{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T09:00:27Z","timestamp":1791277227337,"version":"4.1.0"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Group A Streptococcus (GAS) causes multiple clinical manifestations, including invasive (iGAS) or even life-threatening (severe-iGAS) infections. After the drop in cases during COVID-19 pandemic, in 2022 a sharp increase of GAS was reported globally.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>GAS strains collected in 09\/2022\u201303\/2023 in two university hospitals in Milan, Italy were retrospectively analyzed. Clinical\/epidemiological data were combined with whole-genome sequencing to: (i) define resistome\/virulome, (ii) identify putative transmission chains, (iii) explore associations between <jats:italic>emm-<\/jats:italic>types and clinical severity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-eight isolates were available, 19\/28 (67.9%) from adults and 9\/28 (32.1%) from pediatric population. The criteria for iGAS were met by 19\/28 cases (67.9%), of which 11\/19 (39.3%) met the further criteria for severe-iGAS. Pediatric cases were mainly non-invasive infections (8\/9, 88.9%), adult cases were iGAS and severe-iGAS in 18\/19 (94.7%) and 10\/19 (52.6%), respectively. Thirteen <jats:italic>emm<\/jats:italic>-types were detected, the most prevalent being <jats:italic>emm<\/jats:italic>1 and <jats:italic>emm<\/jats:italic>12 (6\/28 strains each, 21.4%). Single nucleotide polymorphism (SNP) analysis of <jats:italic>emm<\/jats:italic>1.0 and <jats:italic>emm<\/jats:italic>12.0 strains revealed pairwise SNP distance always &amp;gt;10, inconsistent with unique transmission chains. <jats:italic>Emm<\/jats:italic>12.0-type, found to almost exclusively carry virulence factors <jats:italic>spe<\/jats:italic>H and <jats:italic>spe<\/jats:italic>I, was mainly detected in children and in no-iGAS infections (55.6 vs. 5.3%, <jats:italic>p<\/jats:italic> = 0.007 and 66.7 vs. 0.0%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001, respectively), while <jats:italic>emm<\/jats:italic>1.0-type was mainly detected in severe-iGAS (0.0 vs. 45.5%, <jats:italic>p<\/jats:italic> = 0.045).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study showed that multiple <jats:italic>emm<\/jats:italic>-types contributed to a 2022\/2023 GAS infection increase in two hospitals in Milan, with no evidence of direct transmission chains. Specific <jats:italic>emm<\/jats:italic>-types could be associated with disease severity or invasiveness. Overall, these results support the integration of classical epidemiological studies with genomic investigation to appropriately manage severe infections and improve surveillance.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2023.1287522","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T04:42:35Z","timestamp":1704948155000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Increase in invasive group A streptococcal infections in Milan, Italy: a genomic and clinical characterization"],"prefix":"10.3389","volume":"14","author":[{"given":"Davide","family":"Mangioni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Saltini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Lombardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Bussini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Carella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Cariani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnese","family":"Comelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Matinato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Muscatello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Teri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Terranova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Cento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Carloni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Bartoletti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Alteri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Bandera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2023.03.001","article-title":"The ongoing Streptococcus pyogenes (Group A Streptococcus) outbreak in London, United Kingdom in December 2022, a molecular epidemiology study","author":"Alcolea-Medina","year":"2023","journal-title":"Clin. 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