Group A streptococcus: Virulence factors and pathogenic mechanisms
- Dennis L Stevens, MD, PhD
Dennis L Stevens, MD, PhD
- Professor of Medicine
- University of Washington School of Medicine
- Amy Bryant, PhD
Amy Bryant, PhD
- Associate Professor, Department of Medicine
- University of Washington
Group A Streptococcus (GAS), also known as Streptococcus pyogenes, cause a broad range of infections and complications. The interaction between the host and this important pathogen will be reviewed here. The wide variety of GAS infections are discussed separately. (See related topics.)
S. pyogenes is a facultative, gram-positive coccus that grows in chains. It causes an array of infections involving the respiratory tract and soft tissues ranging in severity from mild to severe. The only known reservoirs are the skin and mucous membranes of the human host. The pathogenic mechanisms underlying these infections are poorly understood, largely because each is the culmination of highly complex interactions between the human host defense mechanisms and specific virulence factors of the organism.
Group A Streptococcus (GAS) requires complex media containing blood products. It grows best in an environment of 10 percent carbon dioxide and produces pinpoint colonies on blood agar plates; these are surrounded by a zone of complete (beta) hemolysis.
Classification schemes — The Lancefield classification divides streptococci into types A through O based upon acid-extractable carbohydrate antigens of cell-wall material . GAS has also been subdivided based upon the surface expression of M and T antigens. Subtyping strains of GAS has proven invaluable for epidemiologic studies. High-resolution genotyping provides more specific determination of relatedness among strains isolated in outbreaks of GAS infections . Finally, rapid sequencing of the gene-encoding M protein provides a rapid, definitive comparison of M-typeable and M-nontypeable strains. (See 'M proteins' below.)
A number of different constituents and products of group A Streptococcus (GAS) have been identified as virulence factors (figure 1).
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- GENERAL CHARACTERISTICS
- MICROBIOLOGIC CHARACTERISTICS
- Classification schemes
- VIRULENCE FACTORS
- M proteins
- - Overview
- - Vaccine implications
- - Streptolysin O
- - Other enzymes that are virulence factors
- Pyrogenic exotoxins
- Structural components
- - Capsule
- - Cell wall
- Binding proteins
- - Ig binding M-like proteins
- - Protein F
- Other factors
- - Streptococcal inhibitor of complement
- - Opacity factor
- - Vimentin
- PATHOGENIC MECHANISMS
- Anti-phagocytic properties
- Mechanisms of fever induction
- Cytokine induction
- - Role in innate immunity
- DISEASE MECHANISMS
- Acute rheumatic fever
- Poststreptococcal glomerulonephritis