Emergence of scarlet fever Streptococcus pyogenes emm12 clones in Hong Kong is associated with toxin acquisition and multidrug resistance.
A scarlet fever outbreak began in mainland China and Hong Kong in 2011 (refs. 1-6). Macrolide- and tetracycline-resistant Streptococcus pyogenes emm12 isolates represent the majority of clinical cases. Recently, we identified two mobile genetic elements that were closely associated with emm12 outbreak isolates: the integrative and conjugative element ICE-emm12, encoding genes for tetracycline and macrolide resistance, and prophage ΦHKU.vir, encoding the superantigens SSA and SpeC, as well as the DNase Spd1 (ref. 4). Here we sequenced the genomes of 141 emm12 isolates, including 132 isolated in Hong Kong between 2005 and 2011. We found that the introduction of several ICE-emm12 variants, ΦHKU.vir and a new prophage, ΦHKU.ssa, occurred in three distinct emm12 lineages late in the twentieth century. Acquisition of ssa and transposable elements encoding multidrug resistance genes triggered the expansion of scarlet fever-associated emm12 lineages in Hong Kong. The occurrence of multidrug-resistant ssa-harboring scarlet fever strains should prompt heightened surveillance within China and abroad for the dissemination of these mobile genetic elements.
1] Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia. [2] Wellcome Trust Sanger Institute, Hinxton, UK.
Mark R
MR
Davies
Wellcome Trust Sanger Institute, Hinxton, UK.
Matthew T
MT
Holden
Wellcome Trust Sanger Institute, Hinxton, UK.
Paul
P
Coupland
Department of Microbiology, Queen Mary Hospital, Hong Kong, China.
Jonathan H K
0000000275101696
JH
Chen
Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.
Carola
C
Venturini
Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.
Timothy C
TC
Barnett
Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.
Nouri L Ben
NL
Zakour
1] Department of Microbiology, Queen Mary Hospital, Hong Kong, China. [2] Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. [3] State Key Laboratory for Emerging Infectious Diseases, Hong Kong, China.
Herman
H
Tse
Wellcome Trust Sanger Institute, Hinxton, UK.
Gordon
G
Dougan
1] Department of Microbiology, Queen Mary Hospital, Hong Kong, China. [2] Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China. [3] State Key Laboratory for Emerging Infectious Diseases, Hong Kong, China.
Kwok-Yung
KY
Yuen
Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.
Mark J
MJ
Walker
D000293:Adolescent; D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial / Q000235:genetics; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics*; D002352:Carrier Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D005098:Exotoxins / Q000235:genetics; D040961:Genetic Drift; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D020071:Interspersed Repetitive Sequences / Q000235:genetics*; D008875:Middle Aged; D008969:Molecular Sequence Data; D059645:Mutation Rate; D010802:Phylogeny; D020641:Polymorphism, Single Nucleotide; D011159:Population Surveillance; D039002:Prophages / Q000235:genetics*; D012541:Scarlet Fever / Q000453:epidemiology / Q000382:microbiology*; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification / Q000378:metabolism / Q000821:virology; D055815:Young Adult
D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D002352:Carrier Proteins; D004269:DNA, Bacterial; D005098:Exotoxins; C027951:erythrogenic toxin; C014689:streptococcal M protein; C117321:streptococcal superantigen SSA