title: Emergence of Streptococcus pyogenes emm102 causing toxic shock syndrome in Southern Taiwan during 2005-2012.
abstract: BACKGROUND
  Streptococcal toxic shock syndrome (STSS) is an uncommon but life-threatening disease caused by Streptococcus pyogenes.
  
  
  METHODS
  To understand the clinical and molecular characteristics of STSS, we analyzed clinical data and explored the emm types, superantigen genes, and pulsed-field gel electrophoresis of causative S. pyogenes isolates obtained between 2005 and 2012.
  
  
  RESULTS
  In total, 53 patients with STSS were included in this study. The median age of the patients was 57 years (range: 9-83 years), and 81.1% were male. The most prevalent underlying disease was diabetes mellitus (45.3%). Skin and soft-tissue infection accounted for 86.8% of STSS. The overall mortality rate was 32.1%. Underlying diseases had no statistical impact on mortality. A total of 19 different emm types were identified. The most prevalent emm type was emm102 (18.9%), followed by emm11 (17%), emm1 (11.3%), emm87 (9.4%), and emm89 (7.5%). There was no statistically significant association between emm type and a fatal outcome. Among the superantigen genes, speB was the most frequently detected one (92.5%), followed by smeZ (90.6%), speG (81.1%), speC (39.6%), and speF (39.6%). The majority of emm102 strains were found to have speB, speC, speG, and smeZ. The presence of speG was negatively associated with a fatal outcome (P = 0.045).
  
  
  CONCLUSIONS
  Our surveillance revealed the emergence of uncommon emm types, particularly emm102, causing STSS in southern Taiwan. Characterization of clinical, epidemiological, and molecular characteristics of STSS will improve our understanding of this life-threatening disease.
authors.affiliation: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan ; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Jiun-Nong
authors.initials: JN
authors.lastname: Lin
authors.affiliation: Department of Microbiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Lin-Li
authors.initials: LL
authors.lastname: Chang
authors.affiliation: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chung-Hsu
authors.initials: CH
authors.lastname: Lai
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan ; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hsi-Hsun
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan ; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000145:classification / Q000235:genetics*; D001425:Bacterial Outer Membrane Proteins / Q000145:classification / Q000235:genetics*; D001426:Bacterial Proteins / Q000145:classification / Q000235:genetics*; D015373:Bacterial Typing Techniques; D002352:Carrier Proteins / Q000145:classification / Q000235:genetics*; D002648:Child; D003920:Diabetes Mellitus / Q000503:physiopathology; D005098:Exotoxins / Q000145:classification / Q000235:genetics*; D005260:Female; D015870:Gene Expression; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012772:Shock, Septic / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013297:Streptococcus pyogenes / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D001426:Bacterial Proteins; D002352:Carrier Proteins; D005098:Exotoxins; C027951:erythrogenic toxin; C014689:streptococcal M protein