title: Transfer of scarlet fever-associated elements into the group A Streptococcus M1T1 clone.
abstract: The group A Streptococcus (GAS) M1T1 clone emerged in the 1980s as a leading cause of epidemic invasive infections worldwide, including necrotizing fasciitis and toxic shock syndrome. Horizontal transfer of mobile genetic elements has played a central role in the evolution of the M1T1 clone, with bacteriophage-encoded determinants DNase Sda1 and superantigen SpeA2 contributing to enhanced virulence and colonization respectively. Outbreaks of scarlet fever in Hong Kong and China in 2011, caused primarily by emm12 GAS, led to our investigation of the next most common cause of scarlet fever, emm1 GAS. Genomic analysis of 18 emm1 isolates from Hong Kong and 16 emm1 isolates from mainland China revealed the presence of mobile genetic elements associated with the expansion of emm12 scarlet fever clones in the M1T1 genomic background. These mobile genetic elements confer expression of superantigens SSA and SpeC, and resistance to tetracycline, erythromycin and clindamycin. Horizontal transfer of mobile DNA conferring multi-drug resistance and expression of a new superantigen repertoire in the M1T1 clone should trigger heightened public health awareness for the global dissemination of these genetic elements.
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Nouri L
authors.initials: NL
authors.lastname: Ben Zakour
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.|The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Davies
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, Zhejiang, China.
authors.forename: Yuanhai
authors.initials: Y
authors.lastname: You
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China.|State Key Laboratory for Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Jonathan H K
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Forde
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Stanton-Cook
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China.
authors.forename: Ruifu
authors.initials: R
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China.
authors.forename: Yujun
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Barnett
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Carola
authors.initials: C
authors.lastname: Venturini
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Cheryl-lynn Y
authors.initials: CL
authors.lastname: Ong
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China.|State Key Laboratory for Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Herman
authors.initials: H
authors.lastname: Tse
authors.affiliation: The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom.
authors.forename: Gordon
authors.initials: G
authors.lastname: Dougan
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, Zhejiang, China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Microbiology, The University of Hong Kong, Hong Kong Special Administrative Region, China.|Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong Special Administrative Region, China.|State Key Laboratory for Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Beatson
authors.affiliation: Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Walker
mesh_terms: D000900:Anti-Bacterial Agents; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D020071:Interspersed Repetitive Sequences / Q000235:genetics*; D008826:Microbial Sensitivity Tests; D010802:Phylogeny; D012541:Scarlet Fever / Q000453:epidemiology / Q000382:microbiology*; D013291:Streptococcus / Q000235:genetics*; D014774:Virulence / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001425:Bacterial Outer Membrane Proteins