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Journal of Clinical Microbiology, November 2003, p. 4941-4949, Vol. 41, No. 11
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.11.4941-4949.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Site-Specific Manifestations of Invasive Group A Streptococcal Disease: Type Distribution and Corresponding Patterns of Virulence Determinants

Eijkman Winkler Institute for Medical Microbiology, Infectious Diseases and Inflammation, University Hospital Utrecht, Utrecht,¹ National Institute for Public Health and the Environment, Bilthoven, The Netherlands,² Vienna Biocenter, Institute of Microbiology and Genetics, Vienna, Austria,³ Institute for Medical Microbiology and Virology, University Hospital Düsseldorf, Düsseldorf, Germany⁴

Received 9 May 2003/ Returned for modification 23 June 2003/ Accepted 19 July 2003

As part of a national surveillance program on invasive group A streptococci (GAS), isolates that caused specific manifestations of invasive GAS disease in The Netherlands were collected between 1992 and 1996. These site-specific GAS infections involved meningitis, arthritis, necrotizing fasciitis, and puerperal sepsis. An evaluation was performed to determine whether GAS virulence factors correlate with these different disease manifestations. PCRs were developed to detect 9 genes encoding exotoxins and 12 genes encoding fibronectin binding proteins. The genetic backgrounds of all isolates were determined by M genotyping and pulsed-field gel electrophoresis (PFGE) analysis. The predominant M types included M1, M2, M3, M4, M6, M9, M12, and M28. Most M types were associated with all manifestations of GAS disease. However, M2 was found exclusively in patients with puerperal sepsis, M6 predominated in patients with meningitis, and M12 predominated in patients with GAS arthritis. While characteristic gene profiles were detected in most M types, the resolution of detection of different gene profiles within M genotypes was enhanced by PFGE analysis, which clearly demonstrated the existence of some clonal lineages among invasive GAS isolates in The Netherlands. M1 isolates comprised a single clone carrying highly mitogenic toxin genes (speA, smeZ) and were associated with toxic shock-like syndrome. Toxin profiles were highly conserved among the most virulent strains, such as M1 and M3.

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