{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T14:16:52Z","timestamp":1772806612480,"version":"3.50.1"},"reference-count":34,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2015,5,1]],"date-time":"2015-05-01T00:00:00Z","timestamp":1430438400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Acute rheumatic fever (ARF) is a postsuppurative sequela caused by\n            <jats:named-content content-type=\"genus-species\">Streptococcus pyogenes<\/jats:named-content>\n            infections affecting school-age children. We describe here the occurrence of an ARF outbreak that occurred in Bologna province, northeastern Italy, between November 2012 and May 2013. Molecular analysis revealed that ARF-related group A\n            <jats:named-content content-type=\"genus-species\">Streptococcus<\/jats:named-content>\n            (GAS) strains belonged to the M-18 serotype, including subtypes\n            <jats:italic>emm18.29<\/jats:italic>\n            and\n            <jats:italic>emm18.32<\/jats:italic>\n            . All M-18 GAS strains shared the same antigenic profile, including SpeA, SpeB, SpeC, SpeL, SpeM, and SmeZ. Matrix-assisted laser desorption ionization\u2013time of flight (MALDI-TOF) analysis revealed that M-18 GAS strains grouped separately from other serotypes, suggesting a different\n            <jats:named-content content-type=\"genus-species\">S. pyogenes<\/jats:named-content>\n            lineage. Single nucleotide polymorphisms and phylogenetic analysis based on whole-genome sequencing showed that\n            <jats:italic>emm18.29<\/jats:italic>\n            and\n            <jats:italic>emm18.32<\/jats:italic>\n            GAS strains clustered in two distinct groups, highlighting genetic variations between these subtypes. Comparative analysis revealed a similar genome architecture between\n            <jats:italic>emm18.29<\/jats:italic>\n            and\n            <jats:italic>emm18.32<\/jats:italic>\n            strains that differed from noninvasive\n            <jats:italic>emm18.0<\/jats:italic>\n            strains. The major sources of differences between M-18 genomes were attributable to the prophage elements. Prophage regions contained several virulence factors that could have contributed to the pathogenic potential of\n            <jats:italic>emm18.29<\/jats:italic>\n            and\n            <jats:italic>emm18.32<\/jats:italic>\n            strains. Notably, phage \u03a6SPBO.1 carried erythrogenic toxin A gene (\n            <jats:italic>speA1<\/jats:italic>\n            ) in six ARF-related M-18 GAS strains but not in\n            <jats:italic>emm18.0<\/jats:italic>\n            strains. In addition, a phage-encoded hyaluronidase gene (\n            <jats:italic>hylP.2<\/jats:italic>\n            ) presented different variants among M-18 GAS strains by showing internal deletions located in the \u03b1-helical and TS\u03b2H regions. In conclusion, our study yielded insights into the genome structure of M-18 GAS strains responsible for the ARF outbreak in Italy, thus expanding our knowledge of this serotype.\n          <\/jats:p>","DOI":"10.1128\/jcm.03465-14","type":"journal-article","created":{"date-parts":[[2015,3,5]],"date-time":"2015-03-05T03:12:43Z","timestamp":1425525163000},"page":"1562-1572","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":8,"title":["Matrix-Assisted Laser Desorption Ionization\u2013Time of Flight and Comparative Genomic Analysis of M-18 Group A Streptococcus Strains Associated with an Acute Rheumatic Fever Outbreak in Northeast Italy in 2012 and 2013"],"prefix":"10.1128","volume":"53","author":[{"given":"Paolo","family":"Gaibani","sequence":"first","affiliation":[{"name":"Operative Unit of Clinical Microbiology, St. Orsola\u2013Malpighi University Hospital, Bologna, 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