Abstract
During an open clinical trial in an area where streptococcal infections are hyperendemic, we studied the genetic polymorphism of Streptococcus pyogenes isolates collected from patients and from healthy carriers living in close contact with them. The clonal diversity of isolates was analyzed by pulsed-field gel electrophoresis with three restriction enzymes (SmaI, ApaI, and SacII). The pharynx of each patient and healthy carrier was colonized by a single clone, suggesting the clonal nature of streptococcal colonization in individuals. Among 52 isolates obtained from patients with acute pharyngotonsillitis, we found 14 genetically unrelated clones, showing the genetic diversity of S. pyogenes. However, two clones belonging to the M1 and M12 serotypes represented about 70% of isolates in carriers and patients. Pharyngeal colonization in cured patients was monitored for 3 to 4 months. After the initial elimination of S. pyogenes following antibiotic therapy, the rate of recolonization was high by day 30 (about 20%) and was also at that level between days 90 and 120; this was similar to the carriage rate in family contacts. Thus, cured patients can be recontaminated by unrelated clones, suggesting that colonization of healthy carriers might be a potential source of spread and redistribution of S. pyogenes isolates.
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- Bach J. F., Chalons S., Forier E., Elana G., Jouanelle J., Kayemba S., Delbois D., Mosser A., Saint-Aime C., Berchel C. 10-year educational programme aimed at rheumatic fever in two French Caribbean islands. Lancet. 1996 Mar 9;347(9002):644–648. doi: 10.1016/s0140-6736(96)91202-7. [DOI] [PubMed] [Google Scholar]
- Bingen E., Denamur E., Lambert-Zechovsky N., Braimi N., el Lakany M., Elion J. DNA restriction fragment length polymorphism differentiates recurrence from relapse in treatment failures of Streptococcus pyogenes pharyngitis. J Med Microbiol. 1992 Sep;37(3):162–164. doi: 10.1099/00222615-37-3-162. [DOI] [PubMed] [Google Scholar]
- Bisno A. L. Group A streptococcal infections and acute rheumatic fever. N Engl J Med. 1991 Sep 12;325(11):783–793. doi: 10.1056/NEJM199109123251106. [DOI] [PubMed] [Google Scholar]
- Bouvet A., Geslin P., Kriz-Kuzemenska P., Blanc V., Devine C., Grimont F. Restricted association between biotypes and serotypes within group A streptococci. J Clin Microbiol. 1994 May;32(5):1312–1317. doi: 10.1128/jcm.32.5.1312-1317.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bruneau S., de Montclos H., Drouet E., Denoyel G. A. rRNA gene restriction patterns of Streptococcus pyogenes: epidemiological applications and relation to serotypes. J Clin Microbiol. 1994 Dec;32(12):2953–2958. doi: 10.1128/jcm.32.12.2953-2958.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Feldman S., Bisno A. L., Lott L., Dodge R., Jackson R. E. Efficacy of benzathine penicillin G in group A streptococcal pharyngitis: reevaluation. J Pediatr. 1987 May;110(5):783–787. doi: 10.1016/s0022-3476(87)80024-0. [DOI] [PubMed] [Google Scholar]
- Gastanaduy A. S., Kaplan E. L., Huwe B. B., McKay C., Wannamaker L. W. Failure of penicillin to eradicate group A streptococci during an outbreak of pharyngitis. Lancet. 1980 Sep 6;2(8193):498–502. doi: 10.1016/s0140-6736(80)91832-2. [DOI] [PubMed] [Google Scholar]
- Gordis L. The virtual disappearance of rheumatic fever in the United States: lessons in the rise and fall of disease. T. Duckett Jones memorial lecture. Circulation. 1985 Dec;72(6):1155–1162. doi: 10.1161/01.cir.72.6.1155. [DOI] [PubMed] [Google Scholar]
- Johnson D. R., Stevens D. L., Kaplan E. L. Epidemiologic analysis of group A streptococcal serotypes associated with severe systemic infections, rheumatic fever, or uncomplicated pharyngitis. J Infect Dis. 1992 Aug;166(2):374–382. doi: 10.1093/infdis/166.2.374. [DOI] [PubMed] [Google Scholar]
- Kaplan E. L. The resurgence of group A streptococcal infections and their sequelae. Eur J Clin Microbiol Infect Dis. 1991 Feb;10(2):55–57. doi: 10.1007/BF01964407. [DOI] [PubMed] [Google Scholar]
- LANCEFIELD R. C. Current knowledge of type-specific M antigens of group A streptococci. J Immunol. 1962 Sep;89:307–313. [PubMed] [Google Scholar]
- Markowitz M., Gerber M. A., Kaplan E. L. Treatment of streptococcal pharyngotonsillitis: reports of penicillin's demise are premature. J Pediatr. 1993 Nov;123(5):679–685. doi: 10.1016/s0022-3476(05)80840-6. [DOI] [PubMed] [Google Scholar]
- Martin D. R., Single L. A. Molecular epidemiology of group A streptococcus M type 1 infections. J Infect Dis. 1993 May;167(5):1112–1117. doi: 10.1093/infdis/167.5.1112. [DOI] [PubMed] [Google Scholar]
- Massell B. F., Chute C. G., Walker A. M., Kurland G. S. Penicillin and the marked decrease in morbidity and mortality from rheumatic fever in the United States. N Engl J Med. 1988 Feb 4;318(5):280–286. doi: 10.1056/NEJM198802043180504. [DOI] [PubMed] [Google Scholar]
- Musser J. M., Gray B. M., Schlievert P. M., Pichichero M. E. Streptococcus pyogenes pharyngitis: characterization of strains by multilocus enzyme genotype, M and T protein serotype, and pyrogenic exotoxin gene probing. J Clin Microbiol. 1992 Mar;30(3):600–603. doi: 10.1128/jcm.30.3.600-603.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Musser J. M., Hauser A. R., Kim M. H., Schlievert P. M., Nelson K., Selander R. K. Streptococcus pyogenes causing toxic-shock-like syndrome and other invasive diseases: clonal diversity and pyrogenic exotoxin expression. Proc Natl Acad Sci U S A. 1991 Apr 1;88(7):2668–2672. doi: 10.1073/pnas.88.7.2668. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Seppälä H., Vuopio-Varkila J., Osterblad M., Jahkola M., Rummukainen M., Holm S. E., Huovinen P. Evaluation of methods for epidemiologic typing of group A streptococci. J Infect Dis. 1994 Mar;169(3):519–525. doi: 10.1093/infdis/169.3.519. [DOI] [PubMed] [Google Scholar]
- Single L. A., Martin D. R. Clonal differences within M-types of the group A Streptococcus revealed by pulsed field gel electrophoresis. FEMS Microbiol Lett. 1992 Feb 1;70(1):85–89. doi: 10.1016/0378-1097(92)90567-8. [DOI] [PubMed] [Google Scholar]
- Stollerman G. H. Nephritogenic and rheumatogenic group A streptococci. J Infect Dis. 1969 Aug;120(2):258–263. doi: 10.1093/infdis/120.2.258. [DOI] [PubMed] [Google Scholar]
- Stollerman G. H. Rheumatogenic group A streptococci and the return of rheumatic fever. Adv Intern Med. 1990;35:1–25. [PubMed] [Google Scholar]
- Veasy L. G., Wiedmeier S. E., Orsmond G. S., Ruttenberg H. D., Boucek M. M., Roth S. J., Tait V. F., Thompson J. A., Daly J. A., Kaplan E. L. Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med. 1987 Feb 19;316(8):421–427. doi: 10.1056/NEJM198702193160801. [DOI] [PubMed] [Google Scholar]