{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:00:08Z","timestamp":1790506808974,"version":"4.1.0"},"reference-count":45,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T00:00:00Z","timestamp":1451606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"Public Health Ontario","award":["PIF 2013-14 007"],"award-info":[{"award-number":["PIF 2013-14 007"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            An outbreak of type\n            <jats:italic>emm59<\/jats:italic>\n            invasive group A\n            <jats:named-content content-type=\"genus-species\">Streptococcus<\/jats:named-content>\n            (iGAS) disease was declared in 2008 in Thunder Bay District, Northwestern Ontario, 2 years after a countrywide\n            <jats:italic>emm59<\/jats:italic>\n            epidemic was recognized in Canada. Despite a declining number of\n            <jats:italic>emm59<\/jats:italic>\n            infections since 2010, numerous cases of iGAS disease continue to be reported in the area. We collected clinical information on all iGAS cases recorded in Thunder Bay District from 2008 to 2013. We also\n            <jats:italic>emm<\/jats:italic>\n            typed and sequenced the genomes of all available strains isolated from 2011 to 2013 from iGAS infections and from severe cases of soft tissue infections. We used whole-genome sequencing data to investigate the population structure of GAS strains of the most frequently isolated\n            <jats:italic>emm<\/jats:italic>\n            types. We report an increased incidence of iGAS in Thunder Bay compared to the metropolitan area of Toronto\/Peel and the province of Ontario. Illicit drug use, alcohol abuse, homelessness, and hepatitis C infection were underlying diseases or conditions that might have predisposed patients to iGAS disease. Most cases were caused by clonal strains of skin or generalist\n            <jats:italic>emm<\/jats:italic>\n            types (i.e.,\n            <jats:italic>emm82<\/jats:italic>\n            ,\n            <jats:italic>emm87<\/jats:italic>\n            ,\n            <jats:italic>emm101<\/jats:italic>\n            ,\n            <jats:italic>emm4<\/jats:italic>\n            ,\n            <jats:italic>emm83<\/jats:italic>\n            , and\n            <jats:italic>emm114<\/jats:italic>\n            ) uncommonly seen in other areas of the province. We observed rapid waxing and waning of\n            <jats:italic>emm<\/jats:italic>\n            types causing disease and their replacement by other\n            <jats:italic>emm<\/jats:italic>\n            types associated with the same tissue tropisms. Thus, iGAS disease in Thunder Bay District predominantly affects a select population of disadvantaged persons and is caused by clonally related strains of a few skin and generalist\n            <jats:italic>emm<\/jats:italic>\n            types less commonly associated with iGAS in other areas of Ontario.\n          <\/jats:p>","DOI":"10.1128\/jcm.02201-15","type":"journal-article","created":{"date-parts":[[2015,10,22]],"date-time":"2015-10-22T15:02:03Z","timestamp":1445526123000},"page":"83-92","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":50,"title":["High Incidence of Invasive Group A Streptococcus Disease Caused by Strains of Uncommon\n            <i>emm<\/i>\n            Types in Thunder Bay, Ontario, Canada"],"prefix":"10.1128","volume":"54","author":[{"given":"Taryn B. 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