In 2002, the Romanian National Reference Laboratory was invited to join the Strep-EURO project to study invasive Streptococcus pyogenes infections. During 2003 and 2004, a total of 33 isolates recovered from invasive disease were received from eight Romanian counties. For comparison, 102 isolates from non-invasive disease, as well as a collection of 12 old invasive strains (isolated between 1967 and 1980) were included. All isolates were characterized by several methods: T and emm typing, presence of the fibronectin-binding protein F1 gene (prtF1), serum opacity factor (sof), and superantigen (SAg) genes (speA, speB, speC, speF, speG, speH, ssa and smeZ). The recent invasive isolates exhibited 19 emm-types, of which emm1, emm81, emm76, emm49 and emm78 covered 57 % of the strains. Furthermore, multilocus sequence typing analysis revealed nine new sequence types, corresponding to emm types 1, 12, 49, 81, 92, 100, 106 and 119. The non-invasive isolates comprised 24 different emm types with a predominance of emm1 and 12; the old invasive strains were of eight emm types, of which four were unique for this group. All isolates harboured speB and speF; smeZ was detected in all invasive strains, except for the emm49 and emm81 isolates. The majority of isolates from carriers, and patients with pharyngitis were prtF1 positive, most of these (14 strains) being emm12. High tetracycline resistance rates were noted among both invasive and control isolates (54 % and 35 %, respectively), whereas macrolide resistance rates were low (3 % and 5 %, respectively). Active and continuing surveillance is required to provide an accurate assessment of the disease burden and to provide epidemiological data on the character of isolates in Romania.
AkessonP.,
SjöholmA. G.,
BjörckL.1996; Protein SIC, a novel extracellular protein of Streptococcus pyogenes interfering with complement function. J Biol Chem 271:1081–1088[CrossRef]
BeallB.,
FacklamR.,
ThompsonT.1996; Sequencing emm -specific PCR products for routine and accurate typing of group A streptococci. J Clin Microbiol 34:953–958
BeallB.,
GherardiG.,
LovgrenM.,
FacklamR. R.,
ForwickB. A.,
TyrrellG. J.2000; emm and sof gene sequence variation in relation to serological typing of opacity-factor-positive group A streptococci. Microbiology 146:1195–1209
BiancoS.,
AlliceT.,
ZuccaM.,
SavoiaD.2006; Survey of phenotypic and genetic features of streptococcus pyogenes strains isolated in Northwest Italy. Curr Microbiol 52:33–39[CrossRef]
CaparonM. G.,
ScottJ. R.1987; Identification of a gene that regulates expression of M protein, the major virulence determinant of group A streptococci. Proc Natl Acad Sci U S A 84:8677–8681[CrossRef]
EkelundK.,
DarenbergJ.,
Norrby-TeglundA.,
HoffmannS.,
BangD.,
SkinhøjP.,
KonradsenH. B.2005; Variations in emm type among group A streptococcal isolates causing invasive or noninvasive infections in a nationwide study. J Clin Microbiol 43:3101–3109[CrossRef]
EnrightM. C.,
SprattB. G.,
KaliaA.,
CrossJ. H.,
BessenD. E.2001; Multilocus sequence typing of Streptococcus pyogenes and the relationships between emm type and clone. Infect Immun 69:2416–2427[CrossRef]
FacinelliB.,
SpinaciC.,
MagiG.,
GiovanettiE.,
VaraldoV.2001; Association between erythromycin resistance and ability to enter human respiratory cells in group A streptococci. Lancet 358:30–33[CrossRef]
GardinerD.,
HartasJ.,
CurrieB.,
MathewsJ. D.,
KempD. J.,
SriprakashK. S.1995; Vir typing: a long-PCR typing method for group A streptococci. PCR Methods Appl 4:288–293[CrossRef]
GardinerD. L.,
GoodfellowA. M.,
MartinD. R.,
SriprakashK. S.1998; Group A streptococcal Vir types are M-protein gene ( emm ) sequence type specific. J Clin Microbiol 36:902–907
HanskiE.,
HorwitzP. A.,
CaparonM. G.1992; Expression of protein F, the fibronectin-binding protein of Streptococcus pyogenes JRS4, in heterologous streptococcal and enterococcal strains promotes their adherence to respiratory epithelial cells. Infect Immun 60:5119–5125
JingH. B.,
NingB. A.,
HaoH. J.,
ZhengY. L.,
ChangD.,
JiangW.,
JiangY. Q.2006; Epidemiological analysis of group A streptococci recovered from patients in China. J Med Microbiol 55:1101–1107[CrossRef]
JohnsonD. R.,
KaplanE. L.,
VanGheemA.,
FacklamR. R.,
BeallB.2006; Characterization of group A streptococci ( Streptococcus pyogenes ): correlation of M-protein and emm -gene type with T-protein agglutination pattern and serum opacity factor. J Med Microbiol 55:157–164[CrossRef]
KaplanE. L.,
ChhatwalG. S.,
RohdeM.2006; Reduced ability of penicillin to eradicate ingested group A streptococci from epithelial cells: clinical and pathogenetic implications. Clin Infect Dis 43:1398–1406[CrossRef]
LittauerP.,
CaugantD. A.,
SangvikM.,
HøibyE. A.,
SundsfjordA.,
SimonsenG. S.2006; Macrolide-resistant Streptococcus pyogenes in Norway: population structure and resistance determinants. Antimicrob Agents Chemother 50:1896–1899[CrossRef]
Luca-HarariB.,
EkelundK.,
van der LindenM.,
Staum-KaltoftM.,
HammerumA. M.,
JasirA.2008; Clinical and epidemiological aspects of invasive Streptococcus pyogenes infections in Denmark during 2003 and 2004. J Clin Microbiol 46:79–86[CrossRef]
McGregorK. F.,
SprattB. G.2005; Identity and prevalence of multilocus sequence typing-defined clones of group A streptococci within a hospital setting. J Clin Microbiol 43:1963–1967[CrossRef]
MolinariG.,
TalayS. R.,
Valentin-WeigandP.,
RohdeM.,
ChhatwalG. S.1997; The fibronectin-binding protein of Streptococcus pyogenes , SfbI, is involved in the internalization of group A streptococci by epithelial cells. Infect Immun 65:1357–1363
MoodyM. D.,
PadulaJ.,
LizanaD.,
HallC. T.1965; Epidemiologic characterization of group A streptococci by T-Agglutination and M-Precipitation tests in the Public Health Laboratory. Health Lab Sci 2:149–162
NielsenH. U.,
HammerumA. M.,
EkelundK.,
BangD.,
PallesenL. V.,
Frimodt-MøllerN.2004; Tetracycline and macrolide co-resistance in Streptococcus pyogenes : co-selection as a reason for increase in macrolide-resistant S. pyogenes ?. Microb Drug Resist 10:231–238[CrossRef]
OlsvikB.,
OlsenI.,
TenoverF. C.1995; Detection of tet (M) and tet (O) using the polymerase chain reaction in bacteria isolated from patients with periodontal disease. Oral Microbiol Immunol 10:87–92[CrossRef]
RobertsM. C.,
PangY.,
RileyD. E.,
HillierS. L.,
BergerR. C.,
KriegerJ. N.1993; Detection of Tet M and Tet O tetracycline resistance genes by polymerase chain reaction. Mol Cell Probes 7:387–393[CrossRef]
SeppalaH.,
NissinenA.,
YuQ.,
HuovinenP.1993; Three different phenotypes of erythromycin-resistant Streptococcus pyogenes in Finland. J Antimicrob Chemother 32:885–891[CrossRef]
SriskandanS.,
FaulknerL.,
HopkinsP.2007; Streptococcus pyogenes : insight into the function of the streptococcal superantigens. Int J Biochem Cell Biol 39:12–19[CrossRef]
SurdeanuM.,
ShundiL.,
StrautM.2000; Molecular subtyping of group A streptococcal strains based on virulence regulon polymorphism. Roum Arch Microbiol Immunol 59:89–102
SzczypaK.,
SadowyE.,
IzdebskiR.,
StrakovaL.,
HryniewiczW.2006; Group A streptococci from invasive-disease episodes in Poland are remarkably divergent at the molecular level. J Clin Microbiol 44:3975–3979[CrossRef]
The Working Group on Severe Streptococcal Infections; 1993; Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. JAMA 269:390–391[CrossRef]