Group A streptococcal infections of the skin: molecular advances but limited therapeutic progress.
OBJECTIVE
With the sequencing of several Streptococcus pyogenes (group A Streptococcus) genomes have come major advances in understanding the pathogenesis of group A Streptococcus-associated diseases. This review focuses on group A Streptococcus skin infections and summarizes data published in the English language medical literature in 2004 and 2005.


RESULTS
Group A Streptococcus shows enormous and evolving molecular diversity driven by horizontal transmission between group A Streptococcus strains and between group A Streptococcus and other streptococci. Acquisition of prophages accounts for much of the diversity, conferring both virulence through phage-associated virulence factors and increased bacterial survival against host defences. Studies of group A Streptococcus isolates outside the US also question the generalizability of classic group A Streptococcus M serotype associations with specific disease entities such as acute rheumatic fever and necrotizing fasciitis. The distinction between throat and skin group A Streptococcus has become blurred. Although there have been few advances in treatment of group A Streptococcus skin infections, developments towards group A Streptococcus vaccines are promising.


CONCLUSIONS
The diversity of group A Streptococcus remains a challenge for vaccine development. As acute rheumatic fever and streptococcal pyoderma occur predominantly in disadvantaged populations, international funding support will be necessary for any group A Streptococcus vaccine to have a sustained impact on the global burden of disease.
Currie
Bart J
BJ
Tropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory 0811, Australia. bart@menzies.edu.au
D006801:Humans; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D022541:Streptococcal Vaccines; D013297:Streptococcus pyogenes / Q000145:classification / Q000235:genetics* / Q000472:pathogenicity*; D014774:Virulence
D022541:Streptococcal Vaccines