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Volume 9, Number 10—October 2003

Research

Superantigens and Streptococcal Toxic Shock Syndrome

Thomas Proft*, Shiranee Sriskandan†, Lily Yang*, and John D. Fraser*Comments to Author 
Author affiliations: *University of Auckland, Auckland, New Zealand; †Imperial College, London, United Kingdom

Main Article

Table

Summary of the results from sag genotyping and SAg in vitro expressiona,b

Serum
Isolate
Focus
spe-a
SPE-A
sag gene/SAg protein production
SMEZc
spe-c
SPE-C
spe-g
SPE-G
spe-h
SPE-H
spe-i
SPE-I
spe-j
SPE-J
smez
SMEZ
ssa
SSA
Focal infection/bacteremia with STSS
94/31
H292
Fasciitis
-
-
-
-
+
-
+
-
+
++
+
-
+
-
-
-
+
95/02
H293
Fasciitis
-
-
-
-
+
-
+
-
-
-
+
-
+
-
-
-
++
96/2
H297
Peritonitis
+
-
-
-
+
++
-
-
-
-
+
+
+
-
-
-
+
98/5
H325
Fasciitis
+
+++
-
-
+
-
-
-
-
-
+
-
+
-
+
-
+
98/8
H327
Cellulitis
-
-
-
-
+
+
-
-
-
-
+
-
+
_
+
+
-
98/11
H330
Endometritis
+
+++
-
-
+
-
-
-
-
-
+
+
+
-
+
-
+
99/1
H360
Occult bact.
-
-
+
+
+
+
-
-
-
-
+
-
+
-
-
-
++
99/18
H366
Pneumonia
+
+++
-
-
+
-
-
-
-
-
+
++
+
-
-
-
+
20/07
H378
Pneumonia
-
-
-
-
+
-
+
-
-
-
+
-
+
-
+
-
+
Focal infection/bacteremia, no STSS


95/8
H295
Cellulitis
-
-
-
-
+
-
-
-
-
-
+
+++
+
-
-
-
++
98/1
H319
Cellulitis
-
-
-
-
+
++
-
-
-
-
+
++
+
-
-
-
++
20/01
H369
Pelvic clot
-
-
-
-
+
-
-
-
-
-
+
+
+
-
-
-
+++
20/04
H370
Thromobosis
-
-
-
-
+
+
-
-
-
-
+
-
+
-
-
-
-
Focal infection, no bacteremia, no STSS
97/15
H307
Bursitis
-
-
+
+++
+
-
-
-
-
-
+
+
+
-
-
-
+
97/18
H308
Cellulitis
+
-
-
-
+
-
+
-
-
-
+
-
+
-
+
-
-
97/21
H311
Cellulitis
-
-
-
-
+
-
-
-
-
-
+
-
+
-
-
-
+
97/23
H314
Cellulitis
+
-
-
-
+
+
+
-
+
-
+
+
+
-
-
-
++
97/24
H315
Cellulitis
+
-
-
-
+
-
-
-
-
-
+
+
+
-
-
-
-
97/26 H316 Amnionitis - - + +++ + + - - - - + ++ + - + - -

aSAg, superantigen; SPE, streptococcal pyrogenic exotoxin; SME, streptococcal mitogenic exotoxin; STSS, streptococcal toxic shock syndrome.
bS. pyogenes isolates from patients with and without STSS were genotyped by polymerase chain reaction with sag specific primers. Concentrated supernatant from the in vitro cultured isolates were analyzed for secreted SAgs by using Western blot analysis with recombinant SAg standards. SMEZ expression was also analyzed by using the more sensitive Jurkat cell assay, which has a threshold of approximately 10 pg/mL. SAg expression by Western blot: -, no detectable protein; +, <2 ng/mL; ++, 2–10 ng/mL; +++, >10 ng/mL. SMEZ expression by Jurkat assay: -, no detectable SMEZ; +, >10 pg/ml (10,000–20,000 cpm); ++, 20,000–30,000 cpm; +++, >30,000 cpm.
cJurkat assay.

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