title: Association of phenotypic and genotypic characteristics of invasive Streptococcus pyogenes isolates with clinical components of streptococcal toxic shock syndrome.
abstract: Sixty-two invasive Streptococcus pyogenes strains, including 32 strains isolated from patients with streptococcal toxic shock syndrome (STSS), were analyzed for the following phenotypic and genotypic characteristics: M-protein type, serum opacity factor production, protease production, the presence of streptococcal pyrogenic exotoxin (Spe) genes A, B, and C, and in vitro production of SpeA and SpeB. These characteristics were analyzed for possible associations with each other as well as with clinical components of STSS. M-type 1, the most commonly isolated M-type, was significantly associated with protease production. Protease activity was significantly associated with the clinical sign of soft tissue necrosis. M-type 1 and 3 strains from STSS patients were significantly associated with the clinical signs of shock and organ involvement as well as with SpeA production in vitro. Finally, the production of SpeA was significantly associated with the clinical component of shock and organ involvement as well as with rash. These data suggest that STSS does not make up a single syndrome but, rather, that the multiple STSS clinical criteria probably reflect different phenotypic characteristics of individual S. pyogenes isolates.
authors.affiliation: Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
authors.forename: D F
authors.initials: DF
authors.lastname: Talkington
authors.forename: B
authors.initials: B
authors.lastname: Schwartz
authors.forename: C M
authors.initials: CM
authors.lastname: Black
authors.forename: J K
authors.initials: JK
authors.lastname: Todd
authors.forename: J
authors.initials: J
authors.lastname: Elliott
authors.forename: R F
authors.initials: RF
authors.lastname: Breiman
authors.forename: R R
authors.initials: RR
authors.lastname: Facklam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001426:Bacterial Proteins; D002648:Child; D002675:Child, Preschool; D010450:Endopeptidases / Q000378:metabolism; D005098:Exotoxins / Q000235:genetics / Q000633:toxicity*; D005260:Female; D005798:Genes, Bacterial; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D010641:Phenotype; D011817:Rabbits; D012772:Shock, Septic / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000201:enzymology / Q000235:genetics / Q000472:pathogenicity*
chemical_list: D001426:Bacterial Proteins; D005098:Exotoxins; D008565:Membrane Proteins; C117980:SpeA protein, Streptococcus pyogenes; C027951:erythrogenic toxin; D010450:Endopeptidases