Subscribe to RSS
DOI: 10.1055/s-0043-1772740
Invasive Streptococcus pyogenes: A Short Literature Review
Abstract
Objective Streptococcus pyogenes also called Group A streptococci (GAS) is an important pathogen known since past years and infects millions of people around the world every year and can cause death. Although it often causes pharyngitis and skin infections, it can also spread to the bloodstream and cause invasive GAS (iGAS) infections. In this review, studies on the epidemiology of GAS and iGAS and vaccine studies were reviewed.
Methods A comprehensive search of databases was conducted up to April 1, 2023 to related studies, in English using the following terms: S. pyogenes, GAS, invasive S. pyogenes infections, iGAS, S. pyogenes vaccine. The data extraction was conducted by two investigators using the same methodology.
Results There has been an increase in iGAS infections in various countries in the last year and they have been followed closely. Although the reason for the increase in iGAS cases cannot be determined exactly, it is thought that the recent removal of coronavirus disease 2019 restrictions and the increase in the number of individuals susceptible to GAS and to viral respiratory pathogens is thought to have caused this situation. Another important issue with GAS is the vaccine studies. Vaccines are based on two different targets: M protein-based and non-M protein-based. Phase-I clinical trials have been initiated for some vaccines.
Conclusion The increase in recent iGAS infections will draw attention to this agent and accelerate vaccine studies.
Publication History
Received: 24 April 2023
Accepted: 21 July 2023
Article published online:
31 August 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev 2000; 13 (03) 470-511
- 2 Lamagni TL, Darenberg J, Luca-Harari B. et al; Strep-EURO Study Group. Epidemiology of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol 2008; 46 (07) 2359-2367
- 3 Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5 (11) 685-694
- 4 Avire NJ, Whiley H, Ross K. A review of Streptococcus pyogenes: public health risk factors, prevention and control. Pathogens 2021; 10 (02) 248-253
- 5 Centers for Disease Control and Prevention. Group A Streptococcal (GAS) Disease. Accessed April 5, 2023 at: https://www.cdc.gov/groupastrep/diseases-hcp/index.html
- 6 Invasive group A streptococcal infection and toxic shock syndrome: Treatment and prevention. Accessed April 12, 2023 at: https://www.uptodate.com/contents/invasive-group-a-streptococcal-infection-and-toxic-shock-syndrome-treatment-and-prevention
- 7 Streptococcus Pyogenes. Accessed April 8, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK554528
- 8 Strep A: What is invasive Group A streptococcus?. Accessed April 30, 2023 at: https://patient.info/news-and-features/strep-a-what-is-invasive-group-a-streptococcus
- 9 United Kingdom Health Security Agency (UKHSA). Group A streptococcal infections: report on seasonal activity in England, 2022 to 2023. London: UKHSA; 2022
- 10 Ladhani SN, Guy R, Bhopal SS, Brown CS, Lamagni T, Sharp A. Paediatric group A streptococcal disease in England from October to December, 2022. Lancet Child Adolesc Health 2023; 7 (02) e2-e4
- 11 United Kingdom Health Security Agency (UKHSA). Research and analysis: Group A streptococcal infections: first update on seasonal activity in England, 2022 to 2023. Accessed December 15, 2022 at: https://www.gov.uk/government/publications/group-a-streptococcal-infections-activity-during-the-2022-to-2023-season/ group-a-streptococcal-infections-first-update-on-seasonal-activity-in-england-2022-to-2023
- 12 United Kingdom Health Security Agency (UKHSA). Official statistics: national flu and COVID-19 surveillance reports: 2022 to 2023 season. Accessed December 20, 2022 at: https://www.gov.uk/government/statistics/national-flu-and-covid-19-surveillance-reports-2022-to-2023-season
- 13 United Kingdom Health Security Agency (UKHSA). Research and analysis: GP in hours—weekly bulletins. Available at: https://www.gov.uk/government/publications/gp-in-hours-weekly-bulletins-for-2022
- 14 Alcolea-Medina A, Snell LB, Alder C. et al; Synnovis Microbiology Laboratory Group. The ongoing Streptococcus pyogenes (Group A Streptococcus) outbreak in London, United Kingdom, in December 2022: a molecular epidemiology study. Clin Microbiol Infect 2023; 29 (07) 887-890
- 15 de Gier B, Marchal N, de Beer-Schuurman I. et al; ISIS-AR Study Group, GAS Study group, Members of the GAS study group, Members of the ISIS-AR study group. Increase in invasive group A streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022. Euro Surveill 2023; 28 (01) 2200941
- 16 Holdstock V, Twynam-Perkins J, Bradnock T. et al. National case series of group A streptococcus pleural empyema in children: clinical and microbiological features. The Lancet Inf 2023; 23 (02) 154-156
- 17 Evans AC. Studies on Hemolytic Streptococci: II. Streptococcus pyogenes . J Bacteriol 1936; 31 (06) 611-624
- 18 Lancefield RC. Current knowledge of type-specific M antigens of group A streptococci. J Immunol 1962; 89 (89) 307-313
- 19 Dick GF, Dick GH. Landmark article Jan 26, 1924: The etiology of scarlet fever. By George F. Dick and Gladys Henry Dick. JAMA 1983; 250 (22) 3096
- 20 Hooker SB, Follensby EM. Studies on scarlet fever. II. Different toxins produced by hemolytic streptococci of scarlatinal origin. J Immunol 1934; 27: 177-193
- 21 Watson DW. Host-parasite factors in group A streptococcal infections. Pyrogenic and other effects of immunologic distinct exotoxins related to scarlet fever toxins. J Exp Med 1960; 111 (02) 255-284
- 22 Sriskandan S, Unnikrishnan M, Krausz T, Cohen J. Mitogenic factor (MF) is the major DNase of serotype M89 Streptococcus pyogenes . Microbiology (Reading) 2000; 146 (Pt 11): 2785-2792
- 23 Mollick JA, Miller GG, Musser JM, Cook RG, Grossman D, Rich RR. A novel superantigen isolated from pathogenic strains of Streptococcus pyogenes with aminoterminal homology to staphylococcal enterotoxins B and C. J Clin Invest 1993; 92 (02) 710-719
- 24 Kamezawa Y, Nakahara T, Nakano S, Abe Y, Nozaki-Renard J, Isono T. Streptococcal mitogenic exotoxin Z, a novel acidic superantigenic toxin produced by a T1 strain of Streptococcus pyogenes . Infect Immun 1997; 65 (09) 3828-3833
- 25 Ferretti JJ, McShan WM, Ajdic D. et al. Complete genome sequence of an M1 strain of Streptococcus pyogenes . Proc Natl Acad Sci U S A 2001; 98 (08) 4658-4663
- 26 Wannamaker LW. The chain that links the heart to the throat. Circulation 1973; 48 (01) 9-18
- 27 Fleming A. On the antibacterial action of cultures of a penicillium with special reference to their use in the isolation of B. influenzae . Br J Exp Pathol 1929; 10: 226-236
- 28 Horn DL, Zabriskie JB, Austrian R, Cleary PP, Ferretti JJ, Fischetti VA. Why have group A streptococci remained susceptible to penicillin? Report on a symposium. Clin Inf Dis 1998; 26: 1341-1345
- 29 Efstratiou A, Lamagni T. Epidemiology of Streptococcus pyogenes . In: Ferretti JJ, Stevens DL, Fischetti VA. eds. Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. 2nd ed. Oklahoma City: University of Oklahoma Health Sciences Center 2022. https://www.ncbi.nlm.nih.gov/books/NBK343616/
- 30 Steer AC, Jenney AJ, Oppedisano F. et al. High burden of invasive β-haemolytic streptococcal infections in Fiji. Epidemiol Infect 2008; 136 (05) 621-627
- 31 Al-Shahib A, Afshar B, Underwood A. et al. Genome wide analysis of M3 GAS strains suggests an emergence of a novel phage containing clade that is responsible for the 2009 upsurge in England. XIX Lancefield International Symposium on Streptococci and Streptococcal Diseases, (p. 9). Buenos Aires, 2014
- 32 Ron M, Brosh-Nissimov T, Korenman Z. et al. Invasive multidrug-resistant emm93.0 Streptococcus pyogenes strain harboring a novel genomic Island, Israel, 2017-2019. Emerg Infect Dis 2022; 28 (01) 118-126
- 33 Seale AC, Davies MR, Anampiu K. et al. Invasive group A streptococcus infection among children, rural Kenya. Emerg Infect Dis 2016; 22 (02) 224-232
- 34 Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics 2010; 126 (03) e557-e564
- 35 Holmström L, Nyman B, Rosengren M, Wallander S, Ripa T. Outbreaks of infections with erythromycin-resistant group A streptococci in child day care centres. Scand J Infect Dis 1990; 22 (02) 179-185
- 36 Weiss K, Laverdière M, Lovgren M, Delorme J, Poirier L, Béliveau C. Group A Streptococcus carriage among close contacts of patients with invasive infections. Am J Epidemiol 1999; 149 (09) 863-868
- 37 Davies HD, McGeer A, Schwartz B. et al; Ontario Group A Streptococcal Study Group. Invasive group A streptococcal infections in Ontario, Canada. N Engl J Med 1996; 335 (08) 547-554
- 38 Mizrahi B, Sudry T, Flaks-Manov N. et al. Long COVID outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort study. BMJ 2023; 380: e072529
- 39 Wong SS, Yuen KY. Streptococcus pyogenes and re-emergence of scarlet fever as a public health problem. Emerg Microbes Infect 2012; 1 (07) e2
- 40 Ashbaugh CD, Moser TJ, Shearer MH, White GL, Kennedy RC, Wessels MR. Bacterial determinants of persistent throat colonization and the associated immune response in a primate model of human group A streptococcal pharyngeal infection. Cell Microbiol 2000; 2 (04) 283-292
- 41 Hasty DL, Ofek I, Courtney HS, Doyle RJ. Multiple adhesins of streptococci. Infect Immun 1992; 60 (06) 2147-2152
- 42 Kimura KR, Nakata M, Sumitomo T. et al. Involvement of T6 pili in biofilm formation by serotype M6 Streptococcus pyogenes . J Bacteriol 2012; 194 (04) 804-812
- 43 Beall B, Facklam R, Hoenes T, Schwartz B. Survey of emm gene sequences and T-antigen types from systemic Streptococcus pyogenes infection isolates collected in San Francisco, California; Atlanta, Georgia; and Connecticut in 1994 and 1995. J Clin Microbiol 1997; 35 (05) 1231-1235
- 44 Stålhammar-Carlemalm M, Areschoug T, Larsson C, Lindahl G. The R28 protein of Streptococcus pyogenes is related to several group B streptococcal surface proteins, confers protective immunity and promotes binding to human epithelial cells. Mol Microbiol 1999; 33 (01) 208-219
- 45 Facklam RF, Martin DR, Lovgren M. et al. Extension of the Lancefield classification for group A streptococci by addition of 22 new M protein gene sequence types from clinical isolates: emm103 to emm124. Clin Infect Dis 2002; 34 (01) 28-38
- 46 Ryan PA, Juncosa B. Group A streptococcal adherence. In: Ferretti JJ, Stevens DL, Fischetti VA. eds. Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. 2nd ed. Oklahoma City: : University of Oklahoma Health Sciences Center. https://www.ncbi.nlm.nih.gov/books/NBK333427
- 47 https://www.cdc.gov/streplab/groupa-strep/emm-background.html
- 48 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 (10) 611-616
- 49 Luca-Harari B, Darenberg J, Neal S. et al; Strep-EURO Study Group. Clinical and microbiological characteristics of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol 2009; 47 (04) 1155-1165
- 50 Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH. Manuel of Clinical Microbiology. 8th ed. ASM Press, Washington 2003: 225-233
- 51 Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. Bennett JE, Dolin R, Blaser MJ. ed. https://www.sciencedirect.com/science/book/9781455748013
- 52 Murray RP, Rosenthal KS, Pfaller MA. Medical Microbiology. 8th ed. Elsevier Saunders 2015: 237
- 53 Brooks GF, Carroll KC, Morse SA, Mietzner TA. Jawetz, Melnick and Adelberg's Medical Microbiology. 26th ed. McGraw-Hill; 2013: 209-225
- 54 Shulman ST, Bisno AL, Clegg HW. et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55 (10) 1279-1282
- 55 Johnson DR, Kaplan EL. False-positive rapid antigen detection test results: reduced specificity in the absence of group A streptococci in the upper respiratory tract. J Infect Dis 2001; 183 (07) 1135-1137
- 56 Weinzierl EP, Jerris RC, Gonzalez MD, Piccini JA, Rogers BB. Comparison of Alere Strep A rapid molecular assay with rapid antigen testing and culture in a pediatric outpatient setting. Am J Clin Pathol 2018; 150 (03) 235-239
- 57 Weinzierl EP, Gonzalez MD. You say that you want a molecular revolution? Changing from the Group A streptococcus antigen and culture paradigm to molecular testing. Clin Microbiol Newsl 2020; 42: 105-110
- 58 Toptan H, Agel E, Sagcan H. et al. Rapid molecular diagnosis of group A streptococcus with a novel loop mediated isothermal amplification method. Clin Lab 2022; 68: 1589-1595
- 59 Wessels MR. Clinical practice. Streptococcal pharyngitis. N Engl J Med 2011; 364 (07) 648-655
- 60 Bessen DE. Tissue tropisms in group A Streptococcus: what virulence factors distinguish pharyngitis from impetigo strains?. Curr Opin Infect Dis 2016; 29 (03) 295-303
- 61 Danchin MH, Rogers S, Selvaraj G. et al. The burden of group A streptococcal pharyngitis in Melbourne families. Indian J Med Res 2004; 119: 144-147
- 62 Marshall HS, Richmond P, Nissen M. et al. Group A Streptococcal carriage and seroepidemiology in children up to 10 years of age in Australia. Pediatr Infect Dis J 2015; 34 (08) 831-838
- 63 Martin J. The Streptococcus pyogenes Carrier State,. In: Ferretti JJ, Stevens DL, Fischetti VA. , editors. Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. 2nd ed. Oklahoma City: : University of Oklahoma Health Sciences Center. https://www.ncbi.nlm.nih.gov/books/NBK374206/
- 64 Ryan KJ, Ray CG, Ahmad N. et al. Streptococci and Enterococci. In: Sherris Medical Microbiology (6th ed.). . McGraw Hill Education; 2014: 447
- 65 Kratovac Z, Manoharan A, Luo F, Lizano S, Bessen DE. Population genetics and linkage analysis of loci within the FCT region of Streptococcus pyogenes . J Bacteriol 2007; 189 (04) 1299-1310
- 66 Michael R, Wessels MD. Pharyngitis and scarlet fever. In: Ferretti JJ, Stevens DL, Fischetti VA. eds. Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. 2nd ed. Oklahoma City: : University of Oklahoma Health Sciences Center 2016. https://www.ncbi.nlm.nih.gov/books/NBK333418/
- 67 Spaulding AR, Salgado-Pabón W, Kohler PL, Horswill AR, Leung DY, Schlievert PM. Staphylococcal and streptococcal superantigen exotoxins. Clin Microbiol Rev 2013; 26 (03) 422-447
- 68 Callen JP. Pyoderma gangrenosum. Lancet 1998; 351 (9102) 581-585
- 69 Powell FC, Schroeter AL, Su WP, Perry HO. Pyoderma gangrenosum: a review of 86 patients. Q J Med 1985; 55 (217) 173-186
- 70 Doern CD, Group A. Streptococcus (Streptococcus pyogenes): the most interesting pathogen in the world. Clin Mic News 2022; 45: 39-46
- 71 Basetti S, Hodgson J, Rawson TM, Majeed A. Scarlet fever: a guide for general practitioners. London J Prim Care (Abingdon) 2017; 9 (05) 77-79
- 72 Centers for Disease Control and Prevention. Streptococcal toxic shock syndrome: all you need to know. Accessed April 9, 2023 at: https://www.cdc.gov/groupastrep/diseases-public/streptococcal-toxic-shock-syndrome.html
- 73 Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn Jr WC, Woods GL. Gram positive cocci part II: streptococci, enterococci and the “streptococcus–like” bacteria. Koneman's Color Atlas and Textbook of Diagnostic Microbiology 2006: 672-764
- 74 Ghamari SH, Abbasi-Kangevari M, Saeedi Moghaddam S. et al. Rheumatic heart disease is a neglected disease relative to its burden worldwide: findings from Global Burden of Disease 2019. J Am Heart Assoc 2022; 11 (13) e025284
- 75 Alqanatish J, Alfadhel A, Albelali A, Alqahtani D. Acute rheumatic fever diagnosis and management: review of the global implications of the new revised diagnostic criteria with a focus on Saudi Arabia. J Saudi Heart Assoc 2019; 31 (04) 273-281
- 76 CLSI. Performance standards for antimicrobial susceptibility testing; M100. Wayne, PA: : CLSI; 2022
- 77 https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_13.0_Breakpoint_Tables.pdf
- 78 Stevens DL, Bisno AL, Chambers HF. et al; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59 (02) e10-e52
- 79 Meletis G, Soulopoulos Ketikidis AL, Floropoulou N. et al. Antimicrobial resistance rates of Streptococcus pyogenes in a Greek tertiary care hospital: 6-year data and literature review. New Microbiol 2023; 46 (01) 37-42
- 80 Walker MJ, Barnett TC, McArthur JD. et al. Disease manifestations and pathogenic mechanisms of group A streptococcus. Clin Microbiol Rev 2014; 27 (02) 264-301
- 81 Leclercq R. Mechanisms of resistance to macrolides and lincosamides: nature of the resistance elements and their clinical implications. Clin Infect Dis 2002; 34 (04) 482-492
- 82 Macias Parra M, Medina-Vera I, De la Garz EA, Rodriguez Weber MA, León-Lara X. The impact of Haemophilus influenzae and Streptococcus pneumoniae vaccination in bacterial meningitis in a pediatric referral hospital in Mexico. J Pediatr Infect Dis 2021; 16: 230-236
- 83 Polly SM, Waldman RH, High P, Wittner MK, Dorfman A. Protective studies with a group A streptococcal M protein vaccine. II. Challenge of volunteers after local immunization in the upper respiratory tract. J Infect Dis 1975; 131 (03) 217-224
- 84 Waldman RH, Lee JD, Polly SM, Dorfman A, Fox EN. Group A streptococcal M protein vaccine: protection following immunization via the respiratory tract. Dev Biol Stand 1975; 28: 429-434
- 85 Massell BF, Honikman LH, Amezcua J. Rheumatic fever following streptococcal vaccination. Report of three cases. JAMA 1969; 207 (06) 1115-1119
- 86 Walkinshaw DR, Wright MEE, Mullin AE, Excler JL, Kim JH, Steer AC. The Streptococcus pyogenes vaccine landscape. Vaccines (Basel) 2023; 16: 1-6
- 87 Davies MR, McIntyre L, Mutreja A. et al. Atlas of group A streptococcal vaccine candidates compiled using large-scale comparative genomics. Nat Genet 2019; 51 (06) 1035-1043
- 88 Kotloff KL, Corretti M, Palmer K. et al. Safety and immunogenicity of a recombinant multivalent group a streptococcal vaccine in healthy adults: phase 1 trial. JAMA 2004; 292 (06) 709-715
- 89 McNeil SA, Halperin SA, Langley JM. et al. Safety and immunogenicity of 26-valent group a streptococcus vaccine in healthy adult volunteers. Clin Infect Dis 2005; 41 (08) 1114-1122
- 90 Sekuloski S, Batzloff MR, Griffin P. et al. Evaluation of safety and immunogenicity of a group A streptococcus vaccine candidate (MJ8VAX) in a randomized clinical trial. PLoS One 2018; 13 (07) e0198658
- 91 Fischetti VA, Parry DA, Trus BL, Hollingshead SK, Scott JR, Manjula BN. Conformational characteristics of the complete sequence of group A streptococcal M6 protein. Proteins 1988; 3 (01) 60-69
- 92 Pandey M, Calcutt A, Ozberk V. et al. Antibodies to the conserved region of the M protein and a streptococcal superantigen cooperatively resolve toxic shock-like syndrome in HLA-humanized mice. Sci Adv 2019; 5 (09) eaax3013
- 93 Pastural É, McNeil SA, MacKinnon-Cameron D. et al. Safety and immunogenicity of a 30-valent M protein-based group a streptococcal vaccine in healthy adult volunteers: a randomized, controlled phase I study. Vaccine 2020; 38 (06) 1384-1392
- 94 Guilherme L, Faé KC, Higa F. et al. Towards a vaccine against rheumatic fever. Clin Dev Immunol 2006; 13 (2-4) 125-132
- 95 Guilherme L, Postol E, Freschi de Barros S. et al. A vaccine against S. pyogenes: design and experimental immune response. Methods 2009; 49 (04) 316-321
- 96 Castro SA, Dorfmueller HC. A brief review on group A streptococcus pathogenesis and vaccine development. R Soc Open Sci 2021; 8 (03) 201991
- 97 Edwards RJ, Taylor GW, Ferguson M. et al. Specific C-terminal cleavage and inactivation of interleukin-8 by invasive disease isolates of Streptococcus pyogenes . J Infect Dis 2005; 192 (05) 783-790
- 98 Di Benedetto R, Mancini F, Carducci M. et al. Rational design of a glycoconjugate vaccine against group A streptococcus.. Int J Mol Sci 2020; 21 (22) 8558
- 99 Gao NJ, Satoshi U, Pill L. et al. Site-specific conjugation of cell wall polyrhamnose to protein SpyAD envisioning a safe universal group A streptococcal vaccine. Infect Microbes Dis 2021; 3: 87-100
- 100 Rivera-Hernandez T, Rhyme MS, Cork AJ. et al. Vaccine-induced Th1-type response protects against invasive group A streptococcus infection in the absence of opsonizing antibodies. MBio 2020; 11 (02) e00122-e00120
- 101 Rivera-Hernandez T, Carnathan DG, Jones S. et al. An experimental group a streptococcus vaccine that reduces pharyngitis and tonsillitis in a nonhuman primate model. MBio 2019; 10 (02) 1-10
- 102 Loh JMS, Rivera-Hernandez T, McGregor R. et al. A multivalent T-antigen-based vaccine for group A streptococcus. Sci Rep 2021; 11 (01) 4353