{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:45:15Z","timestamp":1793231115172,"version":"4.5.0"},"reference-count":112,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T00:00:00Z","timestamp":1620604800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>There has been an increasing worldwide incidence of invasive group A streptococcal (GAS) disease in pregnancy and in the puerperal period over the past 30 years. Postpartum Group A streptococci infection, and in particular streptococcal toxic shock syndrome (TSS) and necrotizing fasciitis, can be life threatening and difficult to treat. Despite antibiotics and supportive therapy, and in some cases advanced extensive surgery, mortality associated with invasive group A streptococcal postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome remains high, up to 40% of postpartum septic deaths. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of GAS disease compared to non-pregnant women. Despite the high incidence, many invasive GAS infections are not diagnosed in a timely manner, resulting in potentially preventable maternal and neonatal deaths. In this paper the specific characteristics of GAS infection in the field of Ob\/Gyn are brought to our attention, resulting in guidelines to improve our awareness, early recognition and timely treatment of the disease. New European prevalence data of vaginal GAS colonization are presented, alongside two original case histories. Additionally, aerobic vaginitis is proposed as a supplementary risk factor for invasive GAS diseases.<\/jats:p>","DOI":"10.3390\/jcm10092043","type":"journal-article","created":{"date-parts":[[2021,5,10]],"date-time":"2021-05-10T12:49:49Z","timestamp":1620650989000},"page":"2043","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Genital Tract GAS Infection ISIDOG Guidelines"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9890-6254","authenticated-orcid":false,"given":"Gilbert","family":"Donders","sequence":"first","affiliation":[{"name":"Femicare, Clinical Research for Women, 3300 Tienen, Belgium"},{"name":"Department of Obstetrics and Gynecology, University Hospital Antwerp, 2000 Antwerp, Belgium"},{"name":"Regional Hospital H Hart, 3300 Tienen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Greenhouse","sequence":"additional","affiliation":[{"name":"Clifton Women\u2019s Health, Bristol BS6 6JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0376-0067","authenticated-orcid":false,"given":"Francesca","family":"Donders","sequence":"additional","affiliation":[{"name":"Femicare, Clinical Research for Women, 3300 Tienen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Engel","sequence":"additional","affiliation":[{"name":"Department of Ob\/Gyn Maternit\u00e9, Centre Hospitalier, 1210 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorma","family":"Paavonen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Helsinki University Hospital, 00260 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Mendling","sequence":"additional","affiliation":[{"name":"German Centre for Infections in Gynecology and Obstetrics, at Helios University Hospital Wuppertal, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.1128\/JCM.43.4.1678-1683.2005","article-title":"Invasive group A streptococcal disease in Alberta, Canada (2000 to 2002)","volume":"43","author":"Tyrrell","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1097\/GRF.0b013e31827362fc","article-title":"Group A streptococcal infections in obstetrics and gynecology","volume":"55","author":"Rimawi","year":"2012","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_3","unstructured":"(2020, December 30). Centers for Disease Control and Prevention. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Group A Streptococcus, Available online: https:\/\/www.cdc.gov\/abcs\/reports-findings\/survreports\/gas18.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/cid\/ciw248","article-title":"Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005\u20132012","volume":"63","author":"Nelson","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1086\/342062","article-title":"Population-based surveillance for postpartum invasive group a streptococcus infections, 1995\u20132000","volume":"35","author":"Chuang","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cho, K.H., Port, G.C., and Caparon, M. (2019). Genetics of Group A Streptococci. Microbiol. Spectr., 7.","DOI":"10.1128\/microbiolspec.GPP3-0056-2018"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1038\/s41588-018-0343-1","article-title":"Integrated analysis of population genomics, transcriptomics and virulence provides novel insights into Streptococcus pyogenes pathogenesis","volume":"51","author":"Kachroo","year":"2019","journal-title":"Nat. Genet."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1128\/CMR.00101-13","article-title":"Disease manifestations and pathogenic mechanisms of Group A Streptococcus","volume":"27","author":"Walker","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"18833","DOI":"10.1074\/jbc.M115.655365","article-title":"Direct Host Plasminogen Binding to Bacterial Surface M-protein in Pattern D Strains of Streptococcus pyogenes Is Required for Activation by Its Natural Coinherited SK2b Protein","volume":"290","author":"Chandrahas","year":"2015","journal-title":"J. Biol. Chem."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"982","DOI":"10.2174\/1389450120666190405095712","article-title":"Current Understanding of Group A Streptococcal Biofilms","volume":"20","author":"Vyas","year":"2019","journal-title":"Curr. Drug Targets."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1007\/s12275-019-8648-z","article-title":"Superantigen SpeA attenuates the biofilm forming capacity of Streptococcus pyogenes","volume":"57","author":"Babbar","year":"2019","journal-title":"J. Microbiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1172\/JCI124994","article-title":"Gene fitness landscape of group A streptococcus during necrotizing myositis","volume":"129","author":"Zhu","year":"2019","journal-title":"J. Clin. Investig."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Kachroo, P., Eraso, J.M., Olsen, R.J., Zhu, L., Kubiak, S.L., Pruitt, L., Yerramilli, P., Cantu, C.C., Ojeda Saavedra, M., and Pensar, J. (2020). New Pathogenesis Mechanisms and Translational Leads Identified by Multidimensional Analysis of Necrotizing Myositis in Primates. mBio, 11.","DOI":"10.1128\/mBio.03363-19"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.4049\/jimmunol.1500804","article-title":"Adaptive Immunity against Streptococcus pyogenes in Adults Involves Increased IFN-\u03b3 and IgG3 Responses Compared with Children","volume":"195","author":"Mortensen","year":"2015","journal-title":"J. Immunol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1128\/CMR.00134-14","article-title":"Staphylococcus aureus infections: Epidemiology, pathophysiology, clinical manifestations, and management","volume":"28","author":"Tong","year":"2015","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.mcna.2013.03.003","article-title":"Serious group a streptococcal infections","volume":"97","author":"Wong","year":"2013","journal-title":"Med. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.jiac.2019.10.004","article-title":"Molecular epidemiology, antimicrobial susceptibility, and characterization of fluoroquinolone non-susceptible Streptococcus pyogenes in Japan","volume":"26","author":"Tatara","year":"2020","journal-title":"J. Infect. Chemother."},{"key":"ref_18","first-page":"435","article-title":"The Emergence of Hypervirulent M1T1 Clone of Group A Streptococcus via Genetic Recombination and Host Selection","volume":"32","author":"Liu","year":"2019","journal-title":"Pathog. Streptococci Genom. Syst. Biol. Control"},{"key":"ref_19","unstructured":"Ferretti, J.J., Stevens, D.L., and Fischetti, V.A. (2016). Severe Group A Streptococcal Infections. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, University of Oklahoma Health Sciences Center."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1093\/clinids\/14.1.2","article-title":"Invasive group A streptococcus infections","volume":"14","author":"Stevens","year":"1992","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1086\/313980","article-title":"The initial outpatient-physician encounter in group A streptococcal necrotizing fasciitis","volume":"31","author":"Bisno","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1001\/archinte.1985.00360060076010","article-title":"Streptococcal myositis","volume":"145","author":"Adams","year":"1985","journal-title":"Arch. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/clinids\/14.1.29","article-title":"Group A streptococcal bacteremia in a community teaching hospital--1980-1989","volume":"14","author":"Burkert","year":"1992","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1056\/NEJM199608223350803","article-title":"Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group","volume":"335","author":"Davies","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0163-4453(88)96073-2","article-title":"Streptococcus pyogenes bacteraemia: An old enemy subdued, but not defeated","volume":"16","author":"Ispahani","year":"1988","journal-title":"J. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1093\/clinids\/14.5.1074","article-title":"Streptococcal toxic shock syndrome due to noninvasive pharyngitis","volume":"14","author":"Chapnick","year":"1992","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1093\/clinids\/22.3.490","article-title":"Spread of serious disease-producing M3 clones of group A streptococcus among family members and health care workers","volume":"22","author":"DiPersio","year":"1996","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1086\/344279","article-title":"An outbreak of group A Streptococcal infection among health care workers","volume":"35","author":"Kakis","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S1473-3099(05)70267-X","article-title":"The global burden of group A streptococcal diseases","volume":"5","author":"Carapetis","year":"2005","journal-title":"Lancet Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1093\/cid\/cit282","article-title":"Pregnancy-related group a streptococcal infections: Temporal relationships between bacterial acquisition, infection onset, clinical findings, and outcome","volume":"57","author":"Hamilton","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/01.inf.0000255328.19808.be","article-title":"Chronic pharyngeal carriage of group A streptococci","volume":"26","author":"Tanz","year":"2007","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/PAT.0000000000000001","article-title":"Observational study of Streptococcus pyogenes isolated from vaginal swabs of adult women in a hospital and community laboratory","volume":"45","author":"Upton","year":"2013","journal-title":"Pathology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.jiac.2019.05.001","article-title":"Streptococcal toxic shock syndrome following group A streptococcal vulvovaginitis in a breastfeeding woman","volume":"25","author":"Kawaguchi","year":"2019","journal-title":"J. Infect. Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/1471-0528.15415","article-title":"Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010\u20132016: Assessment of risk and audit of public health management","volume":"126","author":"Leonard","year":"2019","journal-title":"BJOG"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Keller, N.A., Guan, X., Wiczulis, A., and Burcher, P. (2015). Unexplained persistent postpartum palpitations and achycardia due to Group A Streptococcus. BMC Res. Notes, 8.","DOI":"10.1186\/s13104-015-1739-y"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1053\/tvjl.1999.0423","article-title":"Prospects for \u2018competitive exclusion\u2019 treatment to control salmonellas and other foodborne pathogens in poultry","volume":"159","author":"Mead","year":"2000","journal-title":"Vet. J."},{"key":"ref_37","first-page":"217","article-title":"Vaginal-rectal colonization with group A streptococci in late pregnancy","volume":"8","author":"Mead","year":"2000","journal-title":"Infect. Dis. Obstet. Gynecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/PAT.0b013e3283582983","article-title":"Vaginal carriage rate of streptococcal pyogenes in 1600 pregnant women","volume":"44","author":"Saab","year":"2012","journal-title":"Pathology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3109\/01443615.2010.541570","article-title":"A quantitative descriptive study of the prevalence of carriage (colonisation) of haemolytic streptococci groups A, B, C and G in pregnancy","volume":"31","author":"Hassan","year":"2011","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1007\/s10096-009-0733-5","article-title":"Association between group A beta-haemolytic streptococci and vulvovaginitis in adult women: A case-control study","volume":"28","author":"Bruins","year":"2009","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_41","first-page":"196","article-title":"Frequency and antimicrobial susceptibility of aerobic bacterial vaginal isolates","volume":"16","author":"Tariq","year":"2006","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1136\/adc.81.1.64","article-title":"Vulvovaginitis: Clinical features, aetiology, and microbiology of the genital tract","volume":"81","author":"Jaquiery","year":"1999","journal-title":"Arch. Dis. Child."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1136\/adc.88.4.324","article-title":"Vulvovaginitis in prepubertal girls","volume":"88","author":"Stricker","year":"2003","journal-title":"Arch. Dis. Child."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/01.ogx.0000265998.40912.5e","article-title":"Puerperal pyrexia: A review. Part, I","volume":"62","author":"Maharaj","year":"2007","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"(1999). From the Centers for Disease Control and Prevention. Nosocomial group A streptococcal infections associated with asymptomatic health-care workers\u2014Maryland and California, 1997. JAMA, 281, 1077\u20131078.","DOI":"10.1001\/jama.281.12.1077"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1093\/infdis\/138.3.287","article-title":"Wound infections due to group A streptococcus traced to a vaginal carrier","volume":"138","author":"Stamm","year":"1978","journal-title":"J. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"251.e1","DOI":"10.1016\/j.cmi.2018.10.002","article-title":"Risk factors, clinical course and outcomes of pregnancy-related group A streptococcal infections: Retrospective 13-year cohort study","volume":"25","author":"Rottenstreich","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_48","unstructured":"(2004). Interim UK guidelines for management of close community contacts of invasive group A streptococcal disease. Commun. Dis. Public Health, 7, 354\u2013361."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1111\/j.1471-0528.2011.03097.x","article-title":"Saving mothers\u2019 lives. Reviewing maternal deaths to make motherhood safer: 2006\u20132008","volume":"118","author":"Wilkinson","year":"2011","journal-title":"BJOG"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1111\/jog.13136","article-title":"Recommendations for saving mothers\u2019 lives in Japan: Report from the Maternal Death Exploratory Committee (2010\u20132014)","volume":"42","author":"Hasegawa","year":"2016","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_51","first-page":"942","article-title":"Serious maternal morbidity after childbirth: Prolonged hospital stays and readmissions","volume":"94","author":"Hebert","year":"1999","journal-title":"Obstet Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1093\/cid\/cir325","article-title":"Incidence and severity of invasive Streptococcus pneumoniae, group A Streptococcus, and group B Streptococcus infections among pregnant and postpartum women","volume":"53","author":"Deutscher","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/j.1600-0897.2010.00836.x","article-title":"The immune system in pregnancy: A unique complexity","volume":"63","author":"Mor","year":"2010","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1600-0897.2011.01083.x","article-title":"Postpartum group a Streptococcus sepsis and maternal immunology","volume":"67","author":"Mason","year":"2012","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1038\/nm1202-800","article-title":"An immunogenetic and molecular basis for differences in outcomes of invasive group A streptococcal infections","volume":"8","author":"Kotb","year":"2002","journal-title":"Nat. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3523","DOI":"10.1128\/IAI.68.6.3523-3534.2000","article-title":"Genetic relatedness and superantigen expression in group A streptococcus serotype M1 isolates from patients with severe and nonsevere invasive diseases","volume":"68","author":"Chatellier","year":"2000","journal-title":"Infect. Immun."},{"key":"ref_57","first-page":"1","article-title":"Sepsis. Centre for Maternal and Child Enquiries Mission Statement","volume":"118","author":"Harper","year":"2011","journal-title":"BJOG"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/0029-7844(95)00327-N","article-title":"The association between manual removal of the placenta and postpartum endometritis following vaginal delivery","volume":"86","author":"Ely","year":"1995","journal-title":"Obstet Gynecol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1128\/jcm.4.1.54-56.1976","article-title":"Effects of selective media and atmosphere of incubation on the isolation of group A streptococci","volume":"4","author":"Murray","year":"1976","journal-title":"J. Clin. Microbiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1056\/NEJM200101183440308","article-title":"Acute pharyngitis","volume":"344","author":"Bisno","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.bpobgyn.2007.01.002","article-title":"Definition and classification of abnormal vaginal flora","volume":"21","author":"Donders","year":"2007","journal-title":"Best Pract Res. Clin. Obstet Gynaecol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1128\/CMR.15.4.613-630.2002","article-title":"What happened to the streptococci: Overview of taxonomic and nomenclature changes","volume":"15","author":"Facklam","year":"2002","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1128\/JCM.00175-13","article-title":"Severe soft tissue infection caused by a non-beta-hemolytic Streptococcus pyogenes strain harboring a premature stop mutation in the sagC gene","volume":"51","author":"Jantsch","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2","DOI":"10.21037\/atm.2018.06.28","article-title":"MALDI-TOF mass spectrometry technology for detecting biomarkers of antimicrobial resistance: Current achievements and future perspectives","volume":"6","author":"Vrioni","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"5620","DOI":"10.1128\/JCM.42.12.5620-5623.2004","article-title":"Prevalence and mechanisms of erythromycin resistance in group A and group B Streptococcus: Implications for reporting susceptibility results","volume":"42","author":"Desjardins","year":"2004","journal-title":"J. Clin. Microbiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1128\/jcm.25.3.504-508.1987","article-title":"Specificity study of kits for detection of group A streptococci directly from throat swabs","volume":"25","author":"Facklam","year":"1987","journal-title":"J. Clin. Microbiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1128\/JCM.41.1.242-249.2003","article-title":"Comparison of LightCycler PCR, rapid antigen immunoassay, and culture for detection of group A streptococci from throat swabs","volume":"41","author":"Uhl","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1093\/cid\/cis847","article-title":"Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America","volume":"55","author":"Shulman","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"4207","DOI":"10.1128\/JCM.40.11.4207-4210.2002","article-title":"Performance characteristics and utilization of rapid antigen test, DNA probe, and culture for detection of group a streptococci in an acute care clinic","volume":"40","author":"Chapin","year":"2002","journal-title":"J. Clin. Microbiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1099\/00222615-38-5-311","article-title":"A review of the correlation of T-agglutination patterns and M-protein typing and opacity factor production in the identification of group A streptococci","volume":"38","author":"Johnson","year":"1993","journal-title":"J. Med. Microbiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1086\/324621","article-title":"Extension of the Lancefield classification for group A streptococci by addition of 22 new M protein gene sequence types from clinical isolates: Emm103 to emm124","volume":"34","author":"Facklam","year":"2002","journal-title":"Clin. Infect. Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1086\/593176","article-title":"Sequence variation in group A Streptococcus pili and association of pilus backbone types with lancefield T serotypes","volume":"198","author":"Falugi","year":"2008","journal-title":"J. Infect. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e557","DOI":"10.1542\/peds.2009-2648","article-title":"Prevalence of streptococcal pharyngitis and streptococcal carriage in children: A meta-analysis","volume":"126","author":"Shaikh","year":"2010","journal-title":"Pediatrics"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1001\/jama.1981.03320160022023","article-title":"Penicillin V for group A streptococcal pharyngotonsillitis. A randomized trial of seven vs. ten days\u2019 therapy","volume":"246","author":"Schwartz","year":"1981","journal-title":"JAMA"},{"key":"ref_75","first-page":"567","article-title":"Streptococcal pharyngitis: Diagnostic considerations","volume":"13","author":"Shulman","year":"1994","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1542\/peds.2004-0133","article-title":"Group A streptococci among school-aged children: Clinical characteristics and the carrier state","volume":"114","author":"Martin","year":"2004","journal-title":"Pediatrics"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1172\/JCI104510","article-title":"Studies of the carrier state following infection with group A streptococci. 1. Effect of climate","volume":"41","author":"Krause","year":"1962","journal-title":"J. Clin. Investig."},{"key":"ref_78","unstructured":"Kimberlin, D.W., Brady, M.T., Jackson, M., and Long, S.S. (2015). Red Book: 2015 Report of the Committee on Infectious Diseases, American Academy of Pediatrics. [30th ed.]."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0022-3476(05)81052-2","article-title":"Clindamycin treatment of chronic pharyngeal carriage of group A streptococci","volume":"119","author":"Tanz","year":"1991","journal-title":"J. Pediatr."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1016\/S0022-3476(85)80229-8","article-title":"Penicillin plus rifampin eradicates pharyngeal carriage of group A streptococci","volume":"106","author":"Tanz","year":"1985","journal-title":"J. Pediatr."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/S0022-3476(88)80291-9","article-title":"Eradication of group A streptococci from the upper respiratory tract by amoxicillin with clavulanate after oral penicillin V treatment failure","volume":"113","author":"Kaplan","year":"1988","journal-title":"J. Pediatr."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1093\/oxfordjournals.aje.a113495","article-title":"Type-specific immunity and pharyngeal acquisition of group A Streptococcus","volume":"116","author":"Guirguis","year":"1982","journal-title":"Am. J. Epidemiol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/0002-9343(51)90274-4","article-title":"Effect in penicillin and aureomycin on the natural course of streptococcal tonsillitis and pharyngitis","volume":"10","author":"Brink","year":"1951","journal-title":"Am. J. Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/0002-9343(54)90219-3","article-title":"The role of the streptococcus in the pathogenesis of rheumatic fever","volume":"17","author":"Catanzaro","year":"1954","journal-title":"Am. J. Med."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.micpath.2011.03.009","article-title":"Biofilm formation or internalization into epithelial cells enable Streptococcus pyogenes to evade antibiotic eradication in patients with pharyngitis","volume":"51","author":"Ogawa","year":"2011","journal-title":"Microb. Pathog."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"163","DOI":"10.17305\/bjbms.2013.2356","article-title":"Evaluation of emm gene types, toxin gene profiles and clonal relatedness of group A streptococci","volume":"13","author":"Mengeloglu","year":"2013","journal-title":"Bosn. J. Basic Med. Sci."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1128\/CMR.13.3.470","article-title":"Pathogenesis of group A streptococcal infections","volume":"13","author":"Cunningham","year":"2000","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s10156-009-0724-6","article-title":"Distribution of fibronectin-binding protein genes (prtF1 and prtF2) and streptococcal pyrogenic exotoxin genes (spe) among Streptococcus pyogenes in Japan","volume":"15","author":"Hotomi","year":"2009","journal-title":"J. Infect. Chemother."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1086\/515310","article-title":"Invasion and survival of Streptococcus pyogenes in eukaryotic cells correlates with the source of the clinical isolates","volume":"177","author":"Molinari","year":"1998","journal-title":"J. Infect. Dis."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1128\/iai.65.4.1357-1363.1997","article-title":"The fibronectin-binding protein of Streptococcus pyogenes, SfbI, is involved in the internalization of group A streptococci by epithelial cells","volume":"65","author":"Molinari","year":"1997","journal-title":"Infect. Immun."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/S0140-6736(97)12452-7","article-title":"Prevalence of internalisation-associated gene, prtF1, among persisting group-A streptococcus strains isolated from asymptomatic carriers","volume":"352","author":"Neeman","year":"1998","journal-title":"Lancet"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1086\/375589","article-title":"Internalization-associated proteins among Streptococcus pyogenes isolated from asymptomatic carriers and children with pharyngitis","volume":"37","author":"Musumeci","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.micinf.2004.11.015","article-title":"Presence of fibronectin-binding protein gene prtF2 in invasive group A streptococci in tropical Australia is associated with increased internalisation efficiency","volume":"7","author":"Gorton","year":"2005","journal-title":"Microbes Infect."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1089\/mdr.2004.10.264","article-title":"Prevalence of the internalization-associated gene prtF1 in a bacterial population of Streptococcus pyogenes isolated from children with acute pharyngotonsillitis before and after antibiotic therapy","volume":"10","author":"Cocuzza","year":"2004","journal-title":"Microb. Drug. Resist."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/S0140-6736(00)05253-3","article-title":"Association between erythromycin resistance and ability to enter human respiratory cells in group A streptococci","volume":"358","author":"Facinelli","year":"2001","journal-title":"Lancet"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"271","DOI":"10.7883\/yoken.JJID.2004.271","article-title":"The rate of asymptomatic throat carriage of group A Streptococcus in school children and associated ASO titers in Duzce, Turkey","volume":"57","author":"Ozturk","year":"2004","journal-title":"Jpn J. Infect. Dis."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Nayiga, I., Okello, E., Lwabi, P., and Ndeezi, G. (2017). Prevalence of group a streptococcus pharyngeal carriage and clinical manifestations in school children aged 5-15 yrs in Wakiso District, Uganda. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2353-5"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Dray\u00df, M., Claus, H., Hubert, K., Thiel, K., Berger, A., Sing, A., Linden, M.V., Vogel, U., and L\u00e2m, T.T. (2019). Asymptomatic carriage of Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Group A Streptococcus and Staphylococcus aureus among adults aged 65 years and older. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0212052"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1136\/archdischild-2013-304741","article-title":"Toxic shock syndrome surveillance in UK children","volume":"99","author":"Adalat","year":"2014","journal-title":"Arch. Dis Child."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"DeVries, A.S., Lesher, L., Schlievert, P.M., Rogers, T., Villaume, L.G., Danila, R., and Lynfield, R. (2011). Staphylococcal toxic shock syndrome 2000\u20132006: Epidemiology, clinical features, and molecular characteristics. PLoS ONE, 6.","DOI":"10.1371\/journal.pone.0022997"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"30532","DOI":"10.2807\/1560-7917.ES.2017.22.19.30532","article-title":"Household transmission of invasive group A Streptococcus infections in England: A population-based study, 2009, 2011 to 2013","volume":"22","author":"Mearkle","year":"2017","journal-title":"Eur. Surveill."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1097\/AOG.0000000000000175","article-title":"Puerperal group A streptococcal infection: Beyond Semmelweis","volume":"123","author":"Anderson","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref_103","first-page":"251","article-title":"Group A Streptococci: A rare and often misdiagnosed cause of spontaneous bacterial peritonitis in adults","volume":"2015","author":"Malota","year":"2014","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"(2002). Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: Recommendations from the Centers for Disease Control and Prevention. Clin. Infect. Dis., 35, 950\u2013959.","DOI":"10.1086\/342692"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1093\/jpids\/piu107","article-title":"Management of Contacts of Patients with Severe Invasive Group A Streptococcal Infection","volume":"5","author":"Torres","year":"2016","journal-title":"J. Pediatric Infect. Dis. Soc."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.gore.2018.08.003","article-title":"Streptococcal sex syndrome: A curious association between sex and cellulitis","volume":"26","author":"Santos","year":"2018","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jhin.2019.12.004","article-title":"A protracted iGAS outbreak in a long-term care facility 2014\u20132015: Control measures and the use of whole-genome sequencing","volume":"105","author":"Degala","year":"2020","journal-title":"J. Hosp. Infect."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"563627","DOI":"10.3389\/fcimb.2020.563627","article-title":"Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review","volume":"10","author":"Mustafa","year":"2020","journal-title":"Front. Cell Infect. Microbiol."},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Eskes, A., Vermeulen, H., Lucas, C., and Ubbink, D.T. (2013). Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database Syst. Rev., CD008059.","DOI":"10.1002\/14651858.CD008059.pub3"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13017-018-0219-9","article-title":"2018 WSES\/SIS-E consensus conference: Recommendations for the management of skin and soft-tissue infections","volume":"13","author":"Sartelli","year":"2018","journal-title":"World J. Emerg. Surg."},{"key":"ref_111","first-page":"CD011680","article-title":"Interventions for necrotizing soft tissue infections in adults","volume":"5","author":"Hua","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_112","unstructured":"Ferretti, J.J., Stevens, D.L., and Fischetti, V.A. (2016). Current Approaches to Group A Streptococcal Vaccine Development. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, University of Oklahoma Health Sciences Center."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/9\/2043\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:58:54Z","timestamp":1760162334000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/9\/2043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,10]]},"references-count":112,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["jcm10092043"],"URL":"https:\/\/doi.org\/10.3390\/jcm10092043","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,10]]}}}