{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T15:23:22Z","timestamp":1788621802523,"version":"build-2803163510"},"reference-count":27,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2014,5,22]],"date-time":"2014-05-22T00:00:00Z","timestamp":1400716800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Streptococcal toxic shock syndrome (STSS) is a severe invasive infection characterized by the sudden onset of shock, multi-organ failure, and high mortality. In Japan, appropriate notification measures based on the Infectious Disease Control law are mandatory for cases of STSS caused by<jats:italic>\u03b2<\/jats:italic>-haemolytic streptococcus. STSS is mainly caused by group A streptococcus (GAS). Although an average of 60\u201370 cases of GAS-induced STSS are reported annually, 143 cases were recorded in 2011. To determine the reason behind this marked increase, we characterized the<jats:italic>emm<\/jats:italic>genotype of 249 GAS isolates from STSS patients in Japan from 2010 to 2012 and performed antimicrobial susceptibility testing. The predominant genotype was found to be<jats:italic>emm1<\/jats:italic>, followed by<jats:italic>emm89<\/jats:italic>,<jats:italic>emm12<\/jats:italic>,<jats:italic>emm28<\/jats:italic>,<jats:italic>emm3<\/jats:italic>, and<jats:italic>emm90<\/jats:italic>. These six genotypes constituted more than 90% of the STSS isolates. The number of<jats:italic>emm1<\/jats:italic>,<jats:italic>emm89<\/jats:italic>,<jats:italic>emm12<\/jats:italic>, and<jats:italic>emm28<\/jats:italic>isolates increased concomitantly with the increase in the total number of STSS cases. In particular, the number of<jats:italic>mefA<\/jats:italic>-positive<jats:italic>emm1<\/jats:italic>isolates has escalated since 2011. Thus, the increase in the incidence of STSS can be attributed to an increase in the number of cases associated with specific genotypes.<\/jats:p>","DOI":"10.1017\/s0950268814001265","type":"journal-article","created":{"date-parts":[[2014,5,22]],"date-time":"2014-05-22T12:01:47Z","timestamp":1400760107000},"page":"864-872","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":61,"title":["Increased prevalence of group A streptococcus isolates in streptococcal toxic shock syndrome cases in Japan from 2010 to 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