{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T06:13:03Z","timestamp":1788588783075,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":246,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acute Medicine &amp; Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Group A\n                      <jats:italic>Streptococcus<\/jats:italic>\n                      (GAS), particularly the M1UK lineage, has re\u2010emerged as a major global public health concern following the COVID\u201019 pandemic, with a rise in invasive GAS (iGAS) and streptococcal toxic shock syndrome (STSS). Although STSS is under national surveillance in Japan, comprehensive molecular monitoring of iGAS infections remains limited, and the clinical characteristics of M1UK\u2010associated iGAS have not been fully elucidated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed four consecutive iGAS cases requiring intensive care between March and May 2024. Detailed clinical, microbiological, and genomic investigations were performed to characterize the causative strains and their associated virulence profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All patients required respiratory and\/or circulatory support with surgical debridement. Three cases involved necrotizing fasciitis, and one involved intra\u2010abdominal infection secondary to ovarian tumor rupture. All four patients received penicillin G and clindamycin as definitive antimicrobial therapy, with two developing severe drug\u2010related adverse events. Genotypic analysis identified three isolates as\n                      <jats:italic>emm<\/jats:italic>\n                      1 strains, including two M1UK lineage strains. The two M1UK isolates commonly harbored multiple superantigen genes. All isolates remained susceptible to \u03b2\u2010lactam, clindamycin, and macrolide antibiotics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case series documents the identification of the M1UK lineage among critically ill patients with iGAS infections in Japan. Our findings support the need for continued molecular surveillance while reinforcing the importance of prompt surgical source control and appropriate antimicrobial therapy in the management of severe iGAS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ams2.70160","type":"journal-article","created":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T06:10:33Z","timestamp":1788588633000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Microbiological Characteristics of Invasive Group A Streptococcus Infection: Four Case Series of Re\u2010Emerging Pathogens"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1188-158X","authenticated-orcid":false,"given":"Shuji","family":"Okahara","sequence":"first","affiliation":[{"name":"Department of Intensive Care Okayama University Hospital  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4871-4996","authenticated-orcid":false,"given":"Shinnosuke","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Department of Bacteriology Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences  Okayama Japan"},{"name":"Department of Infectious Diseases Okayama University Hospital  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Hamaguchi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Resuscitology Okayama University Hospital  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanobu","family":"Hishiike","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Resuscitology Okayama University Hospital  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Motoi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Resuscitology Okayama University Hospital  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1042-8492","authenticated-orcid":false,"given":"Kazuyoshi","family":"Gotoh","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Science Okayama University Graduate School of Health Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuma","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Science Okayama University Graduate School of Health Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Iio","sequence":"additional","affiliation":[{"name":"Microbiology Division, Clinical Laboratory Okayama University Hospital  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5086-1891","authenticated-orcid":false,"given":"Hideharu","family":"Hagiya","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Okayama University Hospital  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1038\/s41579-023-00865-7","article-title":"Pathogenesis, Epidemiology and Control of Group A Streptococcus Infection","volume":"21","author":"Brouwer S.","year":"2023","journal-title":"Nature Reviews. Microbiology"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1086\/324621","article-title":"Extension of the Lancefield Classification for Group A Streptococci by Addition of 22 New M Protein Gene Sequence Types From Clinical Isolates: emm103 to emm124","volume":"34","author":"Facklam R. F.","year":"2002","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/S1473-3099(19)30446-3","article-title":"Emergence of Dominant Toxigenic M1T1 \n                     Streptococcus pyogenes\n                   Clone During Increased Scarlet Fever Activity in England: A Population\u2010Based Molecular Epidemiological Study","volume":"19","author":"Lynskey N. N.","year":"2019","journal-title":"Lancet Infectious Diseases"},{"key":"e_1_2_8_5_1","first-page":"2116","article-title":"Expansion of Invasive Group A Streptococcus M1(UK) Lineage in Active Bacterial Core Surveillance, United States, 2019\u20132021","volume":"29","author":"Li Y.","year":"2023","journal-title":"Emerging Infectious Diseases"},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s15010-023-02137-1","article-title":"Population of Invasive Group A Streptococci Isolates From a German Tertiary Care Center Is Dominated by the Hypertoxigenic Virulent M1(UK) Genotype","volume":"52","author":"Wolters M.","year":"2024","journal-title":"Infection"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"847","DOI":"10.3201\/eid3104.241076","article-title":"Emerging Trends in Streptococcal Toxic Shock Syndrome, Japan","volume":"31","author":"Ujiie M.","year":"2025","journal-title":"Emerging Infectious Diseases"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s10096-024-05015-2","article-title":"Trends in the Growing Impact of Group A Streptococcus Infection on Public Health After COVID\u201019 Pandemic: A Multicentral Observational Study in Okayama, Japan","volume":"44","author":"Fukushima S.","year":"2025","journal-title":"European Journal of Clinical Microbiology & Infectious Diseases"},{"key":"e_1_2_8_9_1","article-title":"Characterization of Emergent Toxigenic M1(UK) Streptococcus Pyogenes and Associated Sublineages","volume":"9","author":"Li H. 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J.","year":"2024","journal-title":"Microbial Genomics"},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"e375","DOI":"10.1093\/infdis\/jiae437","article-title":"A Rapid Molecular Detection Tool for Toxigenic M1UK \n                     Streptococcus pyogenes","volume":"231","author":"Brouwer S.","year":"2025","journal-title":"Journal of Infectious Diseases"},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1097\/00000658-199505000-00013","article-title":"Determinants of Mortality for Necrotizing Soft\u2010Tissue Infections","volume":"221","author":"McHenry C. R.","year":"1995","journal-title":"Annals of Surgery"},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13017-019-0286-6","article-title":"Time Is of the Essence When Treating Necrotizing Soft Tissue Infections: A Systematic Review and Meta\u2010Analysis","volume":"15","author":"Nawijn F.","year":"2020","journal-title":"World Journal of Emergency Surgery: WJES"},{"issue":"2","key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America","volume":"59","author":"Stevens D. L.","year":"2014","journal-title":"Clinical Infectious Diseases"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1212\/WNL.0000000000002455","article-title":"Antibiotic\u2010Associated Encephalopathy","volume":"86","author":"Bhattacharyya S.","year":"2016","journal-title":"Neurology"}],"container-title":["Acute Medicine &amp; Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ams2.70160","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ams2.70160","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ams2.70160","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T06:10:36Z","timestamp":1788588636000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ams2.70160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/ams2.70160"],"URL":"https:\/\/doi.org\/10.1002\/ams2.70160","archive":["Portico"],"relation":{},"ISSN":["2052-8817","2052-8817"],"issn-type":[{"value":"2052-8817","type":"print"},{"value":"2052-8817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-10-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70160"}}