{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T22:28:12Z","timestamp":1764714492146},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2010,8,5]],"date-time":"2010-08-05T00:00:00Z","timestamp":1280966400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2010,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Hyaluronic acid capsule plays a key role in <jats:italic>Streptococcus pyogenes<\/jats:italic> virulence. Circulation of mucoid or highly encapsulated strains has been related to rheumatic fever epidemics and invasive disease in several countries. In 2009, an outbreak of mucoid <jats:italic>S. pyogenes<\/jats:italic> isolates was detected in northern Spain. The aim of the study was to describe clinical and molecular characteristics of mucoid strains causing this outbreak and to compare them with a sample of non-mucoid <jats:italic>S. pyogenes<\/jats:italic> isolates obtained during the same period of time.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>All <jats:italic>S. pyogenes<\/jats:italic> isolates with a mucoid colony morphology (n = 132), 10% of non-mucoid (n = 144) and all invasive <jats:italic>S. pyogenes<\/jats:italic> isolates (n = 7) obtained in 2009 were included. Characterization was performed by T-agglutination, <jats:italic>emm<\/jats:italic> typing, pulsed field gel electrophoresis and multilocus sequence typing.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>One clone characterized as <jats:italic>emm<\/jats:italic>3.1\/ST15 comprised 98.5% (n = 130) of all mucoid isolates. Subjects of all ages were affected. Main clinical manifestations were pharyngitis and scarlet fever, but this clone also caused invasive disease: two cases of streptococcal toxic shock syndrome, one arthritis, and one celullitis with a fatal outcome. Mucoid isolates were more prone to cause invasive disease than non-mucoid isolates (p = 0.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Although no acute rheumatic fever cases were detected, the most worrisome characteristics of this clone were the success for causing invasive disease and the merge of two virulent features: the serotype, <jats:italic>emm<\/jats:italic>3, and capsule hyper-production, expressed as a mucoid morphology.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1471-2334-10-233","type":"journal-article","created":{"date-parts":[[2010,8,5]],"date-time":"2010-08-05T18:54:10Z","timestamp":1281034450000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Spread of a highly mucoid Streptococcus pyogenes emm3\/ST15 clone"],"prefix":"10.1186","volume":"10","author":[{"given":"Esther","family":"Tamayo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milagrosa","family":"Montes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guadalupe","family":"Garc\u00eda-Medina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 M","family":"Garc\u00eda-Arenzana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio","family":"P\u00e9rez-Trallero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2010,8,5]]},"reference":[{"key":"1213_CR1","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1086\/529194","volume":"46","author":"GH Stollerman","year":"2008","unstructured":"Stollerman GH, Dale JB: The importance of the group a streptococcus capsule in the pathogenesis of human infections: a historical perspective. 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