Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Aug 5:10:233.
doi: 10.1186/1471-2334-10-233.

Spread of a highly mucoid Streptococcus pyogenes emm3/ST15 clone

Esther Tamayo  1 , Milagrosa Montes, Guadalupe García-Medina, José M García-Arenzana, Emilio Pérez-Trallero
Affiliations

Spread of a highly mucoid Streptococcus pyogenes emm3/ST15 clone

Esther Tamayo et al. BMC Infect Dis. .

Abstract

Background: Hyaluronic acid capsule plays a key role in Streptococcus pyogenes virulence. Circulation of mucoid or highly encapsulated strains has been related to rheumatic fever epidemics and invasive disease in several countries. In 2009, an outbreak of mucoid S. pyogenes isolates was detected in northern Spain. The aim of the study was to describe clinical and molecular characteristics of mucoid strains causing this outbreak and to compare them with a sample of non-mucoid S. pyogenes isolates obtained during the same period of time.

Methods: All S. pyogenes isolates with a mucoid colony morphology (n = 132), 10% of non-mucoid (n = 144) and all invasive S. pyogenes isolates (n = 7) obtained in 2009 were included. Characterization was performed by T-agglutination, emm typing, pulsed field gel electrophoresis and multilocus sequence typing.

Results: One clone characterized as emm3.1/ST15 comprised 98.5% (n = 130) of all mucoid isolates. Subjects of all ages were affected. Main clinical manifestations were pharyngitis and scarlet fever, but this clone also caused invasive disease: two cases of streptococcal toxic shock syndrome, one arthritis, and one celullitis with a fatal outcome. Mucoid isolates were more prone to cause invasive disease than non-mucoid isolates (p = 0.001).

Conclusions: Although no acute rheumatic fever cases were detected, the most worrisome characteristics of this clone were the success for causing invasive disease and the merge of two virulent features: the serotype, emm3, and capsule hyper-production, expressed as a mucoid morphology.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Circulation of mucoid and non-mucoid S. pyogenes isolates in 2009 (n = 1571).
Figure 2
Figure 2
Mucoid S. pyogenes colonies on blood agar plates after overnight incubation under an atmosphere enriched with 5% CO2.
Figure 3
Figure 3
PFGE patterns found among emm3/ST15 mucoid S. pyogenes isolates: lanes1, 3, 7, 8 and 11 represent pattern A; lanes 2, 4-6, 9 and 10 represent pattern B; lane M, lambda ladder.
See this image and copyright information in PMC

References

    1. Stollerman GH, Dale JB. The importance of the group a streptococcus capsule in the pathogenesis of human infections: a historical perspective. Clin Infect Dis. 2008;46:1038–1045. doi: 10.1086/529194. - DOI - PubMed
    1. Wessels MR, Moses AE, Goldberg JB, DiCesare TJ. Hyaluronic acid capsule is a virulence factor for mucoid group A streptococci. Proc Natl Acad Sci USA. 1991;88:8317–8321. doi: 10.1073/pnas.88.19.8317. - DOI - PMC - PubMed
    1. Veasy LG, Tani LY, Daly JA, Korgenski K, Miner L, Bale J, Kaplan EL, Musser JM, Hill HR. Temporal association of the appearance of mucoid strains of Streptococcus pyogenes with a continuing high incidence of rheumatic fever in Utah. Pediatrics. 2004;113:e168–e172. doi: 10.1542/peds.113.3.e168. - DOI - PubMed
    1. Erdem G, Mizumoto C, Esaki D, Reddy V, Kurahara D, Yamaga K, Abe L, Johnson D, Yamamoto K, Kaplan EL. Group A streptococcal isolates temporally associated with acute rheumatic fever in Hawaii: differences from the continental United States. Clin Infect Dis. 2007;45:e20–e24. doi: 10.1086/519384. - DOI - PubMed
    1. Luca-Harari B, Darenberg J, Neal S, Siljander T, Strakova L, Tanna A, Creti R, Ekelund K, Koliou M, Tassios PT, van der Linden M, Straut M, Vuopio-Varkila J, Bouvet A, Efstratiou A, Schalén C, Henriques-Normark B. Strep-EURO Study Group. Jasir A. Clinical and microbiological characteristics of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol. 2009;47:1155–1165. doi: 10.1128/JCM.02155-08. - DOI - PMC - PubMed

Publication types

MeSH terms