scholarly journals Antibiotic Treatment, Mechanisms for Failure, and Adjunctive Therapies for Infections by Group A Streptococcus

2021 ◽  
Vol 12 ◽  
Author(s):  
Anders F. Johnson ◽  
Christopher N. LaRock
Keyword(s):  
Streptococcus Pyogenes ◽  
Disease Burden ◽  
Group A Streptococcus ◽  
Human Pathogen ◽  
Invasive Infections ◽  
Group A ◽  
Severe Infections ◽  
Treatment Mechanisms ◽  
Antibiotic Failure ◽  
Global Disease Burden

Group A Streptococcus (GAS; Streptococcus pyogenes) is a nearly ubiquitous human pathogen responsible for a significant global disease burden. No vaccine exists, so antibiotics are essential for effective treatment. Despite a lower incidence of antimicrobial resistance than many pathogens, GAS is still a top 10 cause of death due to infections worldwide. The morbidity and mortality are primarily a consequence of the immune sequelae and invasive infections that are difficult to treat with antibiotics. GAS has remained susceptible to penicillin and other β-lactams, despite their widespread use for 80 years. However, the failure of treatment for invasive infections with penicillin has been consistently reported since the introduction of antibiotics, and strains with reduced susceptibility to β-lactams have emerged. Furthermore, isolates responsible for outbreaks of severe infections are increasingly resistant to other antibiotics of choice, such as clindamycin and macrolides. This review focuses on the challenges in the treatment of GAS infection, the mechanisms that contribute to antibiotic failure, and adjunctive therapeutics. Further understanding of these processes will be necessary for improving the treatment of high-risk GAS infections and surveillance for non-susceptible or resistant isolates. These insights will also help guide treatments against other leading pathogens for which conventional antibiotic strategies are increasingly failing.

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

2008 ◽  
Vol 57 (11) ◽  
pp. 1383-1388 ◽  
Author(s):  
Takeaki Wajima ◽  
Somay Y. Murayama ◽  
Katsuhiko Sunaoshi ◽  
Eiichi Nakayama ◽  
Keisuke Sunakawa ◽  
...  
Keyword(s):  
Streptococcus Pyogenes ◽  
Macrolide Antibiotic ◽  
Group A Streptococcus ◽  
Acute Otitis Media ◽  
Toxic Shock ◽  
Medical Institutions ◽  
Invasive Infections ◽  
Group A ◽  
Resistant Strains ◽  
Emm Type

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 infections (39.2 %) and AOM (43.5 %) than in abscesses (3.8 %) or pharyngotonsillitis (10.2 %). emm12 and emm4 each accounted for 23.5 % of pharyngotonsillitis cases. Susceptibility of GAS strains to eight β-lactam agents was excellent, with MICs of 0.0005–0.063 μg ml−1. Macrolide-resistant strains accounted for 16.2 % of all strains, while the percentages of strains possessing the resistance genes erm(A), erm(B) and mef(A) were 2.5 %, 6.2 % and 7.5 %, respectively. Although no strains with high resistance to levofloxacin were found, strains with an MIC of 2–4 μg ml−1 (17.4 %) had amino acid substitutions at either Ser-79 or Asp-83 in ParC. These levofloxacin-intermediately resistant strains included 16 emm types, but macrolide-resistant strains were more likely than others to represent certain emm types.

scholarly journals Streptococcus pyogenes evades adaptive immunity through specific IgG glycan hydrolysis

2019 ◽  
Vol 216 (7) ◽  
pp. 1615-1629 ◽  
Author(s):  
Andreas Naegeli ◽  
Eleni Bratanis ◽  
Christofer Karlsson ◽  
Oonagh Shannon ◽  
Raja Kalluru ◽  
...  
Keyword(s):  
Streptococcus Pyogenes ◽  
Vaccine Development ◽  
Group A Streptococcus ◽  
Invasive Infection ◽  
Invasive Infections ◽  
Life Threatening ◽  
Group A ◽  
Specific Igg

Streptococcus pyogenes (Group A streptococcus; GAS) is a human pathogen causing diseases from uncomplicated tonsillitis to life-threatening invasive infections. GAS secretes EndoS, an endoglycosidase that specifically cleaves the conserved N-glycan on IgG antibodies. In vitro, removal of this glycan impairs IgG effector functions, but its relevance to GAS infection in vivo is unclear. Using targeted mass spectrometry, we characterized the effects of EndoS on host IgG glycosylation during the course of infections in humans. Substantial IgG glycan hydrolysis occurred at the site of infection and systemically in the severe cases. We demonstrated decreased resistance to phagocytic killing of GAS lacking EndoS in vitro and decreased virulence in a mouse model of invasive infection. This is the first described example of specific bacterial IgG glycan hydrolysis during infection and thereby verifies the hypothesis that EndoS modifies antibodies in vivo. This mechanisms of immune evasion could have implications for treatment of severe GAS infections and for future efforts at vaccine development.

scholarly journals A Novel Sortase, SrtC2, from Streptococcus pyogenes Anchors a Surface Protein Containing a QVPTGV Motif to the Cell Wall

2004 ◽  
Vol 186 (17) ◽  
pp. 5865-5875 ◽  
Author(s):  
Timothy C. Barnett ◽  
Aman R. Patel ◽  
June R. Scott
Keyword(s):  
Cell Wall ◽  
Streptococcus Pyogenes ◽  
Group A Streptococcus ◽  
Surface Protein ◽  
Surface Proteins ◽  
Human Pathogen ◽  
Hydrophobic Region ◽  
C Terminus ◽  
Group A ◽  
Covalently Linked

ABSTRACT The important human pathogen Streptococcus pyogenes (group A streptococcus GAS), requires several surface proteins to interact with its human host. Many of these are covalently linked by a sortase enzyme to the cell wall via a C-terminal LPXTG motif. This motif is followed by a hydrophobic region and charged C terminus, which are thought to retard the protein in the cell membrane to facilitate recognition by the membrane-localized sortase. Previously, we identified two sortase enzymes in GAS. SrtA is found in all GAS strains and anchors most proteins containing LPXTG, while SrtB is present only in some strains and anchors a subset of LPXTG-containing proteins. We now report the presence of a third sortase in most strains of GAS, SrtC. We show that SrtC mediates attachment of a protein with a QVPTGV motif preceding a hydrophobic region and charged tail. We also demonstrate that the QVPTGV sequence is a substrate for anchoring of this protein by SrtC. Furthermore, replacing this motif with LPSTGE, found in the SrtA-anchored M protein of GAS, leads to SrtA-dependent secretion of the protein but does not lead to its anchoring by SrtA. We conclude that srtC encodes a novel sortase that anchors a protein containing a QVPTGV motif to the surface of GAS.

Disease burden due to Streptococcus dysgalactiae subsp. equisimilis (group G and C streptococcus) is higher than that due to Streptococcus pyogenes among Mumbai school children

2010 ◽  
Vol 59 (2) ◽  
pp. 220-223 ◽  
Author(s):  
Pallaval V. Bramhachari ◽  
Santosh Y. Kaul ◽  
David J. McMillan ◽  
Melkote S. Shaila ◽  
Mohan G. Karmarkar ◽  
...  
Keyword(s):  
Streptococcus Pyogenes ◽  
Disease Burden ◽  
Group A Streptococcus ◽  
Genetic Material ◽  
Haemolytic Activity ◽  
Streptococcus Dysgalactiae ◽  
Carriage Rate ◽  
Municipal Schools ◽  
Group A ◽  
Rheumatic Heart

Streptococcus pyogenes [group A streptococcus (GAS)], a human pathogen, and Streptococcus dysgalactiae subsp. equisimilis [human group G and C streptococcus (GGS/GCS)] are evolutionarily related, share the same tissue niche in humans, exchange genetic material, share up to half of their virulence-associated genes and cause a similar spectrum of diseases. Yet, GGS/GCS is often considered as a commensal bacterium and its role in streptococcal disease burden is under-recognized. While reports of the recovery of GGS/GCS from normally sterile sites are increasing, studies describing GGS/GCS throat colonization rates relative to GAS in the same population are very few. This study was carried out in India where the burden of streptococcal diseases, including rheumatic fever and rheumatic heart disease, is high. As part of a surveillance study, throat swabs were taken from 1504 children attending 7 municipal schools in Mumbai, India, during 2006–2008. GAS and GGS/GCS were identified on the basis of β-haemolytic activity, carbohydrate group and PYR test, and were subsequently typed. The GGS/GCS carriage rate (166/1504, 11 %) was eightfold higher than the GAS carriage (22/1504, 1.5 %) 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 rates of throat colonization by GGS/GCS underscore its importance in the pathogenesis of pharyngitis.

scholarly journals Pyogenic Streptococci – Danger of Re-Emerging Pathogens

2010 ◽  
Vol 59 (4) ◽  
pp. 219-226 ◽  
Author(s):  
IZABELA SITKIEWICZ ◽  
WALERIA HRYNIEWICZ
Keyword(s):  
Group A Streptococcus ◽  
Emerging Pathogens ◽  
Animal Pathogens ◽  
Invasive Infections ◽  
Group A ◽  
Severe Infections ◽  
Multiple Species ◽  
Streptococcus Canis ◽  
Major Surface ◽  
Human Infections

Beta-hemolytic, pyogenic streptococci are classified according to type of major surface antigen into A (Streptococcus pyogenes), B (Streptococcus agalactiae), C (multiple species including Streptococcus dysagalactiae) and G (multiple species including Streptococcus canis) Lancefield groups. Group A Streptococcus causes each year hundreds of thousands deaths globally as a result of infections and post-infectional sequelae. An increasing number of severe, invasive infections is caused by selected, specialized pathogenic clones. Within the last 50 years, an increasing number of human infections caused by groups B, C and G Streptococcus (GBS, GCS, GGS) has been observed worldwide. GBS was first identified as animal pathogen but the spectrum of diseases caused by GBS quickly shifted to human infections. Groups C and G Streptococcus are still regarded mostly as animal pathogens, however, an increased number of severe infections caused by these groups is observed. The increasing number of human infections caused worldwide by GCS/GGS can be a sign of similar development from animal to human pathogen as observed in case of GBS and this group will gain much more clinical interest in the future.The situation in Poland regarding invasive infections caused by pyogenic streptococci is underestimated.

scholarly journals Invasive infections due to Streptococcus pyogenes: seasonal variation of severity and clinical characteristics, Iceland, 1975 to 2012

2014 ◽  
Vol 19 (17) ◽  
Author(s):  
L B Olafsdottir ◽  
H Erlendsdóttir ◽  
J Melo-Cristino ◽  
D M Weinberger ◽  
M Ramirez ◽  
...  
Keyword(s):  
Streptococcus Pyogenes ◽  
Clinical Characteristics ◽  
Population Based ◽  
Host Susceptibility ◽  
Population Based Study ◽  
Virulent Strains ◽  
Invasive Infections ◽  
Group A ◽  
Severe Infections

Epidemiology and clinical characteristics of invasive Group A streptococcal infections (IGASI) are highly variable. Long-term studies are needed to understand the interplay between epidemiology and virulence. In a population-based study of IGASI in Iceland from 1975 to 2012, 288 cases were identified by positive cultures from normally sterile body sites. Charts were reviewed retrospectively and emm-types of viable Streptococcus pyogenes isolates (n=226) determined. Comparing the first and last decade of the study period, IGASI incidence increased from 1.09 to 3.96 cases per 100,000 inhabitants per year. The most common were emm types 1 (25%), 28 (11%) and 89 (11%); emm1 strains were most likely to cause severe infections. Infections in adults were significantly more likely to be severe during the seasonal peak from January to April (risk ratio: 2.36, 95% confidence interval: 1.34–4.15). Significant seasonal variability in severity was noted among patients with diagnosis of sepsis, respiratory infection and cellulitis, with 38% of severe infections in January to April compared with 16% in other months (p<0.01). A seasonal increase in severity of IGASI suggested that generalised seasonal increase in host susceptibility, rather than introduction of more virulent strains may play a role in the pathogenesis of these potentially fatal infections.

scholarly journals Zinc’ing it out: zinc homeostasis mechanisms and their impact on the pathogenesis of human pathogen group A streptococcus

Metallomics ◽  
2017 ◽  
Vol 9 (12) ◽  
pp. 1693-1702 ◽  
Author(s):  
Nishanth Makthal ◽  
Muthiah Kumaraswami
Keyword(s):  
Streptococcus Pyogenes ◽  
Group A Streptococcus ◽  
Bacterial Pathogenesis ◽  
Zinc Homeostasis ◽  
Human Pathogen ◽  
Group A

The ability ofStreptococcus pyogenesto resist host-mediated zinc starvation or poisoning is critical for bacterial pathogenesis.

scholarly journals Streptococcus pyogenes (“Group A Streptococcus”), a Highly Adapted Human Pathogen—Potential Implications of Its Virulence Regulation for Epidemiology and Disease Management

Pathogens ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 776
Author(s):  
Nikolai Siemens ◽  
Rudolf Lütticken
Keyword(s):  
Virulence Factors ◽  
Streptococcus Pyogenes ◽  
Group A Streptococcus ◽  
Human Pathogen ◽  
Virulence Regulation ◽  
Regulatory Systems ◽  
Global Epidemiology ◽  
Group A ◽  
Prevention Methods ◽  
Streptococcus A

Streptococcus pyogenes (group A streptococci; GAS) is an exclusively human pathogen. It causes a variety of suppurative and non-suppurative diseases in people of all ages worldwide. Not all can be successfully treated with antibiotics. A licensed vaccine, in spite of its global importance, is not yet available. GAS express an arsenal of virulence factors responsible for pathological immune reactions. The transcription of all these virulence factors is under the control of three types of virulence-related regulators: (i) two-component systems (TCS), (ii) stand-alone regulators, and (iii) non-coding RNAs. This review summarizes major TCS and stand-alone transcriptional regulatory systems, which are directly associated with virulence control. It is suggested that this treasure of knowledge on the genetics of virulence regulation should be better harnessed for new therapies and prevention methods for GAS infections, thereby changing its global epidemiology for the better.

scholarly journals IgG Protease Mac/IdeS Is Not Essential for Phagocyte Resistance or Mouse Virulence of M1T1 Group A Streptococcus

mBio ◽  
2013 ◽  
Vol 4 (4) ◽  
Author(s):  
Cheryl Y. M. Okumura ◽  
Ericka L. Anderson ◽  
Simon Döhrmann ◽  
Dan N. Tran ◽  
Joshua Olson ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Living Organism ◽  
Immune Defense ◽  
Common Disease ◽  
Invasive Infection ◽  
Invasive Infections ◽  
Life Threatening ◽  
Group A ◽  
Severe Infections ◽  
Human Infections

ABSTRACT The Mac/IdeS protein of group A Streptococcus (GAS) is a secreted cysteine protease with cleavage specificity for IgG and is highly expressed in the GAS serotype M1T1 clone, which is the serotype most frequently isolated from patients with life-threatening invasive infections. While studies of Mac/IdeS with recombinant protein have shown that the protein can potentially prevent opsonophagocytosis of GAS by neutrophils, the role of the protein in immune evasion as physiologically produced by the living organism has not been studied. Here we examined the contribution of Mac/IdeS to invasive GAS disease by generating a mutant lacking Mac/IdeS in the hyperinvasive M1T1 background. While Mac/IdeS was highly expressed and proteolytically active in the hyperinvasive strain, elimination of the bacterial protease did not significantly influence GAS phagocytic uptake, oxidative-burst induction, cathelicidin sensitivity, resistance to neutrophil or macrophage killing, or pathogenicity in pre- or postimmune mouse infectious challenges. We conclude that in the highly virulent M1T1 background, Mac/IdeS is not essential for either phagocyte resistance or virulence. Given the conservation of Mac/IdeS and homologues across GAS strains, it is possible that Mac/IdeS serves another important function in GAS ecology or contributes to virulence in other strain backgrounds. IMPORTANCE Group A Streptococcus (GAS) causes human infections ranging from strep throat to life-threatening conditions such as flesh-eating disease and toxic shock syndrome. Common disease-associated clones of GAS can cause both mild and severe infections because of a characteristic mutation and subsequent change in the expression of several genes that develops under host immune selection. One of these genes encodes Mac/IdeS, a protease that has been shown to cleave antibodies important to the immune defense system. In this study, we found that while Mac/IdeS is highly expressed in hypervirulent GAS, it does not significantly contribute to the ability of the bacteria to survive white blood cell killing or produce invasive infection in the mouse. These data underscore the importance of correlating studies on virulence factor function with physiologic expression levels and the complexity of streptococcal pathogenesis and contribute to our overall understanding of how GAS causes disease.

scholarly journals The Shock of Strep: Rapid Deaths Due to Group a Streptococcus

2018 ◽  
Vol 8 (1) ◽  
pp. 136-149 ◽  
Author(s):  
Katrina M. Thompson ◽  
Alana K. Sterkel ◽  
Joseph A. McBride ◽  
Robert F. Corliss
Keyword(s):  
Streptococcus Pyogenes ◽  
Group A Streptococcus ◽  
Invasive Disease ◽  
Significant Morbidity ◽  
Invasive Group ◽  
Life Threatening ◽  
Group A ◽  
Severe Infections ◽  
Microscopic Findings ◽  
Positive Coccus

Streptococcus pyogenes, also known as group A beta-hemolytic strep, is a Gram positive coccus responsible for several million infections every year. The types of infections vary widely from pharyngitis to myositis, but all can advance to severe life threatening invasive disease. Of those infected, approximately 1100 to 1600 people die each year due to invasive disease. Why certain individuals contract severe infections is not known, but many strains of Streptococcus pyogenes are known to produce toxins and superantigens. Invasive Streptococcus pyogenes infections have been shown to cause significant morbidity and rapid mortality. In many cases, patients expire before full antemortem testing can be performed, causing physicians and families to look to forensic pathologists for answers. Understanding the pathogenesis of invasive group A strep infections, relevant gross and microscopic findings, and proper culturing techniques is critical for forensic pathologists to diagnosis this condition and assist in the education and protection of the communities they serve.

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