title: Real-time molecular epidemiologic analysis of an outbreak of Streptococcus pyogenes invasive disease in US Air Force trainees.
abstract: OBJECTIVE
  To determine if molecular epidemiologic techniques, including comparative automated DNA sequencing of polymorphic virulence genes, could be used in the course of a bacterial disease outbreak to unambiguously determine clonal relationships among implicated strains.
  
  
  METHODS
  Strains recovered from all patients with invasive infections and a sample of carriers were analyzed by multilocus enzyme electrophoresis and automated DNA sequencing of a gene encoding an extracellular protease and a highly polymorphic part of the streptokinase gene.
  
  
  METHODS
  A US Air Force training facility in San Antonio, Tex.
  
  
  METHODS
  A squadron with about 800 Air Force trainees, including three recruits with invasive Streptococcus pyogenes infections.
  
  
  RESULTS
  Multilocus enzyme electrophoresis and automated DNA sequencing of polymorphic virulence genes unambiguously defined person-to-person spread of an otherwise rare S pyogenes clone in the course of the disease outbreak and clarified strain relationships in real time.
  
  
  CONCLUSIONS
  Molecular strain characterization techniques can be employed rapidly in a disease outbreak to definitively resolve complex relationships among pathogenic bacteria, infer patterns of clone spread, and help formulate rational public health control measures. The approach has broad applicability to other infectious agents.
authors.affiliation: Department of Pathology, Baylor College of Medicine, Houston, Tex. 77030.
authors.forename: J M
authors.initials: JM
authors.lastname: Musser
authors.forename: V
authors.initials: V
authors.lastname: Kapur
authors.forename: J E
authors.initials: JE
authors.lastname: Peters
authors.forename: C W
authors.initials: CW
authors.lastname: Hendrix
authors.forename: D
authors.initials: D
authors.lastname: Drehner
authors.forename: G D
authors.initials: GD
authors.lastname: Gackstetter
authors.forename: D R
authors.initials: DR
authors.lastname: Skalka
authors.forename: P L
authors.initials: PL
authors.lastname: Fort
authors.forename: J T
authors.initials: JT
authors.lastname: Maffei
authors.forename: L L
authors.initials: LL
authors.lastname: Li
mesh_terms: D000328:Adult; D001483:Base Sequence; D002353:Carrier State; D003199:Computer Systems; D004247:DNA / Q000235:genetics; D004196:Disease Outbreaks; D004586:Electrophoresis / Q000379:methods; D010450:Endopeptidases / Q000235:genetics; D006801:Humans; D008297:Male; D008889:Military Personnel; D008967:Molecular Biology / Q000379:methods*; D008969:Molecular Sequence Data; D015345:Oligonucleotide Probes / Q000235:genetics; D013290:Streptococcal Infections / Q000453:epidemiology*; D013297:Streptococcus pyogenes / Q000235:genetics; D013300:Streptokinase / Q000235:genetics; D014481:United States
chemical_list: D015345:Oligonucleotide Probes; D004247:DNA; D010450:Endopeptidases; D013300:Streptokinase