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Increased kasugamycin sensitivity in Escherichia coli caused by the presence of an inducible erythromycin resistance (erm) gene of Streptococcus pyogenes.

An inducible erythromycin resistance gene (erm) of Streptococcus pyogenes was introduced into Escherichia coli by transformation with a plasmid. The recipient E. coli cells were either kasugamycin sensitive (wildtype) or kasugamycin resistant (ksgA). The MIC values of erythromycin increased from 150 micrograms/ml to greater than 3000 micrograms/ml for E. coli. An extract of transformed cells, particularly a high-salt ribosomal wash, contained an enzyme that was able to methylate 23S rRNA from untransformed cells in vitro; however, 23S rRNA from transformed cells was not a substrate for methylation by such an extract. 165 rRNA and 30S ribosomal subunits of either the wild type or a kasugamycin resistant (ksgA) mutant were not methylated in vitro. Transformation of E. coli by the erm-containing plasmid led to a reduction of the MIC values for kasugamycin. This happened in wild-type as well as in ksgA cells. However, in vitro experiments with purified ksgA encoded methylase demonstrated that also in erm transformed E. coli, the ksgA encoded enzyme was active in wild-type, but not in ksgA cells. It was also shown by in vitro experiments that ribosomes from erm ksgA cells have become sensitive to kasugamycin. Our experiments show that in vivo methylation of 23S rRNA, presumably of the adenosine at position 2058, leads to enhanced resistance to erythromycin and to reduced resistance to kasugamycin. This, together with previous data, argues for a close proximity of the two sites on the ribosome that are substrates for adenosine dimethylation.

Aminoglycosides↗

The emergence of erythromycin-resistant Streptococcus pyogenes in Seoul, Korea.

High frequencies of erythromycin-resistant streptococci were reported in Japan in the mid-1970s, and in Finland in the late 1980s, related to an increase in the consumption of macrolide antibiotics in these countries. The frequency of erythromycin-resistant Streptococcus pyogenes was reported to be only 2% in 1994, but we know that the susceptibility of the strains to antibiotics had not been tested routinely. We studied the resistance rates of Streptococcus pyogenes to various antibiotics in Seoul, Korea, where antibiotics could be purchased without prescription. From January through December, 1998, 92 isolates of group A streptococci were collected from inpatients and outpatients with pharyngotonsillitis or invasive streptococcal infections, from institutions in five different geographic areas of Seoul; one pediatric clinic, three university hospitals, and one general hospital. All isolates were serotyped by T-agglutination, and minimum inhibitory concentrations (MICs) were determined by agar dilution methods, according to the guidelines of the National Committee for Clinical Laboratory Standards (NCCLS). The most common T-serotype was T12 (44.6%), followed by T4 (19.6%). All the isolates tested were susceptible to penicillin, vancomycin, and cefotaxime. However, 38 isolates (41.3%) were resistant to erythromycin, 32 (34.8%) were resistant to clindamycin, and 48 (52.1%) were resistant to tetracycline. Twenty-seven of 41 isolates serotyped T12 and 3 of 18 isolates serotyped T28 were multiresistant to erythromycin, clindamycin, and tetracycline. Almost half of the isolates obtained from the five different areas in Seoul showed erythromycin resistance in Streptococcus pyogenes. Routine monitoring of antibiotic susceptibility tests and further extensive nationwide surveys are needed to determine the frequency and the extent of the spread of resistant strains in various geographic regions in Korea.

Adolescent↗

Streptococcus pyogenes meningitis.

Group A Streptococcus (GAS) is a rare cause of meningitis. Although it has a high mortality, the condition is easily treatable if diagnosed early since the bacteria retains its sensitivity to many antimicrobials. The authors report here two cases of GAS meningitis along with a review of world literature.

Anti-Bacterial Agents↗

Two distinct genotypes of prtF2, encoding a fibronectin binding protein, and evolution of the gene family in Streptococcus pyogenes.

The group A Streptococcus (GAS) is an important pathogen that is responsible for a wide range of human diseases. Fibronectin binding proteins (FBPs) play an important role in promoting GAS adherence and invasion of host cells. The prtF2 gene encodes an FBP and is present in approximately 60% of GAS strains. In the present study we examined 51 prtF2-positive GAS strains isolated from the Northern Territory of Australia, and here we describe two genotypes of prtF2 which are mutually exclusive. The two genotypes have been identified previously as pfbp and fbaB. We show that these genotypes map to the same chromosomal location within the highly recombinatorial fibronectin-collagen-T antigen (FCT) locus, indicating that they arose from a common ancestor, and in this study these genotypes were designated the pfbp type and the fbaB type. Phylogenetic analysis of seven pfbp types, 14 fbaB types, and 11 prtF2-negative GAS strains by pulsed-field gel electrophoresis (PFGE) produced 32 distinct PFGE patterns. Interpretation of evolution based on the PFGE dendrogram by parsimony suggested that the pfbp type had a recent origin compared to the fbaB type. A comparison of multiple DNA sequences of the pfbp and fbaB types revealed a mosaic pattern for the amino-terminal region of the pfbp types. The fbaB type is generally conserved at the amino terminus but varies in the number of fibronectin binding repeats in the carboxy terminus. Our data also suggest that there is a possible association of the pfbp genotype with sof (84.2%), while the fbaB genotype was found in a majority of the GAS strains negative for sof (90.6%), indicating that these two prtF2 subtypes may be under different selective pressures.

Adhesins, Bacterial↗

Complex surveillance of Streptococcus pyogenes V. Protective features complex surveillance of streptococcus of cell-mediated immunity against group a streptococci.

Exoproducts of incubated white blood elements from persons hypersensitive to zymosan were found to promote the phagocytic activity of human microphages (and guinea pig macrophages) under conditions of a combined model of "MIF-opsonophagocytic test". The stimulation resulted in a bacteriostatic effect, was non-type-specific and improved microphage potential to inactivate streptococci opsonized with anti-M antibodies in low titre. The microphages pre-exposed to anti-M sera remained unaffected, the effect was non-species-specific and nontype-specific and the stimulation resulted from the action of albumin fraction exoproducts. This seems to suggest that human mediators (lymphokines) may promote the activity of phagocytes. The cell-mediated immunity appears thus to have protective features even in the case of streptococci which are the typical extracellular parasites. The drawbacks of the model used, which make it difficult to quantify the found mechanism under in vivo conditions, are discussed in detail.

Animals↗

[M protein gene (emm) typing of Streptococcus pyogenes].

T-agglutination typing and M protein gene (emm) typing were determined on the isolates of Streptococcus pyogenes taken from patients in Osaka and neighboring districts during 1996-2000. A total of 701 isolates were classified to 15 kinds of T types and type untypable. In all isolates, T 12 was revealed as the most dominant serotype, followed by T1, T4 and T2. The isolation rates of T 12 strains were high through these five years, and these of T1 or T4 strains formed epidemic waves showing the peak to be from 1997 to 1999 and 1998 to 2000, respectively. These of T2 strains were high in 1996 and 1997 and decreased rapidly. In 2000 T2 strain has not been detected. A total of 304 isolates were examined for emm typing. We are able to determine the emm type of all isolates including T-untypable (UT) isolates and to classify 21 kinds of emm types. T1, T2, T4, T6, T9, T11, T12, T22, T25 strains exhibited one T-type and emm type pattern association respectively such as T1/emm1, T2/emm2, T4/emm4, T6/emm6, T9/emm9, T11/emm11, T12/emm12, T22/emm22, T25/emm75. Whereas T13 strains had varied T/emm pattern associations such as T13/emm73, T13/emm77, T13/emm101. Similarly, T28, TB3264, UT had varied T/emm pattern associations. emm28 and emm87 were seen in T28, emm89 and emm94 in TB3264, emm2, emm12, emm22, emm58, emm75, emm77 and emm112 in UT. The emm typing method did not require many kinds of M typing antisera, and were successful by using the two highly conserved primers to amplify the emm gene and direct sequencing. Therefore, this method was a useful tool for typing Streptococcus pyogenes isolates.

Antigens, Bacterial↗

Dissemination of emm28 erythromycin-, clindamycin- and bacitracin-resistant Streptococcus pyogenes in Spain.

Reported here is an unusual cluster of non-invasive infections caused by an emm28 Streptococcus pyogenes strain resistant to bacitracin, erythromycin and clindamycin detected in Santander, Spain. Since one of the characteristics of group A streptococci is their almost uniform susceptibility to bacitracin, this finding was unusual, and a search for bacitracin-resistant Streptococcus pyogenes strains was conducted in two other distant cities of Spain (Madrid and San Sebastián) where their presence was confirmed. These strains were frequently associated with erythromycin- and clindamycin-resistance, and most of them belonged to a unique emm28 T28, ST52 clone.

Bacitracin↗

Spectrum of disease in bacteraemic patients during a Streptococcus pyogenes serotype M-1 epidemic in Norway in 1988.

All 87 known cases of bacteraemia due to Streptococcus pyogenes (beta-haemolytic group A streptococci) occurring during the peak of a nationwide outbreak in Norway (population 4.2 million) between January and June 1988 were reviewed. Clinical features varied widely and appeared largely to be dependent on the patients' age. The case fatality rate ranged from 11% in the age group under 30 years to 44% in patients over 60 years. Clinical complications such as shock, severe renal or respiratory failure or serious local infection occurred particularly in 30-to 59-year old individuals. Shock was manifest in 32% of the patients and carried a 68% case fatality rate. Chronic heart disease in the elderly and pneumonia seemed to be associated with a fatal outcome. In the 25 patients (29%) who died the disease showed a fulminant course, 80% dying within 48 hours after admission. However, 56% of the patients had experienced symptoms for more than two days before admission, suggesting that early diagnosis and treatment might possibly have prevented the development of a serious disease. This study revealed a wide spectrum of clinical manifestations in bacteraemia cases in a unique epidemiological situation caused largely by a single serotype of Streptococcus pyogenes; 89% of the 27 preserved bacteraemia strains carried the M-1 antigen. The observations call attention to the ability of these organisms to cause fulminant clinical illness, indicating a probable increase in both invasiveness and toxicity of group A streptococci responsible for the epidemic.

Adolescent↗

Rapidly fatal necrotising fasciitis caused by Streptococcus pyogenes.

AIMS: To describe the morbid anatomical and bacteriological features in a series of five cases of rapidly fatal Streptococcus pyogenes necrotising fasciitis. METHODS: Post mortem and bacteriological examinations were made of five patients dying within 48 hours from rapidly fatal necrotising fasciitis. RESULTS: All five cases died rapidly from a toxic Streptococcus toxin syndrome as a result of developing necrotising fasciitis following trivial injury. CONCLUSIONS: Necrotising fasciitis caused by Streptococcus pyogenes infection can be rapidly fatal. This is probably the result of a toxic shock syndrome. Rapid, early diagnosis and swift and probably empirical treatment is required to avoid a fatal outcome.

Adult↗

Parameters affecting the adherence and tissue tropisms of Streptococcus pyogenes.

Virulent M protein-containing strains of Streptococcus pyogenes were found to adhere well to human pharyngeal cells in vitro. In contrast, an avirulent M - strain and an enteropathogenic Escherichia coli strain adhered feebly. When various rat tissues were exposed to mixtures of a virulent S. pyogenes strain and an enteropathogenic E. coli strain, the relative proportions of the two pathogenic strains recovered from mucosal surfaces differed among the sites studied. S. pyogenes cells were found to adhere in higher proportions than enteropathogenic E. coli cells to the mucosal surfaces of rat tongues, whereas on surfaces of the urinary bladder, their affinities were reversed. The data indicate that bacterial adherence is influenced by the specificity of both the bacterial and epithelial surfaces, and they suggest that adherence may influence the tissue tropisms of pathogens. Early stationary-phase cells of S. pyogenes attached better to epithelial cells than did bacteria in other growth phases. The adherence of S. pyogenes cells was impaired by pretreatment with trypsin, wheat germ lipase, Tween 80, Triton X-100, sodium lauryl sulfate, heat at 56 C, anti-group A antiserum, the presence of phospholipids, and preincubation of the epithelial cells with Streptococcus salivarius cell walls. Altering the pH or treatment with ethylenediaminetetraacetic acid had no effect on the ability of S. pyogenes cells to adhere.

Animals↗

Host-pathogen interactions in Streptococcus pyogenes infections, with special reference to puerperal fever and a comment on vaccine development.

Streptococcus pyogenes (group A streptococcus) causes a variety of diseases, including acute pharyngitis, impetigo, rheumatic fever and the streptococcal toxic shock syndrome. Moreover, S. pyogenes was responsible for the classical example of a nosocomial infection, the epidemics of puerperal fever (childbed fever) that caused the death of numerous women in earlier centuries. The most extensively studied virulence factor of S. pyogenes is the surface M protein, which inhibits phagocytosis and shows antigenic variation. Recent data indicate that many M proteins confer phagocytosis resistance because the variable N-terminal region has non-overlapping sites that specifically bind two components of the human immune system, the complement inhibitor C4b-binding protein (C4BP) and IgA-Fc. Concerning puerperal fever, molecular and epidemiological analysis suggests that the S. pyogenes surface protein R28 may have played a pathogenetic role in these epidemics. This article summarizes the properties of M protein and the R28 protein and considers a potential problem encountered in connection with the use of animal models for vaccine development.

Antigens, Bacterial↗

A novel sortase, SrtC2, from Streptococcus pyogenes anchors a surface protein containing a QVPTGV motif to the cell wall.

The important human pathogen Streptococcus pyogenes (group A streptococcus GAS), requires several surface proteins to interact with its human host. Many of these are covalently linked by a sortase enzyme to the cell wall via a C-terminal LPXTG motif. This motif is followed by a hydrophobic region and charged C terminus, which are thought to retard the protein in the cell membrane to facilitate recognition by the membrane-localized sortase. Previously, we identified two sortase enzymes in GAS. SrtA is found in all GAS strains and anchors most proteins containing LPXTG, while SrtB is present only in some strains and anchors a subset of LPXTG-containing proteins. We now report the presence of a third sortase in most strains of GAS, SrtC. We show that SrtC mediates attachment of a protein with a QVPTGV motif preceding a hydrophobic region and charged tail. We also demonstrate that the QVPTGV sequence is a substrate for anchoring of this protein by SrtC. Furthermore, replacing this motif with LPSTGE, found in the SrtA-anchored M protein of GAS, leads to SrtA-dependent secretion of the protein but does not lead to its anchoring by SrtA. We conclude that srtC encodes a novel sortase that anchors a protein containing a QVPTGV motif to the surface of GAS.

Amino Acid Motifs↗

Streptococcus pyogenes protein F promotes invasion of HeLa cells.

Although the Gram-positive bacterium Streptococcus pyogenes (group A streptococcus) has been considered an extracellular pathogen which adheres to human mucosal epithelium, the streptococcus possesses invasive capacity for cultured human epithelial cells. This study provides genetic and functional evidence supporting the conclusion that protein F is capable of mediating entry of S. pyogenes into HeLa cells. Using Tn916 insertion mutagenesis or an isogenic S. pyogenes strain with a defined mutation in the gene encoding protein F (prtF), it was observed that the invasive capacity was affected by the levels of surface-exposed protein F, but not by those of M protein. In addition, heterologous expression of protein F on Enterococcus faecalis conferred upon the bacteria an efficient invasive phenotype. Several assays demonstrated that both the fibronectin-binding domains of protein F, UR and RD2, were involved in host-cell invasion. In addition, coinfection experiments of HeLa cells with S. pyogenes and an Escherichia coli K-12 strain expressing an afimbrial adhesin AFA-I showed that the uptake of S. pyogenes did not permit internalization of the E. coli cells.

Adhesins, Bacterial↗

Prophage association of mef(A) elements encoding efflux-mediated erythromycin resistance in Streptococcus pyogenes.

OBJECTIVES: To compare different mef(A) elements of Streptococcus pyogenes for a possible chimeric genetic nature, i.e. a transposon inserted into a prophage. METHODS: Eleven S. pyogenes isolates with efflux-mediated erythromycin resistance were used. The isolates were typed using several genotypic approaches. Gene detection was performed by PCR using specific primer pairs. The mef(A) elements of the test strains were induced with mitomycin C and phage DNA was extracted. Induction was monitored by PCR using primers targeting mef(A). RESULTS: Six tetracycline-susceptible isolates had PCR evidence of all of the eight open reading frames (ORFs) of the Tn1207.1 element; their mef(A) element was consistent with the Tn1207.3 element in four isolates and with the 58.8 kb chimeric element in two. Five tetracycline-resistant isolates had no PCR evidence of orf1 and orf2 and showed variable patterns as to orf3, orf7, and orf8. Three ORFs placed along the conserved region downstream of Tn1207.1 in the 58.8 kb mef(A) chimeric element were detected in the six tetracycline-susceptible, but not in the five tetracycline-resistant isolates. Induction assays with mitomycin C demonstrated that the mef(A) elements of all strains tested were present in culture supernatants in a DNAse-resistant form, such as a phage capsid. CONCLUSIONS: All recognized mef(A) elements of S. pyogenes appear to be prophage-associated. Whereas the two elements detected in tetracycline-susceptible isolates (Tn1207.3 and the 58.8 kb one) were apparently inserted into the same prophage, the tet(O)-mef(A) element was inserted into a different prophage. Phage transfer is likely to play a critical role in the dissemination of erythromycin resistance in S. pyogenes populations.

Bacterial Proteins↗

Cloning and characterization of two novel DNases from Streptococcus pyogenes.

The proteins in the culture supernatant (exoproteins) from Streptococcus pyogenes serotype M1 were separated by two-dimensional gel electrophoresis, and their N-terminal amino acid sequences were determined. The amino acid sequences were compared to sequences in the S. pyogenes genome database. The coding sequence showed similarity to sequences of two genes, mf2-v ( mf2 variant) and mf3, which had sequence similarity to genes encoding mitogenic factor (MF); MF has DNase activity. The recombinant genes were expressed in Escherichia coli and the proteins were synthesized. Mf2-v and Mf3 had DNase activity. The activity of Mf2-v was localized to the C-terminal half of the protein. The mf3 gene was shown to be present in most clinically isolated strains of S. pyogenes tested, and the mf2gene was detected in 20% of the isolates. The products of the mf2 and mf3 genes in clinically isolated S. pyogenes strains were thus shown to be DNases.

Amino Acid Sequence↗

Identification of an insertion sequence located in a region encoding virulence factors of Streptococcus pyogenes.

An insertion sequence, IS1562, was identified in a Streptococcus pyogenes strain of the clinically important M1 serotype. IS1562 is located in the mga regulon between the genes coding for the M protein and the C5a peptidase, both important virulence factors. The same or similar insertion sequences were found in most S. pyogenes strains, but the chromosomal location differed among isolates.

Adhesins, Bacterial↗

Identification of a novel glycoprotein-binding activity in Streptococcus pyogenes regulated by the mga gene.

The interaction between Streptococcus pyogenes and the host cell surface is not completely understood. Characterization of the adhesion mechanisms of the bacterium to the host cell surface is needed in order to develop new vaccines and anti-adhesion drugs. The presence of glycoprotein-binding activities among streptococcal strains was investigated. An activity binding to thyroglobulin, fetuin, asialofetuin and mucin but not non-glycosylated proteins was found to be present in the majority of the S. pyogenes strains studied. Cross-inhibition experiments suggested that the glycoproteins share a common structure recognized by the bacteria. The glycoprotein-binding activity was found to be proteinaceous, tightly attached to the bacterial surface and it also mediated the adherence of bacteria to solid surfaces coated with glycoproteins. The activity was found by transposon mutagenesis and complementation to be regulated by the multiple-gene regulator Mga, which has been implicated as a regulator of S. pyogenes virulence factors.

Bacterial Adhesion↗

Erythromycin resistance genes in Streptococcus pyogenes isolates in Kanagawa, Japan.

The susceptibility of 224 Streptococcus pyogenes isolates obtained from children in Japan from 1981 to 1997 to treatment with erythromycin was determined by the agar dilution method. A total of 17 isolates belonging to serotype M12T12 were resistant (MICs>1 microg/ml). Fourteen of the 17 resistant strains obtained from 1982 to 1985 harbored ermB and showed an identical pulsed-field gel electrophoresis pattern, indicating the spread of a single clone. Two ermTR-containing isolates were obtained in 1983. mefA gene was found in a strain obtained in 1994 in the present study, although this gene is predominantly associated with recent erythromycin resistance among S. pyogenes strains in many countries.

Anti-Bacterial Agents↗