MedWorm: Group A Streptococcus

[Case Report] Nosocomial transmission of necrotising fasciitis

LANCET — Fri, 19 Mar 2010 00:00:00 +0100

In June, 2008, a previously healthy 8-month-old girl presented with chickenpox, fever (39·5°C), and a red, painful, and swollen right arm with dusky and purplish skin discoloration (). Empirical intravenous antimicrobial therapy with amoxicillin-clavulanate and clindamycin was initiated after microbiological screening (blood culture and wound smear). A diagnosis of cellulitis with suspicion of necrotising fasciitis was made and surgical debridement was undertaken within 8 h after admission (). Macroscopic and microscopic examination confirmed extensive necrosis. A few hours later, she developed hypotension, renal failure, coagulopathy, and thrombocytopenia. Probable toxic shock syndrome was diagnosed and intensive supportive care started. Multi-susceptible group A streptococcus was isola...

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Microbiological investigation of a hospital outbreak of invasive group A streptococcal disease in Krakow, Poland

Clinical Microbiology and Infection — Sat, 13 Mar 2010 00:00:00 +0100

Clin Microbiol Infect The present study reports the epidemiological investigations undertaken in one of Krakow's city hospitals regarding the source of infection and the routes of transmission of a group A streptococcus (Streptococcus pyogenes), using fluorescent in situ hybridization as a rapid method for detecting S. pyogenes carriage in the medical personnel involved. Four patients from the gynaecology department and two patients from the surgery department presented with clinical signs of infection. Characteristics of the S. pyogenes strains isolated from patients and from one medical staff member, including the emm gene and superantigens encoding genes, are described. All patients (four confirmed and two probable cases) survived; the operating theatre aid was identified as an S. pyoge...

Preferences for health outcomes associated with Group A Streptococcal disease and vaccination

Health and Quality of Life Outcomes — Fri, 12 Mar 2010 00:00:00 +0100

Conclusions: Parents strongly prefer to prevent GAS disease in children compared to vaccine adverse events. However, WTP/QALY thresholds were higher for the prevention of vaccine adverse events. Regret for errors of commission vs. omission may differ and should be considered by vaccine policymakers. (Source: Health and Quality of Life Outcomes)

Interactome analysis of longitudinal pharyngeal infection of cynomolgus macaques by group A Streptococcus [Microbiology]

Proceedings of the National Academy of Sciences — Tue, 09 Mar 2010 17:27:19 +0100

Relatively little is understood about the dynamics of global host–pathogen transcriptome changes that occur during bacterial infection of mucosal surfaces.... (Source: Proceedings of the National Academy of Sciences)

Broad Spectrum Respiratory Pathogen Analysis of Throat Swabs from Military Recruits Reveals Interference Between Rhinoviruses and Adenoviruses.

Microbial Ecology — Tue, 09 Mar 2010 00:00:00 +0100

In this study, we explore the carriage rates and disease associations of adenovirus, enterovirus, rhinovirus, Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis in military recruits using high-density resequencing microarrays. The results showed that rhinoviruses, adenoviruses, S. pneumoniae, H. influenzae, and N. meningitidis were widely distributed in recruits. Of these five agents, only adenovirus showed significant correlation with illness. Among the samples tested, only pathogens associated with FRI, such as adenovirus 4 and enterovirus 68, revealed strong temporal and spatial clustering of specific strains, indicating that they are transmitted primarily within sites. The results showed a strong negative association between adenoviral FRI and the presence of ...

Genome Study Shows How Strep Throat Germ Circumvents Our Immune System

Immune System / Vaccines News From Medical News Today — Tue, 23 Feb 2010 10:00:00 +0100

Investigators at The Methodist Hospital Research Institute in Houston examined for the first time the long-term response to strep throat on a genome-wide level, shedding light on how group A streptococcus interacts with the patient's immune system and attempts to circumvent it. Results were published in the Proceedings of the National Academy of Sciences (PNAS)... (Source: Immune System / Vaccines News From Medical News Today)

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Genome Study Shows How Strep Throat Germ Circumvents Our Immune System

Health News from Medical News Today — Tue, 23 Feb 2010 10:00:00 +0100

Investigators at The Methodist Hospital Research Institute in Houston examined for the first time the long-term response to strep throat on a genome-wide level, shedding light on how group A streptococcus interacts with the patient's immune system and attempts to circumvent it. Results were published in the Proceedings of the National Academy of Sciences (PNAS). In the United States, the human bacterial pathogen group A streptococcus causes an estimated 30 million cases of strep throat annually and also causes rheumatic fever that damages the heart... (Source: Health News from Medical News Today)

Modest Genetic Differences Seen in Streptococcus Strains

Modern Medicine — Tue, 16 Feb 2010 00:00:00 +0100

Group A Streptococcus strains from successive epidemics have relatively modest genetic differences but very different global gene expression, which may provide clues about their biology, according to a study published online Feb. 8 in the Proceedings of the National Academy of Sciences. (Source: Modern Medicine)

Dissection of the Molecular Basis for Hypervirulence of an In Vivo–Selected Phenotype of the Widely Disseminated M1T1 Strain of Group A Streptococcus Bacteria

The Journal of Infectious Diseases Latest Issue — Fri, 12 Feb 2010 21:58:19 +0100

The Journal of Infectious Diseases, Volume 0, Issue 0, Page 000, Latest Articles. Group A streptococci (GAS) may engage different sets of virulence strategies, depending on the site of infection and host context. We previously isolated 2 phenotypic variants of a globally disseminated M1T1 GAS clone: a virulent wild‐type (WT) strain, characterized by a SpeB+/SpeA−/Sda1low phenotype, and a hypervirulent animal‐passaged (AP) strain, better adapted to survive in vivo, with a SpeB−/SpeA+/Sda1high phenotype. This AP strain arises in vivo due to the selection of bacteria with mutations in covS, the sensor part of a key 2‐component regulatory system, CovR/S. To determine whether covS mutations explain the hypervirulence of the AP strain, we deleted covS from WT bacteria (ΔCovS) an...

The 4.5S RNA component of the signal recognition particle is required for group A Streptococcus virulence.

Microbiology — Thu, 28 Jan 2010 00:00:00 +0100

Authors: Treviño J, Perez N, Sumby P The signal recognition particle (SRP) is a ribonucleoprotein complex that targets proteins for secretion in a co-translational manner. While originally thought to be essential in all bacteria, recent data show that the SRP is dispensable in at least some streptococcal species. The SRP from the human pathogen group A Streptococcus (GAS, Streptococcus pyogenes) is predicted to be composed of protein Ffh and RNA 4.5S. Deletion of ffh alters the secretion of several GAS proteins, and leads to a severe reduction in virulence. Here, we report that mutation of the 4.5S RNA-encoding gene results in phenotypes both similar and distinct from that observed following ffh mutation. Similarities include a reduction in secretion of the hemolysin streptolysin ...

Combinational SNARE Proteins VAMP8 and Vti1b Mediate Fusion of Antimicrobial and Canonical Autophagosomes with Lysosomes.

Mol Biol Cell — Wed, 20 Jan 2010 00:00:00 +0100

We examined the involvement of endocytic soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNAREs) in xenophagosome/lysosome fusion. Confocal microscopic analysis showed that SNAREs, including VAMP7, VAMP8, and Vti1b, colocalized with GFP-LC3 in xenophagosomes. Knockdown of Vti1b and VAMP8 with siRNAs disturbed the colocalization of LC3 with LAMP1. The invasive efficiency of GAS into cells was not altered by knockdown of VAMP8 or Vti1b, whereas cellular bactericidal efficiency was significantly diminished, indicating that antimicrobial autophagy was functionally impaired. Knockdown of Vti1b and VAMP8 also disturbed colocalization of LC3 with LAMP1 in canonical autophagy, in which LC3-II proteins were negligibly degraded. In contrast, knockdown of Syntaxin 7 and Syntax...

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The Human Immune Response to Streptococcal Extracellular Antigens: Clinical, Diagnostic, and Potential Pathogenetic Implications

Clinical Infectious Diseases Latest Issue — Tue, 12 Jan 2010 21:28:11 +0100

Conclusions. Single time‐point cultures and single antibody titers are often misleading. Sequential samples more accurately define infection, allowing correlation of titer increases with temporal confirmation of GAS acquisition. Understanding kinetics of the immune response(s) to GAS infection is necessary in formulating accurate clinical diagnostic conclusions, to appropriate design of clinical and epidemiological studies examining the association of GAS with subsequent sequelae, and to providing insight into pathogenetic mechanisms associated with this important human pathogen. (Source: Clinical Infectious Diseases Latest Issue)

Reactive oxygen species induced by Streptococcus pyogenes invasion trigger apoptotic cell death in infected epithelial cells

Cellular Microbiology — Mon, 11 Jan 2010 00:00:00 +0100

Streptococcus pyogenes (group A streptococcus, GAS), one of the most common pathogens of humans, attaches and invades into human pharyngeal or skin epithelial cells. We have previously reported that induction of apoptosis is associated with GAS invasion, which induces mitochondrial dysfunction and apoptotic cell death. We demonstrate here that GAS-induced apoptosis is mediated by reactive oxygen species (ROS) production. Both the induction of apoptosis and ROS production markedly increased upon invasion of wild-type GAS strain JRS4 into HeLa cells; however, the apoptotic response was not observed in fibronectin-binding protein F1-disrupted mutant SAM1-infected cells. In Bcl-2-overexpressing HeLa cells (HBD98-2-4), the induction of apoptosis, ROS production and mitochondrial dysfunction wer...

Complement inhibition by gram-positive pathogens: molecular mechanisms and therapeutic implications

Journal of Molecular Medicine — Fri, 08 Jan 2010 21:44:04 +0100

Abstract The plasma proteins of the complement system are essential in the innate immune response against bacteria. Complement labels bacteria with opsonins to support phagocytosis and generates chemoattractants to attract phagocytes to the site of infection. In turn, bacterial human pathogens have evolved different strategies to specifically impair the complement response. Here, we review the large arsenal of complement inhibitors produced by the gram-positive pathogens Staphylococcus aureus and Group A Streptococcus. We discuss how these bacterial molecules provide us with new tools to treat both infectious and inflammatory disease conditions in humans. Content Type Journal ArticleCategory ReviewDOI 10.1007/s00109-009-0572-yAuthors Alexander Laarman, University Medica...

Structure-activity relationship of lipopeptide Group A streptococcus (GAS) vaccine candidates on toll-like receptor 2.

Vaccine — Wed, 30 Dec 2009 00:00:00 +0100

Authors: Zaman M, Abdel-Aal AB, Phillipps KS, Fujita Y, Good MF, Toth I Incorporation of lipoamino acids (LAAs) into peptide structures effectively imparts self-adjuvanting activity onto otherwise ineffective immunogens. Our fully synthetic lipopeptide vaccine candidates against group A streptococcus (GAS) were composed of J14 as a target GAS B-cell epitope alongside a universal helper T-cell epitope (P25) and a LAA-based lipid moiety. In the current study, we investigated the ability of our lipopeptides to activate nuclear factor-kappaB (NF-kappaB) in a toll-like receptor-2 (TLR2)-dependent manner as the possible mode of action and reported the structure-function requirements for novel TLR2 targeting lipopeptides based on LAAs. The NF-kappaB activation was dependent on the dose and th...

The ribonucleases J1 and J2 are essential for growth and have independent roles in mRNA decay in Streptococcus pyogenes

Molecular Microbiology — Wed, 16 Dec 2009 00:00:00 +0100

We report that RNases J1 and J2 affect the rate of decay of Class I messages and the length of the first phase in decay of Class II messages. (Source: Molecular Microbiology)

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M1T1 group A streptococcal pili promote epithelial colonization but diminish systemic virulence through neutrophil extracellular entrapment

Journal of Molecular Medicine — Fri, 04 Dec 2009 07:18:49 +0100

Abstract Group A Streptococcus is a leading human pathogen associated with a diverse array of mucosal and systemic infections. Cell wall anchored pili were recently described in several species of pathogenic streptococci, and in the case of GAS, these surface appendages were demonstrated to facilitate epithelial cell adherence. Here we use targeted mutagenesis to evaluate the contribution of pilus expression to virulence of the globally disseminated M1T1 GAS clone, the leading agent of both GAS pharyngitis and severe invasive infections. We confirm that pilus expression promotes GAS adherence to pharyngeal cells, keratinocytes, and skin. However, in contrast to findings reported for group B streptococcal and pneumococcal pili, we observe that pilus expression reduces GAS vi...

Clinical lesson: old diseases may affect older patientsCovering Letter

Journal of Infection — Tue, 01 Dec 2009 00:00:00 +0100

We describe a case in a 34 year-old, black-African patient with well-controlled HIV disease, in whom the findings of carditis, along with fever and elevated acute phase reactants, fulfilled the Duckett-Jones Criteria (one major and two minor criteria, respectively) and followed a recent Group A Streptococcus pharyngitis. The patient was confident that she had not had rheumatic fever as a child. The case highlights a number of important points. Firstly, the importance of scrutinising previous microbiological results that may not initially seem relevant to the patient's presenting complaint. Secondly, that ASO titres may be negative in up to 80-90% of patients with the condition, as it was in this particular case and that when this occurs, efforts should be made to look for rising titres of ...

Expand the pharyngitis paradigm for adolescents and young adults.

Annals of Internal Medicine — Tue, 01 Dec 2009 00:00:00 +0100

Authors: Centor RM Current guidelines and review articles emphasize that clinicians should consider group A beta-hemolytic streptococcus in the diagnosis and management of patients with acute pharyngitis. Recent data suggest that in adolescents and young adults (persons aged 15 to 24 years), Fusobacterium necrophorum causes endemic pharyngitis at a rate similar to that of group A beta-hemolytic streptococcus. On the basis of published epidemiologic data, F. necrophorum is estimated to cause the Lemierre syndrome-a life-threatening suppurative complication-at a higher incidence than that at which group A streptococcus causes acute rheumatic fever. Moreover, these estimates suggest greater morbidity and mortality from the Lemierre syndrome. The diagnostic paradigm for adolescent pharyngi...

Epidemiology of group a streptococcal pharyngitis & impetigo: A cross-sectional & follow up study in a rural community of northern India.

Indian J Med Res — Tue, 01 Dec 2009 00:00:00 +0100

CONCLUSION: In north India, pharyngitis was more common than impetigo. Most prevalent emm types of GAS in this region differ from those included in M protein-based vaccines. PMID: 20090140 [PubMed - in process] (Source: Indian J Med Res)

Staphylococcal and streptococcal infections

Medicine — Mon, 30 Nov 2009 16:03:39 +0100

Abstract: Staphylococcal and streptococcal infections are common infectious diseases and can range from mild, superficial skin infections to severe, life-threatening systemic infections. Staphylococcus aureus, group A streptococcus, and Streptococcus pneumoniae are the three major pathogens. The prevalence of invasive infections caused by community-associated meticillin-resistant S. aureus and group A streptococcus appears to be increasing. The emergence of drug resistance (e.g. meticillin and glycopeptide resistance in S. aureus, macrolide resistance in group A streptococci and penicillin resistance in S. pneumoniae), is concerning and a potential threat to successful treatment. Streptococcus suis has recently emerged as an important human pathogen. (Source: Medicine)

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Scl1, the multifunctional adhesin of group A Streptococcus, selectively binds cellular fibronectin and laminin, and mediates pathogen internalization by human cells

FEMS Microbiology Letters — Mon, 23 Nov 2009 00:00:00 +0100

The streptococcal collagen-like protein-1, Scl1, is widely expressed by the well-recognized human pathogen group A Streptococcus (GAS). Screening of human ligands for binding to recombinant Scl1 identified cellular fibronectin and laminin as binding partners. Both ligands interacted with the globular domain of Scl1, which is also able to bind the low-density lipoprotein. Native Scl1 mediated GAS adherence to ligand-coated glass cover slips and promoted GAS internalization into HEp-2 cells. This work identifies new ligands of the Scl1 protein that are known to be important in GAS pathogenesis and suggests a novel ligand-switching mechanism between blood and tissue environments, thereby facilitating host colonization and GAS dissemination. (Source: FEMS Microbiology Letters)

A case of structure determination using pseudosymmetry

Acta Crystallographica Section D — Tue, 17 Nov 2009 00:00:00 +0100

Here, a case is presented of an unusual structure determination which was facilitated by the use of pseudosymmetry. Group A streptococcus uses cysteine protease Mac-1 (also known as IdeS) to evade the host immune system. Native Mac-1 was crystallized in the orthorhombic space group P21212. Surprisingly, crystals of the inactive C94A mutant of Mac-1 displayed monoclinic symmetry with space group P21, despite the use of native orthorhombic Mac-1 microcrystals for seeding. Attempts to solve the structure of the C94A mutant by MAD phasing in the monoclinic space group did not produce an interpretable map. The native Patterson map of the C94A mutant showed two strong peaks along the (1 0 1) diagonal, indicating possible translational pseudosymmetry in space group P21. Interestingly, one-third o...

Artificial induction of autophagy around polystyrene beads in nonphagocytic cells.

Autophagy — Fri, 13 Nov 2009 04:10:07 +0100

Authors: Kobayashi S, Kojidani T, Osakada H, Yamamoto A, Yoshimori T, Hiraoka Y, Haraguchi T Autophagy is an intracellular event that acts as an innate cellular defense mechanism to kill invading bacteria such as group A Streptococcus in nonphagocytic epithelial-like cells. The cellular events underlying autophagosome formation upon bacterial invasion remain unclear due to the biochemical complexity associated with uncharacterized bacterial components, and the difficulty of predicting the location as well as the timing of where/when autophagosome formation will take place. To overcome these problems, we monitored autophagosome formation in living nonphagocytic cells by inducing autophagy around artificial micrometer-sized beads instead of bacteria. Beads conjugated with bio-reactive mo...

A Novel Study Discovers A New Communication System Between Streptococci

Health News from Medical News Today — Wed, 11 Nov 2009 03:00:00 +0100

Group A streptococcus (GAS) is a human pathogenic bacteria. Many people carry GAS asymptomatically in their upper respiratory tract and other anatomic sites. (Source: Health News from Medical News Today)

A Novel Study Discovers A New Communication System Between Streptococci

Infectious Diseases / Bacteria / Viruses News From Medical News Today — Wed, 11 Nov 2009 03:00:00 +0100

Group A streptococcus (GAS) is a human pathogenic bacteria. Many people carry GAS asymptomatically in their upper respiratory tract and other anatomic sites. However, these bacteria can cause a variety of human diseases ranging from superficial skin and throat infections to highly invasive life-threatening diseases such as toxic shock and necrotizing fasciitis, commonly known as the flesh-eating bacteria. (Source: Infectious Diseases / Bacteria / Viruses News From Medical News Today)

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Passive protection in mice challenged with a recombinant bioluminescent M49 group A streptococcus strain: Correlation between bioluminescence and bacterial burden.

Clinical and Vaccine Immunology — Wed, 04 Nov 2009 00:00:00 +0100

Authors: Sheel M, Pandey M, Good MF, Batzloff MR Streptococcus pyogenes also known as group A streptococcus (GAS), is a human pathogen which infects people of all age groups. Previous work has reported conformationally constrained chimeric peptide J8 to protect against GAS challenge. In the current study, we demonstrate the utility of bioluminescent imaging as a rapid technique to monitor bacterial dissemination following the passive transfer of rabbit anti-J8 antibodies to naïve mice and subsequent challenge with recombinant M49 GAS strain, an emm type shown to be associated with post-streptococcal glomerular nephritis. PMID: 19889937 [PubMed - as supplied by publisher] (Source: Clinical and Vaccine Immunology)

Invasive GAS Infections on the Rise in England

Pediatric News — Sun, 01 Nov 2009 00:00:00 +0100

SAN FRANCISCO — The number of invasive group A streptococcal infections in England is on an upsurge, for reasons that remain unclear. “The current increases in diseases caused by group A streptococcus [GAS] being seen in some regions of England may be attributable to the natural cycle of the disease, with some ‘quiet’ years followed by a year of high incidence,” Androulla Efstratiou, Ph.D., said at the annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy. Speaking in an interview after a study about the increase was presented during a poster session, Dr. Efstratiou said that “nonetheless, the Health Protection Agency has been monitoring the situation closely and has launched enhanced surveillance.” (Source: Pediatric News)

Acute post-streptococcal glomerulonephritis in children of French Polynesia: a 3-year retrospective study

Pediatric Nephrology — Thu, 29 Oct 2009 19:39:19 +0100

Abstract The aim of this study was to define the current demographic, clinical and prognostic characteristics of acute post-streptococcal glomerulonephritis (APSGN) in French Polynesia and to compare these features with those of other populations. Fifty children, all of whom were <15 years old and had been admitted to the Territorial Hospital of Papeete for APSGN between January 2005 and December 2007, were retrospectively enrolled in the study. Diagnostic criteria were microscopic or macroscopic haematuria, decreased C3 fraction of the complement and evidence of recent streptococcal infection. The annual incidence was 18 cases per 100,000 children <15 years of age in 2007. Most of the children (98%) enrolled in the study were of Polynesian ethnic origin, 27 were mal...

Sacroiliitis infected with group A streptococcus in a child presenting with confusion and combativeness

Journal of Infection and Chemotherapy — Sat, 24 Oct 2009 05:58:03 +0100

Abstract Group A streptococcus-associated severe invasive infection (streptococcal toxic shock syndrome) has been described. Streptococcal toxic shock syndrome occurs when the infecting strain of group A streptococcus produces superantigens. Confusion and combativeness are well known as the common symptoms of streptococcal toxic shock syndrome. We encountered a child who suffered from pyogenic sacroiliitis, with confusion and combativeness. Group A streptococcus was isolated from the patient’s blood culture. However, his disease did not fulfill the criteria of streptococcal toxic shock syndrome. Pyogenic sacroiliitis in children is rare, but patients with pyogenic sacroiliitis due to group A streptococcus infection could show confusion and combativeness as clinical signs...

Retinal hemorrhages associated with meningitis in a child with a congenital disorder of glycosylation

Forensic Science, Medicine, and Pathology — Thu, 22 Oct 2009 18:41:22 +0100

Abstract A 9-month old infant presented in a state of shock to a district hospital. She was subsequently referred to the regional tertiary hospital. On admission, bruises were noted on the vertex of the skull. Retinal hemorrhages were present on ophthalmological examination. CT scan of the brain showed poor grey–white matter differentiation with apparent frontoparietal fractures of the skull. Her case was subsequently referred to the relevant authorities as it was suspicious for nonaccident injury (NAI). Her condition deteriorated and she died the next day. Postmortem examination showed that the bruises on the vertex were caused by rapid widening of the sutures of the skull, caused by rising intracranial pressure. There was no skull fracture or evidence of trauma. Histol...

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Autophagy Induction by the Pathogen Receptor CD46.

Cell Host and Microbe — Wed, 21 Oct 2009 17:48:10 +0100

We report here that the engagement of CD46, a ubiquitous human surface receptor able to bind several different pathogens, is sufficient to induce autophagy. CD46-Cyt-1, one of the two C-terminal splice variants of CD46, is linked to the autophagosome formation complex VPS34/Beclin1 via its interaction with the scaffold protein GOPC. Measles virus and group A Streptococcus, two CD46-binding pathogens, induce autophagy through a CD46-Cyt-1/GOPC pathway. Thus, upon microorganism recognition, a cell surface pathogen receptor can directly trigger autophagy, a critical step to control infection. PMID: 19837375 [PubMed - in process] (Source: Cell Host and Microbe)

Disease burden due to Streptococcus dysgalactiae subsp. equisimilis (group G and C streptococci; GGS/GCS) is higher than due to S. pyogenes among Mumbai school children.

Journal of Medical Microbiology — Wed, 14 Oct 2009 23:00:00 +0100

This study was carried out in India where burden of streptococcal diseases, including rheumatic fever (RF) and rheumatic heart disease (RHD), is high. As part of surveillance study, throat swabs were taken from 1504 children attending seven municipal schools in Mumbai, India during 2006-08. GAS and GGS/GCS were identified on the basis of beta-haemolytic activity, group carbohydrate and PYR-test, and subsequently typed. The GGS/GCS carriage rate (166/1504, 10%) was eight-fold higher than the GAS carriage (22/1504, 1.4%) rate in this population. The 166 GGS/GCS isolates collected represented 21 different emm-types (molecular types), and the 22 GAS isolates represented 15 different emm-types. Although the rate of pharyngitis associated with GGS/GCS is marginally lower than with GAS, high rate...

Streptococcal toxic shock syndrome following insertion of an intrauterine device--a case report.

The European Journal of Contraception and Reproductive Health Care — Thu, 01 Oct 2009 00:00:00 +0100

CONCLUSION: This is the first reported case of GAS causing a TSS associated with insertion of an IUD. Streptococcal TSS can be fatal. Early aggressive management is mandatory. PMID: 19916766 [PubMed - in process] (Source: The European Journal of Contraception and Reproductive Health Care)

Development of a Patient-Reported Outcome Measure for Children With Streptococcal Pharyngitis

PEDIATRICS — Sun, 27 Sep 2009 23:00:00 +0100

CONCLUSIONS: The scale seems to measure effectively both pain and overall functional status in children with GAS pharyngitis. These data support the use of Strep-PRO as a measure of outcome in future clinical trials. (Source: PEDIATRICS)

Molecular typing identifies virulence in childbed fever

Baylor College of Medicine News — Wed, 23 Sep 2009 05:00:00 +0100

Childbed fever – once a leading cause of death and disability in women – continues as a rare but potentially devastating infection. In an effort to better understand why, researchers from Baylor College of Medicine and the University of Utah Health Sciences Center and LDS Hospital in Salt Lake City, have looked at specific proteins in the causative bacteria (Group A streptococcus)—called M-protein type antigens—as a source of virulence. Their findings are published in the current issue of the Journal of Reproductive Immunology . "We needed to make some initial attempts to understand why this is such a clinically variable infection," said Dr. Kjersti Aagaard-Tillery , assistant professor of obstetric and gynecology at BCM and corresponding author on the stu...

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Molecular Pathogenesis of Necrotizing Fasciitis.

Annual Review of Pathology — Mon, 07 Sep 2009 23:00:00 +0100

Authors: Olsen RJ, Musser JM Necrotizing fasciitis, also known as the flesh-eating disease, is a severe invasive infection associated with very high rates of human morbidity and mortality. It is most commonly caused by group A Streptococcus (GAS), a versatile human pathogen that causes diseases ranging in severity from uncomplicated pharyngitis (or strep throat) to life-threatening infections such as necrotizing fasciitis. Herein, we review recent discoveries bearing on the molecular pathogenesis of GAS necrotizing fasciitis. Importantly, the integration of new technologies and the development of human-relevant animal models have markedly expanded our understanding of the key pathogen-host interactions underlying GAS necrotizing fasciitis. For example, we now know that GAS organisms se...

Contribution of AmyA, an extracellular α-glucan degrading enzyme, to group A streptococcal host–pathogen interaction

Molecular Microbiology — Thu, 03 Sep 2009 23:00:00 +0100

[alpha]-Glucans such as starch and glycogen are abundant in the human oropharynx, the main site of group A Streptococcus (GAS) infection. However, the role in pathogenesis of GAS extracellular [alpha]-glucan binding and degrading enzymes is unknown. The serotype M1 GAS genome encodes two extracellular proteins putatively involved in [alpha]-glucan binding and degradation; pulA encodes a cell wall anchored pullulanase and amyA encodes a freely secreted putative cyclomaltodextrin [alpha]-glucanotransferase. Genetic inactivation of amyA, but not pulA, abolished GAS [alpha]-glucan degradation. The [Delta]amyA strain had a slower rate of translocation across human pharyngeal epithelial cells. Consistent with this finding, the [Delta]amyA strain was less virulent following mouse mucosal challeng...

A decade of molecular pathogenomic analysis of group A Streptococcus

Journal of Clinical Investigation — Wed, 02 Sep 2009 17:50:05 +0100

Molecular pathogenomic analysis of the human bacterial pathogen group A Streptococcus has been conducted for a decade. Much has been learned as a consequence of the confluence of low-cost DNA sequencing, microarray technology, high-throughput proteomics, and enhanced bioinformatics. These technical advances, coupled with the availability of unique bacterial strain collections, have facilitated a systems biology investigative strategy designed to enhance and accelerate our understanding of disease processes. Here, we provide examples of the progress made by exploiting an integrated genome-wide research platform to gain new insight into molecular pathogenesis. The studies have provided many new avenues for basic and translational research. (Source: Journal of Clinical Investigation)

Clinical aspects of invasive infections with Streptococcus dysgalactiae ssp. equisimilis in Japan: differences with respect to Streptococcus pyogenes and Streptococcus agalactiae infections

Clinical Microbiology and Infection — Tue, 01 Sep 2009 23:00:00 +0100

Clin Microbiol Infect Streptococcus dysgalactiae ssp. equisimilis (SDSE) is increasingly being identified as a pathogen responsible for invasive and non-invasive infections. We compared the clinical features of invasive SDSE infections with those of invasive infections caused by Streptococcus pyogenes (group A streptococcus (GAS)) and Streptococcus agalactiae (group B streptococcus (GBS)). Active surveillance for invasive SDSE, GAS and GBS was maintained over 1 year at 142 medical institutions throughout Japan. Clinical information was collected together with isolates, which were characterized microbiologically. Two hundred and thirty-one invasive SDSE infections were identified, 97 other patients had infections with GAS, and 151 had infections with GBS. The median age of the SDSE patients...

Inhibition of Dendritic Cell Maturation by Group A Streptococcus

The Journal of Infectious Diseases Latest Issue — Thu, 27 Aug 2009 21:27:51 +0100

Conclusions. These results demonstrate that GAS virulence factors modulate maturation and survival of human DC, effects that are likely to have a critical impact on activation of innate and adaptive immune responses to this important human pathogen. (Source: The Journal of Infectious Diseases Latest Issue)

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Inhibition of group A streptococcal infection by Melaleuca alternifolia (tea tree) oil concentrate in the murine model

Journal of Applied Microbiology — Sun, 19 Jul 2009 23:00:00 +0100

Conclusions: These results suggest that MAC may inhibit GAS-induced skin damage and mouse death by directly inhibiting GAS growth and enhancing the bactericidal activity of macrophages.Significance and Impact of the Study: Our results provide scientific data on the use of MAC for the treatment of GAS-induced necrotizing fasciitis in the murine model. (Source: Journal of Applied Microbiology)

Nosocomial Transmission of Invasive Group A Streptococcus from Patient to Health Care Worker

Clinical Infectious Diseases Latest Issue — Mon, 06 Jul 2009 15:32:57 +0100

Conclusions. Nosocomial transmission of GAS from a patient to a health care worker who developed streptococcal toxic shock syndrome may have occurred after the index patient had received 48 h of antibiotic therapy and despite placement in contact isolation. Isolation guidelines for patients with severe GAS infection may need to be reviewed. (Source: Clinical Infectious Diseases Latest Issue)

What Is Strep Throat? What Is Sore Throat?

Health News from Medical News Today — Thu, 25 Jun 2009 20:00:00 +0100

Strep throat is a sore throat caused by bacteria known as Streptococcus pyogenes, or group A streptococcus. Sore throat is a term for any situation where the throat feels scratchy, tender, and possibly painful. Strep throat is a type of sore throat. Sore throat may be caused by bacteria or viruses, while strep throat is only caused by bacteria. (Source: Health News from Medical News Today)

Stand-Alone Response Regulators Controlling Global Virulence Networks in Streptococcus pyogenes.

Contributions to Microbiology — Sat, 13 Jun 2009 05:20:04 +0100

Authors: McIver KS Global regulation of virulence gene expression via transcriptional regulators plays a central role in the ability of the bacterial pathogen Streptococcus pyogenes (the group A Streptococcus, GAS) to rapidly adapt during infection. The 'stand-alone' regulators Mga, RofA-like proteins (RALPs), and RopB/Rgg control important and diverse virulence regulons in response to growth-related signals and other environmental conditions in GAS. Stand-alone regulated genes encode factors important for colonization of tissues, immune evasion, persistence, dissemination, metabolism, and the response to stressors. Although conserved 'core' regulons have been established for each, recent studies have revealed significant inter-serotype and even intra-serotype variation in the regulato...

[Protein Structure and Folding] Defining the Structural Basis of Human Plasminogen Binding by Streptococcal Surface Enolase

Journal of Biological Chemistry — Thu, 11 Jun 2009 23:00:00 +0100

This study demonstrates the ability of combining in silico structural modeling with ion mobility-MS validation for undertaking functional studies on complex protein structures. (Source: Journal of Biological Chemistry)

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Postpartum Invasive Group A Streptococcal Disease in the Modern Era

Infectious Diseases in Obstetrics and Gynecology — Tue, 09 Jun 2009 20:06:24 +0100

To describe the clinical features of individuals hospitalized for postpartum invasive group A Streptococcus (GAS) infection, a retrospective, population-based study of hospitalized patients in the state of Florida was conducted. Cases of postpartum invasive GAS infection (occurring within 42 days of delivery) were compared to women with other manifestations of invasive GAS disease with respect to their age at the time of admission. Four cases of postpartum invasive GAS infection were detected in this population, yielding a prevalence of 1.6% (4/257) of postpartum disease in this invasive GAS infection database. Patients presented a median of 4 days (mean of 9 days) after delivery with signs and symptoms of infection. Three cases were complicated by bacteremia and one patient had streptococ...

Provider Knowledge, Attitudes, and Practices regarding Obstetric and Postsurgical Gynecologic Infections Due to Group A Streptococcus and Other Infectious Agents

Infectious Diseases in Obstetrics and Gynecology — Tue, 09 Jun 2009 20:06:24 +0100

Conclusions. Postpartum and postsurgical infections are common. Providing empiric treatment without attaining diagnostic cultures represents a missed opportunity for potential prevention of diseases such as severe GAS infections. (Source: Infectious Diseases in Obstetrics and Gynecology)

Distribution of emm types among group A streptococcal isolates from Serbia

Clinical Microbiology and Infection — Tue, 09 Jun 2009 04:00:00 +0100

Clin Microbiol Infect This is the first study concerning the molecular epidemiology of group A streptococcus in Serbia and includes 145 isolates from patients with various infections during the period 2001[ndash]2007. The emm types, superantigen profile and susceptibility pattern were determined. Among 31 emm types identified, the most prevalent were emm6, emm12, emm1, and emm58. All isolates showed uniform antimicrobial susceptibility to all tested antibiotics, with the exception of tetracycline and erythromycin (41% and 0.7% resistant strains, respectively). Significant heterogeneity of emm types was found, with a high frequency of emm6 and emm58, as well as a considerable prevalence of tetracycline resistance, and a low level of macrolide resistance. (Source: Clinical Microbiology and I...

A prolonged course of Group A streptococcus-associated nephritis: a mild case of dense deposit disease (DDD)?

Clinical Nephrology — Sun, 31 May 2009 23:00:00 +0100

Authors: Sawanobori E, Umino A, Kanai H, Matsushita K, Iwasa S, Kitamura H, Oda T, Yoshizawa N, Sugita K, Higashida K We herein report the case of a 12-year-old boy with dense deposit disease (DDD) evoked by streptococcal infection. He had been diagnosed to have asymptomatic hematuria syndrome at the age of 6 during school screening. At 12 years of age, he was found to have macrohematuria and overt proteinuria with hypocomplementemia 2 months after streptococcal pharyngitis. Renal biopsy showed endocapillary proliferative glomerulonephritis with double contours of the glomerular basement membrane. Hypocomplementemia and proteinuria were sustained for over 8 weeks. He was suspected to have dense deposit disease due to intramembranous deposits in the first and the second biopsies. 1 mont...

[errata] Correction for Shelburne et al., A direct link between carbohydrate utilization and virulence in the major human pathogen group A Streptococcus

Proceedings of the National Academy of Sciences — Tue, 26 May 2009 04:00:00 +0100

(Source: Proceedings of the National Academy of Sciences)

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Linkage of T3 and Cpa pilins in the Streptococcus pyogenes M3 pilus

Molecular Microbiology — Sat, 16 May 2009 04:00:00 +0100

The important human pathogen Streptococcus pyogenes (group A streptococcus, GAS) initiates infection by pilus-mediated attachment to host tissue. Thus, the pilus is an excellent target for design of anti-infective strategies. The T3 pilus of GAS is composed of multiple covalently linked subunits of the T3 protein to which the two minor pilins, Cpa and OrfB, are covalently attached. Because the proteins of GAS pili do not contain either of the motifs required for pilus polymerization in other Gram-positive bacteria, we investigated the residues involved in their linkage. We show that linkage of Cpa to T3 by the sortase family transpeptidase SrtC2 requires the VPPTG motif in the cell wall-sorting signal of Cpa. We also demonstrate that K173 of T3 is required both for T3 polymerization and fo...

[Glycobiology and Extracellular Matrices] Serum Opacity Factor Is a Streptococcal Receptor for the Extracellular Matrix Protein Fibulin-1

Journal of Biological Chemistry — Fri, 01 May 2009 04:00:00 +0100

The adhesion of bacteria to host tissues is often mediated by interactions with extracellular matrices. Herein, we report on the interactions of the group A streptococcus, Streptococcus pyogenes, with the extracellular matrix protein fibulin-1. S. pyogenes bound purified fibulin-1 in a dose-dependent manner. Genetic ablation of serum opacity factor (SOF), a virulence determinant of S. pyogenes, reduced binding by ~50%, and a recombinant peptide of SOF inhibited binding of fibulin-1 to streptococci by ~45%. Fibulin-1 bound to purified SOF2 in a dose-dependent manner with high affinity (Kd = 1.6 nm). The fibulin-1-binding domain was localized to amino acid residues 457–806 of SOF2, whereas the fibronectin-binding domain is contained within residues 807–931 of SOF2, indicating tha...

Antibiotic Selection for Purulent Skin and Soft-Tissue Infections in Ambulatory Care: A Decision-Analytic Approach

Academic Pediatrics — Fri, 01 May 2009 04:00:00 +0100

Objective: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has caused a nationwide epidemic of skin and soft-tissue infections in ambulatory pediatrics. Antibiotic treatment recommendations suggest incorporating local epidemiology for the prevalence of CA-MRSA. We sought to identify the antibiotic strategy with the highest probability of activity and to identify threshold values for epidemiologic variables including bacterial prevalence and antibiotic resistance.Methods: We used decision analysis to evaluate 3 empiric antibiotic strategies: clindamycin, trimethoprim/sulfamethoxazole (T/S), and cephalexin. We calculated the probability of activity against the bacteria causing the infection (CA-MRSA, methicillin-sensitive S. aureus and group A Streptococcus [GAS]) ...

AHA: Compounds Inhibit Virulence of Group A Strep

Geriatrics Magazine — Thu, 30 Apr 2009 04:00:00 +0100

Small molecules can reduce the virulence of group A streptococcus and possibly reduce selection for antibiotic resistance, according to a study presented at the American Heart Association's Arteriosclerosis, Thrombosis and Vascular Biology Annual Conference. (Source: Geriatrics Magazine)

M-protein and other intrinsic virulence factors of Streptococcus pyogenes are encoded on an ancient pathogenicity island

BioMed Central — Mon, 27 Apr 2009 04:00:00 +0100

Conclusions: Thus, this non-phagic SSR is compatible with a pathogenicity island, acquired before S. pyogenes speciation. Its potential excision might bear relevance for vaccine development, because vaccines targeting M-protein might select for M-protein-negative variants that still carry other virulence determinants. (Source: BioMed Central)

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Lemierre?s syndrome resulting from streptococcal induced otitis media and mastoiditis: a case report

Journal of Medical Case Reports — Sun, 26 Apr 2009 23:00:00 +0100

Conclusion: Since Lemierre?s syndrome is classically detected by clinical diagnosis, these findings should prompt clinicians to consider Group A Streptococcus as an alternative catalyst. It should be pondered that patients who present with typical Group A streptococcal infections have the possibility for developing Lemierre?s syndrome. Though this complication appears to be rare, early diagnosis and prompt intervention have proven critical in survival outcome. Indeed, what would seem to be a routine case of strep throat or otitis media easily treated with antibiotics could end up being an unalterable progression to death unless Lemierre?s syndrome is immediately diagnosed and treated. (Source: Journal of Medical Case Reports)

Puerperal group A Streptococcus infection

Archives of Gynecology and Obstetrics — Thu, 23 Apr 2009 08:26:36 +0100

Abstract Group A Streptococci infection during antenatal period as well as postnally can be very serious and would require intense management—both surgical and medical. Many authors believe the incidence is rising. High index of clinical suspicion is necessary in order to early intervention. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00404-009-1078-0Authors Kanapathippillai Sivanesan, North Manchester General Hospital Delaunays Road Manchester M8 5RB UKManika Singh, Royal Lancaster Infirmary Ashton road Lancaster LA1 4RP UKDavid Burch, Royal Lancaster Infirmary Ashton road Lancaster LA1 4RP UK Journal Archives of Gynecology and ObstetricsOnline ISSN 1432-0711Print ISSN 0932-0067 (Source: Archives of Gynecology and Obstetrics)

[Review] Gram-positive toxic shock syndromes

The Lancet Infectious Diseases — Wed, 22 Apr 2009 04:00:00 +0100

Toxic shock syndrome (TSS) is an acute, multi-system, toxin-mediated illness, often resulting in multi-organ failure. It represents the most fulminant expression of a spectrum of diseases caused by toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes (group A streptococcus). The importance of Gram-positive organisms as pathogens is increasing, and TSS is likely to be underdiagnosed in patients with staphylococcal or group A streptococcal infection who present with shock. TSS results from the ability of bacterial toxins to act as superantigens, stimulating immune-cell expansion and rampant cytokine expression in a manner that bypasses normal MHC-restricted antigen processing. A repetitive cycle of cell stimulation and cytokine release results in a cytokine avalanche t...

Acute rheumatic fever and its consequences: A persistent threat to developing nations in the 21st century.

Autoimmunity Reviews — Sat, 18 Apr 2009 23:00:00 +0100

Authors: Lee JL, Naguwa SM, Cheema GS, Gershwin ME Acute rheumatic fever (ARF) is an autoimmune, multi-system response secondary to molecular mimicry following Lancefield group A streptococcus (GAS) pharyngitis; it is now most commonly found in the pediatric populations of developing nations. The major source of morbidity and mortality of ARF stems from rheumatic heart disease (RHD), although the cardinal symptoms of the disease also include polyarthritis, Sydenham's chorea, subcutaneous nodules, and erythema marginatum. Therapy is aimed towards treating the initial GAS infection, using anti-inflammatory medications for acute symptoms and surgery to correct RHD. Secondary prevention is crucial, given the high risk of recurrence, and includes long-term antibiotic prophylaxis. However, v...

Bacteriophage content of M49 strains of Streptococcus pyogenes

FEMS Microbiology Letters — Mon, 16 Mar 2009 04:00:00 +0100

Bacteriophages are common autonomous migrating mobile genetic elements in group A Streptococcus (GAS) and are often associated with the carriage of various virulence genes, including toxins, mitogens and enzymes. Two collections of GAS type M49 strains isolated from invasive (22 strains) and noninvasive (16 strains) clinical cases have been studied for the presence of phage and phage-associated virulence genes. All the GAS strains carried from at least two to six phage genomes as determined by the number of known phage integrase genes found. A sampling of the invasive M49 strains showed that they belonged to the same multilocus sequence typing type, carried two specific integrase genes (int5 and int7), and contained the toxin genes speA, speH and speI. Other invasive strains lacking this g...

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Skin and soft tissue infections in returning travelers.

The American Journal of Tropical Medicine and Hygiene — Sun, 01 Mar 2009 05:00:00 +0100

Authors: Hochedez P, Canestri A, Lecso M, Valin N, Bricaire F, Caumes E Skin and soft tissue infections (SSTI) are a leading cause of cutaneous problems in travelers. Sixty travelers who presented with an SSTI were prospectively included over a 20-month period. Bacterial analysis and research for Panton-Valentine leukocidine (PVL) were performed according to clinical and bacterial presentation. The SSTI appeared abroad in 73% and were predominantly localized on lower limbs (75%). The main clinical forms were impetigo (35%) and cutaneous absess (23%). Insect bites were significantly associated with impetigo and ecthyma. Methicillin-susceptible Staphylococcus aureus (MSSA) was identified in 15 patients (43%), Group A Streptococcus (GAS) in 12 patients (34%), and an association of both in...

Positive correlation between low adhesion of group A Streptococcus to mammalian cells and virulence in a mouse model

FEMS Microbiology Letters — Fri, 13 Feb 2009 05:00:00 +0100

We previously reported that a mouse model reflected, at least in part, the pathogenic mechanism of bacteremia observed during streptococcal toxic shock syndrome caused by group A Streptococcus (GAS). We have extended this study by assaying the in vitro adhesion of these same isolates to mammalian cells. Unexpectedly, we found that high-virulence GAS isolates in the mouse model showed low adhesion to the host cells. Similarly, the rate of recovery from the peritoneal cavity and cardiac blood of mice after intraperitonial injection was higher for high- than for low-virulence strains. Levels of expression of molecules that affect the adhesion of GAS to host cells were not significantly correlated with GAS virulence. Taken together, these results indicate that the invasiveness of GAS, reflecte...

Regulation of streptokinase expression by CovR/S in Streptococcus pyogenes: CovR acts through a single high-affinity binding site.

Microbiology — Sun, 01 Feb 2009 05:00:00 +0100

Authors: Churchward G, Bates C, Gusa AA, Stringer V, Scott JR The important human pathogen Streptococcus pyogenes (the group A streptococcus or GAS) produces many virulence factors that are regulated by the two-component signal transduction system CovRS (CsrRS). Dissemination of GAS infection originating at the skin has been shown to require production of streptokinase, whose transcription is repressed by CovR. In this work we have studied the interaction of CovR and phosphorylated CovR (CovR-P) with the promoter for streptokinase, Pska. We found that, in contrast to the other CovR-repressed promoters, Pska regulation by CovR occurs through binding at a single ATTARA consensus binding sequence (CB) that overlaps the -10 region of the promoter. Binding of CovR to other nearby consensus ...

Remission of minimal change disease in Type 2 diabetes after streptococcus bacteremia.

Clinical Nephrology — Sun, 01 Feb 2009 05:00:00 +0100

This report extends the spectrum of infections associated with remission of minimal change disease (MCD). PMID: 19203511 [PubMed - in process] (Source: Clinical Nephrology)

Similar Ability of FbaA with M Protein to Elicit Protective Immunity Against Group A Streptococcus Challenge in Mice.

Cellular and Molecular Immunology — Sun, 01 Feb 2009 05:00:00 +0100

Authors: Ma CQ, Li CH, Wang XR, Zeng RH, Yin XL, Feng HD, Wei L Group A streptococcus (GAS), an important human pathogen, can cause various kinds of infections including superficial infections and potentially lethal infections, and the search for an effective vaccine to prevent GAS infections has been ongoing for many years. This paper compares the immunogenicity and immunoprotection of FbaA (an Fn-binding protein expressed on the surface of GAS) with that of M protein, the best immunogen of GAS. Assay for immune response showed that FbaA, similar to M protein, could induce protein-specific high IgG titer in BALB/c mice. Furthermore, following GAS challenge, the mice immunized with FbaA showed the same protective rate as those with M protein. These results indicate that FbaA is similar...

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Molecular epidemiological investigation of an outbreak of invasive β-haemolytic streptococcal infection in western Norway

Clinical Microbiology and Infection — Thu, 29 Jan 2009 05:00:00 +0100

During a decade-long, high endemic situation with severe group A streptococcal disease in western Norway, a cluster of 16 patients with invasive streptococcal disease was hospitalized during a period of 11 weeks. A study including clinical characteristics and molecular epidemiology of the outbreak was initiated. Relevant clinical information was obtained from the medical records of the patients. Nine of the 16 patients had soft tissue infection, and seven of these had streptococcal toxic shock syndrome (STSS). Mortality, both overall and among those with STSS, was 25%. Streptococcal isolates from these patients were characterized by serogrouping and emm sequence typing. The emm amplicons were further characterized by sequence analysis and restriction fragment length polymorphism (emm RFLP)...

Performance of a Rapid Antigen-Detection Test and Throat Culture in Community Pediatric Offices: Implications for Management of Pharyngitis

PEDIATRICS — Mon, 26 Jan 2009 05:00:00 +0100

CONCLUSIONS. The sensitivity of the office culture was significantly greater than the sensitivity of the rapid antigen-detection test, but neither test was highly sensitive. The sensitivities of each diagnostic modality and the recommended combined approach were best among patients with greater pretest likelihood of group A streptococcus pharyngitis. (Source: PEDIATRICS)

Group a streptococcus causing necrotizing fasciitis and toxic shock syndrome after medical termination of pregnancy.

Obstetrics and Gynecology — Fri, 23 Jan 2009 10:56:04 +0100

CONCLUSION:: This case demonstrates the need for prompt recognition and treatment of necrotizing fasciitis/toxic shock syndrome. PMID: 19155935 [PubMed - in process] (Source: Obstetrics and Gynecology)

Postpartum Invasive Group A Streptococcal Disease in the Modern Era

Infectious Diseases in Obstetrics and Gynecology — Sat, 03 Jan 2009 17:13:56 +0100

[Mechanisms Of Signal Transduction] Streptolysin O Promotes Group A Streptococcus Immune Evasion by Accelerated Macrophage Apoptosis

Journal of Biological Chemistry — Fri, 02 Jan 2009 05:00:00 +0100

Group A Streptococcus (GAS) is a leading human bacterial pathogen capable of producing invasive infections even in previously healthy individuals. As frontline components of host innate defense, macrophages play a key role in control and clearance of GAS infections. We find GAS induces rapid, dose-dependent apoptosis of primary and cultured macrophages and neutrophils. The cell death pathway involves apoptotic caspases, is partly dependent on caspase-1, and requires GAS internalization by the phagocyte. Analysis of GAS virulence factor mutants, heterologous expression, and purified toxin studies identified the pore-forming cytolysin streptolysin O (SLO) as necessary and sufficient for the apoptosis-inducing phenotype. SLO-deficient GAS mutants induced less macrophage apoptosis in vitro and...

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Biofilm formation by group A Streptococcus: a role for the streptococcal regulator of virulence (Srv) and streptococcal cysteine protease (SpeB).

Microbiology — Thu, 01 Jan 2009 05:00:00 +0100

In this study, we sought to learn more about the make-up of these structures and gain insight into biofilm regulation. Enzymic studies indicated that biofilm formation by GAS strain MGAS5005 required an extracellular protein and DNA component(s). Previous results indicated that inactivation of the transcriptional regulator Srv in MGAS5005 resulted in a significant decrease in virulence. Here, inactivation of Srv also resulted in a significant decrease in biofilm formation under both static and flow conditions. Given that production of the extracellular cysteine protease SpeB is increased in the srv mutant, we tested the hypothesis that increased levels of active SpeB may be responsible for the reduction in biofilm formation. Western immunoblot analysis indicated that SpeB was absent from M...

Group A Streptococcus meningitis: Microbiological evidence clinches the issue.

Indian Journal of Pathology and Microbiology — Thu, 01 Jan 2009 05:00:00 +0100

Authors: Thakur R, Sarma S, Bala K PMID: 19136813 [PubMed - in process] (Source: Indian Journal of Pathology and Microbiology)

[Glycobiology and Extracellular Matrices] Identification of the First Prokaryotic Collagen Sequence Motif That Mediates Binding to Human Collagen Receptors, Integrins {alpha}2{beta}1 and {alpha}11{beta}1

Journal of Biological Chemistry — Fri, 19 Dec 2008 05:00:00 +0100

Many pathogenic bacteria interact with human integrins to enter host cells and to augment host colonization. Group A Streptococcus (GAS) employs molecular mimicry by direct interactions between the cell surface streptococcal collagen-like protein-1 (Scl1) and the human collagen receptor, integrin 2β1. The collagen-like (CL) region of the Scl1 protein mediates integrin-binding, although, the integrin binding motif was not defined. Here, we used molecular cloning and site-directed mutagenesis to identify the GLPGER sequence as the 2β1 and the 11β1 binding motif. Electron microscopy experiments mapped binding sites of the recombinant 2-integrin-inserted domain to the GLPGER motif of the recombinant Scl (rScl) protein. rScl proteins and a synthetic peptide harboring the GLPGER m...

Management of facial necrotizing fasciitis

European Archives of Oto-Rhino-Laryngology — Sun, 30 Nov 2008 07:07:39 +0100

Abstract Necrotizing fasciitis is a progressive, life-threatening, bacterial infection of the skin, the subcutaneous tissue and the underlying fascia, in most cases caused by ß-hemolytic group A streptococcus. Only early diagnosis and aggressive therapy including broad spectrum antibiotics and surgical intervention can avoid systemic toxicity with a high mortality rate. This uncommon disease generally occurs in the lower extremities and trunk, and only rarely affects the head and neck region. When located in the face necrotizing fasciitis is associated with severe cosmetic and functional restrictions due to the invasive infection and often to the necessary surgical treatment. Generally surgical intervention cannot be performed in the face as aggressively as in the extremi...

Severe Group A Streptococcus Infection after Thyroidectomy: Report of Three Cases and Review

Surgical Infections — Tue, 04 Nov 2008 14:03:01 +0100

Surgical Infections Oct 2008, Vol. 9, No. 5: 529-531. Abstract Background: Group A Streptococcus (GAS) is an uncommon cause of infection after clean surgery in non-pregnant adults. Methods: Report of three cases and review of the literature. Results: For the first time in France, severe GAS infections were ... (Source: Surgical Infections)

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T serotypes and antimicrobial susceptibilities of group a streptococcus isolates from pediatric pharyngotonsillitis.

Japanese Journal of Infectious Diseases — Sat, 01 Nov 2008 04:00:00 +0100

In this study we determined the T serotype and antimicrobial susceptibility of GAS isolates from Japanese children. From January to December 2006, a total of 438 isolates of GAS were obtained from pharyngeal swabs of 438 children with pharyngotonsillitis. The commonest T serotype was type 1 (110 strains, 25.1%), followed by type 12 (107, 24.4%) and type 4 (77, 17.6%). All GAS isolated from pharyngeal swabs were susceptible to beta-lactams (benzylpenicillin, amoxicillin, cefotaxime, ceftriaxone, imipenem, panipenem, and cefditoren) and vancomycin, but 19.6, 19.6, 3.2, 11.6, and 27.6% were resistant to erythromycin, clarithromycin, clindamycin, minocycline, and norfloxacin, respectively. Resistance varied considerably with the T serotype. In particular, type 4 isolates had the highest resist...

[Microbiology] Induction of group A Streptococcus virulence by a human antimicrobial peptide

Proceedings of the National Academy of Sciences — Tue, 28 Oct 2008 04:00:00 +0100

Group A streptococci (Streptococcus pyogenes or GAS) freshly isolated from individuals with streptococcal sore throat or invasive ("flesh-eating") infection often... (Source: Proceedings of the National Academy of Sciences)

Distribution of emm type and antibiotic susceptibility of group A streptococci causing invasive and noninvasive disease.

Journal of Medical Microbiology — Sat, 18 Oct 2008 17:07:44 +0100

Authors: Wajima T, Murayama SY, Sunaoshi K, Nakayama E, Sunakawa K, Ubukata K To determine the prevalence of macrolide antibiotic and levofloxacin resistance in infections with Streptococcus pyogenes (group A streptococcus or GAS), strains were collected from 45 medical institutions in various parts of Japan between October 2003 and September 2006. Four hundred and eighty-two strains from patients with GAS infections were characterized genetically. Strains were classified into four groups according to the type of infection: invasive infections (n=74) including sepsis, cellulitis and toxic-shock-like syndrome; acute otitis media (AOM; n=23); abscess (n=53); and pharyngotonsillitis (n=332). Among all strains, 32 emm types were identified; emm1 was significantly more common in invasive in...

Necrotizing fasciitis with toxic shock syndrome in a child: a case report and review of literature

Cases Journal — Wed, 08 Oct 2008 04:00:00 +0100

Conclusion: Necrotizing fasciitis in children is a frequently misdiagnosed condition; early identification of the necrotizing process can improve the outcome of this life-threatening disease. Surgical debridement and antibiotics were the most important therapeutic measures. (Source: Cases Journal)

Necrotizing fasciitis with toxic shock syndrome in a child: a case report and review of literature

Cases Journal — Tue, 07 Oct 2008 23:00:00 +0100

ConclusionNecrotizing fasciitis in children is a frequently misdiagnosed condition; early identification of the necrotizing process can improve the outcome of this life-threatening disease. Surgical debridement and antibiotics were the most important therapeutic measures. (Source: Cases Journal)

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Determination of the mimic epitope of the M-like protein adhesin in swine Streptococcus equi subsp. zooepidemicus

BioMed Central — Tue, 07 Oct 2008 04:00:00 +0100

Conclusion: Collectively, our findings suggest that the motif XSLSRX may represent an immunodominant mimic epitope of the SzP of S. zooepidemicus strain ATCC 35246, and that the same epitope may be used to mediate SzP binding to HEp-2 cells. (Source: BioMed Central)

An overview of the microbiology of acute ear, nose and throat infections requiring hospitalisation

European Journal of Clinical Microbiology & Infectious Diseases — Thu, 02 Oct 2008 09:27:39 +0100

This study is the first to provide an extensive overview of the microbiology of acute ear, nose and throat infections requiring hospitalisation. All 2,028 cases of acute infections admitted between 1 January 2001 and 31 December 2006 were reviewed to assess the use of pre-admission antibiotics, microbiological results, antibiotic and surgical management and length of hospitalisation. Infections of the oropharynx accounted for the vast majority of admissions, followed by ear infections, and cutaneous neck abscesses. Peritonsillar abscess was the most frequent diagnosis, accounting for over one third of admissions (39.8%, 808 out of 2,028). Complete microbiological data were available for 1,430 cultures, and were analysed for trends with respect to diagnosis, age, gender and use of pre...

[Pneumonia with empyema during varicella.]

Archives de Pediatrie — Wed, 01 Oct 2008 04:00:00 +0100

CONCLUSION: Bacterial pneumoniae with empyema are not current complications of chicken pox but have to be sought when prolonged fever and/or alteration of the health status occurs during chicken pox eruption. PMID: 18835141 [PubMed - as supplied by publisher] (Source: Archives de Pediatrie)

Clinical inquiries: should you treat carriers of pharyngeal group A strep?

The Journal of Family Practice — Wed, 01 Oct 2008 04:00:00 +0100

Authors: Sepdham D, Rao S, Hitchcock K, Goodwin MA PMID: 18842194 [PubMed - in process] (Source: The Journal of Family Practice)

Complement factor H allotype 402H is associated with increased C3b opsonization and phagocytosis of Streptococcus pyogenes

Molecular Microbiology — Sat, 27 Sep 2008 04:00:00 +0100

In conclusion the data indicate that the AMD-associated allotype 402H leads to diminished binding of FH to GAS and increased opsonophagocytosis of the bacteria in blood. These results suggest that the homozygous presence of the allele 402H could be associated with decreased risk for severe GAS infections offering an explanation for the high frequency of the allele despite its association with visual impairment. (Source: Molecular Microbiology)

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Superantigen genes in group A streptococcal isolates and their relationship with emm types.

Journal of Medical Microbiology — Fri, 26 Sep 2008 20:15:27 +0100

This study investigated 107 isolates of GAS for possession of each of the 11 currently known superantigen genes to determine the prevalence, co-occurrence and genetic restriction amongst different emm types of GAS. The results were compared with those in previously published studies. Superantigen genes were not randomly distributed amongst GAS isolates. Certain combinations of superantigen genes were more common and the majority of emm types showed restricted superantigen profiles. This is the first prevalence study of GAS isolates to include the complete range of known superantigen genes and their restriction amongst emm types. This study contributes to the understanding of the relationship between superantigen genes and emm types, and highlights the importance of comprehensive studies in...

Age-associated differences in prevalence of group A streptococcal type-specific M antibodies in children

European Journal of Pediatrics — Wed, 24 Sep 2008 08:20:50 +0100

Abstract Our prior studies of the molecular epidemiology of group A streptococcus (GAS) pharyngitis indicated that the most common emm types associated with pediatric pharyngitis in North America were 12, 1, 28, and 4. We previously reported that the proportions of pediatric pharyngitis due to emm types 12 and 4 decreased with increasing age throughout childhood. We hypothesized that this is due to age-associated acquisition of antibodies to the amino-terminal type-specific region of common GAS M proteins during childhood. We sought to demonstrate this in sera from healthy children by using ELISAs for M 12, 1, 28, and 4. Enzyme-linked immunosorbent assays (ELISA) using chemically synthesized peptides copying amino-terminal type-specific regions of the M proteins were perfor...

Mainline Technology, Inc. - Mainline Confirms Strep A, - Class 2 Recall

Medical Device Recalls since July 07, 2006 — Tue, 23 Sep 2008 01:00:13 +0100

Mainline Confirms Strep A, Group A Streptococcus; A rapid one-step visual test for the detection of group A streptococcal antigen directly from throat swabs, Mainline Technology, Inc., Ann Arbor, MI; Cat. Nos. 3030-20 (20 test) and 3030-40 (40 test). (Source: Medical Device Recalls since July 07, 2006)

Use of Drotrecogin Alfa in Necrotizing Fasciitis: A Case Report and Pharmacologic Review

Journal of Intensive Care Medicine — Fri, 19 Sep 2008 04:00:00 +0100

We present a case of NF in an immunocompetent patient and the subsequent use of drotrecogin alfa (Xigris). A review of the pharmacologic treatment of streptococcal NF is included. The addition of drotrecogin alfa to operative debridement and penicillin G/clindamycin therapy may be a useful adjunct in the treatment of necrotizing fasciitis due to group A streptococcus. (Source: Journal of Intensive Care Medicine)

Comparative analysis of emm type pattern of Group A Streptococcus throat and skin isolates from India and their association with closely related SIC, a streptococcal virulence factor

BioMed Central — Tue, 16 Sep 2008 04:00:00 +0100

Conclusion: Despite the diversity in emm type pattern of throat and skin isolates, no significant association between emm type and source of isolation was observed. The finding that the crs gene is highly conserved even in two different variants of emm1-2 GAS (speA +ve and -ve) suggests a single allele of crs may be prevalent in the highly diverse throat and skin isolates of GAS in India. (Source: BioMed Central)

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Genetic diversity of Group A Streptococcus M protein: Implications for typing and vaccine development.

Vaccine — Tue, 09 Sep 2008 04:00:00 +0100

Authors: Smeesters PR, Mardulyn P, Vergison A, Leplae R, Van Melderen L Group A Streptococci (GAS) are classified into 180 emm-types based on the sequence of the amino-terminal hyper-variable region of the M surface protein. The genetic relatedness of the whole surface-exposed part of M was investigated in well-characterized Belgian and Brazilian GAS isolates which belong to different epidemiological and clinical landscapes. Despite a small number of different emm-types and an apparent low diversity in the Belgian isolates (as revealed by the emm-typing method), our data showed that the overall genetic diversity of the M proteins was higher than expected. On the contrary, the M proteins from the Brazilian isolates were genetically highly related. Since M is a multi-functional protein, ...

What Else Causes Acute Pharyngitis That Isn't Group A Streptococcus?

PediatricEducation.org — Mon, 08 Sep 2008 07:00:00 +0100

Discussion Acute pharyngitis is a common problem accounting for 1-2% of all outpatient visits. Patients usually complain of pain to various degrees, fever and erythema of the pharynx. Acute pharyngitis is more common in the colder months of the year. The most important bacterial cause is Streptococcus pyogenes, or beta-hemolytic, group A streptococcus (GAS). It causes 15-30% of tonsillopharyngitis in school age children. GAS is often spread between family members with children being the reservoir. Common signs of GAS include erythema and exudates of the tonsils and pharynx, petechiae on the soft palate, anteriorcervical adenitis and scarlatiniform rash. Common symptoms of GAS include pharyngeal pain, fever, headache, abdominal pain, nausea and vomiting. Treatment for GAS usually inc...

Review of Compartment Syndrome Due to Group A Streptococcal Infection.

The American Journal of the Medical Sciences — Mon, 01 Sep 2008 04:00:00 +0100

CONCLUSIONS:: Nontraumatic acute compartment syndrome presenting with fever, or hypotension, or leukocytosis may be associated with infection such as group A streptococcus. Prompt surgical and antibiotic therapy was associated with a relatively low mortality rate. A high clinical index of suspicion should occur for the possibility of infection with an organism such as group A streptococcus in patients presenting with acute extremity pain and tense compartments without trauma and with signs of a systemic inflammatory response. PMID: 18794622 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)

Effects of Streptococcal Pyrogenic Exotoxin B on Pathogenesis of Streptococcus pyogenes.

J Formos Med Assoc — Mon, 01 Sep 2008 04:00:00 +0100

Authors: Chiang-Ni C, Wu JJ Streptococcus pyogenes (group A streptococcus, GAS) is a ubiquitous and important human bacterial pathogen. This organism possesses several virulence factors to establish infection. One of these, the streptococcal pyrogenic exotoxin B (SpeB), is the predominant secreted cysteine protease of GAS. SpeB cleaves or degrades host serum proteins such as human extracellular matrix, immunoglobulins, complement components, and even GAS surface and secreted proteins. Destruction of both host and bacterial proteins makes SpeB the key virulence factor in GAS pathogenesis. Although several lines of evidence have shown that SpeB is an important virulence factor of GAS, its role in streptococcal infection remains controversial. Here, we review several publications and desc...

A Healthy 47-year-old Man Dies of Group A Streptococcus

Journal of Emergency Nursing: JEN — Sun, 31 Aug 2008 23:00:00 +0100

A 47-year-old man experienced a 4-day history of headache, profuse nausea, vomiting, diarrhea, and dehydration. On the day of presentation, our patient awoke with sudden onset of dyspnea. The man attributed his symptoms to cathartic supplements ingested during the past 7 to 10 days to “detoxify.” He was seen by his primary care provider, who noted that the patient was “bluish-purple from the waist up.” Alarmed by this condition, the primary care provider summoned an ambulance to the medical office. When paramedics arrived, the man’s vital signs were as follows: blood pressure, 96/60 mm Hg; heart rate, 136 per minute; respiratory rate, 36; and oxygen saturation, 79% on room air. The patient was alert, with a Glasgow Coma Scale score of 15; however, his blood glucose level was 51 m...

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Synthesis and immunological evaluation of self-adjuvanting glycolipopeptide vaccine candidates.

Bioorganic & Medicinal Chemistry — Fri, 29 Aug 2008 04:00:00 +0100

Authors: Fujita Y, Abdel-Aal AB, Wimmer N, Batzloff MR, Good MF, Toth I Synthesis of four glycolipids with different number of lauroyl groups on glucose or cellobiose as scaffolds is described. Their immunological evaluations either admixed with or covalently linked to J8, a peptide antigen derived from the C-terminus of the antiphagocytic M-protein of group A streptococcus, are also investigated. Administration of mixtures of J8 and glycolipids to B10BR (H-2(k)) mice induced low-levels of J8-specific IgG antibodies. While glycolipopeptides, in which J8 was covalently linked to the synthetic glycolipids, demonstrated high-levels of antibody titers comparable with the co-administration of these glycolipopeptides with complete Freund's adjuvant, suggesting clearly the strong potency of t...

A foodborne outbreak of a group A streptococcal infection in a Japanese university hospital

European Journal of Clinical Microbiology & Infectious Diseases — Thu, 21 Aug 2008 09:32:44 +0100

We describe an outbreak of foodborne tonsillopharyngitis caused by group A streptococcus (GAS), a rarely reported event that occurred during a campus orientation meeting in Japan. Of 461 students and staff members who had eaten boxed lunches during a meeting at Kitasato University, 298 developed sore throat and/or fever, and 285 underwent medical examination. Amoxicillin was prescribed when throat culture specimens yielded GAS. The attack rate was 64.6%. T-25 GAS was isolated from 150 examined persons. Of 65 patients who received amoxicillin for 3 days, GAS was eradicated before the first follow-up throat culture in 46 (70.8%) cases. Susceptibility was demonstrated to penicillins, cephalosporins, and macrolides in 86 GAS isolates obtained more than once from a given patient. GAS...

BOOSTER SHOTS: Flesh-eating bacteria -- Scientists identify the perpetrator

L.A. Times - Health — Thu, 14 Aug 2008 03:40:48 +0100

By Shari Roan Study shows how group A Streptococcus survives and spreads by disabling an immune defense molecule, raising hopes that researchers are closer to finding a way to stop the dangerous organism. (Source: L.A. Times - Health)

BOOSTER SHOTS: Flesh-eating bacteria -- Scientists identify the perpetrator

L.A. Times - Health — Thu, 14 Aug 2008 03:40:48 +0100

The IL-8 Protease SpyCEP/ScpC of Group A Streptococcus Promotes Resistance to Neutrophil Killing.

Cell Host and Microbe — Tue, 12 Aug 2008 14:04:50 +0100

Authors: Zinkernagel AS, Timmer AM, Pence MA, Locke JB, Buchanan JT, Turner CE, Mishalian I, Sriskandan S, Hanski E, Nizet V Interleukin-8 (IL-8) promotes neutrophil-mediated host defense through its chemoattractant and immunostimulatory activities. The Group A Streptococcus (GAS) protease SpyCEP (also called ScpC) cleaves IL-8, and SpyCEP expression is strongly upregulated in vivo in the M1T1 GAS strains associated with life-threatening systemic disease including necrotizing fasciitis. Coupling allelic replacement with heterologous gene expression, we show that SpyCEP is necessary and sufficient for IL-8 degradation. SpyCEP decreased IL-8-dependent neutrophil endothelial transmigration and bacterial killing, the latter by reducing neutrophil extracellular trap formation. The knockout ...

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Streptococcus pyogenes degrades extracellular matrix in chondrocytes via MMP-13.

Biochemical and Biophysical Research communications — Fri, 08 Aug 2008 09:28:06 +0100

We report here that GAS strain JRS4 invaded a chondrogenic cell line ATDC5 and induced the degradation of the extracellular matrix (ECM), whereas an isogenic mutant of JRS4 lacking a fibronectin-binding protein, SAM1, failed to invade the chondrocytes or degrade the ECM. Reverse transcription-PCR and Western blot analysis revealed that the expression of matrix metalloproteinase (MMP)-13 was strongly elevated during the infection with GAS. A reporter assay revealed that the activation of the AP-1 transcription factor and the phosphorylation of c-Jun terminal kinase participated in MMP-13 expression. These results suggest that MMP-13 plays an important role in the destruction of infected joints during the development of septic arthritis. PMID: 18586009 [PubMed - indexed for MEDLINE] (Sou...

Group A Streptococcus vulvovaginitis in breastfeeding women.

American Journal of Obstetrics and Gynecology — Fri, 01 Aug 2008 04:00:00 +0100

Authors: Rahangdale L, Lacy J, Hillard PA Group A beta-hemolytic streptococcus-associated vulvovaginitis is uncommon in adult women. Clinicians should include group A beta-hemolytic streptococcus as a possible cause of vulvovaginal symptoms in breastfeeding women. Along with appropriate antibiotic therapy, vaginal estrogen therapy may be considered to diminish susceptibility to recurrent infection in women with vaginal atrophy. PMID: 18674653 [PubMed - in process] (Source: American Journal of Obstetrics and Gynecology)

[Mechanisms Of Signal Transduction] Group A Streptococcus Activates Type I Interferon Production and MyD88-dependent Signaling without Involvement of TLR2, TLR4, and TLR9

Journal of Biological Chemistry — Fri, 11 Jul 2008 04:00:00 +0100

Bacterial pathogens are recognized by the innate immune system through pattern recognition receptors, such as Toll-like receptors (TLRs). Engagement of TLRs triggers signaling cascades that launch innate immune responses. Activation of MAPKs and NF-B, elements of the major signaling pathways induced by TLRs, depends in most cases on the adaptor molecule MyD88. In addition, Gram-negative or intracellular bacteria elicit MyD88-independent signaling that results in production of type I interferon (IFN). Here we show that in mouse macrophages, the activation of MyD88-dependent signaling by the extracellular Gram-positive human pathogen group A streptococcus (GAS; Streptococcus pyogenes) does not require TLR2, a receptor implicated in sensing of Gram-positive bacteria, or TLR4 and TLR9. Redunda...

Point-of-care testing of group A streptococcal antigen: performance evaluated by external quality assessment

European Journal of Clinical Microbiology & Infectious Diseases — Sat, 05 Jul 2008 06:23:13 +0100

Abstract The purpose of this study was to evaluate the overall performance of rapid antigen detection (RAD) in group A streptococcus (GAS) in Finland by using the results of external quality assurance (EQA) samples. We also compared the performance of laboratory professionals to that of nursing professionals. Around 22,800 EQA results among a total of 383 laboratories and physician’s offices were analysed. Vocational data on the personnel who carried out the tests were available for 10,088 EQA samples, 7,428 of which were tested by laboratory technicians and 2,531 by nursing staff. The best overall performance was found with GAS-negative samples: 99% of the reports were correct. In contrast, the overall performance was only 76% when the samples were weakly positive for G...

Group A streptococcal infection caused by emm 1 strains among children in southern Taiwan

European Journal of Clinical Microbiology & Infectious Diseases — Thu, 03 Jul 2008 08:18:17 +0100

Abstract The aim of this study was to characterize the molecular epidemiology of invasive and non-invasive group A streptococcus (GAS) infections in children from 1997 through 2004 in southern Taiwan. A collection of 32 invasive and 150 non-invasive isolates were recruited for analysis. emm1 (34.4%) and emm12 (40.0%) predominated in the invasive and non-invasive isolates, respectively. The peak incidence of invasive GAS infection (IGASI) occurred between 2002 and 2003. emm4 and emm12 were the major types among clinical isolates before 2001, and was replaced by emm1 during 2002–2003. All emm1 isolates were clonal relatedness. The declined prevalence of erythromycin resistance occurred in the major shift of the endemic isolates to emm1 strains during 2002–2003 in the commu...

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Five-day oral cefditoren pivoxil versus 10-day oral amoxicillin for pediatric group A streptococcal pharyngotonsillitis

Journal of Infection and Chemotherapy — Tue, 24 Jun 2008 07:50:26 +0100

Abstract We prospectively compared the efficacy of oral cefditoren-pivoxil and conventional oral amoxicillin for pharyngotonsillitis caused by group A streptococcus in children. Either oral cefditoren-pivoxil (3 mg/kg t.i.d. for 5 days) or amoxicillin (10 mg/kg t.i.d. for 10 days) was administered to patients with group A streptococcal pharyngotonsillitis attending the pediatric outpatient clinic of Showa Hospital (Konan, Japan) between January and December 2006. Diagnosis was based on isolation of bacteria from a pharyngeal swab. Culture was always done to confirm eradication, and urinalysis and follow-up were performed at least once weekly for 4 weeks. Among 258 patients, 103 (aged 5.5 ± 2.3 years) received cefditoren-pivoxil and 155 (aged 5.2 ± 2.0 years) received amo...

MALDI-TOF mass spectrometry as a tool for differentiation of invasive and noninvasive Streptococcus pyogenes isolates

FEMS Immunology and Medical Microbiology — Thu, 05 Jun 2008 18:19:49 +0100

FEMS Immunology & Medical Microbiology, Volume 0, Issue 0, Page ???, OnlineEarly Articles. 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 ... (Source: FEMS Immunology and Medical Microbiology)

Provider Knowledge, Attitudes, and Practices regarding Obstetric and Postsurgical Gynecologic Infections Due to Group A Streptococcus and Other Infectious Agents

Infectious Diseases in Obstetrics and Gynecology — Tue, 03 Jun 2008 22:13:30 +0100

Acute streptococcal myopericarditis mimicking myocardial infarction.

The American Journal of Emergency Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Authors: Khavandi A, Whitaker J, Elkington A, Probert J, Walker PR A 25-year-old man who had recurrent sore throats presented with sharp central chest pain 5 hours after starting penicillin for tonsillitis. Electrocardiogram (ECG) revealed ST-segment elevation in leads I and aVL with reciprocal ST depression in lead III (Fig. 1). Troponin I was measured as 33 microg/L (normal range, b0.1 microg/L), and C-reactive protein (CRP) was 127 (normal range b10). Echocardiogram revealed a nondilated well-contracting left ventricle, and cardiac catheterization revealed normal coronary arteries. A diagnosis of acute myopericarditis was made, and he was treated with moxifloxacin. Throat swabs grew Lancefield group A Streptococcus. Over subsequent days, his symptoms and ECG changes resolved, and he...

Children with Bacterial Meningitis Presenting to the Emergency Department during the Pneumococcal Conjugate Vaccine Era.

Accident and Emergency Nursing — Sun, 01 Jun 2008 04:00:00 +0100

Conclusions: Although now a rare infectious disease in United States, bacterial meningitis still causes substantial morbidity in affected children. Despite the introduction of PCV7, S. pneumoniae remains the most common cause of bacterial meningitis in U.S. children, with approximately half of cases due to nonvaccine serotypes. PMID: 18616437 [PubMed - in process] (Source: Accident and Emergency Nursing)

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Molecular characterization of group A Streptococcus maltodextrin catabolism and its role in pharyngitis

Molecular Microbiology — Wed, 28 May 2008 00:19:48 +0100

Molecular Microbiology, Volume 0, Issue 0, Page ???, December 2004. Summary We previously demonstrated that the cell-surface lipoprotein MalE contributes to GAS maltose/maltodextrin utilization, but MalE inactivation does not completely abrogate GAS catabolism of maltose or maltotriose. Using a genome-wide approach, we ... (Source: Molecular Microbiology)

Mast cell cathelicidin antimicrobial Peptide prevents invasive group a streptococcus infection of the skin.

Journal of Immunology — Wed, 21 May 2008 15:14:41 +0100

Authors: Di Nardo A, Yamasaki K, Dorschner RA, Lai Y, Gallo RL Mast cells (MC) express cathelicidin antimicrobial peptides that act as broad-spectrum antibiotics and influence the immune defense of multiple epithelial surfaces. We hypothesized that MC help protect against skin infection through the expression of cathelicidin. The susceptibility of MC-deficient mice (Kit Wsh(-/-)) to invasive group A streptococcus (GAS) was compared with control mice. Following s.c. injection of GAS, MC-deficient mice had 30% larger skin lesions, 80% more lesional bacteria, and 30% more spleens positive for bacteria. In contrast to results obtained when GAS was injected into skin, no significant differences were noted between MC-deficient mice and control mice after GAS was applied topically, indicating...

The prospect of vaccination against group a β-hemolytic streptococci

Current Infectious Disease Reports — Fri, 16 May 2008 06:14:52 +0100

Abstract Group A streptococcus is a widespread human pathogen that causes a broad spectrum of human disease. The persistent high burden and severity of illness in developing and industrialized countries speaks to the need for a safe and effective vaccine. Modern approaches to vaccine construction include M protein type-specific vaccines, vaccines utilizing conserved M antigens, and vaccines based on other conserved surface-expressed or secreted antigens. Vaccine candidates in various stages of development offer promise for prevention of Group A streptococcal infections and their sequelae. Content Type Journal ArticleDOI 10.1007/s11908-008-0032-9Authors Karen L. Kotloff, University of Maryland School of Medicine Division of Infectious Disease and Tropical Pediatrics, Dep...

Toward a Designer GAS Vaccine

This Week in Science — Fri, 07 Mar 2008 08:31:32 +0100

M proteins are antigenically variable cell-surface virulence factors of group A Streptococcus (GAS). This organism is an important cause of human illness and notably provokes the autoimmune disease rheumatic fever. … [Read more] (Source: This Week in Science)

[REPORTS] Coiled-Coil Irregularities and Instabilities in Group A Streptococcus M1 Are Required for Virulence

Science: Current Issue — Fri, 07 Mar 2008 08:14:11 +0100

Mutating a cell-surface virulence protein on strep bacteria stabilizes its structure, minimizing its inflammatory side effects and potentially making it a better vaccine.Authors: Case McNamara, Annelies S. Zinkernagel, Pauline Macheboeuf, Madeleine W. Cunningham, Victor Nizet, Partho Ghosh (Source: Science: Current Issue)

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Inverness Medical

Hospital Management — Thu, 28 Feb 2008 00:00:00 +0100

Innovations is a leading provider of innovative diagnostic products. With focus on women's health, oncology, infectious diseases and cardiology, the current product portfolio targets more than 100 disease states and conditions. As well as leading the way in advanced technologies for professional diagnostic markets we remain committed to advancing healthcare through a continual flow of innovative new products driven by our strategy of investing in R&D and intellectual property. By maintaining our own state-of-the-art manufacturing facilities, we produce high-quality, cutting edge products at the speed of life. CLINICAL RAPID DIAGNOSTICS Through our internal R&D programmes, some strategic acquisitions and further planned acquisitions, our portfolio is rapidly growing and evolving. Some of...

The severity of Streptococcus pyogenes infections in children is significantly associated with plasma levels of inflammatory cytokines.

Diagnostic Microbiology and Infectious Disease — Fri, 22 Feb 2008 05:00:00 +0100

This study was designed to determine the expression of inflammatory cytokines in children by the severity of Streptococcus pyogenes (group A Streptococcus [GAS]) infections. The study population consisted of 16 invasive, 20 noninvasive, and 24 pharyngeal colonization, and 21 healthy controls. All children underwent the laboratory tests and cytokine measurement. GAS isolates were analyzed for emm gene typing. Patients with invasive GAS diseases had significantly higher interferon (IFN)-gamma, interleukin (IL)-1beta, IL-6, IL-8, IL-10, and IL-18 than those with noninvasive diseases, colonization, and healthy controls. There was no difference in tumor necrosis factor (TNF)-alpha, IL-12, and IL-2 levels among the groups. Elevated white blood cell counts and levels of C-reactive protein and C3 ...

Streptococcal immunoglobulin-binding protein Sib35 exerts stimulatory and mitogenic effects toward mouse B lymphocytes

FEMS Microbiology Letters — Wed, 13 Feb 2008 19:18:34 +0100

FEMS Microbiology Letters, Volume 0, Issue 0, Page ???, OnlineEarly Articles. Abstract Group A Streptococcus (GAS) produces several immunopotent proteins such as the immunoglobulin-binding protein 35 (Sib35) family, known to be an immunoglobulin G-degrading enzyme of GAS and a CD16-binding protein of GAS, Mac-1-like protein/IdeS. ... (Source: FEMS Microbiology Letters)

[Microbiology] A direct link between carbohydrate utilization and virulence in the major human pathogen group A Streptococcus

Proceedings of the National Academy of Sciences — Tue, 05 Feb 2008 05:00:00 +0100

Although central to pathogenesis, the molecular mechanisms used by microbes to regulate virulence factor production in specific environments during host–pathogen... (Source: Proceedings of the National Academy of Sciences)

Necrotizing cervical and uterine infection in the postpartum period caused by group a streptococcus.

Obstetrics and Gynecology — Fri, 01 Feb 2008 05:00:00 +0100

CONCLUSION: Puerperal sepsis from Group A Streptococcus can be a cause of necrotizing infection following delivery. Physicians should be aware of the resurgence of this potentially fatal pathogen. PMID: 18239012 [PubMed - in process] (Source: Obstetrics and Gynecology)

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A Non-Human Primate Model of Acute Group A Streptococcus Pharyngitis

Springer protocols feed by Microbiology — Fri, 01 Feb 2008 05:00:00 +0100

Humana Press, Totowa, NJ This chapter describes methods for using non-human primates as a model of group A streptococcal (GAS) pharyngitis. This model has been used successfully to study host–pathogen interactions occurring during pharyngeal GAS infections. The protocol as described will compare two different GAS strains for their ability to cause clinical symptoms of pharyngitis. (Source: Springer protocols feed by Microbiology)

Antibiotic resistant β-hemolytic streptococci

Indian Journal of Pediatrics — Mon, 21 Jan 2008 16:13:24 +0100

Conclusion All β-hemolytic streptococci were susceptible to penicillin, amoxycillin, cephalosporins and linezolid. Resistance to erythromycin, tetracycline, clindamycin, chloramphenicol, and quinolones is emerging. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s12098-007-0200-1Authors Charmaine A. C. Lloyd, University of Madras Dr. ALM Post Graduate Institute of Basic Medical Sciences Taramani, Chennai 600 113 IndiaSwarna E. Jacob, University of Madras Dr. ALM Post Graduate Institute of Basic Medical Sciences Taramani, Chennai 600 113 IndiaThangam Menon, University of Madras Dr. ALM Post Graduate Institute of Basic Medical Sciences Taramani, Chennai 600 113 India Journal Indian Journal of PediatricsOnline ISSN 0973-7693Print ISSN 0019-5456 ...

Peritonsillar abscess.

American Family Physician — Tue, 15 Jan 2008 05:00:00 +0100

Authors: Galioto NJ Peritonsillar abscess remains the most common deep infection of the head and neck. The condition occurs primarily in young adults, most often during November to December and April to May, coinciding with the highest incidence of streptococcal pharyngitis and exudative tonsillitis. A peritonsillar abscess is a polymicrobial infection, but Group A streptococcus is the predominate organism. Symptoms generally include fever, malaise, sore throat, dysphagia, and otalgia. Physical findings may include trismus and a muffled voice (also called "hot potato voice"). Drainage of the abscess, antibiotics, and supportive therapy for maintaining hydration and pain control are the foundation of treatment. Antibiotics effective against Group A streptococcus and oral anaerobes shoul...

Genotyping of group A streptococcus by various molecular methods.

Indian J Med Res — Tue, 01 Jan 2008 05:00:00 +0100

CONCLUSION: The finding of our study demonstrated the RAPD profiling to be the most discriminatory for genotyping of group A streptococcus isolates as well as comparable to the most commonly used sophisticated technique of emm typing. PMID: 18316856 [PubMed - in process] (Source: Indian J Med Res)

The Scl1 protein of M6-type group A Streptococcus binds the human complement regulatory protein, factor H, and inhibits the alternative pathway of complement

Molecular Microbiology — Wed, 19 Dec 2007 02:07:44 +0100

Molecular Microbiology, Volume 0, Issue 0, Page ???, December 2004. Summary Non-specific activation of the complement system is regulated by the plasma glycoprotein factor H (FH). Bacteria can avoid complement-mediated opsonization and phagocytosis through acquiring FH to the cell surface. Here, we characterize an ... (Source: Molecular Microbiology)

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Clinical utility of a new rapid test for the detection of group A Streptococcus and discriminate use of antibiotics for bacterial pharyngitis in an outpatient setting.

International Journal of Infectious Diseases — Thu, 15 Nov 2007 05:00:00 +0100

CONCLUSION: The Diaquick Strep. A Test (SAT) is a quick, reliable, and clinically useful test, which could help to dramatically reduce the usage of antibiotics in children with fever, catarrh, and acute pharyngotonsillitis. PMID: 18024107 [PubMed - as supplied by publisher] (Source: International Journal of Infectious Diseases)

RivR and the small RNA RivX: the missing links between the CovR regulatory cascade and the Mga regulon

Molecular Microbiology — Wed, 14 Nov 2007 05:06:54 +0100

Molecular Microbiology, Volume 0, Issue 0, Page ???, December 2004. Summary The CovR/S two-component system regulates the transcription of many genes that are crucial for the virulence of Streptococcus pyogenes (group A Streptococcus, GAS). Previously, we demonstrated that one gene repressed directly by CovR is rivR, ... (Source: Molecular Microbiology)

The Mga virulence regulon: infection where the grass is greener

Molecular Microbiology — Mon, 12 Nov 2007 20:46:15 +0100

Molecular Microbiology, Volume 66, Issue 5, Page 1056-1065, December 2007. Summary Co-ordinate regulation of virulence gene expression in response to different host environments is central to the success of the group A streptococcus (GAS, Streptococcus pyogenes) as an important human pathogen. Mga represents a ubiquitous stand-... (Source: Molecular Microbiology)

Psychological stress downregulates epidermal antimicrobial peptide expression and increases severity of cutaneous infections in mice

Journal of Clinical Investigation — Thu, 01 Nov 2007 04:00:00 +0100

The skin is the first line of defense against microbial infection, and psychological stress (PS) has been shown to have adverse effects on cutaneous barrier function. Here we show that PS increased the severity of group A Streptococcus pyogenes (GAS) cutaneous skin infection in mice; this was accompanied by increased production of endogenous glucocorticoids (GCs), which inhibited epidermal lipid synthesis and decreased lamellar body (LB) secretion. LBs encapsulate antimicrobial peptides (AMPs), and PS or systemic or topical GC administration downregulated epidermal expression of murine AMPs cathelin-related AMP and ß-defensin 3. Pharmacological blockade of the stress hormone corticotrophin-releasing factor or of peripheral GC action, as well as topical administration of physiologic l...

Characterization of the immune response to collagen-like proteins Scl1 and Scl2 of serotype M1 and M28 group A Streptococcus

FEMS Microbiology Letters — Thu, 25 Oct 2007 18:22:12 +0100

FEMS Microbiology Letters, Volume 0, Issue 0, Page ???, -Not available-. Abstract Group A Streptococcus (GAS) infections may trigger autoimmune sequelae thought to involve streptococcal antibodies cross-reactive to human antigens. Here, the antigenicity of the streptococcal collagen-like (CL) proteins, Scl1 and Scl2, that ... (Source: FEMS Microbiology Letters)

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Necrotizing fasciitis caused by group A Streptococcus with no apparent predisposing factors presenting as acute abdomen.

International Journal of Infectious Diseases — Thu, 25 Oct 2007 04:00:00 +0100

Authors: Al-Tamimi HA, Thomas L PMID: 17964842 [PubMed - as supplied by publisher] (Source: International Journal of Infectious Diseases)

Interpersonal relationships and group A streptococcus spread in a Mexican day-care center.

Salud Publica de Mexico — Mon, 01 Oct 2007 04:00:00 +0100

CONCLUSION: The spread of specific GAS clones was associated with groups of children having a high proportion of ties and a high centrality level. This is evidence that spread of GAS strains among children attending day-care centers is not random but dependent on the degree of communication and physical contact between pairs. PMID: 17952239 [PubMed - as supplied by publisher] (Source: Salud Publica de Mexico)

[Acute rheumatic fever associated with Henoch-Schonlein purpura. Case report and review of the literature]

Acta Reumatologica Portuguesa — Mon, 01 Oct 2007 04:00:00 +0100

DISCUSSION: Literature reports HSP associated with rheumatic fever and carditis. Our case adds further evidence to the possibility of streptococcus being a causal agent of HSP. PMID: 18159205 [PubMed - indexed for MEDLINE] (Source: Acta Reumatologica Portuguesa)

Differences among international pharyngitis guidelines: not just academic.

Annals of Family Medicine — Sat, 01 Sep 2007 04:00:00 +0100

CONCLUSION: Although the evidence for the management of acute sore throat is easily available, national guidelines are different with regard to the choice of evidence and the interpretation for clinical practice. Also a transparent and standardized guideline development method is lacking. These findings are important in the context of appropriate antibiotic use, the problem of growing antimicrobial resistance, and costs for the community. PMID: 17893386 [PubMed - in process] (Source: Annals of Family Medicine)

Volume 45, number 7: Group A Streptococcus Epidemiology and Vaccine Implications

Clinical Infectious Diseases Latest Issue — Fri, 31 Aug 2007 19:51:33 +0100

(Source: Clinical Infectious Diseases Latest Issue)

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Volume 45, number 7: The Epidemiology of Invasive Group A Streptococcal Infection and Potential Vaccine Implications: United States, 2000-2004

Clinical Infectious Diseases Latest Issue — Fri, 31 Aug 2007 19:51:33 +0100

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. (Source: Clinical Infectious Diseases Latest Issue)

Group A Streptococcus Epidemiology and Vaccine Implications

Clinical Infectious Diseases Latest Articles — Wed, 29 Aug 2007 05:00:00 +0100

(Source: Clinical Infectious Diseases Latest Articles)

The Epidemiology of Invasive Group A Streptococcal Infection and Potential Vaccine Implications: United States, 2000-2004

Clinical Infectious Diseases Latest Articles — Wed, 29 Aug 2007 05:00:00 +0100

Surveillance for hospital outbreaks of invasive group a streptococcal infections in Ontario, Canada, 1992 to 2000.

Annals of Internal Medicine — Tue, 21 Aug 2007 04:00:00 +0100

CONCLUSIONS: Practices to prevent hospital transmission of group A streptococci should include isolation of patients admitted to the intensive care unit with necrotizing fasciitis, investigation after a single nosocomial case, and emphasis on identifying and treating health care worker carriers on surgical and obstetric services and patient reservoirs on other wards. PMID: 17709757 [PubMed - in process] (Source: Annals of Internal Medicine)

A painful large ganglion cyst of the ankle treated by the injection of OK-432

Modern Rheumatology — Sat, 11 Aug 2007 06:40:03 +0100

Abstract Despite its benign nature, a ganglion can be problematic. We successfully treated a patient with large painful ganglion in his ankle by OK-432 (lyophilized incubation mixture of group A Streptococcus pyogenes of human origin) injection. OK-432 injection seems to be a safe, convenient, and effective alternative to surgical treatment for either symptomatic or recurrent ganglia. Content TypeJournal Article JournalModern RheumatologyOnline ISSN 1439-7609Print ISSN 1439-7595 Journal VolumeVolume 17 Journal IssueVolume 17, Number 4 / August, 2007 (Source: Modern Rheumatology)

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Blunt Trauma as a Risk Factor for Group A Streptococcal Necrotizing Fasciitis.

Annals of Epidemiology — Sat, 11 Aug 2007 04:00:00 +0100

CONCLUSIONS: Nonpenetrating trauma is significantly associated with the development of GAS NF. PMID: 17697787 [PubMed - as supplied by publisher] (Source: Annals of Epidemiology)

Mg2+ signalling defines the group A streptococcal CsrRS (CovRS) regulon

Molecular Microbiology — Tue, 03 Jul 2007 10:42:41 +0100

Molecular Microbiology Volume 0, Issue 0, Page ???-???. Summary CsrRS (or CovRS) is a two-component system implicated in the control of multiple virulence determinants in the important human pathogen, group A Streptococcus (GAS). Earlier studies suggested that extracellular Mg2+ signalled through the presumed ... (Source: Molecular Microbiology)

Understanding how leading bacterial pathogens subvert innate immunity to reveal novel therapeutic targets.

Journal of Allergy and Clinical Immunology — Sun, 01 Jul 2007 04:00:00 +0100

Authors: Nizet V Staphylococcus aureus (SA) and group A Streptococcus (GAS) are prominent Gram-positive bacterial pathogens, each associated with a variety of mucosal and invasive human infections. SA and GAS systemic disease reflects diverse abilities of these pathogens to resist clearance by the multifaceted defenses of the human innate immune system. Here we review how SA and GAS avoid the bactericidal activities of cationic antimicrobial peptides, delay phagocyte recruitment, escape neutrophil extracellular traps, inhibit complement and antibody opsonization functions, impair phagocytotic uptake, resist oxidative burst killing, and promote phagocyte lysis or apoptosis. Understanding the molecular basis of SA and GAS innate immune resistance reveals novel therapeutic targets for tre...

New understanding of the group A Streptococcus pathogenesis cycle.

Trends in Microbiology — Sun, 01 Jul 2007 04:00:00 +0100

Authors: Tart AH, Walker MJ, Musser JM Group A Streptococcus (GAS) has long been recognized as a human pathogen causing an exceptionally broad range of infections. Despite intense research, however, the molecular mechanisms of GAS disease remain unclear. Recently, many important discoveries have been made that shed light on GAS pathogenesis and open exciting avenues for future research. Advances in genome sequencing, microarray technology and proteomic analysis, in combination with the development of more suitable animal models, have markedly increased our knowledge of the mechanisms underlying GAS pathogenesis. The information gained from these studies will translate into improved diagnostics and new targets for therapeutic drugs and vaccines. PMID: 17524649 [PubMed - in process] ...

Apparent Contrasting Rates of Pharyngitis and Pyoderma in Regions where Rheumatic Heart Disease is Highly Prevalent.

Heart, Lung & Circulation — Mon, 18 Jun 2007 04:00:00 +0100

CONCLUSIONS: Although the data are limited, the epidemiology of pharyngitis and pyoderma in this Central Australian Aboriginal community appears to be more akin to that seen in temperate climates rather than tropical Top End communities. In this community, RHD preventative measure should continue to include aggressive treatment of pharyngitis according to recommendations. PMID: 17581789 [PubMed - as supplied by publisher] (Source: Heart, Lung & Circulation)

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Pharyngitis and Epiglottitis.

Infectious Diseases Clinics of North America — Sun, 17 Jun 2007 04:43:20 +0100

Authors: Alcaide ML, Bisno AL Acute pharyngitis is one of the most common illnesses for which patients visit primary care physicians. Most cases are of viral origin, and with few exceptions these illnesses are both benign and self-limited. The most important bacterial cause is the beta-hemolytic group A streptococcus. There are other uncommon or rare types of pharyngitis. For some of these treatment is required or available, and some may be life threatening. Among those discussed in this article are diphtheria, gonorrhea, HIV infection, peritonsillar abscess, and epiglottitis. PMID: 17561078 [PubMed - as supplied by publisher] (Source: Infectious Diseases Clinics of North America)

Scl1-dependent internalization of group A Streptococcus via direct interactions with the α2β1 integrin enhances pathogen survival and re-emergence

Molecular Microbiology — Thu, 31 May 2007 05:18:17 +0100

Molecular Microbiology Volume 64, Issue 5, Page 1319-1331, Jun 2007. (Source: Molecular Microbiology)

Molecular epidemiology of group A streptococcus causing scarlet fever in northern Taiwan, 2001-2002.

Diagnostic Microbiology and Infectious Disease — Fri, 25 May 2007 04:00:00 +0100

In this study, 830 Streptococcus pyogenes isolates collected between 2001 and 2002 from patients with scarlet fever in northern Taiwan were analyzed by M protein gene (emm) sequence typing, pulsed-field gel electrophoresis (PFGE), and antimicrobial susceptibility testing. A total of 21 emm types and 56 PFGE patterns were identified. The most frequent emm types were emm1 (29.2%), emm4 (24.1%), emm12 (19.0%), emm6 (15.8%), stIL103 (5.7%), and emm22 (1.9%). Antimicrobial resistance profiles were determined, and resistance to erythromycin (24.6%), clindamycin (2.0%), and chloramphenicol (1.3%) was detected. Five major emm types (emm4, emm12, emm1, emm22, and emm6) accounted for 95.6% of the erythromycin-resistant isolates. The decreased prevalence of erythromycin-resistant emm12 strains coinci...

MRI findings of rhabdomyolysis from streptococcal pharyngitis

Pediatric Radiology — Tue, 15 May 2007 21:03:47 +0100

We report a case of rhabdomyolysis in a child after an uncomplicated course of group A streptococcal pharyngitis. Although MRI of rhabdomyolysis from other causes has been described in a few case reports, this is a unique MRI description of its occurrence with streptococcal pharyngitis. Content TypeJournal Article JournalPediatric RadiologyOnline ISSN 1432-1998Print ISSN 0301-0449 (Source: Pediatric Radiology)