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Abstract

Group A β haemolytic streptococcus (GAS) or is a human pathogen that causes an array of infections, including pharyngitis, cellulitis, impetigo, scarlet fever, toxic shock syndrome, and necrotizing fasciitis. The present study characterizes 51 GAS isolates from invasive infections in Sri Lanka, focusing on resistance profiles, genetic determinants of resistance, and virulence markers. Isolates were tested for sensitivity to penicillin, erythromycin, clindamycin, and tetracycline. The presence of (A), (B), and (A) was detected in erythromycin-resistant isolates, while (M) was detected in the tetracycline-resistant isolates. PCR was used to identify SpeA, SpeB, SpeC, SpeF, SpeG, , and as virulence markers. Selected GAS isolates were -typed using the updated CDC protocol. All 51 isolates were susceptible to penicillin. The number of isolates non-susceptible to erythromycin was 16. The commonest resistance determinant identified was (B) (11/16). Tetracycline non-susceptibility was found in 36 (70.6 %) isolates and 26 of them contained the (M) gene. Thirteen (25.5 %) isolates were resistant to both tetracycline and erythromycin, while 12 (23.5 %) isolates were sensitive to both antibiotics. The commonest virulence markers detected among the isolates were SpeB (44, 86.3 %), SpeG (36, 70.6 %), and SpeF (35, 68.6 %), while SpeJ (15, 29.4 %), SpeA (10, 19.6 %), and (5,9.8 %) were less common. The types were diverse. In conclusion, the GAS isolates studied showed resistance to erythromycin and tetracycline, while retaining universal susceptibility to penicillin. Additionally, these isolates exhibited diverse genetic backgrounds, displaying varying patterns of virulence genes and types.

Funding
This study was supported by the:
  • University of Peradeniya (Award URG/2021/22/M)
    • Principle Award Recipient: VeranjaLiyanapathirana
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. The microbiology society waived the open access fees for this article.
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/content/journal/acmi/10.1099/acmi.0.000697.v4
2024-06-06
2025-04-27
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References

  1. Efstratiou A, Lamagni T. Epidemiology of Streptococcus pyogenes. In Streptococcus pyogenes: Basic Biology to Clinical Manifestations, 2nd. edn 2022
    [Google Scholar]
  2. Jasim SA, Hatem ZA, Abd Mohammed Z. Virulence factors and clinical features of Streptococcus pyogenes: overview. In Annals of the Romanian Society for Cell Biology 2021 pp 603–613
    [Google Scholar]
  3. Commons R, Rogers S, Gooding T, Danchin M, Carapetis J et al. Superantigen genes in group A streptococcal isolates and their relationship with emm types. J Med Microbiol 2008; 57:1238–1246 [View Article] [PubMed]
    [Google Scholar]
  4. Vekemans J, Gouvea-Reis F, Kim JH, Excler J-L, Smeesters PR et al. The path to group A Streptococcus vaccines: World Health Organization Research and Development Technology roadmap and preferred product characteristics. Clin Infect Dis 2019; 69:877–883 [View Article] [PubMed]
    [Google Scholar]
  5. Steer AC, Law I, Matatolu L, Beall BW, Carapetis JR. Global emm type distribution of group A streptococci: systematic review and implications for vaccine development. Lancet Infect Dis 2009; 9:611–616 [View Article] [PubMed]
    [Google Scholar]
  6. Chiang-Ni C, Wu A-B, Liu C-C, Chen K-T, Lin Y-S et al. Emergence of uncommon emm types of Streptococcus pyogenes among adult patients in southern Taiwan. J Microbiol Immunol Infect 2011; 44:424–429 [View Article] [PubMed]
    [Google Scholar]
  7. Rafei R, Hawli M, Osman M, Dabboussi F, Hamze M. Distribution of emm types and macrolide resistance determinants among group A streptococci in the Middle East and North Africa region. J Glob Antimicrob Resist 2020; 22:334–348 [View Article] [PubMed]
    [Google Scholar]
  8. Tsai W-C, Shen C-F, Lin Y-L, Shen F-C, Tsai P-J et al. Emergence of macrolide-resistant Streptococcus pyogenes emm12 in southern Taiwan from 2000 to 2019. J Microbiol Immunol Infect 2021; 54:1086–1093 [View Article] [PubMed]
    [Google Scholar]
  9. Gröndahl-Yli-Hannuksela K, Beres SB, Hyyryläinen HL, Kallonen T, Musser JM et al. Genetic evolution of invasive emm28 Streptococcus pyogenes strains and significant association with puerperal infections in young women in Finland. Clin Microbiol Infect 2021; 27:420–427 [View Article] [PubMed]
    [Google Scholar]
  10. de Crombrugghe G, Baroux N, Botteaux A, Moreland NJ, Williamson DA et al. The limitations of the rheumatogenic concept for group A Streptococcus: systematic review and genetic analysis. Clin Infect Dis 2020; 70:1453–1460 [View Article] [PubMed]
    [Google Scholar]
  11. Clinical and laboratory standards institute Performance Standards for Antimicrobial Susceptibility Testing, 30th. edn The USA: Clinical Laboratory Standard InstituteLocation; 2020
    [Google Scholar]
  12. Khan RMA, Anwar S, Pirzada ZA. Streptococcus pyogenes strains associated with invasive and non-invasive infections present possible links with emm types and superantigens. Iran J Basic Med Sci 2020; 23:133–139 [View Article] [PubMed]
    [Google Scholar]
  13. Rivera A, Rebollo M, Miró E, Mateo M, Navarro F et al. Superantigen gene profile, emm type and antibiotic resistance genes among group A streptococcal isolates from Barcelona, Spain. J Med Microbiol 2006; 55:1115–1123 [View Article] [PubMed]
    [Google Scholar]
  14. Frost HR, Davies MR, Velusamy S, Delforge V, Erhart A et al. Updated emm-typing protocol for Streptococcus pyogenes. Clin Microbiol Infect 2020; 26:946 [View Article] [PubMed]
    [Google Scholar]
  15. Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005; 41:1373–1406 [View Article] [PubMed]
    [Google Scholar]
  16. Silva-Costa C, Friães A, Ramirez M, Melo-Cristino J. Macrolide-resistant Streptococcus pyogenes: prevalence and treatment strategies. Expert Rev Anti Infect Ther 2015; 13:615–628 [View Article] [PubMed]
    [Google Scholar]
  17. Li H, Zhou L, Zhao Y, Ma L, Zhang H et al. Epidemiological analysis of group A streptococcus infection diseases among children in Beijing, China under COVID-19 pandemic. BMC Pediatr 2023; 23:76 [View Article] [PubMed]
    [Google Scholar]
  18. Abraham T, Sistla S. Trends in antimicrobial resistance patterns of group A streptococci, molecular basis and implications. Indian J Med Microbiol 2018; 36:186–191 [View Article] [PubMed]
    [Google Scholar]
  19. Arêas GP, Schuab RBB, Neves FPG, Barros RR. Antimicrobial susceptibility patterns, emm type distribution and genetic diversity of Streptococcus pyogenes recovered in Brazil. Mem Inst Oswaldo Cruz 2014; 109:935–939 [View Article] [PubMed]
    [Google Scholar]
  20. Liu X, Shen X, Chang H, Huang G, Fu Z et al. High macrolide resistance in Streptococcus pyogenes strains isolated from children with pharyngitis in China. Pediatr Pulmonol 2009; 44:436–441 [View Article] [PubMed]
    [Google Scholar]
  21. Arnold B, Bélard S, Alabi A, Hufnagel M, Berner R et al. High diversity of emm types and marked tetracycline resistance of group A streptococci and Other ß-hemolytic Streptococci in Gabon, Central Africa. Pediatr Infect Dis J 2022; 41:405–410 [View Article] [PubMed]
    [Google Scholar]
  22. Ayer V, Tewodros W, Manoharan A, Skariah S, Luo F et al. Tetracycline resistance in group A Streptococci: emergence on a global scale and influence on multiple-drug resistance. Antimicrob Agents Chemother 2007; 51:1865–1868 [View Article]
    [Google Scholar]
  23. Giovanetti E, Brenciani A, Lupidi R, Roberts MC, Varaldo PE. Presence of the tet(O) gene in erythromycin- and tetracycline-resistant strains of Streptococcus pyogenes and linkage with either the mef(A) or the erm(A) gene. Antimicrob Agents Chemother 2003; 47:2844–2849 [View Article] [PubMed]
    [Google Scholar]
  24. Golińska E, van der Linden M, Więcek G, Mikołajczyk D, Machul A et al. Virulence factors of Streptococcus pyogenes strains from women in peri-labor with invasive infections. Eur J Clin Microbiol Infect Dis 2016; 35:747–754 [View Article]
    [Google Scholar]
  25. Nelson DC, Garbe J, Collin M. Cysteine proteinase SpeB from Streptococcus pyogenes – a potent modifier of immunologically important host and bacterial proteins. bchm 2011; 392:1077–1088 [View Article]
    [Google Scholar]
  26. Olsen RJ, Raghuram A, Cantu C, Hartman MH, Jimenez FE et al. The majority of 9,729 group A streptococcus strains causing disease secrete SpeB cysteine protease: pathogenesis implications. Infect Immun 2015; 83:4750–4758 [View Article] [PubMed]
    [Google Scholar]
  27. Reglinski M, Sriskandan S, Turner CE. Identification of two new core chromosome-encoded superantigens in Streptococcus pyogenes; speQ and speR. J Infect 2019; 78:358–363 [View Article] [PubMed]
    [Google Scholar]
  28. Ray D, Saha S, Sinha S, Pal NK, Bhattacharya B. Molecular characterization and evaluation of the emerging antibiotic-resistant Streptococcus pyogenes from eastern India. BMC Infect Dis 2016; 16:753 [View Article] [PubMed]
    [Google Scholar]
  29. Rantala S, Vähäkuopus S, Siljander T, Vuopio J, Huhtala H et al. Streptococcus pyogenes bacteraemia, emm types and superantigen profiles. Eur J Clin Microbiol Infect Dis 2012; 31:859–865 [View Article]
    [Google Scholar]
  30. Maripuu L, Eriksson A, Norgren M. Superantigen gene profile diversity among clinical group A streptococcal isolates. FEMS Immunol Med Microbiol 2008; 54:236–244 [View Article]
    [Google Scholar]
  31. Bencardino D, Di Luca MC, Petrelli D, Prenna M, Vitali LA. High virulence gene diversity in Streptococcus pyogenes isolated in Central Italy. PeerJ 2019; 7:e6613 [View Article] [PubMed]
    [Google Scholar]
  32. Lintges M, van der Linden M, Hilgers R-D, Arlt S, Al-Lahham A et al. Superantigen genes are more important than the emm type for the invasiveness of group A Streptococcus infection. J Infect Dis 2010; 202:20–28 [View Article] [PubMed]
    [Google Scholar]
  33. Hurst JR, Brouwer S, Walker MJ, McCormick JK. Streptococcal superantigens and the return of scarlet fever. PLoS Pathog 2021; 17:e1010097 [View Article]
    [Google Scholar]
  34. McMillan DJ, Drèze P-A, Vu T, Bessen DE, Guglielmini J et al. Updated model of group A Streptococcus M proteins based on a comprehensive worldwide study. Clin Microbiol Infect 2013; 19:E222–9 [View Article] [PubMed]
    [Google Scholar]
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