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Surveillance for severe cases of<jats:italic>S. pyogenes<\/jats:italic>infection diagnosed during 2003 and 2004 was undertaken in 11 countries across Europe by using a standardized case definition and questionnaire. Patient data as well as bacterial isolates were collected and characterized by T and M\/<jats:italic>emm<\/jats:italic>typing, and selected strains were analyzed for the presence of superantigen genes. Data were analyzed to compare the clinical and microbiological patterns of the infections across the participating countries. A total of 4,353 isolates were collected from 5,521 cases with severe<jats:italic>S. pyogenes<\/jats:italic>infections who were identified. A wide diversity of M\/<jats:italic>emm<\/jats:italic>types (<jats:italic>n<\/jats:italic>= 104) was found among the<jats:italic>S. pyogenes<\/jats:italic>clinical isolates, but the M\/<jats:italic>emm<\/jats:italic>type distribution varied broadly between participating countries. The 10 most predominant M\/<jats:italic>emm<\/jats:italic>types were M\/<jats:italic>emm<\/jats:italic>type 1 (M\/<jats:italic>emm<\/jats:italic>1), M\/<jats:italic>emm<\/jats:italic>28, M\/<jats:italic>emm<\/jats:italic>3, M\/<jats:italic>emm<\/jats:italic>89, M\/<jats:italic>emm<\/jats:italic>87, M\/<jats:italic>emm<\/jats:italic>12, M\/<jats:italic>emm<\/jats:italic>4, M\/<jats:italic>emm<\/jats:italic>83, M\/<jats:italic>emm<\/jats:italic>81, and M\/<jats:italic>emm<\/jats:italic>5, in descending order. A correlation was found between some specific disease manifestations, the age of the patients, and the<jats:italic>emm<\/jats:italic>types. Although streptococcal toxic shock syndrome and necrotizing fasciitis were caused by a large number of types, they were particularly associated with M\/<jats:italic>emm<\/jats:italic>1 and M\/<jats:italic>emm<\/jats:italic>3. The<jats:italic>emm<\/jats:italic>types included in the 26-valent vaccine under development were generally well represented in the present material; 16 of the vaccine types accounted for 69% of isolates. The Strep-EURO collaborative program has contributed to enhancement of the knowledge of the spread of invasive disease caused by<jats:italic>S. pyogenes<\/jats:italic>within Europe and encourages future surveillance by the notification of cases and the characterization of strains, which are important for vaccination strategies and other health care issues.<\/jats:p>","DOI":"10.1128\/jcm.02155-08","type":"journal-article","created":{"date-parts":[[2009,1,22]],"date-time":"2009-01-22T02:10:15Z","timestamp":1232590215000},"page":"1155-1165","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":265,"title":["Clinical and Microbiological Characteristics of Severe<i>Streptococcus pyogenes<\/i>Disease in Europe"],"prefix":"10.1128","volume":"47","author":[{"given":"Bogdan","family":"Luca-Harari","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Division of Medical Microbiology, Lund University, Lund, 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