title: Cluster of Fatal Group A Streptococcal emm87 Infections in a Single Family: Molecular Basis for Invasion and Transmission.
abstract: Hypervirulent disease due to group A Streptococcus (GAS) can result from strains with mutations that enhance virulence gene expression but reduce subsequent transmission. We used whole-genome sequencing to investigate intrafamilial spread among 4 siblings of infection due to a hypervirulent GAS strain that resulted in a fatality. All invasive and pharyngeal GAS isolates had an identical mutation in a gene encoding a key regulatory protein that yielded a hyperinvasive phenotype. These data challenge the prevailing theory of reduced transmission induced by mutations that lead to hypervirulent GAS by showing that spread of hypervirulent GAS may lead to clusters of invasive disease.
authors.affiliation: Section of Infectious Diseases, Department of Pediatrics.|Department of Molecular Virology and Microbiology, Baylor College of Medicine.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Flores
authors.affiliation: Department of Pathology and Immunology.|Texas Children's Microbiome Center, Texas Children's Hospital.
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Luna
authors.affiliation: Department of Pathology and Immunology.|Texas Children's Microbiome Center, Texas Children's Hospital.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Runge
authors.affiliation: Infectious Diseases.|Genomic Medicine, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Shelburne
authors.affiliation: Section of Infectious Diseases, Department of Pediatrics.|Department of Molecular Virology and Microbiology, Baylor College of Medicine.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Baker
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000235:genetics; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000635:transmission; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D002352:Carrier Proteins / Q000235:genetics; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D000071677:Histidine Kinase; D006801:Humans; D007223:Infant; D047908:Intracellular Signaling Peptides and Proteins / Q000235:genetics; D008297:Male; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000635:transmission*; D013297:Streptococcus pyogenes / Q000235:genetics* / Q000472:pathogenicity*
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; D047908:Intracellular Signaling Peptides and Proteins; C014689:streptococcal M protein; C534547:CovS protein, Streptococcus pyogenes; D000071677:Histidine Kinase
keywords: Group A Streptococcus; bacterial pathogenesis; transmission; virulence; whole genome sequencing