{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:54:17Z","timestamp":1785419657269,"version":"3.56.0"},"reference-count":95,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"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":["mSphere"],"published-print":{"date-parts":[[2026,3,31]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Invasive infections caused by\n                      <jats:italic toggle=\"yes\">Streptococcus pyogenes<\/jats:italic>\n                      (iGAS) have increased in Europe over the past decade, with a marked upsurge after the COVID-19 pandemic. Here, we examined whether the increase in iGAS infections in Norway was associated with the spread of variants that had acquired new virulence factors. A collection of 1,163 iGAS isolates submitted to the National Reference Laboratory between January 2017 and April 2023, representing 87% of all cases recorded by the Norwegian Surveillance System for Infectious Diseases, was analyzed by whole genome sequencing. Resistance to one or more antibiotics was found in 15.6% of the isolates: 14.1% were resistant to tetracycline, 6.4% to erythromycin, and 4.0% to clindamycin. Resistance to other antibiotics was &lt; 1%. The dominating\n                      <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                      types were\n                      <jats:italic toggle=\"yes\">emm1<\/jats:italic>\n                      (30.9%),\n                      <jats:italic toggle=\"yes\">emm12<\/jats:italic>\n                      (13.8%),\n                      <jats:italic toggle=\"yes\">emm89<\/jats:italic>\n                      (9.3%),\n                      <jats:italic toggle=\"yes\">emm28<\/jats:italic>\n                      (8.3%),\n                      <jats:italic toggle=\"yes\">emm4<\/jats:italic>\n                      (6.0%), and\n                      <jats:italic toggle=\"yes\">emm87<\/jats:italic>\n                      (4.5%), with the remaining isolates belonging to 55 other\n                      <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                      types; 62.3% of\n                      <jats:italic toggle=\"yes\">emm1<\/jats:italic>\n                      belonged to the hypervirulent lineage M1\n                      <jats:sub>UK<\/jats:sub>\n                      . Genetic characterization of the virulence factors of the dominant six\n                      <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                      types demonstrated extensive competition between related phages, leading to phage switching and interplay between integration and excision of temperate phages carrying virulence factors. Bacteriophages carrying virulence factors\n                      <jats:italic toggle=\"yes\">speC<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">spd1<\/jats:italic>\n                      displayed a particularly high turnover rate, with several pairs of otherwise genomically identical isolates exhibiting different phage-carrying status. We identified and characterized four new\n                      <jats:italic toggle=\"yes\">speC<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">spd1<\/jats:italic>\n                      -carrying phages. The rapid turnover pattern of these, as well as other phages carrying superantigens and DNAses suggests an important role in pathogenesis.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        This analysis of 1,163 iGAS isolates collected between January 2017 and April 2023 aimed to map virulence factor content to understand the observed increased incidence of iGAS in Norway. Our findings indicate that 15.6% of the isolates were resistant to at least one antibiotic, with tetracycline resistance being the most common. The dominant\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        types were\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        1,\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        4,\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        12,\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        28,\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        87, and\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        89, which together accounted for 72.7% of the isolates. The study highlights the dynamic nature of virulence factor-carrying temperate phages, particularly the ones carrying\n                        <jats:italic toggle=\"yes\">speC<\/jats:italic>\n                        and\n                        <jats:italic toggle=\"yes\">spd1<\/jats:italic>\n                        , which frequently integrate and excise within\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        types. Four previously unseen phages carrying\n                        <jats:italic toggle=\"yes\">speC<\/jats:italic>\n                        and\n                        <jats:italic toggle=\"yes\">spd1<\/jats:italic>\n                        were identified and characterized. This research underscores the complexity of iGAS epidemiology and the need for continuous surveillance to understand the evolving landscape of bacterial virulence factors, antibiotic resistance, and circulating\n                        <jats:italic toggle=\"yes\">emm<\/jats:italic>\n                        types.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/msphere.00775-25","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T13:40:48Z","timestamp":1773236448000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Evolutionary dynamics and virulence factor variability in invasive\n                    <i>Streptococcus pyogenes<\/i>\n                    in Norway, 2017\u22122023"],"prefix":"10.1128","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7566-4133","authenticated-orcid":true,"given":"Ola Br\u00f8nstad","family":"Brynildsrud","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/046nvst19","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Method Development and Analytics, Division of Infection Control, Norwegian Institute of Public Health","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde S.","family":"Vollan Gjerdrum","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/046nvst19","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Method Development and Analytics, Division of Infection Control, Norwegian Institute of Public Health","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Einar Sverre","family":"Berg","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/046nvst19","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Bacteriology, Division of Infection Control, Norwegian Institute of Public Health","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid L.","family":"Wester","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0331wat71","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Microbiology and Infection Control, Akershus University Hospital","place":["L\u00f8renskog, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique A.","family":"Caugant","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/046nvst19","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Method Development and Analytics, Division of Infection Control, Norwegian Institute of Public Health","place":["Oslo, Norway"]},{"id":[{"id":"https:\/\/ror.org\/01xtthb56","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Community Medicine, Faculty of Medicine, University of Oslo","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_5_2_2","volume-title":"StatPearls [Internet]Streptococcus pyogenes","author":"Kanwal S","year":"2021","unstructured":"Kanwal S, Vaitla P. 2021. 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