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Journal of Clinical Microbiology, March 2003, p. 937-942, Vol. 41, No. 3
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.3.937-942.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Epidemiologic Analysis of Invasive and Noninvasive Group A Streptococcal Isolates in Hong Kong

P. L. Ho,1* D. R. Johnson,2 A. W. Y. Yue,1 D. N. C. Tsang,1 T. L. Que,1 B. Beall,3 and E. L. Kaplan2

Center of Infection, Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region, People's Republic of China,1 WHO Collaborating Center for Reference and Research on Streptococci, Medical School, University of Minnesota, Minneapolis, Minnesota,2 The Division of Bacterial and Mycotic Diseases, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia3

Received 9 September 2002/ Returned for modification 10 October 2002/ Accepted 9 December 2002

Since the mid-1980s, there has been a resurgence of severe forms of invasive group A streptococcal (GAS) disease in many Western countries. In Hong Kong, a similar increase has also been observed in recent years. One hundred seven GAS isolates collected from 1995 to 1998 from individuals with necrotizing fasciitis, toxic shock syndrome, meningitis, or other type of bacteremic sepsis (invasive group, n = 24) as well as from individuals with minor skin and throat infections (noninvasive group, n = 83) were characterized through serologic and/or emm sequence typing. Thirty-two M protein gene sequence types were identified. Types M1, M4, and M12 were the most prevalent in both the invasive group and the noninvasive group; together they accounted for 70.8 and 37.3% of the isolates, respectively. No clear pattern of skin and throat infection M types was observed. Type M1 was overrepresented in the invasive and pharyngeal isolates. The same pulsed-field gel electrophoresis pattern was shared by most invasive and all pharyngeal M1 isolates. Overall, resistance to erythromycin (32%) and tetracycline (53%) was high, but M1 isolates were significantly less likely to have resistance to either antimicrobial agent than non-M1 isolates. One novel emm sequence type, stHK, was identified in an isolate from a patient with necrotizing fasciitis. Minor emm gene sequence alterations were noted for 31 isolates, and for 13 of these isolates, deletion, insertion, or point mutations were seen in the hypervariable 50 N-terminal residues.

* Corresponding author. Mailing address: Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Rd., Pokfulam, Hong Kong, Special Administrative Region, People's Republic of China. Phone: 852-2855-4892. Fax: 852-2855-1241. E-mail: plho{at}hkucc.hku.hk.

Journal of Clinical Microbiology, March 2003, p. 937-942, Vol. 41, No. 3
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.3.937-942.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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