{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:17:04Z","timestamp":1781187424096,"version":"3.54.1"},"reference-count":43,"publisher":"American Society for Microbiology","issue":"5","license":[{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"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":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,5,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              <jats:italic>Streptococcus pyogenes<\/jats:italic>\n              (Group A\n              <jats:italic>Streptococcus<\/jats:italic>\n              ; GAS) is a pathogen of global significance. In the pre-antibiotic era, GAS was a major cause of childhood morbidity and mortality, but its spread rapidly declined until the mid-2010s. The continuing increase in GAS infections, associated with the expansion of the M1\n              <jats:sub>UK<\/jats:sub>\n              lineage, was observed first in the United Kingdom (UK) and, later, globally. Here, we endeavor to assess the various determinants underlying the post-pandemic GAS upsurge, with a focus on microbial genomic features. We performed an epidemiological analysis of all laboratory-confirmed GAS infections identified between June 2018 and June 2024 at a tertiary University Hospital located in Northern Italy, dividing them into three levels of severity: mild, moderate, and invasive GAS infections. A subset of 34 representative GAS isolates identified in the post-pandemic period were subjected to short- and long-read whole genome sequencing (WGS). Of the 531 GAS cases analyzed during this period, the majority (415, 78.2%) occurred in the last two years. This increase in GAS cases correlated with a significant shift in infection severity: among the 118 GAS cases identified in the June 2018\u2013May 2022 period, only one resulted in an invasive infection (1\/118, 0.8%). In contrast, among the 531 GAS cases identified in the June 2022\u2013May 2024 period, 32 caused invasive infections (32\/531, 7.9%). WGS of 34 isolates (including 15 invasive isolates) identified 11 different\n              <jats:italic>emm<\/jats:italic>\n              types, the most frequent being\n              <jats:italic>emm<\/jats:italic>\n              1 (9 isolates) followed by\n              <jats:italic>emm<\/jats:italic>\n              12 (7 isolates), then\n              <jats:italic>emm<\/jats:italic>\n              89 and\n              <jats:italic>emm<\/jats:italic>\n              28 (4 isolates each). Among the\n              <jats:italic>emm<\/jats:italic>\n              1 isolates, the M1\n              <jats:sub>UK<\/jats:sub>\n              sublineage was the most represented (8 out of 9 isolates), with the remaining \u201csingleton\u201d belonging to the M1\n              <jats:sub>13SNP<\/jats:sub>\n              sublineage.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>IMPORTANCE<\/jats:title>\n            <jats:p>\n              <jats:italic>Streptococcus pyogenes<\/jats:italic>\n              (GAS) is a narrow-spectrum pathogen, circulating only in humans. Following the loosening of various public health measures implemented to face the challenge of the COVID-19 pandemic, a significant rise in GAS cases has been observed. Our study revealed a significant rise in GAS cases, particularly invasive infections, over the last two years. Genomic analysis identified multiple sequence types, including isolates belonging to an emerging lineage named M1\n              <jats:sub>UK<\/jats:sub>\n              . These findings underscore the importance of ongoing surveillance and genomic monitoring of GAS infections, especially considering their rising incidence and severity. Public health strategies should consider not only microbe-associated aspects but also host-associated and external factors to effectively address this resurgence and prevent future outbreaks.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1128\/spectrum.02494-24","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T14:16:01Z","timestamp":1742998561000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":7,"title":["Post-pandemic upsurge in Group A\n            <i>Streptococcus<\/i>\n            infections at an Italian tertiary university hospital"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9629-4637","authenticated-orcid":true,"given":"Gabriele","family":"Arcari","sequence":"first","affiliation":[{"name":"Department of Medicine and Technological Innovation, University of Insubria","place":["Varese, Italy"]},{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Novazzi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Technological Innovation, University of Insubria","place":["Varese, Italy"]},{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0171-7495","authenticated-orcid":false,"given":"Lorenzo","family":"Colombini","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena","place":["Siena, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Drago Ferrante","sequence":"additional","affiliation":[{"name":"Department of Medicine and Technological Innovation, University of Insubria","place":["Varese, Italy"]},{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Boutahar","sequence":"additional","affiliation":[{"name":"Department of Medicine and Technological Innovation, University of Insubria","place":["Varese, Italy"]},{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Paolo Genoni","sequence":"additional","affiliation":[{"name":"Department of Medicine and Technological Innovation, University of Insubria","place":["Varese, Italy"]},{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Cassani","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Gigante","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8484-3205","authenticated-orcid":true,"given":"Mattia","family":"Carbotti","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bianco","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena","place":["Siena, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8668-7479","authenticated-orcid":true,"given":"Mariana","family":"Tirziu","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena","place":["Siena, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Capuano","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di Circolo e Fondazione Macchi","place":["Varese, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renee","family":"Pasciuta","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Microbiology and Virology, Ospedale di 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