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Journal of Clinical Microbiology, July 2005, p. 3101-3109, Vol. 43, No. 7
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.7.3101-3109.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Variations in emm Type among Group A Streptococcal Isolates Causing Invasive or Noninvasive Infections in a Nationwide Study

Kim Ekelund,^1* Jessica Darenberg,² Anna Norrby-Teglund,² Steen Hoffmann,¹ Didi Bang,^3, Peter Skinhøj,⁴ and Helle Bossen Konradsen¹

Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark,¹ Karolinska Institute, Center for Infectious Medicine, Karolinska University Hospital, Stockholm, Sweden,² Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen, Denmark,³ Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark⁴

Received 2 February 2005/ Returned for modification 16 March 2005/ Accepted 29 March 2005

Since the late 1980s several studies have described the increased incidence and severity of invasive group A streptococcal (GAS) infections. However, most studies on GAS pathogenesis have focused on information obtained during outbreaks. We analyzed isolate distribution and host susceptibility as part of a nationwide prospective surveillance study performed between January 2001 and August 2002. GAS isolates collected from 201 patients with invasive infections, 335 patients with noninvasive infections, and 17 asymptomatic carriers were characterized with respect to their emm types and superantigen genotypes. The superantigen-neutralizing capacity and levels of antibodies against streptolysin O and DNAse B were determined for isolates from the sera from 36 invasive cases and 91 noninvasive cases. emm type 1 (emm-1) isolates were significantly more common among invasive cases, whereas emm-4, emm-6, and emm-12 dominated among the noninvasive cases. The distributions of the phage-associated superantigen genes (speA, speC, speH, speI, ssa) differed among invasive and noninvasive isolates, mainly due to their linkage to certain emm types. No significant differences in serum superantigen-neutralizing capacities were observed. The levels of anti-streptolysin O and anti-DNAse B antibodies were highest in the sera from invasive cases. Our study emphasizes the importance of obtaining data during years with stable incidences, which will enable evaluation of future outbreak data.

Present address: International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.

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