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EBioMedicine Jul 2022Streptococcus dysgalactiae subspecies equisimilis (SDSE) has emerged as an important cause of severe invasive infections including streptococcal toxic shock syndrome...
Natural mutation in the regulatory gene (srrG) influences virulence-associated genes and enhances invasiveness in Streptococcus dysgalactiae subsp. equisimilis strains isolated from cases of streptococcal toxic shock syndrome.
BACKGROUND
Streptococcus dysgalactiae subspecies equisimilis (SDSE) has emerged as an important cause of severe invasive infections including streptococcal toxic shock syndrome (STSS). The present study aimed to identify genes involved in differences in invasiveness between STSS and non-invasive SDSE isolates.
METHODS
STSS and non-invasive SDSE isolates were analysed to identify csrS/csrR mutations, followed by a comparative analysis of genomic sequences to identify mutations in other genes. Mutant strains were generated to examine changes in gene expression profiles and altered pathogenicity in mice.
FINDINGS
Of the 79 STSS-SDSE clinical isolates, 15 (19.0%) harboured csrS/csrR mutations, while none were found in the non-invasive SDSE isolates. We identified a small RNA (sRNA) that comprised three direct repeats along with an inverted repeat and was transcribed in the same direction as the sagA gene. The sRNA was referred to as srrG (streptolysin S regulatory RNA in GGS). srrG mutations were identified in the STSS-SDSE strains and were found to be associated with elevated expression of the streptolysin S (SLS) gene cluster and enhanced pathogenicity in mice.
INTERPRETATION
The csrS/csrR and srrG mutations that increased virulence gene expression in STSS-SDSE isolates were identified, and strains carrying these mutations caused increased lethality in mice. A significantly higher frequency of mutations was observed in STSS-SDSE isolates, thereby highlighting their importance in STSS.
FUNDING
Japan Agency for Medical Research and Development, the Japan Society for the Promotion of Science (JSPS), and the Ministry of Health, Labor, and Welfare of Japan.
Topics: Animals; Genes, Regulator; Mice; Mutation; RNA, Small Untranslated; Shock, Septic; Streptococcal Infections; Streptococcus; Streptolysins; Virulence
PubMed: 35779495
DOI: 10.1016/j.ebiom.2022.104133 -
Medicine Jan 2013We present 2 patients with Streptococcus agalactiae toxic shock-like syndrome and review another 11 well-reported cases from the literature. Streptococcal toxic... (Review)
Review
We present 2 patients with Streptococcus agalactiae toxic shock-like syndrome and review another 11 well-reported cases from the literature. Streptococcal toxic shock-like syndrome is a devastating illness with a high mortality rate, therefore we stress the importance of early supportive management, antimicrobial therapy, and surgical intervention. Toxic shock-like syndrome is likely to be underestimated in patients with invasive Streptococcus agalactiae infection who present with shock. Early diagnosis requires high suspicion of the illness, along with a thorough mucocutaneous examination. Streptococcus agalactiae produces uncharacterized pyrogenic toxins, which explains the ability of the organism to cause toxic shock-like syndrome.
Topics: Aged; Diabetes Mellitus; Fatal Outcome; Female; Humans; Middle Aged; Shock, Septic; Streptococcal Infections; Streptococcus agalactiae
PubMed: 23263717
DOI: 10.1097/MD.0b013e31827dea11 -
International Journal of Medical... Apr 2021Streptococcal toxic shock syndrome (STSS) is a severe invasive infection characterized by the sudden onset of shock, multi-organ failure, and puerperal sepsis and shows...
Streptococcal toxic shock syndrome (STSS) is a severe invasive infection characterized by the sudden onset of shock, multi-organ failure, and puerperal sepsis and shows high mortality. Its primary cause is group A streptococcus (GAS, Streptococcus pyogenes). In this study, we genotyped the cell-surface M virulence protein gene (emm) from 621 GAS isolates obtained from patients with STSS in Japan in 2013-2018 and performed antimicrobial susceptibility testing using the broth microdilution method. The predominant emm type was found to be 1, followed by 89, 12, and 3, which were identified in more than 70 % of STSS isolates. The proportions of emm3 and emm89 increased from 2.4 % and 12.0 %, respectively, during 2010-2012 to 5.6 % and 23.3 % during 2013-2018. In contrast, the proportion of emm1 decreased from 60.6 % to 39.3 % during the same two periods. Some emm types showed increasing proportions and were not isolated from patients with STSS in 2010-2012. Among these, an emm76 type increased in prevalence and was not included in the 30-valent M protein-based vaccine. Continual investigation of changes in the epidemiology of GAS which causes STSS can provide useful monitoring information such as future vaccination strategies and the emergence status of antimicrobial-resistant bacteria.
Topics: Anti-Bacterial Agents; Antigens, Bacterial; Bacterial Outer Membrane Proteins; Drug Resistance, Bacterial; Humans; Japan; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes
PubMed: 33756191
DOI: 10.1016/j.ijmm.2021.151496 -
Medical Hypotheses Nov 2020Most pediatric patients with COVID-19 are asymptomatic or show only mild symptoms. However, in the last two months, first in Europe and recently in the United States, a...
Most pediatric patients with COVID-19 are asymptomatic or show only mild symptoms. However, in the last two months, first in Europe and recently in the United States, a small number of children have developed a more severe inflammatory syndrome associated with COVID-19, which often leads to hospitalization and sometimes requires intensive care. A potential relationship was observed, especially between the occurrence of the Kawasaki disease and viral upper respiratory tract infections.
Topics: Adenoviridae Infections; COVID-19; Child; Coronavirus Infections; Europe; Humans; Mucocutaneous Lymph Node Syndrome; Respiratory Tract Infections; Shock, Septic
PubMed: 32562912
DOI: 10.1016/j.mehy.2020.109986 -
Epidemiology and Infection Jun 1993Over the 7 years 1985-91, 997 strains of Staphylococcus aureus from 962 patients with diseases other than food poisoning have been tested for the production of...
Over the 7 years 1985-91, 997 strains of Staphylococcus aureus from 962 patients with diseases other than food poisoning have been tested for the production of enterotoxins and toxic shock syndrome toxin-1 (TSST-1) and phage typed. In all, 128 cases could be classified as confirmed or probable toxic shock syndrome (TSS) but a further 199 cases were classified as possible or unconfirmed TSS. In 219 cases, an alternative diagnosis could be supported and 45 cases were classified as sudden infant death syndrome. In 371 cases, insufficient information for classification was available. Strains of phage group I producing TSST-1 were associated with menstrual TSS. Many menstrual TSS cases were aged less than 20 and were using non-introducer tampons. When all strains were reviewed, strong associations were observed between TSST-1 production and phage group I strains, enterotoxin B production and group V strains, enterotoxin C and phage-type 95 strains and between enterotoxin A without TSST-1 and phage group III strains.
Topics: Adolescent; Adult; Aged; Bacterial Toxins; Bacteriophage Typing; Child; Enterotoxins; Female; Humans; Male; Middle Aged; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Superantigens; United Kingdom
PubMed: 8519313
DOI: 10.1017/s0950268800050901 -
Canadian Medical Association Journal Apr 1982Since 1976, 53 confirmed or suspected cases of toxic shock syndrome (TSS) have been reported in Canada. Twenty-two cases occurred in 1980, and by October 1981 another 21... (Comparative Study)
Comparative Study Review
Since 1976, 53 confirmed or suspected cases of toxic shock syndrome (TSS) have been reported in Canada. Twenty-two cases occurred in 1980, and by October 1981 another 21 had been reported. In Canada, like the United States, where nearly 1200 cases have been recorded, TSS appears to be associated with tampon use, although a few cases have occurred in males and in nonmenstruating women. Of the 53 patients 3 died. The enterotoxin produced by Staphylococcus aureus is probably responsible for TSS. Manufacturers of tampons have now placed warning labels on tampon boxes and information on TSS in the instruction inserts. Women should select tampons of appropriate absorbency for the various stages of menstruation.
Topics: Adolescent; Adult; Aged; Canada; Child; Child, Preschool; Female; Humans; Male; Menstrual Hygiene Products; Menstruation; Middle Aged; Seasons; Shock, Septic; Staphylococcal Infections; United States
PubMed: 7042059
DOI: No ID Found -
Infection and Immunity Mar 2020is an emerging zoonotic agent that causes streptococcal toxic shock-like syndrome (STSLS) and meningitis in humans, with high mortality and morbidity. The pathogenesis...
is an emerging zoonotic agent that causes streptococcal toxic shock-like syndrome (STSLS) and meningitis in humans, with high mortality and morbidity. The pathogenesis of both STSLS and central nervous system (CNS) infections caused by is not well understood. TRIM32, a member of the tripartite motif (TRIM) protein family, has been reported to regulate host inflammatory responses. In this study, we showed that TRIM32 deficiency significantly reduced the level of bacteremia and the production of proinflammatory cytokines following severe infection, protecting infected mice from STSLS. The influence of TRIM32 gene deletion on a range of processes known to be involved in meningitis was also examined. Both levels of bacterial loads and indications of brain hemorrhage were reduced in infected mice compared with infected wild-type (WT) controls. We also found that TRIM32 deficiency increased the permeability of the blood-brain barrier (BBB) and the recruitment of inflammatory monocytes during the early course of infection, potentially limiting the development of meningitis. Our results suggest that TRIM32 sensitizes -induced infection via innate immune response regulation.
Topics: Animals; Disease Models, Animal; Disease Susceptibility; Host-Pathogen Interactions; Immunity, Innate; Meningitis, Bacterial; Mice; Mice, Knockout; Shock, Septic; Streptococcus suis; Ubiquitin-Protein Ligases
PubMed: 31988176
DOI: 10.1128/IAI.00957-19 -
International Journal of Infectious... May 2024Streptococcal toxic shock syndrome (STSS) is caused by group A Streptococcus (GAS; Streptococcus pyogenes) strains. In Japan, the number of STSS cases has decreased;...
OBJECTIVES
Streptococcal toxic shock syndrome (STSS) is caused by group A Streptococcus (GAS; Streptococcus pyogenes) strains. In Japan, the number of STSS cases has decreased; however, the underlying reason remains unclear. Moreover, information on distribution and prevalence of specific emm types in STSS cases is scarce. Hence, we investigated the reason for the decreased number of STSS cases in Japan.
METHODS
We genotyped emm of 526 GAS isolates obtained from 526 patients with STSS between 2019 and 2022. The distributions of emm types in each year were compared.
RESULTS
The emm1 type was predominant, with the highest proportion in 2019, which decreased after 2020 following the onset of the coronavirus disease 2019 (COVID-19) pandemic. Strains isolated during the pandemic correlated with strains associated with skin infection, whereas those isolated during the prepandemic period correlated with strains associated with both throat and skin infections. The decrease in the annual number of STSS cases during the COVID-19 pandemic could be due to a decreased proportion of strains associated with pharyngeal infections.
CONCLUSIONS
Potential associations between pandemic and STSS numbers with respect to public health measures, such as wearing masks and changes in healthcare-seeking behavior, may have affected the number of GAS-induced infections.
Topics: Humans; Streptococcus pyogenes; Shock, Septic; Japan; Pandemics; COVID-19; Streptococcal Infections
PubMed: 38382822
DOI: 10.1016/j.ijid.2024.01.021 -
Public Health Reports (Washington, D.C.... 2022Routine surveillance for streptococcal toxic shock syndrome (STSS), a severe manifestation of invasive group A (GAS) infections, likely underestimates its true...
OBJECTIVES
Routine surveillance for streptococcal toxic shock syndrome (STSS), a severe manifestation of invasive group A (GAS) infections, likely underestimates its true incidence. The objective of our study was to evaluate routine identification of STSS in a national surveillance system for invasive GAS infections.
METHODS
Active Bacterial Core surveillance (ABCs) conducts active population-based surveillance for invasive GAS disease in selected US counties in 10 states. We categorized invasive GAS cases with a diagnosis of STSS made by a physician as STSS-physician and cases that met the Council of State and Territorial Epidemiologists (CSTE) clinical criteria for STSS based on data in the medical record as STSS-CSTE. We evaluated agreement between the 2 methods for identifying STSS and compared the estimated national incidence of STSS when applying proportions of STSS-CSTE and STSS-physician among invasive GAS cases from this study with national invasive GAS estimates for 2017.
RESULTS
During 2014-2017, of 7572 invasive GAS cases in ABCs, we identified 1094 (14.4%) as STSS-CSTE and 203 (2.7%) as STSS-physician, a 5.3-fold difference. Of 1094 STSS-CSTE cases, we identified only 132 (12.1%) as STSS-physician cases. Agreement between the 2 methods for identifying STSS was low (κ = 0.17; 95% CI, 0.14-0.19). Using ABCs data, we estimated 591 cases of STSS-physician and 3618 cases of STSS-CSTE occurred nationally in 2017.
CONCLUSIONS
We found a large difference in estimates of incidence of STSS when applying different surveillance methods and definitions. These results should help with better use of currently available surveillance data to estimate the incidence of STSS and to evaluate disease prevention efforts, in addition to guiding future surveillance efforts for STSS.
Topics: Humans; Incidence; Population Surveillance; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; United States
PubMed: 33960856
DOI: 10.1177/00333549211013460 -
Journal of Infection and Public Health Dec 2012Group A Streptococcal (GAS) Toxic Shock Syndrome (TSS) is an acute, rapidly progressive, and often fatal illness. Outbreaks can occur in hospitals. However, early... (Review)
Review
Group A Streptococcal (GAS) Toxic Shock Syndrome (TSS) is an acute, rapidly progressive, and often fatal illness. Outbreaks can occur in hospitals. However, early infection control measures may interrupt transmissions and prevent morbidity and mortality. Two cases of invasive GAS TSS were diagnosed within 48h after two uncomplicated laparoscopic surgeries that were performed in the same operating room of a women's hospital. Investigations conducted by the infection prevention and control department of the hospital identified 46 obstetrical staff members who were involved in the surgeries and/or had contact with either of the patients. All of the staff members were interviewed regarding any recent history of upper respiratory tract infections, the presence of skin lesions and vaginal or rectal symptoms. Throat, rectal, and vaginal cultures were obtained two times from all of the involved staff members. Throat colonization with GAS was detected in the cultures from one obstetrical intern who attended the 1st surgery and from one nurse who had formerly worked in the postnatal ward. These two strains were epidemiologically different from each other and from the outbreak strain. Both carriers were suspended from direct patient care and were treated with a ten-day course of oral clindamycin. The success of their decolonization status was assessed at the end of therapy and at three, six, nine and twelve months thereafter before reassigning them to routine work. Unfortunately, in spite of the extensive investigation of all involved personnel and of the environment, the mode of transmission to the second patient could not be established. However, droplet or airborne transmission could not be ruled out. Early and meticulous implementation of infection control measures was crucial and instrumental in the successful management and control of this outbreak. Furthermore, there were no subsequent GAS cases detected during the 24 months following the outbreak.
Topics: Adult; Anti-Bacterial Agents; Clindamycin; Cross Infection; Disease Outbreaks; Fatal Outcome; Female; Humans; Postoperative Complications; Salpingectomy; Shock, Septic; Sterilization, Tubal; Streptococcal Infections; Streptococcus pyogenes
PubMed: 23287609
DOI: 10.1016/j.jiph.2012.07.006