title: Group A streptococcal puerperal sepsis: initial characterization of virulence factors in association with clinical parameters.
abstract: Group A beta-hemolytic streptococcus (GAS) is an uncommon but potentially fatal source of postpartum infection. Pathogenesis in invasive GAS infections has been linked to bacterial virulence factors. In this study, we sought to provide an initial description of potential virulence factors in association with puerperal morbidity by virtue of specific M-protein type antigens. Women with confirmed GAS puerperal infection in the Salt Lake City region were prospectively identified over a 6-year interval (1991-1997). From this cohort, GAS isolates were analyzed with respect to M-serotype and presence of genes encoding the Streptococcal Pyogenic Exotoxins A and B (SPE-A and SPE-B). Bacterial isolates from 18 subjects with GAS puerperal infection underwent M-serotyping and PCR-based genotyping for the speA and speB genes. Among these, 8/18 subjects manifest criteria of severe disease. All 18 isolate strains expressed speB; 6/18 isolates expressed speA. Of the M-serotypes, 8/8 severe disease isolates expressed M-types 1 (N=3) or 28 (N=5). Pulse-field gel electrophoresis did not indicate an outbreak strain among similar isolates. We conclude that in this initial characterization, morbidity among women with GAS puerperal infection is associated with M-types 1 and 28, but not speB genotype.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, USA.
authors.forename: Janice L B
authors.initials: JL
authors.lastname: Byrne
authors.forename: Kjersti M
authors.initials: KM
authors.lastname: Aagaard-Tillery
authors.forename: Jason L
authors.initials: JL
authors.lastname: Johnson
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Wright
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D000328:Adult; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D004269:DNA, Bacterial / Q000032:analysis*; D018450:Disease Progression; D004198:Disease Susceptibility / Q000382:microbiology; D005098:Exotoxins / Q000235:genetics / Q000378:metabolism*; D005260:Female; D005838:Genotype; D006801:Humans; D008565:Membrane Proteins / Q000235:genetics / Q000378:metabolism*; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D011645:Puerperal Infection / Q000453:epidemiology / Q000382:microbiology* / Q000503:physiopathology; D012703:Serotyping; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology* / Q000503:physiopathology; D013297:Streptococcus pyogenes / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D037521:Virulence Factors / Q000235:genetics
chemical_list: D001426:Bacterial Proteins; D004269:DNA, Bacterial; D005098:Exotoxins; D008565:Membrane Proteins; C117980:SpeA protein, Streptococcus pyogenes; D037521:Virulence Factors; C027951:erythrogenic toxin