Sequence Type and
            <i>emm</i>
            Type Diversity in
            <i>Streptococcus pyogenes</i>
            Isolates Causing Invasive Disease in Norway between 1988 and 2003

Meisal, Roger; Høiby, E. Arne; Aaberge, Ingeborg S.; Caugant, Dominique A.

doi:10.1128/jcm.00363-08

Cited by 14 publications

(20 citation statements)

References 27 publications

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“…It is noteworthy that all cases of meningitis caused by the emm-1 strain were in patients older than 40 years of age, while cases caused by the emm-12 strain all occurred in children. Pneumonia, on the other hand, was found mainly in persons older than 50 years of age, which is in accordance with previous findings (37). Puerperal sepsis was associated with emm-28, whose role in puerperal sepsis has long been recognized.…”

Section: Discussionsupporting

confidence: 81%

“…Resistance to both clindamycin and erythromycin was found in 2.3% of the isolates, while some macrolide resistance was found for 3.4% of the isolates. Susceptibility results correlated well with those from our previous study of 100 strains from 1988 to 2003 (37) and from reports of the Norwegian Surveillance Program for Antimicrobial Resistance in Human Pathogens (41,42), indicating that macrolide and tetracycline resistance in Norway is still low. Four emm-77 isolates were resistant to tetracycline in this study.…”

Section: Discussionsupporting

confidence: 79%

“…However, our emm-75 strains were resistant or of intermediate susceptibility to fluoroquinolones, which may be explained by the loss of macrolide resistance and acquisition of fluoroquinolone resistance, as described by Billal et al (5,6), suggesting that emm-75 strains presently circulating in Norway have changed genetically since 2002. Most of the fluoroquinolone-resistant strains in both this study and our previous study (37), however, were emm-6 strains.…”

Section: Discussioncontrasting

confidence: 39%

“…Antibiotics used were penicillin-G (10 U), clindamycin (2 g), erythromycin (15 g), ofloxacin (5 g), quinupristin-dalfopristin (15 g), trimethoprim-sulfamethoxazole (1.25/ 23.75 g), and tetracycline (30 g). Inhibitory zones were measured as recommended by the manufacturer, after overnight growth in 5% CO 2 (37). CLSI breakpoints were used, except for trimethoprim-sulfamethoxazole, for which the criteria given by CA-SFM were used (critical concentrations were Յ1/19 mg/liter for S strains and Ն2/38 mg/liter for R strains).…”

Section: Methodsmentioning

confidence: 99%

“…Thereafter, until the early 2000s, there was a significant decrease in the frequency of emm-1 strains and, at the same time, an increase in diversity among the Norwegian GAS strains (37). Antibiotic resistance levels were generally very low in Norway during this period (37).…”

mentioning

confidence: 99%

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Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

et al. 2010

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To investigate the epidemiological patterns and genetic characteristics of disease caused by group A Streptococcus (GAS), all available isolates from invasive cases in Norway during 2006 to 2007 (262 isolates) were subjected to antimicrobial susceptibility testing, T serotyping, emm typing, and multilocus sequence typing and screened for known streptococcal pyrogenic exotoxin (Spe) genes, smeZ, and ssa. The average incidence rate was 3.1 cases per 100,000 individuals. The most prevalent sequence types (STs) were STs 52, 28, and 334. In association with emm types 28, 77, and 87, the serotype T-28 comprised 24.8% of the strains. emm types 28, 1, and 82 were dominating. In 2007, a sharp increase in the number of emm-6 strains was noted. All strains were sensitive to penicillin and quinupristin-dalfopristin, while 3.4% and 6.1% of the strains were resistant to macrolides and tetracycline, respectively. Furthermore, the emm-6 strains had intermediate susceptibility to ofloxacin. Isolates displayed a wide variety of gene profiles, as shown by the presence or absence of the Spe genes, smeZ, and ssa, but 48% of the isolates fell into one of three profiles. In most cases, an emm type was restricted to one gene profile. Although the incidence decreased during this study, invasive GAS disease still has a high endemic rate, with involvement of both established and emerging emm types displaying variability in virulence gene profiles as well as differences in gender and age group preferences.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 39%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

et al. 2010

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Molecular characteristics of pharyngeal and invasive emm3 Streptococcus pyogenes strains from Norway, 1988–2003

Meisal

Høiby

Caugant

et al. 2009

Eur J Clin Microbiol Infect Dis

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A major virulence factor of group A streptococci (GAS) is the M protein. Strains with the M3 type are more often associated with necrotizing fasciitis (NF) and streptococcal toxic shock syndrome, and have a higher case fatality rate than strains of other M types. To better understand the epidemiology of M3 GAS strains in Norway, we analyzed 59 invasive and 69 pharyngeal isolates with respect to prophage content, allelic variation in emm3, mtsR encoding the metal transporter of Streptococcus repressor (mtsR), and sclB coding for streptococcal collagen-like protein B. The Norwegian emm3 strains were very homogeneous, mainly harboring the emm allele 3.1 and prophage profile PhiG3.01. Other prophage profiles were transient. The mutation in mtsR known to truncate the protein and result in decreased capacity to cause NF was not found in our isolates. The sclB gene usually harbored five or eight contiguous repeats of a CAAAA pentanucleotide sequence and a highly modular and variable collagen structural motif (CSM) region with 9 and 12 amino acid M3-specific conserved motif repeats distributed across the entire CSM region. Strains with 5 CAAAA repeats emerged in 1993 and these strains were associated with the increase in invasive M3 cases in the period 1993-2003.

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emm gene diversity, superantigen gene profiles and presence of SlaA among clinical isolates of group A, C and G streptococci from western Norway

Kittang

Skrede

Langeland

et al. 2010

Eur J Clin Microbiol Infect Dis

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In order to investigate molecular characteristics of beta-hemolytic streptococcal isolates from western Norway, we analysed the entire emm gene sequences, obtained superantigen gene profiles and determined the prevalence of the gene encoding streptococcal phospholipase A2 (SlaA) of 165 non-invasive and 34 contemporary invasive group A, C and G streptococci (GAS, GCS and GGS). Among the 25 GAS and 26 GCS/GGS emm subtypes identified, only emm3.1 was significantly associated with invasive disease. M protein size variation within GAS and GCS/GGS emm types was frequently identified. Two non-invasive and one invasive GGS possessed emm genes that translated to truncated M proteins as a result of frameshift mutations. Results suggestive of recombinations between emm or emm-like gene segments were found in isolates of emm4 and stG485 types. One non-invasive GGS possessed speC, speG, speH, speI and smeZ, and another non-invasive GGS harboured SlaA. speA and SlaA were over-represented among invasive GAS, probably because they were associated with emm3. speGdys was identified in 83% of invasive and 63% of non-invasive GCS/GGS and correlated with certain emm subtypes. Our results indicate the invasive potential of isolates belonging to emm3, and show substantial emm gene diversity and possible lateral gene transfers in our streptococcal population.

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Sequence Type and emm Type Diversity in Streptococcus pyogenes Isolates Causing Invasive Disease in Norway between 1988 and 2003

Cited by 14 publications

References 27 publications

Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

Molecular characteristics of pharyngeal and invasive emm3 Streptococcus pyogenes strains from Norway, 1988–2003

emm gene diversity, superantigen gene profiles and presence of SlaA among clinical isolates of group A, C and G streptococci from western Norway

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