 PMCID: PMC4560406 DOI: 10.1371/journal.pone.0137313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany. Invasive isolates (n = 1,281) were obtained between 2003 and 2013. All isolates were susceptible to penicillin, cefotaxime and vancomycin. Tetracycline showed the highest rate of resistant or intermediate resistant isolates with 9.8%, followed by macrolides (4.0%), trimethoprim/sulfamethoxazole (SXT) (1.9%), levofloxacin (1.3%), chloramphenicol (0.9%) and clindamycin (0.7%). The most prominent trends were the appearance of levofloxacin non-susceptible isolates since 2011, and an increase of SXT non-susceptibility since 2012.
Collapse
Affiliation(s)
- Matthias Imöhl
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
| | - Mark van der Linden
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
50
|
Complete Genome Sequence of Streptococcus pyogenes emm28 Clinical Isolate M28PF1, Responsible for a Puerperal Fever. GENOME ANNOUNCEMENTS 2015; 3:3/4/e00750-15. [PMID: 26184934 PMCID: PMC4505122 DOI: 10.1128/genomea.00750-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the sequence of the Streptococcus pyogenes emm28 strain M28PF1, isolated from a patient with postpartum endometritis. The M28 protein is smaller than that of MGAS6180 (NC_007296.1). Furthermore, the 1,896,976-bp-long chromosome presents, compared to that of MGAS6180, an inversion between the two comX genes.
Collapse
|