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Volume 29, Number 11—November 2023
Research Letter

Changes in Group A Streptococcus emm Types Associated with Invasive Infections in Adults, Spain, 2023

Alba Bellés-Bellés, Núria PrimComments to Author , Saray Mormeneo-Bayo, Pilar Villalón-Panzano, Mónica Valiente-Novillo, Alfredo Jover-Sáenz, Núria Aixalà, Albert Bernet, Éric López-González, Ivan Prats, and Mercè García-González
Author affiliations: Hospital Universitari Arnau de Vilanova, Lleida, Spain (A. Bellés-Bellés, N. Prim, S. Mormeneo-Bayo, A. Jover-Sáenz, N. Aixalà, A. Bernet, É. López-González, I. Prats, M. García-González); Institut de Recerca Biomèdica de Lleida, Lleida (A. Bellés-Bellés, N. Prim, S. Mormeneo-Bayo, A. Jover-Sáenz, A. Bernet, É. López-González, I. Prats, M. García-González); Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain (P. Villalón-Panzano, M. Valiente-Novill)

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Table

Phenotypic and genotypic characteristics of 61 Streptococcus pyogenes isolates in invasive infections and clinical manifestations, Lleida province, northeast Spain, January 2019–May 2023*

emm type, n = 61 emm cluster† Exotoxin gene profile Resistance phenotype Clinical manifestations
emm1, n = 18 A-C3 A, G, J, smeZ, n = 11 ND Pneumonia, n = 8‡
A, C, G, J, smeZ, n = 7 Septic shock, n = 3‡
Skin infection, n = 3
UTI / PID, n = 3
AOM, n = 1
emm4, n = 1
 E1
 C, G, ssa, smeZ
 ND
 Cellulitis and septic shock
emm11, n = 3 E6 C, G, H, n = 2 ND Cellulitis, n = 2
C, G, H, J, n = 1
Postoperative fever, n = 1
emm12, n = 6 A-C4 C, G, H, n = 6 ND, n = 5 Fever, n = 2
ERI, CLI, n = 1 Scarlet fever, n = 1
Cellulitis, n = 1
Postchemotherapy fever, n = 1
Odynophagia, n = 1
emm33, n = 1
 D4
 G, H, J, smeZ
 TET
 Septic arthritis
emm44, n = 1
 E3
 A, G, J, ssa
 ND
 Pneumonia
emm49, n = 8 E3 G, n = 5 TET, n = 7 Cellulitis, n = 6
G, ssa, n = 1 ND, n = 1 Postchemotherapy fever, n = 1
A, G, n = 1 Vascular ulcers, n = 1
ND, n = 1
emm58, n = 1
 E3
 G, ssa
 ERI, TET
 Cellulitis
emm63, n = 1
 E6
 ssa
 TET
 Cellulitis
emm75, n = 2
 E6
 C, G, n = 2
 ND
 Cellulitis
emm77, n = 4 E4 C, G, n = 2 iMLSB, TET, n = 4 Cellulitis, n = 3
C, n = 2
Septic arthritis, n = 1
emm81, n = 1
 E6
 G
 TET
 Cellulitis
emm82, n = 1
 E3
 C, G, H
 ND
 Septic tenosynovitis
emm89, n = 8 E4 C, G, n = 7 ND Cellulitis, n = 3
C, G, J, smeZ, n = 1 PID, n = 1
Pneumonia, n = 3
Prosthetic infection, n = 1
emm118, n = 1
 E3
 G
 TET
 Cellulitis
emm132, n = 2
 Unknown
 ND, n = 2
 TET, n = 2
 Cellulitis
emm145, n = 1
 Unknown
 G, H
 TET
 PID
emm170, n = 1 E5 C, G, H ND Septic arthritis

*AOM, acute otitis media; CLI, clindamycin; ERI, erythromycin; iMLSB, inducible macrolide-lincosamide-streptogramin B phenotype; ND, not detected; PID, pelvic inflammatory disease; TET, tetracyclin; UTI, urinary tract infection. †emm cluster classification as previously reported (6). ‡Exitus: emm1 (n = 3) and emm4 (n = 1).

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References
  1. Nabarro  LE, Brown  CS, Balasegaram  S, Decraene  V, Elston  J, Kapadia  S, et al. Invasive group A Streptococcus outbreaks associated with home healthcare, England, 2018–2019. Emerg Infect Dis. 2022;28:915–23. DOIPubMedGoogle Scholar
  2. World Health Organization. Increased incidence of scarlet fever and invasive Group A Streptococcus infection—multi-country. 2022 Dec 15 [cited 2023 Jun 23]. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429
  3. Centers for Disease Control and Prevention. Increase in pediatric invasive group A streptococcal infections. 2022 Dec 22 [cited 2023 Jun 23]. https://emergency.cdc.gov/han/2022/han00484.asp
  4. Alcolea-Medina  A, Snell  LB, Alder  C, Charalampous  T, Williams  TGS, Tan  MKI, 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;29:887–90. DOIPubMedGoogle Scholar
  5. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep. 1997;46(RR-10):1–55.PubMedGoogle Scholar
  6. 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;9:611–6. DOIPubMedGoogle Scholar
  7. Villalón  P, Sáez-Nieto  JA, Rubio-López  V, Medina-Pascual  MJ, Garrido  N, Carrasco  G, et al. Invasive Streptococcus pyogenes disease in Spain: a microbiological and epidemiological study covering the period 2007-2019. Eur J Clin Microbiol Infect Dis. 2021;40:2295–303. DOIPubMedGoogle Scholar
  8. Li  Y, Rivers  J, Mathis  S, Li  Z, Velusamy  S, Nanduri  SA, et al. Genomic surveillance of Streptococcus pyogenes strains causing invasive disease, United States, 2016–2017. Front Microbiol. 2020;11:1547. DOIPubMedGoogle Scholar
  9. Naseer  U, Steinbakk  M, Blystad  H, Caugant  DA. Epidemiology of invasive group A streptococcal infections in Norway 2010-2014: A retrospective cohort study. Eur J Clin Microbiol Infect Dis. 2016;35:1639–48. DOIPubMedGoogle Scholar
  10. de Ceano-Vivas  M, Molina Gutiérrez  MÁ, Mellado-Sola  I, García Sánchez  P, Grandioso  D, Calvo  C. Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence. Enferm Infecs Microbiol Clín (Engl Ed). 2023 Jun 30 [Epub ahead of print].

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