Molecular Characterization of the 2011 Hong Kong Scarlet Fever Outbreak

Overview

Journal J Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2012 May 23

PMID 22615319

Citations 44

Authors

Herman Tse

Jessie Y J Bao

Mark R Davies

Peter Maamary

Hoi-Wah Tsoi

Amy H Y Tong

Tom C C Ho

Chi-Ho Lin

Christine M Gillen

Timothy C Barnett

Jonathan H K Chen

Mianne Lee

Wing-Cheong Yam

Chi-Kin Wong

Cheryl-Lynn Y Ong

Yee-Wai Chan

Cheng-Wei Wu

Tony Ng

Wilina W L Lim

Thomas H F Tsang

Cindy W S Tse

Gordon Dougan

Mark J Walker

Si Lok

Kwok-Yung Yuen

Affiliations

Soon will be listed here.

Abstract

A scarlet fever outbreak occurred in Hong Kong in 2011. The majority of cases resulted in the isolation of Streptococcus pyogenes emm12 with multiple antibiotic resistances. Phylogenetic analysis of 22 emm12 scarlet fever outbreak isolates, 7 temporally and geographically matched emm12 non-scarlet fever isolates, and 18 emm12 strains isolated during 2005-2010 indicated the outbreak was multiclonal. Genome sequencing of 2 nonclonal scarlet fever isolates (HKU16 and HKU30), coupled with diagnostic polymerase chain reaction assays, identified 2 mobile genetic elements distributed across the major lineages: a 64.9-kb integrative and conjugative element encoding tetracycline and macrolide resistance and a 46.4-kb prophage encoding superantigens SSA and SpeC and the DNase Spd1. Phenotypic comparison of HKU16 and HKU30 with the S. pyogenes M1T1 strain 5448 revealed that HKU16 displays increased adherence to HEp-2 human epithelial cells, whereas HKU16, HKU30, and 5448 exhibit equivalent resistance to neutrophils and virulence in a humanized plasminogen murine model. However, in contrast to M1T1, the virulence of HKU16 and HKU30 was not associated with covRS mutation. The multiclonal nature of the emm12 scarlet fever isolates suggests that factors such as mobile genetic elements, environmental factors, and host immune status may have contributed to the 2011 scarlet fever outbreak.

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