Streptococcus pyogenes (group A in the Lancefield classification)is one of the most common human pathogens. Although this ubiquitousorganism is responsible for a wide array of illnesses, mostattention has focused on its relation to acute pharyngitis,because of the frequency of that condition and its potentialfor inciting acute rheumatic fever. The recent resurgence ofinvasive group A streptococcal infections,1,2 however, is areminder that the pathogen can cause a variety of skin and soft-tissueinfections, some of which are severe and even life-threatening.
Streptococcal Pyoderma
Pyoderma, or impetigo, is a localized, purulent infection ofthe skin that is . . . [Full Text of this Article]
Erysipelas and Cellulitis
Erysipelas
Acute Cellulitis
Necrotizing Infections of the Soft Tissue
Streptococcal Toxic Shock Syndrome
Clinical Features
Virulence Factors of Strep. pyogenes and Their Role in Pathogenesis
Antibiotic Therapy
Other Therapies
Conclusions
Source Information
From the Medical Service, Miami Veterans Affairs Medical Center, and the Department of Medicine, University of Miami School of Medicine, both in Miami (A.L.B.); and the Infectious Diseases Section, Boise Veterans Affairs Medical Center, Boise, Idaho, and the University of Washington School of Medicine, Seattle (D.L.S.).
Address reprint requests to Dr. Bisno at the Veterans Affairs Medical Center, 1201 N.W. 16th St., Miami, FL 33125.
Matsui, H., Sekiya, Y., Nakamura, M., Murayama, S. Y., Yoshida, H., Takahashi, T., Imanishi, K., Tsuchimoto, K., Uchiyama, T., Sunakawa, K., Ubukata, K.
(2009). CD46 Transgenic Mouse Model of Necrotizing Fasciitis Caused by Streptococcus pyogenes Infection. Infect. Immun.
77: 4806-4814
[Abstract][Full Text]
Ma, Y., Bryant, A. E., Salmi, D. B., McIndoo, E., Stevens, D. L.
(2009). vfr, a Novel Locus Affecting Cysteine Protease Production in Streptococcus pyogenes. J. Bacteriol.
191: 3189-3194
[Abstract][Full Text]
Bellapianta, J. M., Ljungquist, K., Tobin, E., Uhl, R.
(2009). Necrotizing Fasciitis. J Am Acad Orthop Surg
17: 174-182
[Abstract][Full Text]
Sun, H., Wang, X., Degen, J. L., Ginsburg, D.
(2009). Reduced thrombin generation increases host susceptibility to group A streptococcal infection. Blood
113: 1358-1364
[Abstract][Full Text]
Pecci, M., Comeau, D., Chawla, V.
(2009). Skin Conditions in the Athlete. Am J Sports Med
37: 406-418
[Abstract][Full Text]
Gryllos, I., Tran-Winkler, H. J., Cheng, M.-F., Chung, H., Bolcome, R. III, Lu, W., Lehrer, R. I., Wessels, M. R.
(2008). Induction of group A Streptococcus virulence by a human antimicrobial peptide. Proc. Natl. Acad. Sci. USA
105: 16755-16760
[Abstract][Full Text]
Sura, R., Hinckley, L. S., Risatti, G. R., Smyth, J. A.
(2008). Fatal necrotising fasciitis and myositis in a cat associated with Streptococcus canis. Vet Rec.
162: 450-453
[Abstract][Full Text]
Fjordbakk, C. T., Arroyo, L. G., Hewson, J.
(2008). Retrospective study of the clinical features of limb cellulitis in 63 horses. Vet Rec.
162: 233-236
[Abstract][Full Text]
Phelps, H. A., Neely, M. N.
(2007). SalY of the Streptococcus pyogenes Lantibiotic Locus Is Required for Full Virulence and Intracellular Survival in Macrophages. Infect. Immun.
75: 4541-4551
[Abstract][Full Text]
Daneman, N., Green, K. A., Low, D. E., Simor, A. E., Willey, B., Schwartz, B., Toye, B., Jessamine, P., Tyrrell, G. J., Krajden, S., Ramage, L., Rose, D., Schertzberg, R., Bragg, D., McGeer, A., and the Ontario Group A Streptococcal Study Group*,
(2007). Surveillance for Hospital Outbreaks of Invasive Group A Streptococcal Infections in Ontario, Canada, 1992 to 2000. ANN INTERN MED
147: 234-241
[Abstract][Full Text]
Sawai, J., Hasegawa, T., Kamimura, T., Okamoto, A., Ohmori, D., Nosaka, N., Yamada, K., Torii, K., Ohta, M.
(2007). Growth Phase-Dependent Effect of Clindamycin on Production of Exoproteins by Streptococcus pyogenes. Antimicrob. Agents Chemother.
51: 461-467
[Abstract][Full Text]
LESAFFER, J., VAN HOLDER, C., HAECK, L.
(2006). Necrotizing Fasciitis of the First Ray Caused by Group a Streptococcus. J Hand Surg Eur Vol
31: 317-319
[Abstract][Full Text]
Boel, G., Jin, H., Pancholi, V.
(2005). Inhibition of Cell Surface Export of Group A Streptococcal Anchorless Surface Dehydrogenase Affects Bacterial Adherence and Antiphagocytic Properties. Infect. Immun.
73: 6237-6248
[Abstract][Full Text]
Giacometti, A., Cirioni, O., Kamysz, W., Silvestri, C., Del Prete, M. S., Licci, A., D'Amato, G., Lukasiak, J., Scalise, G.
(2005). In Vitro Activity and Killing Effect of Citropin 1.1 against Gram-Positive Pathogens Causing Skin and Soft Tissue Infections. Antimicrob. Agents Chemother.
49: 2507-2509
[Abstract][Full Text]
Miller, L. G., Perdreau-Remington, F., Rieg, G., Mehdi, S., Perlroth, J., Bayer, A. S., Tang, A. W., Phung, T. O., Spellberg, B.
(2005). Necrotizing Fasciitis Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus in Los Angeles. NEJM
352: 1445-1453
[Abstract][Full Text]
Olafsson, E. J., Zeni, T., Wilkes, D. S.
(2005). A 46-Year-Old Man With Excruciating Shoulder Pain. Chest
127: 1039-1044
[Abstract][Full Text]
Bauer, S., Tapper, H.
(2004). Membrane retrieval in neutrophils during phagocytosis: inhibition by M protein-expressing S. pyogenes bacteria. J. Leukoc. Biol.
76: 1142-1150
[Abstract][Full Text]
Wilkinson, D., Doolette, D.
(2004). Hyperbaric Oxygen Treatment and Survival From Necrotizing Soft Tissue Infection. Arch Surg
139: 1339-1345
[Abstract][Full Text]
Perez-Caballero, D., Garcia-Laorden, I., Cortes, G., Wessels, M. R., de Cordoba, S. R., Alberti, S.
(2004). Interaction between Complement Regulators and Streptococcus pyogenes: Binding of C4b-Binding Protein and Factor H/Factor H-Like Protein 1 to M18 Strains Involves Two Different Cell Surface Molecules. J. Immunol.
173: 6899-6904
[Abstract][Full Text]
Lafontaine, E. R., Wall, D., Vanlerberg, S. L., Donabedian, H., Sledjeski, D. D.
(2004). Moraxella catarrhalis Coaggregates with Streptococcus pyogenes and Modulates Interactions of S. pyogenes with Human Epithelial Cells. Infect. Immun.
72: 6689-6693
[Abstract][Full Text]
Sun, H., Ringdahl, U., Homeister, J. W., Fay, W. P., Engleberg, N. C., Yang, A. Y., Rozek, L. S., Wang, X., Sjobring, U., Ginsburg, D.
(2004). Plasminogen Is a Critical Host Pathogenicity Factor for Group A Streptococcal Infection. Science
305: 1283-1286
[Abstract][Full Text]
Davies, C. E., Hill, K. E., Wilson, M. J., Stephens, P., Hill, C. M., Harding, K. G., Thomas, D. W.
(2004). Use of 16S Ribosomal DNA PCR and Denaturing Gradient Gel Electrophoresis for Analysis of the Microfloras of Healing and Nonhealing Chronic Venous Leg Ulcers. J. Clin. Microbiol.
42: 3549-3557
[Abstract][Full Text]
Kim, S. W., Grant, J. E., Kim, S. I., Swanson, T. A., Bernstein, G. A., Jaszcz, W. B., Williams, K. A., Schlievert, P. M.
(2004). A Possible Association of Recurrent Streptococcal Infections and Acute Onset of Obsessive-Compulsive Disorder. J. Neuropsychiatry Clin. Neurosi.
16: 252-260
[Abstract][Full Text]
Weineisen, M., Sjobring, U., Fallman, M., Andersson, T.
(2004). Streptococcal M5 Protein Prevents Neutrophil Phagocytosis by Interfering with CD11b/CD18 Receptor-Mediated Association and Signaling. J. Immunol.
172: 3798-3807
[Abstract][Full Text]
Muller, W. J., Schmitt, B. D.
(2004). Group A{beta}-hemolytic Streptococcal Vulvovaginitis: Diagnosis by Rapid Antigen Testing. CLIN PEDIATR
43: 179-183
Nseir, S., Pronnier, P., Soubrier, S., Onimus, T., Saulnier, F., Mathieu, D., Durocher, A.
(2004). Fatal streptococcal necrotizing fasciitis as a complication of axillary brachial plexus block. Br J Anaesth
92: 427-429
[Abstract][Full Text]
Purushothaman, S. S., Wang, B., Cleary, P. P.
(2003). M1 Protein Triggers a Phosphoinositide Cascade for Group A Streptococcus Invasion of Epithelial Cells. Infect. Immun.
71: 5823-5830
[Abstract][Full Text]
Neely, M. N., Lyon, W. R., Runft, D. L., Caparon, M.
(2003). Role of RopB in Growth Phase Expression of the SpeB Cysteine Protease of Streptococcus pyogenes. J. Bacteriol.
185: 5166-5174
[Abstract][Full Text]
Park, H.-S., Francis, K. P., Yu, J., Cleary, P. P.
(2003). Membranous Cells in Nasal-Associated Lymphoid Tissue: A Portal of Entry for the Respiratory Mucosal Pathogen Group A Streptococcus. J. Immunol.
171: 2532-2537
[Abstract][Full Text]
Bryant, A. E.
(2003). Biology and Pathogenesis of Thrombosis and Procoagulant Activity in Invasive Infections Caused by Group A Streptococci and Clostridium perfringens. Clin. Microbiol. Rev.
16: 451-462
[Abstract][Full Text]
Fontaine, M. C., Lee, J. J., Kehoe, M. A.
(2003). Combined Contributions of Streptolysin O and Streptolysin S to Virulence of Serotype M5 Streptococcus pyogenes Strain Manfredo. Infect. Immun.
71: 3857-3865
[Abstract][Full Text]
Collin, M., Olsen, A.
(2003). Extracellular Enzymes with Immunomodulating Activities: Variations on a Theme in Streptococcus pyogenes. Infect. Immun.
71: 2983-2992
[Full Text]
Frick, I.-M., Akesson, P., Rasmussen, M., Schmidtchen, A., Bjorck, L.
(2003). SIC, a Secreted Protein of Streptococcus pyogenes That Inactivates Antibacterial Peptides. J. Biol. Chem.
278: 16561-16566
[Abstract][Full Text]
Bryant, A. E., Hayes-Schroer, S. M., Stevens, D. L.
(2003). M Type 1 and 3 Group A Streptococci Stimulate Tissue Factor-Mediated Procoagulant Activity in Human Monocytes and Endothelial Cells. Infect. Immun.
71: 1903-1910
[Abstract][Full Text]
Rekha, A., Ravi, A.
(2003). A Retrospective Study of Necrotising Fasciitis. INT J LOW EXTREM WOUNDS
2: 46-49
[Abstract]
Jeng, A., Sakota, V., Li, Z., Datta, V., Beall, B., Nizet, V.
(2003). Molecular Genetic Analysis of a Group A Streptococcus Operon Encoding Serum Opacity Factor and a Novel Fibronectin-Binding Protein, SfbX. J. Bacteriol.
185: 1208-1217
[Abstract][Full Text]
Bickels, J., Ben-Sira, L., Kessler, A., Wientroub, S.
(2002). Primary Pyomyositis. JBJS
84: 2277-2286
[Full Text]
Gemmell, C. G., Ford, C. W.
(2002). Virulence factor expression by Gram-positive cocci exposed to subinhibitory concentrations of linezolid. J Antimicrob Chemother
50: 665-672
[Abstract][Full Text]
Bernard, P., Chosidow, O., Vaillant, L.
(2002). Oral pristinamycin versus standard penicillin regimen to treat erysipelas in adults: randomised, non-inferiority, open trial. BMJ
325: 864-864
[Abstract][Full Text]
Latorre, C., Garcia-Rey, C., Garcia-Perea, A., Perea, E., Aguilar, L., Cercenado, E., Garcia-de-Lomas, J., the Spanish Surveillance Group for Respiratory Pat,
(2002). Activity of six quinolones against 226 recent clinical isolates of Streptococcus pyogenes with reduced susceptibility to ciprofloxacin. J Antimicrob Chemother
50: 301-303
[Full Text]
Neely, M. N., Pfeifer, J. D., Caparon, M.
(2002). Streptococcus-Zebrafish Model of Bacterial Pathogenesis. Infect. Immun.
70: 3904-3914
[Abstract][Full Text]
Fustes-Morales, A., Gutierrez-Castrellon, P., Duran-Mckinster, C., Orozco-Covarrubias, L., Tamayo-Sanchez, L., Ruiz-Maldonado, R.
(2002). Necrotizing Fasciitis: Report of 39 Pediatric Cases. Arch Dermatol
138: 893-899
[Abstract][Full Text]
McEntegart, A., Capell, H. A.
(2002). Necrotizing fasciitis in a patient with rheumatoid arthritis. Rheumatology (Oxford)
41: 828-829
[Full Text]
Larose-Pierre, M., Scrivens, J. J. Jr., Norwood, D., Rappa, L.
(2002). Necrotizing Fasciitis Caused by Group A Streptococcus: Case Report and Therapy Update. Journal of Pharmacy Practice
15: 290-296
[Abstract]
Giannakis, E., Jokiranta, T. S., Ormsby, R. J., Duthy, T. G., Male, D. A., Christiansen, D., Fischetti, V. A., Bagley, C., Loveland, B. E., Gordon, D. L.
(2002). Identification of the Streptococcal M Protein Binding Site on Membrane Cofactor Protein (CD46). J. Immunol.
168: 4585-4592
[Abstract][Full Text]
Korzets, A., Ori, Y., Zevin, D., Weinberger, M., Kesslin, J., Seror, D., Kuperman, A., Gafter, U.
(2002). Group A Streptococcal bacteraemia and necrotizing faciitis in a renal transplant patient: a case for intravenous immunoglobulin therapy. Nephrol Dial Transplant
17: 150-152
[Full Text]
Gillen, C. M., Towers, R. J., McMillan, D. J., Delvecchio, A., Sriprakash, K. S., Currie, B., Kreikemeyer, B., Chhatwal, G. S., Walker, M. J.
(2002). Immunological response mounted by Aboriginal Australians living in the Northern Territory of Australia against Streptococcus pyogenes serum opacity factor. Microbiology
148: 169-178
[Abstract][Full Text]
Collin, M., Olsen, A.
(2001). Effect of SpeB and EndoS from Streptococcus pyogenes on Human Immunoglobulins. Infect. Immun.
69: 7187-7189
[Abstract][Full Text]
Limbago, B., McIver, K. S., Penumalli, V., Weinrick, B., Scott, J. R.
(2001). Restoration of Mga Function to a Streptococcus pyogenes Strain (M Type 50) That Is Virulent in Mice. Infect. Immun.
69: 1215-1220
[Abstract][Full Text]
Harris, S. R., Hugi, M. R., Olivotto, I. A., Levine, M.
(2001). Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema. CMAJ
164: 191-199
[Abstract][Full Text]
Stevens, D. L., Smith, L. G., Bruss, J. B., McConnell-Martin, M. A., Duvall, S. E., Todd, W. M., Hafkin, B.
(2000). Randomized Comparison of Linezolid (PNU-100766) versus Oxacillin-Dicloxacillin for Treatment of Complicated Skin and Soft Tissue Infections. Antimicrob. Agents Chemother.
44: 3408-3413
[Abstract][Full Text]
Limbago, B., Penumalli, V., Weinrick, B., Scott, J. R.
(2000). Role of Streptolysin O in a Mouse Model of Invasive Group A Streptococcal Disease. Infect. Immun.
68: 6384-6390
[Abstract][Full Text]
Cunningham, M. W.
(2000). Pathogenesis of Group A Streptococcal Infections. Clin. Microbiol. Rev.
13: 470-511
[Abstract][Full Text]
SELA, S., NEEMAN, R., KELLER, N., BARZILAI, A.
(2000). Relationship between asymptomatic carriage of Streptococcus pyogenes and the ability of the strains to adhere to and be internalised by cultured epithelial cells. J Med Microbiol
49: 499-502
[Abstract][Full Text]
Scaramuzzino, D. A., McNiff, J. M., Bessen, D. E.
(2000). Humanized In Vivo Model for Streptococcal Impetigo. Infect. Immun.
68: 2880-2887
[Abstract][Full Text]
DESCHEEMAEKER, P., VAN LOOCK, F., HAUCHECORNE, M., VANDAMME, P., GOOSSENS, H.
(2000). Molecular characterisation of group A streptococci from invasive and non-invasive disease episodes in Belgium during 1993-1994. J Med Microbiol
49: 467-471
[Abstract][Full Text]
Descheemaeker, P., Chapelle, S., Lammens, C., Hauchecorne, M., Wijdooghe, M., Vandamme, P., Ieven, M., Goossens, H.
(2000). Macrolide resistance and erythromycin resistance determinants among Belgian Streptococcus pyogenes and Streptococcus pneumoniae isolates. J Antimicrob Chemother
45: 167-173
[Abstract][Full Text]
Giacometti, A., Cirioni, O., Schimizzi, A. M., Del Prete, M. S., Barchiesi, F., D'Errico, M. M., Petrelli, E., Scalise, G.
(2000). Epidemiology and Microbiology of Surgical Wound Infections. J. Clin. Microbiol.
38: 918-922
[Abstract][Full Text]
Kotarsky, H., Thern, A., Lindahl, G., Sjobring, U.
(2000). Strain-Specific Restriction of the Antiphagocytic Property of Group A Streptococcal M Proteins. Infect. Immun.
68: 107-112
[Abstract][Full Text]
Urschel, J. D
(1999). Classic diseases revisited: Necrotizing soft tissue infections. Postgrad. Med. J.
75: 645-649
[Abstract][Full Text]
Li, Z., Sledjeski, D. D., Kreikemeyer, B., Podbielski, A., Boyle, M. D. P.
(1999). Identification of pel, a Streptococcus pyogenes Locus That Affects both Surface and Secreted Proteins. J. Bacteriol.
181: 6019-6027
[Abstract][Full Text]
Dupuy, A., Benchikhi, H., Roujeau, J.-C., Bernard, P., Vaillant, L., Chosidow, O., Sassolas, B., Guillaume, J.-C., Grob, J.-J., Bastuji-Garin, S.
(1999). Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ
318: 1591-1594
[Abstract][Full Text]
Kihlberg, B.-M., Collin, M., Olsen, A., Bjorck, L.
(1999). Protein H, an Antiphagocytic Surface Protein in Streptococcus pyogenes. Infect. Immun.
67: 1708-1714
[Abstract][Full Text]
Basma, H., Norrby-Teglund, A., Guedez, Y., McGeer, A., Low, D. E., El-Ahmedy, O., Schwartz, B., Kotb, M.
(1999). Risk Factors in the Pathogenesis of Invasive Group A Streptococcal Infections: Role of Protective Humoral Immunity. Infect. Immun.
67: 1871-1877
[Abstract][Full Text]
Knudtson, K. J., Gigantelli, J. W.
(1998). Necrotizing Fasciitis of the Eyelids and Orbit. Arch Ophthalmol
116: 1548-1549
[Full Text]
Basma, H., Norrby-Teglund, A., McGeer, A., Low, D. E., El-Ahmedy, O., Dale, J. B., Schwartz, B., Kotb, M.
(1998). Opsonic Antibodies to the Surface M Protein of Group A Streptococci in Pooled Normal Immunoglobulins (IVIG): Potential Impact on the Clinical Efficacy of IVIG Therapy for Severe Invasive Group A Streptococcal Infections. Infect. Immun.
66: 2279-2283
[Abstract][Full Text]
Blackmore, T. K., Fischetti, V. A., Sadlon, T. A., Ward, H. M., Gordon, D. L.
(1998). M Protein of the Group A Streptococcus Binds to the Seventh Short Consensus Repeat of Human Complement Factor H. Infect. Immun.
66: 1427-1431
[Abstract][Full Text]
Fluckiger, U., Jones, K. F., Fischetti, V. A.
(1998). Immunoglobulins to Group A Streptococcal Surface Molecules Decrease Adherence to and Invasion of Human Pharyngeal Cells. Infect. Immun.
66: 974-979
[Abstract][Full Text]
Thern, A., Wastfelt, M., Lindahl, G.
(1998). Expression of Two Different Antiphagocytic M Proteins by Streptococcus pyogenes of the OF+ Lineage. J. Immunol.
160: 860-869
[Abstract][Full Text]
Hirose, Y., Yagi, K., Honda, H., Shibuya, H., Okazaki, E.
(1997). Toxic Shock--like Syndrome Caused by Non--Group A {beta}-Hemolytic Streptococci. Arch Intern Med
157: 1891-1894
[Abstract]
Berge, A., Kihlberg, B.-M., Sjoholm, A. G., Bjorck, L.
(1997). Streptococcal Protein H Forms Soluble Complement-activating Complexes with IgG, but Inhibits Complement Activation by IgG-coated Targets. J. Biol. Chem.
272: 20774-20781
[Abstract][Full Text]
Couper, R., Charytan, D., Kujath, P., Eckmann, C., McGeer, A., Low, D. E., Davies, H. D., Schwartz, B., Holm, S. E.
(1997). Invasive Group A Streptococcal Infections. NEJM
336: 513-515
[Full Text]
Ris, H.-B., Banic, A., Furrer, M., Caversaccio, M., Cerny, A., Zbaren, P.
(1996). Descending Necrotizing Mediastinitis: Surgical Treatment Via Clamshell Approach. Ann. Thorac. Surg.
62: 1650-1654
[Abstract][Full Text]
Brogan, T. V., Nizet, V., Waldhausen, J. H.T., Bisno, A. L., Stevens, D. L.
(1996). Streptococcal Skin Infections. NEJM
334: 1478-1478
[Full Text]
Tomasini-Johansson, B. R., Kaufman, N. R., Ensenberger, M. G., Ozeri, V., Hanski, E., Mosher, D. F.
(2001). A 49-Residue Peptide from Adhesin F1 of Streptococcus pyogenes Inhibits Fibronectin Matrix Assembly. J. Biol. Chem.
276: 23430-23439
[Abstract][Full Text]
Ensenberger, M. G., Tomasini-Johansson, B. R., Sottile, J., Ozeri, V., Hanski, E., Mosher, D. F.
(2001). Specific Interactions between F1 Adhesin of Streptococcus pyogenes and N-terminal Modules of Fibronectin. J. Biol. Chem.
276: 35606-35613
[Abstract][Full Text]
Nomizu, M., Pietrzynski, G., Kato, T., Lachance, P., Menard, R., Ziomek, E.
(2001). Substrate Specificity of the Streptococcal Cysteine Protease. J. Biol. Chem.
276: 44551-44556
[Abstract][Full Text]
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