{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:10:54Z","timestamp":1789787454004,"version":"4.0.1"},"reference-count":0,"publisher":"National Academy of Sciences","issue":"7","content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[1991,4]]},"abstract":"<jats:p>Genetic diversity and relationships among 108 isolates of the bacterium Streptococcus pyogenes recently recovered from patients in the United States with toxic-shock-like syndrome or other invasive diseases were estimated by multilocus enzyme electrophoresis. Thirty-three electrophoretic types (ETs), representing distinctive multilocus clonal genotypes, were identified, but nearly half the disease episodes, including more than two-thirds of the cases of toxic-shock-like syndrome, were caused by strains of two related clones (ET 1 and ET 2). These two clones were also represented by recent pathogenic European isolates. A previous report of a relatively high frequency of expression of exotoxin A among isolates recovered from toxic-shock-like syndrome patients in the United States was confirmed; and the demonstration of this association both within clones and among distantly related clones supports the hypothesis that exotoxin A is a causal factor in pathogenesis of this disease. Near identity of the nucleotide sequences of the exotoxin A structural gene of six isolates of five ETs in diverse phylogenetic lineages was interpreted as evidence that the gene has been horizontally distributed among clones, presumably by bacteriophage-mediated transfer.<\/jats:p>","DOI":"10.1073\/pnas.88.7.2668","type":"journal-article","created":{"date-parts":[[2006,5,31]],"date-time":"2006-05-31T07:56:40Z","timestamp":1149062200000},"page":"2668-2672","update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":269,"title":["Streptococcus pyogenes causing toxic-shock-like syndrome and other invasive diseases: clonal diversity and pyrogenic exotoxin expression."],"prefix":"10.1073","volume":"88","author":[{"given":"J M","family":"Musser","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A R","family":"Hauser","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M H","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P M","family":"Schlievert","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R K","family":"Selander","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[1991,4]]},"container-title":["Proceedings of the National Academy of Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pnas.org\/doi\/pdf\/10.1073\/pnas.88.7.2668","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T13:05:04Z","timestamp":1649855104000},"score":1,"resource":{"primary":{"URL":"https:\/\/pnas.org\/doi\/full\/10.1073\/pnas.88.7.2668"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,4]]},"references-count":0,"journal-issue":{"issue":"7","published-print":{"date-parts":[[1991,4]]}},"alternative-id":["10.1073\/pnas.88.7.2668"],"URL":"https:\/\/doi.org\/10.1073\/pnas.88.7.2668","relation":{},"ISSN":["0027-8424","1091-6490"],"issn-type":[{"value":"0027-8424","type":"print"},{"value":"1091-6490","type":"electronic"}],"subject":[],"published":{"date-parts":[[1991,4]]},"assertion":[{"value":"1991-04-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}