Journal of Antimicrobial Chemotherapy (2000) 45, 3-12
© 2000 The British Society for Antimicrobial Chemotherapy
Group A streptococci in the 1990s
WHO Collaborating Centre for Diphtheria and Streptococcal Infections, PHLS Respiratory and Systemic Infection Laboratory, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5HT, UK
The last decade has witnessed a remarkable change in the epidemiology of group A streptococcal infections. There has been a marked increase globally in the reporting of invasive infections caused by Streptococcus pyogenes, Lancefield group A streptococci. Many of these cases were deep-seated infections associated with shock and multi-organ failure and are defined as streptococcal toxic shock syndrome. In addition, reports of streptococcal sequelae, in particular, acute rheumatic fever, have re-emerged and remain a serious health threat in developed countries. It appears that these infections are related to the type distributions of the organism among the general population, with the re-emergence of more ‘virulent’ strains, such as the M1 serotype which in earlier decades was primarily seen in cases of either superficial disease or scarlet fever. Population-based surveillance studies have clearly indicated the importance and relevance of type identification for epidemiological purposes. There have also been suggestions that certain extracellular products and toxins play a major role in the so-called ‘increased virulence’ of the organism; these include cell surface molecules such as the M protein, opacity factor, the hyaluronic acid capsule, C5a peptidase and streptococcal inhibitor of complement (SIC), in addition to secreted proteins, pyrogenic exotoxins, cysteine proteinase, streptolysins O and S, hyaluronidase, streptokinase and other enzymes. All these factors, and events during the last decade, strongly emphasize the need for a better understanding of the epidemiology, pathogenesis, treatment and prevention of group A streptococcal infections.
* Tel: +44-208-200-4400, ext. 4270; Fax: +44-208-205-6528; E-mail: aefstratiou{at}phls.nhs.uk
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