title: Clinical and molecular epidemiology of beta-hemolytic streptococcal infections in India.
abstract: BACKGROUND
  Beta-hemolytic streptococci (βHS) cause a diverse array of human infections. Despite the high number of cases of streptococcal carriers and diseases, studies discerning the molecular epidemiology of βHS in India are limited. This study reports the molecular and clinical epidemiology of beta-hemolytic streptococcal infections from two geographically distinct regions of India.
  
  
  METHODS
  A total of 186 isolates of βHS from north and south India were included. The isolates were identified to species level and subjected to antimicrobial susceptibility testing. Polymerase chain reaction (PCR) was done to detect exotoxin genes, and emm types of group A streptococci (GAS) strains were ascertained by sequencing.
  
  
  RESULTS
  GAS was the most common isolate (71.5%), followed by group G streptococci (GGS) (21%). A large proportion of GAS produced speB (97%), smeZ (89%), speF (91%), and speG (84%). SmeZ was produced by 21% and 50% of GGS and GGS, respectively. A total of 45 different emm types/subtypes were seen in GAS, with emm 11 being the most common. Resistance to tetracycline (73%) and erythromycin (34.5%) was commonly seen in GAS.
  
  
  CONCLUSIONS
  A high diversity of emm types was seen in Indian GAS isolates with high macrolide and tetracycline resistance. SpeA was less commonly seen in Indian GAS isolates. There was no association between disease severity and exotoxin gene production.
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India. purvamathur@yahoo.co.in.
authors.forename: Purva
authors.initials: P
authors.lastname: Mathur
authors.forename: Nidhi
authors.initials: N
authors.lastname: Bhardwaj
authors.forename: Kushal
authors.initials: K
authors.lastname: Mathur
authors.forename: Bijayini
authors.initials: B
authors.lastname: Behera
authors.forename: Gunjan
authors.initials: G
authors.lastname: Gupta
authors.forename: Arti
authors.initials: A
authors.lastname: Kapil
authors.forename: Sarman
authors.initials: S
authors.lastname: Singh
authors.forename: Mahesh Chandra
authors.initials: MC
authors.lastname: Misra
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000942:Antigens, Bacterial / Q000235:genetics; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D002352:Carrier Proteins / Q000235:genetics; D024881:Drug Resistance, Bacterial; D014644:Genetic Variation; D006460:Hemolysin Proteins / Q000235:genetics*; D006801:Humans; D007194:India / Q000453:epidemiology; D018942:Macrolides / Q000494:pharmacology; D017720:Molecular Epidemiology; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013291:Streptococcus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D013752:Tetracycline / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; D006460:Hemolysin Proteins; D018942:Macrolides; C014689:streptococcal M protein; D013752:Tetracycline