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Freschi de Barros S, De Amicis KM, Alencar R, Smeesters PR, Trunkel A, Postól E, Almeida Junior JN, Rossi F, Pignatari ACC, Kalil J, Guilherme L. Streptococcus pyogenes strains in Sao Paulo, Brazil: molecular characterization as a basis for StreptInCor coverage capacity analysis. BMC Infect Dis 2015; 15:308. [PMID: 26243278 PMCID: PMC4525746 DOI: 10.1186/s12879-015-1052-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/22/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Several human diseases are caused by Streptococcus pyogenes, ranging from common infections to autoimmunity. Characterization of the most prevalent strains worldwide is a useful tool for evaluating the coverage capacity of vaccines under development. In this study, a collection of S. pyogenes strains from Sao Paulo, Brazil, was analyzed to describe the diversity of strains and assess the vaccine coverage capacity of StreptInCor. METHODS Molecular epidemiology of S. pyogenes strains was performed by emm-genotyping the 229 isolates from different clinical sites, and PCR was used for superantigen profile analysis. The emm-pattern and tissue tropism for these M types were also predicted and compared based on the emm-cluster classification. RESULTS The strains were fit into 12 different emm-clusters, revealing a diverse phylogenetic origin and, consequently, different mechanisms of infection and escape of the host immune system. Forty-eight emm-types were distinguished in 229 samples, and the 10 most frequently observed types accounted for 69 % of all isolates, indicating a diverse profile of circulating strains comparable to other countries under development. A similar proportion of E and A-C emm-patterns were observed, whereas pattern D was less frequent, indicating that the strains of this collection primarily had a tissue tropism for the throat. In silico analysis of the coverage capacity of StreptInCor, an M protein-conserved regionally based vaccine candidate developed by our group, had a range of 94.5 % to 59.7 %, with a mean of 71.0 % identity between the vaccine antigen and the predicted amino acid sequence of the emm-types included here. CONCLUSIONS This is the first report of S. pyogenes strain characterization in Sao Paulo, one of the largest cities in the world; thus, the strain panel described here is a representative sample for vaccine coverage capacity analysis. Our results enabled evaluation of StreptInCor candidate vaccine coverage capacity against diverse M-types, indicating that the vaccine candidate likely would induce protection against the diverse strains worldwide.
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Affiliation(s)
- Samar Freschi de Barros
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Karine Marafigo De Amicis
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Raquel Alencar
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Pierre Robert Smeesters
- Laboratoire de Génétique et Physiologie Bactérienne, Institute de Biologie et de Médecine Moléculaires, Faculté des Sciences, Université Libre de Bruxelles, Bruxelles, 1050, Belgium.
- Murdoch Childrens Research Institute, Parkville, 3052, Australia.
| | - Ariel Trunkel
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - Edilberto Postól
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
| | - João Nóbrega Almeida Junior
- Microbiology Laboratory of Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | - Flavia Rossi
- Microbiology Laboratory of Clinical Hospital, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | | | - Jorge Kalil
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
- Clinical Immunology and Allergy Division, School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
| | - Luiza Guilherme
- Heart Institute (InCor), School of Medicine, University of Sao Paulo, Sao Paulo, 01246-000, Brazil.
- Institute for Immunology Investigation, National Institute of Science and Technology, Sao Paulo, 01246-000, Brazil.
- Laboratory of Immunology, Clinical Hospital, Heart Institute (HC-FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 44, Sao Paulo, 05403-000, Brazil.
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Arêas GP, Schuab RBB, Neves FPG, Barros RR. Antimicrobial susceptibility patterns, emm type distribution and genetic diversity of Streptococcus pyogenes recovered in Brazil. Mem Inst Oswaldo Cruz 2014; 109:935-9. [PMID: 25410998 PMCID: PMC4296499 DOI: 10.1590/0074-0276140231] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022] Open
Abstract
Streptococcus pyogenes is responsible for a variety of infectious diseases and immunological complications. In this study, 91 isolates of S. pyogenes recovered from oropharynx secretions were submitted to antimicrobial susceptibility testing, emm typing and pulsed-field gel electrophoresis (PFGE) analysis. All isolates were susceptible to ceftriaxone, levofloxacin, penicillin G and vancomycin. Resistance to erythromycin and clindamycin was 15.4%, which is higher than previous reports from this area, while 20.9% of the isolates were not susceptible to tetracycline. The macrolide resistance phenotypes were cMLSB (10) and iMLSB (4). The ermB gene was predominant, followed by the ermA gene. Thirty-two emm types and subtypes were found, but five (emm1, emm4, emm12, emm22, emm81) were detected in 48% of the isolates. Three new emm subtypes were identified (emm1.74, emm58.14, emm76.7). There was a strong association between emm type and PFGE clustering. A variety of PFGE profiles as well as emm types were found among tetracycline and erythromycin-resistant isolates, demonstrating that antimicrobial resistant strains do not result from the expansion of one or a few clones. This study provides epidemiological data that contribute to the development of suitable strategies for the prevention and treatment of such infections in a poorly studied area.
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Affiliation(s)
| | | | | | - Rosana R Barros
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico,
Universidade Federal Fluminense, Niterói, RJ, Brasil
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Alfaresi MS. Group A streptococcal genotypes from throat and skin isolates in the United Arab Emirates. BMC Res Notes 2010; 3:94. [PMID: 20370898 PMCID: PMC2907864 DOI: 10.1186/1756-0500-3-94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 04/06/2010] [Indexed: 11/10/2022] Open
Abstract
Background The bacterium Streptococcus pyogenes causes a variety of human diseases that range from relatively mild skin infections to severe invasive diseases, such as acute rheumatic fever, glomerulonephritis, puerperal sepsis, necrotizing fasciitis, meningitis, and streptococcal toxic shock syndrome. Accurate identification and typing of group A hemolytic streptococci (GAS) is essential for epidemiological and pathogenetic studies of streptococcal diseases. For this reason, The genetic diversity of group A streptococcal (GAS) isolates from subjects in the United Arab Emirates with streptococcal disease was studied using emm gene sequence analysis. The emm typing system which is based on sequence analysis of PCR products of the N-terminal hypervariable region of the M protein gene, concurs with M serotyping almost 1:1. Findings A total of 38 GAS isolates were analyzed, including 35 isolates from throat and 3 from skin. Among the 38 isolates, a total of 25 different emm/st types were detected: 20 isolates (53%) belonged to 16 validated standard reference emm types and 18 isolates (47%) belonged to 9 recognized sequence types. Conclusions This is the first emm typing study in the United Arab Emirates to demonstrate the heterogeneity of the GAS population.
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Affiliation(s)
- Mubarak S Alfaresi
- Department of pathology & Laboratory medicine, Zayed Military Hospital, PO BOX 3740, Abudhabi, UAE.
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Moura H, Woolfitt AR, Carvalho MG, Pavlopoulos A, Teixeira LM, Satten GA, Barr JR. MALDI-TOF mass spectrometry as a tool for differentiation of invasive and noninvasive Streptococcus pyogenes isolates. ACTA ACUST UNITED AC 2008; 53:333-42. [PMID: 18537829 PMCID: PMC2658026 DOI: 10.1111/j.1574-695x.2008.00428.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A novel mass spectral fingerprinting and proteomics approach using MALDI-TOF MS was applied to detect and identify protein biomarkers of group A Streptococcus (GAS) strains. Streptococcus pyogenes ATCC 700294 genome strain was compared with eight GAS clinical isolates to explore the ability of MALDI-TOF MS to differentiate isolates. Reference strains of other bacterial species were also analyzed and compared with the GAS isolates. MALDI preparations were optimized by varying solvents, matrices, plating techniques, and mass ranges for S. pyogenes ATCC 700294. Spectral variability was tested. A subset of common, characteristic, and reproducible biomarkers in the range of 2000–14 000 Da were detected, and they appeared to be independent of the culture media. Statistical analysis confirmed method reproducibility. Random Forest analysis of all selected GAS isolates revealed differences among most of them, and summed spectra were used for hierarchical cluster analysis. Specific biomarkers were found for each strain, and invasive GAS isolates could be differentiated. GAS isolates from cases of necrotizing fasciitis were clustered together and were distinct from isolates associated with noninvasive infections, despite their sharing the same emm type. Almost 30% of the biomarkers detected were tentatively identified as ribosomal proteins.
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Affiliation(s)
- Hercules Moura
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA
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O'Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, Craig A, Albanese BA, Farley MM, Barrett NL, Spina NL, Beall B, Harrison LH, Reingold A, Van Beneden C. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis 2007; 45:853-62. [PMID: 17806049 DOI: 10.1086/521264] [Citation(s) in RCA: 347] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 05/23/2007] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Invasive group A Streptococcus (GAS) infection causes significant morbidity and mortality in the United States. We report the current epidemiologic characteristics of invasive GAS infections and estimate the potential impact of a multivalent GAS vaccine. METHODS From January 2000 through December 2004, we collected data from Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs), a population-based system operating at 10 US sites (2004 population, 29.7 million). We defined a case of invasive GAS disease as isolation of GAS from a normally sterile site or from a wound specimen obtained from a patient with necrotizing fasciitis or streptococcal toxic shock syndrome in a surveillance area resident. All available isolates were emm typed. We used US census data to calculate rates and to make age- and race-adjusted national projections. RESULTS We identified 5400 cases of invasive GAS infection (3.5 cases per 100,000 persons), with 735 deaths (case-fatality rate, 13.7%). Case-fatality rates for streptococcal toxic shock syndrome and necrotizing fasciitis were 36% and 24%, respectively. Incidences were highest among elderly persons (9.4 cases per 100,000 persons), infants (5.3 cases per 100,000 persons), and black persons (4.7 cases per 100,000 persons) and were stable over time. We estimate that 8950-11,500 cases of invasive GAS infection occur in the United States annually, resulting in 1050-1850 deaths. The emm types in a proposed 26-valent vaccine accounted for 79% of all cases and deaths. Independent factors associated with death include increasing age; having streptococcal toxic shock syndrome, meningitis, necrotizing fasciitis, pneumonia, or bacteremia; and having emm types 1, 3, or 12. CONCLUSIONS GAS remains an important cause of severe disease in the United States. The introduction of a vaccine could significantly reduce morbidity and mortality due to these infections.
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Affiliation(s)
- Rosalyn E O'Loughlin
- Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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McDonald MI, Towers RJ, Andrews R, Benger N, Fagan P, Currie BJ, Carapetis JR. The dynamic nature of group A streptococcal epidemiology in tropical communities with high rates of rheumatic heart disease. Epidemiol Infect 2007; 136:529-39. [PMID: 17540052 PMCID: PMC2870827 DOI: 10.1017/s0950268807008655] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Prospective surveillance was conducted in three remote Aboriginal communities with high rates of rheumatic heart disease in order to investigate the epidemiology of group A beta-haemolytic streptococci (GAS). At each household visit, participants were asked about sore throat. Swabs were taken from all throats and any skin sores. GAS isolates were emm sequence and pattern-typed using standard laboratory methods. There were 531 household visits; 43 different emm types and subtypes (emmST) were recovered. Four epidemiological patterns were observed. Multiple emmST were present in the population at any one time and household acquisition rates were high. Household acquisition was most commonly via 5- to 9-year-olds. Following acquisition, there was a 1 in 5 chance of secondary detection in the household. Throat detection of emmST was brief, usually <2 months. The epidemiology of GAS in these remote Aboriginal communities is a highly dynamic process characterized by emmST diversity and turnover.
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Affiliation(s)
- M I McDonald
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia.
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Tanna A, Emery M, Dhami C, Arnold E, Efstratiou A. Molecular characterization of clinical isolates of M non-typable group A streptococci from invasive disease cases. J Med Microbiol 2006; 55:1419-1423. [PMID: 17005792 DOI: 10.1099/jmm.0.46465-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Currently there are 93 validated M serotypes of Streptococcus pyogenes, Lancefield group A streptococcus (GAS), and >130 emm genotypes. A marked increase in the number of non-typable GAS isolates (2 % in 2000, 4 % in 2001 and 9 % in 2002) from invasive disease cases referred to the authors' reference laboratory was noted during 2000–2002. A total of 217 (92 %) were from blood cultures, 14 (6 %) from deep abscesses and five (2 %) from aspirates. The clinical manifestations included bacteraemia, septicaemia, cellulitis, meningitis, necrotizing fasciitis and toxic-shock syndrome. In order to establish whether this increase was due to the emergence of novel types or the unavailability of M-typing sera, these isolates were subjected to emm sequencing. A total of 144 isolates (61 %) belonged to M types for which sera were no longer available; 112 (48 %) belonged to higher M types, including emm83.1 (9 %), emm94 (8 %) emm87 (6 %) and emm89 (6 %); and 32 (13 %) belonged to lower M types that were not commonly isolated in the UK, and included M25, M43, M49, M64, M73 and M74. Sixty-six (28 %) of the isolates belonged to newly designated emm types. Other isolates belonged to the novel emm types st2147, STNS1033 and st854, recently registered in the Centers for Disease Control (CDC) database by other laboratories. One novel emm type, st2161, was isolated from an injecting drug user. There were differences in the type distribution of these isolates according to geographic location. However, 90 % of emm93, one of seven predominant emm types identified amongst the collection of M non-typable (MNT) isolates, were isolated from the London region.
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Sakota V, Fry AM, Lietman TM, Facklam RR, Li Z, Beall B. Genetically diverse group A streptococci from children in far-western Nepal share high genetic relatedness with isolates from other countries. J Clin Microbiol 2006; 44:2160-6. [PMID: 16757615 PMCID: PMC1489425 DOI: 10.1128/jcm.02456-05] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The genetic diversity of group A streptococci (GAS) throughout much of the world has not been adequately explored. To assess genetic variation among GAS in western Nepal, 120 noninvasive GAS, collected from eight different villages, were genetically characterized using emm typing, sof sequencing, and multilocus sequence typing (MLST). A high level of genetic diversity was observed among these isolates, with 51 genotypes based upon 51 multilocus sequence types (STs), 45 emm sequence types, and 28 sof sequence types. On the basis of shared ST-emm and sof-emm associations, 40 of the 51 genotypes were identical or highly related to genotypes characterized from locations outside of Nepal, even though most of the emm sequence and clonal types are rare among GAS within the United States. When analyzing all known STs highly related to Nepal STs, only one example of similar STs shared between a sof PCR-positive strain and a sof PCR-negative strain was observed. Since previous data indicate free exchange of MLST loci between sof-positive and sof-negative strains, there is possibly selection against the expansion of subclones resulting from horizontal transfers of sof or emm genes between sof-positive and sof-negative strains. All 45 emm types encountered in Nepal have also been documented from other countries. These data, together with data encompassing the past decade of emm type surveillance, support the possibility that most existing GAS emm types have been discovered. Similarly, since most (40/51) strain types were highly related to strains found elsewhere, it is likely that a major fraction of the existing GAS clonal complexes have been discovered.
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Affiliation(s)
- Varja Sakota
- Division of Bacterial and Myotic Diseases, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Eisner A, Leitner E, Feierl G, Kessler HH, Marth E. Prevalence of emm types and antibiotic resistance of group A streptococci in Austria. Diagn Microbiol Infect Dis 2006; 55:347-50. [PMID: 16725301 DOI: 10.1016/j.diagmicrobio.2006.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 01/13/2006] [Accepted: 01/13/2006] [Indexed: 11/13/2022]
Abstract
The prevalence of emm types and the antibiotic resistance patterns of consecutive isolates of Streptococcus pyogenes from South-East Australian patients collected in 1996 and 2003 were determined. Emm 1, emm 4, emm 12, and emm 28 were found to be the predominant types. A remarkable decrease of macrolide resistance from 1996 (19%) to 2003 (3%) was observed.
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Affiliation(s)
- Alexandra Eisner
- Institute of Hygiene, Medical University of Graz, A-8010 Graz, Austria
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Abdissa A, Asrat D, Kronvall G, Shittu B, Achiko D, Zeidan M, Yamuah LK, Aseffa A. High diversity of group A streptococcal emm types among healthy schoolchildren in Ethiopia. Clin Infect Dis 2006; 42:1362-7. [PMID: 16619146 DOI: 10.1086/503422] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2005] [Accepted: 01/21/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although the prevalence of rheumatic heart disease in Ethiopia is one of the highest in the world, the epidemiology of group A streptococci (GAS) in this country is little known. GAS typing is a hallmark of both the epidemiology and understanding of diseases caused by these organisms. We have therefore conducted this study to investigate the emm (M-protein gene) type distribution of GAS carriers among Ethiopian schoolchildren. METHODS In the present study, we performed emm typing of 82 GAS isolates collected from the throats of healthy schoolchildren (6-14 years of age) residing in 3 different urban sites in Ethiopia: Addis Ababa, Gondar, and Dire Dawa. RESULTS We report high diversity of GAS isolates recovered from healthy schoolchildren. Eighty-two isolates represented 43 different sequence types. Thirteen newly described subtypes were detected in this study. Of the emm types prevalent in the study communities, 46% were not included in the 26-valent GAS vaccine. CONCLUSIONS The high diversity of emm types encountered within 3 months of collection suggest that production of a vaccine candidate based on the M-protein amino termini appears to be impractical for this population. We suggest that investigations of other vaccine candidates, including the C5a peptidase, GAS carbohydrate, and fibronectin-binding proteins, as well as conserved M-protein region vaccines, should be intensified to address the needs of this population.
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Affiliation(s)
- Alemseged Abdissa
- Armauer Hansen Research Institute, Addis Ababa University, Addis Ababa, Ethiopia.
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Johnson DR, Kaplan EL, VanGheem A, Facklam RR, Beall B. Characterization of group A streptococci (Streptococcus pyogenes): correlation of M-protein and emm-gene type with T-protein agglutination pattern and serum opacity factor. J Med Microbiol 2006; 55:157-164. [PMID: 16434707 DOI: 10.1099/jmm.0.46224-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Strain characterization of group A streptococci (GAS) has traditionally been based on serological identification of M protein. Additional tests to determine T-protein serotype and production of streptococcal serum opacity factor (SOF) provide important information both to aid in and to supplement M-protein serotyping. Advances in DNA-sequencing technology in the late twentieth century resulted in the development of a method for determining the M type of GAS from the sequence of the gene encoding M protein, the emm gene. Although emm-sequence typing has largely replaced M typing in many laboratories, information provided by T typing and SOF determination continues to provide valuable supplementary information for strain characterization. A comprehensive summary of the correlation of T pattern and SOF production with M type was last published in 1993, several years before emm typing became widely available. Since then, the ease of M-type identification afforded by emm typing has resulted in an increase in the number of confirmed M/emm types of more than 50 %. However, comprehensive information about T-protein serotype and the correlation of SOF production with these new M/emm types is not widely available. This report presents a comprehensive summary of this information, not only for newly described types, but also updated information for previously described types. This information was extracted from combined records from streptococcal reference laboratories at the University of Minnesota and at the Centers for Disease Control and Prevention in Atlanta. Data from more than 40,000 strains (representing uncomplicated GAS infections, systemic invasive infections and strains associated with non-suppurative sequelae, collected from the US and diverse locations worldwide) were analysed.
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Affiliation(s)
- Dwight R Johnson
- Department of Pediatrics and the World Health Organization Collaborating Center for Reference and Research on Streptococci, University of Minnesota, Minneapolis, MN 55455, USA
| | - Edward L Kaplan
- Department of Pediatrics and the World Health Organization Collaborating Center for Reference and Research on Streptococci, University of Minnesota, Minneapolis, MN 55455, USA
| | - Amy VanGheem
- Department of Pediatrics and the World Health Organization Collaborating Center for Reference and Research on Streptococci, University of Minnesota, Minneapolis, MN 55455, USA
| | - Richard R Facklam
- Centers for Disease Control and Prevention, Division of Bacterial and Mycotic Diseases, Respiratory Diseases Branch, 1600 Clifton Rd, Mailstop CO2, Atlanta, GA 30333, USA
| | - Bernard Beall
- Centers for Disease Control and Prevention, Division of Bacterial and Mycotic Diseases, Respiratory Diseases Branch, 1600 Clifton Rd, Mailstop CO2, Atlanta, GA 30333, USA
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Tewodros W, Kronvall G. M protein gene (emm type) analysis of group A beta-hemolytic streptococci from Ethiopia reveals unique patterns. J Clin Microbiol 2005; 43:4369-76. [PMID: 16145079 PMCID: PMC1234087 DOI: 10.1128/jcm.43.9.4369-4376.2005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The genetic diversity of group A streptococcal (GAS) isolates obtained in 1990 from Ethiopian children with various streptococcal diseases was studied by using emm gene sequence analysis. A total of 217 GAS isolates were included: 155 and 62 isolates from throat and skin, respectively. A total of 78 different emm/st types were detected among the 217 isolates. Of these, 166 (76.5%) belonged to 52 validated reference emm types, 26 (11.9%) belonged to 16 already recognized sequence types (st types) and 25 (11.5%) belonged to 10 undocumented new sequence types. Resistance to tetracycline (148 of 217) was not correlated to emm type. Isolation rate of the classical rheumatogenic and nephritogenic strains was low from cases of acute rheumatic fever (ARF) and acute glomerulonephritis (AGN), respectively. Instead, the recently discovered st types were overrepresented among isolates from patients with ARF (3 of 7) and AGN (9 of 16) (P < 0.01) compared to isolates from subjects with tonsillitis and from healthy carriers (10 of 57 and 16 of 90, respectively). In contrast to rheumatogenic strains from the temperate regions, more than half of the isolates from ARF (four of seven) carried the genetic marker for skin preference, emm pattern D, although most of them (six of seven) were isolated from throat. Of 57 tonsillitis-associated isolates, 16 (28%) belonged to emm pattern D compared to <1% in temperate regions. As in other reports emm patterns A to C were strongly associated with throat, whereas emm pattern D did not correlate to skin. This first large-scale emm typing report from Africa has demonstrated a heterogeneous GAS population and contrasting nature of GAS epidemiology in the region.
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Dey N, McMillan DJ, Yarwood PJ, Joshi RM, Kumar R, Good MF, Sriprakash KS, Vohra H. High Diversity of Group A Streptococcal emm Types in an Indian Community: The Need to Tailor Multivalent Vaccines. Clin Infect Dis 2005; 40:46-51. [PMID: 15614691 DOI: 10.1086/426443] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Accepted: 08/23/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Concern about the emergence of antibiotic-resistant strains and about morbidity and/or mortality related to rheumatic fever and rheumatic heart disease has been a continuous impetus for the development of a safe, effective vaccine against group A Streptococcus (GAS). To date, >120 GAS M types are known, as identified by serological typing. In general, serum immunoglobulin G directed to the hypervariable NH2 terminal portion of M protein leads to complement fixation and opsonophagocytosis of the homologous streptococcal serotype by polymorphonuclear leukocytes, and the protection is type specific. The sequence variation at the N terminus ultimately affects the binding of opsonic antibodies. Because of hypervariability in these opsonic sequences from different M types, it was relevant to use epitopes derived from these multiple sequences in a "multivalent vaccine" design for evaluation of protection against these M types of GAS. Thus, any attempts to design vaccines for a given community will require information on N terminal-sequence typing and variation. METHODS In the present study, we performed molecular characterization of isolates recovered from patients in northern India--to our knowledge, for the first time--in an attempt to study the circulating M types and their N terminal sequence variability. RESULTS We report tremendous diversity in GAS strains recovered from symptomatic patients, with implications on the design of appropriate vaccines. Fifty-nine isolates represented 33 different sequence types. Very few novel types and no predominant clones were found. CONCLUSIONS The high diversity of emm types encountered in a single year suggests that any M protein-based multivalent vaccine would have to be specifically tailored for this region.
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Affiliation(s)
- Nilay Dey
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Chiou CS, Liao TL, Wang TH, Chang HL, Liao JC, Li CC. Epidemiology and molecular characterization of Streptococcus pyogenes recovered from scarlet fever patients in central Taiwan from 1996 to 1999. J Clin Microbiol 2004; 42:3998-4006. [PMID: 15364982 PMCID: PMC516299 DOI: 10.1128/jcm.42.9.3998-4006.2004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
One hundred seventy-nine Streptococcus pyogenes isolates recovered from scarlet fever patients from 1996 to 1999 in central Taiwan were characterized by emm, Vir, and pulsed-field gel electrophoresis (PFGE) typing methods. The protocols for Vir and PFGE typing were standardized. A database of the DNA fingerprints for the isolates was established. Nine emm or emm-like genes, 19 Vir patterns, and 26 SmaI PFGE patterns were detected among the isolates. Among the three typing methods, PFGE was the most discriminatory. However, it could not completely replace Vir typing because some isolates with identical PFGE patterns could be further differentiated into several Vir patterns. The prevalent emm types were emm4 (n = 81 isolates [45%]), emm12 (n = 64 [36%]), emm1 (n = 14 [8%]), and emm22 (n = 13 [7%]). Some emm type isolates could be further differentiated into several emm-Vir-PFGE genotypes; however, only one genotype in each emm group was usually predominant. DNA from nine isolates was resistant to SmaI digestion. Further PFGE analysis with SgrAI showed that the SmaI digestion-resistant strains could be derived from indigenous strains by horizontal transfer of exogenous genetic material. The emergence of the new strains could have resulted in an increase in scarlet fever cases in central Taiwan since 2000. The emm sequences, Vir, and PFGE pattern database will serve as a basis for information for the long-term evolutionary study of local S. pyogenes strains.
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Affiliation(s)
- Chien-Shun Chiou
- The Central Branch Office, Center for Disease Control, 5F 20 Wen-Sin South 3rd Rd., Taichung City 408, Taiwan.
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Nunes De Melo MC, Figueiredo AMS, Ferreira-Carvalho BT. Antimicrobial susceptibility patterns and genomic diversity in strains of Streptococcus pyogenes isolated in 1978-1997 in different Brazilian cities. J Med Microbiol 2003; 52:251-258. [PMID: 12621091 DOI: 10.1099/jmm.0.04938-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Penicillin has been the antimicrobial of choice for the treatment of Streptococcus pyogenes infections for almost six decades. Although penicillin-resistant isolates have not been described to date, clinical failures have been reported after treatment with beta-lactams. In this study, we analysed the antimicrobial susceptibility and genetic diversity of S. pyogenes isolates obtained from healthy carriers or patients in different cities in the south and south east of Brazil. The MICs were determined for penicillin and seven other antimicrobials. Penicillin tolerance was also investigated. Genetic diversity was analysed by PFGE after SmaI fragmentation of the genomic DNA. All 211 isolates tested were susceptible to penicillin (MIC 0.0025-0.02 mg l(-1)). Four isolates were moderately penicillin-tolerant (MBC/MIC = 16 mg l(-1)). Most of the other drugs tested were very active against the strains examined, except for tetracycline, to which 50 % of strains were resistant. We also found extensive genetic diversity, in that 60 different patterns were recognized in the 96 strains studied. Indeed, we found no correlation between tetracycline resistance and clonality. Despite this diversity, some PFGE patterns persisted for up to 18 years and specific clone types were spread over different geographical locations
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Affiliation(s)
- Maria Celeste Nunes De Melo
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Professor Paulo de Góes, Laboratório de Biologia Molecular de Bactérias, CCS, Bloco I, Cidade Universitária, Rio de Janeiro, RJ, 21941-590, Brazil
| | - Agnes Marie Sá Figueiredo
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Professor Paulo de Góes, Laboratório de Biologia Molecular de Bactérias, CCS, Bloco I, Cidade Universitária, Rio de Janeiro, RJ, 21941-590, Brazil
| | - Bernadete Teixeira Ferreira-Carvalho
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Professor Paulo de Góes, Laboratório de Biologia Molecular de Bactérias, CCS, Bloco I, Cidade Universitária, Rio de Janeiro, RJ, 21941-590, Brazil
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Tanaka D, Gyobu Y, Kodama H, Isobe J, Hosorogi S, Hiramoto Y, Karasawa T, Nakamura S. emm Typing of group A streptococcus clinical isolates: identification of dominant types for throat and skin isolates. Microbiol Immunol 2003; 46:419-23. [PMID: 12222927 DOI: 10.1111/j.1348-0421.2002.tb02715.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
T and emm types were determined for group A streptococci isolated from patients with various infections during 1990-1999 in Toyama Prefecture, Japan. Out of 906 isolates, 872 isolates were divided into 20 T serotypes, and 34 isoltes were T nontypeable (TNT). T12, T1, and T4 were dominant among 699 throat isolates; on the other hand, T11, T28, TB3264, and TNT were dominant among 80 skin isolates. The emm types of 190 isolates were determined following specific PCR amplification and sequencing of the products. Twenty T serotypes were divided into 34 T type/emm type combinations. Thirty-four TNT isolates were divided into 14 emm types, in which emm58 was the most common (38%). Among 82 throat isolates randomly selected, predominant T types T12, T1, and T4 isolates were of the respective same numbers in emm type. T11/emm89, T28/emm28, TB3264/emm13w, and TNT/emm58 were predominant among 80 skin isolates. emm-type distribution observed in the present study was that usually reported in the western world. To our knowledge, 3 T/emm is a novel combination. These results show that emm typing allows the characterization of group A streptococci from various sources.
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Affiliation(s)
- Daisuke Tanaka
- Department of Bacteriology, Toyama Institute of Health, Kosugi, Japan.
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Dicuonzo G, Fiscarelli E, Gherardi G, Lorino G, Battistoni F, Landi S, De Cesaris M, Petitti T, Beall B. Erythromycin-resistant pharyngeal isolates of Streptococcus pyogenes recovered in Italy. Antimicrob Agents Chemother 2002; 46:3987-90. [PMID: 12435707 PMCID: PMC132735 DOI: 10.1128/aac.46.12.3987-3990.2002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Three classes of macrolide resistance phenotypes and three different erythromycin resistance determinants were found among 127 erythromycin-resistant group A streptococcal (GAS) isolates recovered from 355 (35.8%) pediatric pharyngitis patients in Rome, Italy. According to emm and sof sequence typing results, erythromycin-resistant isolates comprised 11 different clonal types. Remarkably, 126 of the 127 macrolide-resistant isolates were serum opacity factor (sof) gene positive. These data suggest a strong association between macrolide resistance and the presence of sof among GAS isolates recovered from Italian pediatric pharyngitis patients.
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Affiliation(s)
- Giordano Dicuonzo
- Department of Laboratory Medicine. Hospital Infection Control Program, Università Campus Bio-Medico, Rome, Italy
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