Toxic shock syndrome due to group C Streptococci A case report

Natoli, Silvia; Fimiani, Caterina; Faglieri, N.; Laurenzi, L; Calamaro, A.; Frasca, Angelisa; Arcuri, Edna Apparecida Moura

doi:10.1007/bf02044129

Cited by 35 publications

(22 citation statements)

References 32 publications

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“…Compounds from group G streptococci have been partially characterized that are mitogenic and can produce fevers and induce lethal activity in the endotoxin hypersensitivity model of toxic shock syndrome (2). Since numerous cases of STSS caused by group C (15,28,43) and group G (15, 30) streptococci have been reported, it is possible that other novel superantigens are involved. Further study of this important family of toxins will improve our understanding of superantigen biology and evolution and may ultimately lead to improved treatments for severe streptococcal disease.…”

Section: Discussionmentioning

confidence: 99%

Functional Characterization of Streptococcal Pyrogenic Exotoxin J, a Novel Superantigen

et al. 2001

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Streptococcal toxic shock syndrome (STSS) is a highly lethal, acute-onset illness that is a subset of invasive streptococcal disease. The majority of clinical STSS cases have been associated with the pyrogenic toxin superantigens (PTSAgs) streptococcal pyrogenic exotoxin A or C (SPE A or C), although cases have been reported that are not associated with either of these exotoxins. Recent genome sequencing projects have revealed a number of open reading frames that potentially encode proteins with similarity to SPEs A and C and to other PTSAgs. Here, we describe the cloning, expression, purification, and functional characterization of a novel exotoxin termed streptococcal pyrogenic exotoxin J (SPE J). Purified recombinant SPE J (rSPE J) expressed from Escherichia coli stimulated the expansion of both rabbit splenocytes and human peripheral blood lymphocytes, preferentially expanded human T cells displaying V␤2, -3, -12, -14, and -17 on their T-cell receptors, and was active at concentrations as low as 5 ؋ 10 ؊6 g/ml. Furthermore, rSPE J induced fevers in rabbits and was lethal in two models of STSS. Biochemically, SPE J had a predicted molecular weight of 24,444 and an isoelectric point of 7.7 and lacked the ability to form the cystine loop structure characteristic of many PTSAgs. SPE J shared 19.6, 47.1, 38.8, 18.1, 19.6, and 24.4% identity with SPEs A, C, G, and H, streptococcal superantigen, and streptococcal mitogenic exotoxin Z-2, respectively, and was immunologically cross-reactive with SPE C. The characterization of a seventh functional streptococcal PTSAg raises important questions relating to the evolution of the streptococcal superantigens.

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Section: Discussionmentioning

confidence: 99%

Functional Characterization of Streptococcal Pyrogenic Exotoxin J, a Novel Superantigen

et al. 2001

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“…equisimilis strains having group A antigen rather than group C or G antigen have also been reported (Bert & Lambert-Zechovsky, 1997;Brandt et al, 1999;Katsukawa et al, 2002). Many recent studies have reported that this organism causes invasive and systemic streptococcal infections like GAS (Natoli et al, 1996;Wagner et al, 1996; Hirose et al, 1997; Kugi et al, 1998;Barnham et al, 2002;Cohen-Poradosu et al, 2004;Hashikawa et al, 2004). The organism has also been reported to cause a wide variety of human infections such as pharyngitis, cellulitis, sepsis, meningitis and endocarditis (Woo et al, 2001).…”

Section: Introductionmentioning

confidence: 98%

Molecular emm genotyping and antibiotic susceptibility of Streptococcus dysgalactiae subsp. equisimilis isolated from invasive and non-invasive infections

Sunaoshi

Murayama

Adachi

et al. 2010

Journal of Medical Microbiology

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To analyse the characteristics of infections caused by Streptococcus dysgalactiae subsp. equisimilis, clinical isolates (n5145) were collected at 11 medical institutions between September 2003 and October 2005. These isolates belonged to Lancefield group A (n55), group C (n518) or group G (n5122). Among all isolates, 42 strains were isolated from sterile samples such as blood, synovial fluid and tissue specimens from patients who were mostly over 50 years with invasive infections, and included seven cases of streptococcal toxic shock syndrome and necrotizing fasciitis. In contrast, the remaining 103 were isolated mainly from patients of all age groups with non-invasive infections such as pharyngotonsillitis. These isolates were classified into 25 types based on emm genotyping. A significant difference in emm types was observed between isolates from invasive and non-invasive infections (P,0.001): stG485, stG6792 and stG2078 predominated among isolates from invasive infections. A phylogenetic tree of complete open reading frames of emm genes in this organism showed high homology with those of Streptococcus pyogenes, but not with those of other streptococci. The presence of five different clones was estimated based on DNA profiles of isolates from invasive infections obtained by PFGE. Genes for resistance to macrolides [erm(A), three isolates; erm(B), five isolates; mef(A), seven isolates] and levofloxacin (mutations in gyrA and parC, four isolates) were identified in this organism. These results suggest the need for further nationwide surveillance of invasive infections caused by S. dysgalactiae subsp. equisimilis. INTRODUCTIONMost b-haemolytic streptococcal pathogens isolated from humans are identified as Streptococcus pyogenes (group A streptococci; GAS), Streptococcus agalactiae (group B streptococci; GBS), Streptococcus dysgalactiae subsp. equisimilis and species of the anginosus group that belong to Lancefield groups A, B, C, G or F (Facklam, 2002;Ruoff et al., 2003). In contrast to GAS and GBS, which are known to cause serious and systemic invasive infections, streptococci with Lancefield group C or G antigens were long considered to be commensal organisms that only rarely caused invasive infections as opportunistic pathogens.In 1996, S. dysgalactiae subsp. equisimilis was proposed as a new streptococcal taxon (Vandamme et al., 1996). Although rare, S. dysgalactiae subsp. equisimilis strains having group A antigen rather than group C or G antigen have also been reported (Bert & Lambert-Zechovsky, 1997;Brandt et al., 1999;Katsukawa et al., 2002 Notably, S. dysgalactiae subsp. equisimilis possesses many virulence factors shared with GAS, such as M protein (Fischetti, 1989; Schnitzler et al., 1995), streptolysin O (Gerlach et al., 1993Okumura et al., 1994), streptolysin S (Humar et al., 2002 and streptokinase (Walter et al., 1989;Ikebe et al., 2004). It has been suggested that these factors were transmitted from GAS to this species (Kalia et al., 2001).In the present report, we have described S. dysgalactiae ...

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“…Recently, case reports referring to STSS caused by the Lancefield group C streptococci (GCS and G i and GGS, respectively) have also accumulated (1,2,11,14,17,24,27,30,35,38,45,49; H. Watanabe (ed. ), Rep. 24th Hyg.…”

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confidence: 99%

Characterization of Group C and G Streptococcal Strains That Cause Streptococcal Toxic Shock Syndrome

Hashikawa

Iinuma

Furushita³

et al. 2004

J Clin Microbiol

164

119

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Twelve strains (the largest number ever reported) of group C and G 1 streptococci (GCS and GGS, respectively) that caused streptococcal toxic shock syndrome (STSS) were collected and characterized. Eleven strains were identified as Streptococcus dysgalactiae subsp. equisimilis, and one strain was identified as Streptococcus equi subsp. zooepidemicus. We found that it was the first reported case of STSS caused by S. equi subsp. zooepidemicus. Cluster analysis according to the 16S rRNA gene (rDNA) sequences revealed that the S. dysgalactiae strains belonged to clusters I and II, both of which were closely related. The emm types and the restriction patterns of chromosomal DNA measured by pulsed-field gel electrophoresis were highly variable in these strains except BL2719 and N1434. The 16S rDNA sequences and other characteristics of these two strains were indistinguishable, suggesting the clonal dissemination of this particular S. dysgalactiae strain in Japan. As the involvement of superantigens in the pathogenesis of group A streptococcus-related STSS has been suggested, we tried to detect known streptococcal superantigens in GCS and GGS strains. However, only the spegg gene was detected in seven S. dysgalactiae strains, with none of the other superantigen genes being detected in any of the strains. However, the sagA gene was detected in all of the strains except Tokyo1291. In the present study no apparent factor(s) responsible for the pathogenesis of STSS was identified, although close genetic relationships of GCS and GGS strains involved in this disease were suggested.

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Toxic shock syndrome due to group C Streptococci A case report

Abstract: This case illustrates how an early diagnosis and prompt antibiotic therapy can determine a more favorable outcome.

Cited by 35 publications

References 32 publications

Functional Characterization of Streptococcal Pyrogenic Exotoxin J, a Novel Superantigen

Functional Characterization of Streptococcal Pyrogenic Exotoxin J, a Novel Superantigen

Molecular emm genotyping and antibiotic susceptibility of Streptococcus dysgalactiae subsp. equisimilis isolated from invasive and non-invasive infections

Characterization of Group C and G Streptococcal Strains That Cause Streptococcal Toxic Shock Syndrome

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