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PMID: 10885988 Published · ppublish English Journal Article Research Support, U.S. Gov't, P.H.S. Review

Pathogenesis of group A streptococcal infections.

Clinical microbiology reviews ·Vol. 13 ·No. 3 ·2000-07-00 ·Pages 470-511

Cunningham MW

Abstract

Group A streptococci are model extracellular gram-positive pathogens responsible for pharyngitis, impetigo, rheumatic fever, and acute glomerulonephritis. A resurgence of invasive streptococcal diseases and rheumatic fever has appeared in outbreaks over the past 10 years, with a predominant M1 serotype as well as others identified with the outbreaks. emm (M protein) gene sequencing has changed serotyping, and new virulence genes and new virulence regulatory networks have been defined. The emm gene superfamily has expanded to include antiphagocytic molecules and immunoglobulin-binding proteins with common structural features. At least nine superantigens have been characterized, all of which may contribute to toxic streptococcal syndrome. An emerging theme is the dichotomy between skin and throat strains in their epidemiology and genetic makeup. Eleven adhesins have been reported, and surface plasmin-binding proteins have been defined. The strong resistance of the group A streptococcus to phagocytosis is related to factor H and fibrinogen binding by M protein and to disarming complement component C5a by the C5a peptidase. Molecular mimicry appears to play a role in autoimmune mechanisms involved in rheumatic fever, while nephritis strain-associated proteins may lead to immune-mediated acute glomerulonephritis. Vaccine strategies have focused on recombinant M protein and C5a peptidase vaccines, and mucosal vaccine delivery systems are under investigation.

MeSH Terms
Amino Acid Sequence Antigens, Bacterial Bacterial Adhesion Bacterial Outer Membrane Proteins Bacterial Proteins/physiology Carrier Proteins/physiology Glomerulonephritis/etiology Humans Molecular Sequence Data Phagocytosis Rheumatic Fever/etiology Streptococcal Infections/diagnosis,etiology,immunology Streptococcus pyogenes/genetics,immunology,pathogenicity Superantigens/physiology Virulence
Chemicals
Antigens, Bacterial Bacterial Outer Membrane Proteins Bacterial Proteins Carrier Proteins Superantigens streptococcal M protein
Authors & Affiliations
1 authors, click to expand affiliations / ORCID
Cunningham M W
Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
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Article Info
Journal
Clinical microbiology reviews
Abbr.
Clin Microbiol Rev
ISSN
0893-8512
DOI
10.1128/CMR.13.3.470
Published
2000-07-00
Pages
470-511
Language
English
Region
United States
NLM ID
8807282
PMCID
PMC88944
Subset
IM
Grants
NHLBI NIH HHS · HL35280 · United States
NHLBI NIH HHS · R56 HL056267 · United States
NHLBI NIH HHS · R37 HL035280 · United States
NHLBI NIH HHS · R01 HL056267 · United States
NHLBI NIH HHS · HL56267 · United States
External Links
PubMed source DOI: 10.1128/CMR.13.3.470 PMC Full Text View journal details
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