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Pathogenesis of Group A Streptococcal Infections

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Cunningham, Madeleine W.·2000·Clinical Microbiology Reviews
DOI 10.1128/cmr.13.3.470
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Abstract

SUMMARY: 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.

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Metadata

Authors
Cunningham, M. W.
Venue
Clinical Microbiology Reviews
Publisher
American Society for Microbiology
Published
2000-07
Volume
13
Issue
3
Pages
470-511
ISSN
  • 0893-8512 (ISSN-L)
  • 1098-6618
DOI
10.1128/cmr.13.3.470
OpenAlex
W2104305294
Cited by
2,261
References
5
FWCI
68.30
Type
journal article
Language
en
Open access
bronze
Licence
journals.asm.org/non-commercial-tdm-license (tdm)

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Cunningham, M. W. (2000). Pathogenesis of Group A Streptococcal Infections. Clinical Microbiology Reviews. https://doi.org/10.1128/cmr.13.3.470

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