{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T12:57:48Z","timestamp":1785243468427,"version":"3.55.0"},"reference-count":54,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Faculty, Sofia University \u201cSt. Kliment Ohridski\u201d","award":["80-10-191\/17.05.2023"],"award-info":[{"award-number":["80-10-191\/17.05.2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Recently a resurgence of Streptococcus pyogenes infections has arisen, with concerns around the highly virulent M1UK lineage. Our aim was to characterize S. pyogenes, the immune responses it causes, and to determine the presence of the M1UK lineage in Sofia, Bulgaria. In our study, the infections were confirmed by culture testing or rapid antigen test. Identification was performed by MALDI-TOF and was followed up by antibiotic susceptibility testing (EUCAST). Virulence factors were identified using multiplex PCR and whole genome sequencing (WGS). Immune responses were measured through detection of serum complement levels, lymphocyte subsets, and cytokine profiling. Out of 82 children, 38 had scarlet fever and the rest had streptococcal pharyngitis. Strains were susceptible to penicillin (\u03b2-lactams), macrolides, clindamycin, tetracyclines, co-trimoxazole, fluoroquinolones, and linezolid. Superantigen profiles were identified: SpeA + SpeJ (45%), SpeC, and SpeI + SpeH (27.5% each). A novel Multilocus sequence typing (MLST) haplotype in the mutS gene (d90b) was found in four strains. The M1UK lineage was detected for the first time in Bulgaria. We observed an increase in complement fractions C3 and C4 and a decrease in T lymphocytes. A significant increase in the levels of IFN-\u03b3, IL-6, and IL-10 with corresponding reduction in IL-17A were revealed. In conclusion, the studied S. pyogenes strains were characterized by their susceptibility to antibiotics and the predominance of SpeA superantigen; for the first time in Bulgaria the presence of M1UK and a novel SNP variation in the mutS gene (d90b) were found. A mixed pattern of pro- and anti-inflammatory immune responses in patients was observed.<\/jats:p>","DOI":"10.3390\/microorganisms13010179","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T04:55:19Z","timestamp":1737003319000},"page":"179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Characterization of Streptococcus pyogenes Strains from Tonsillopharyngitis and Scarlet Fever Resurgence, 2023\u2014FIRST Detection of M1UK in Bulgaria"],"prefix":"10.3390","volume":"13","author":[{"given":"Emma","family":"Keuleyan","sequence":"first","affiliation":[{"name":"Clinical Microbiology and Virology Laboratory, University Hospital \u201cLozenetz\u201d, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0548-5487","authenticated-orcid":false,"given":"Theodor","family":"Todorov","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Genetics and Molecular Biology, University Hospital \u201cLozenetz\u201d, 1407 Sofia, Bulgaria"},{"name":"Medical Faculty, Sofia University \u201cSt. Kliment Ohridski\u201d, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7447-7627","authenticated-orcid":false,"given":"Deyan","family":"Donchev","sequence":"additional","affiliation":[{"name":"National Reference Laboratory for Control and Monitoring of Antimicrobial Resistance, National Center for Infectious and Parasitic Diseases, 1504 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ani","family":"Kevorkyan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University\u2014Plovdiv, 4002 Plovdiv, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0374-5046","authenticated-orcid":false,"given":"Radoslava","family":"Vazharova","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Genetics and Molecular Biology, University Hospital \u201cLozenetz\u201d, 1407 Sofia, Bulgaria"},{"name":"Medical Faculty, Sofia University \u201cSt. Kliment Ohridski\u201d, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Kukov","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Immunology, University Hospital \u201cLozenetz\u201d, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgi","family":"Todorov","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Virology Laboratory, University Hospital \u201cLozenetz\u201d, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boriana","family":"Georgieva","sequence":"additional","affiliation":[{"name":"Clinic of Pediatrics, University Hospital \u201cLozenetz\u201d, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iskra","family":"Altankova","sequence":"additional","affiliation":[{"name":"Medical Faculty, Sofia University \u201cSt. Kliment Ohridski\u201d, 1407 Sofia, Bulgaria"},{"name":"Laboratory of Clinical Immunology, University Hospital \u201cLozenetz\u201d, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yordanka","family":"Uzunova","sequence":"additional","affiliation":[{"name":"Medical Faculty, Sofia University \u201cSt. Kliment Ohridski\u201d, 1407 Sofia, Bulgaria"},{"name":"Clinic of Pediatrics, University Hospital \u201cLozenetz\u201d, 1407 Sofia, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1038\/s41579-023-00865-7","article-title":"Pathogenesis, epidemiology and control of Group A Streptococcus infection","volume":"21","author":"Brouwer","year":"2023","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lu, Q., Yu, D., and Yang, Y. (2023). Group A Streptococcus Is Still at Large. J. Clin. Med., 12.","DOI":"10.3390\/jcm12072739"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wilde, S., Johnson, A.F., and LaRock, C.N. (2021). Playing with Fire: Proinflammatory Virulence Mechanisms of Group A Streptococcus. Front. Cell. Infect. Microbiol., 11.","DOI":"10.3389\/fcimb.2021.704099"},{"key":"ref_4","unstructured":"Ferretti, J., Stevens, D., and Fischetti, V. (2022). Secreted Virulence Factors of Streptococcus pyogenes. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, University of Oklahoma Health Sciences Center. [2nd ed.]."},{"key":"ref_5","unstructured":"Ferretti, J., Stevens, D., and Fischetti, V. (2022). Streptococcus pyogenes Superantigens: Biological properties and potential role in disease. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, University of Oklahoma Health Sciences Center. [2nd ed.]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5018","DOI":"10.1038\/s41467-020-18700-5","article-title":"Prophage exotoxins enhance colonization fitness in epidemic scarlet fever-causing Streptococcus pyogenes","volume":"11","author":"Brouwer","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"201991","DOI":"10.1098\/rsos.201991","article-title":"A brief review on Group A Streptococcus pathogenesis and vaccine development","volume":"8","author":"Castro","year":"2021","journal-title":"R. Soc. Open. Sci."},{"key":"ref_8","first-page":"603","article-title":"Virulence Factors and Clinical Features of Streptococcus pyogenes: Overview","volume":"25","author":"Jasim","year":"2021","journal-title":"Ann. Rom. Soc. Cell Biol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cunningham, M.W. (2000). Pathogenesis of Group A Streptococcal Infections. Clin. Microbiol. Rev., 13.","DOI":"10.1128\/CMR.13.3.470"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1093\/cid\/ciac291","article-title":"A Systematic Framework for Prioritizing Burden of Disease Data Required for Vaccine Development and Implementation: The Case for Group A Streptococcal Diseases","volume":"75","author":"Moore","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.wjorl.2021.05.005","article-title":"The treatment of streptococcal tonsillitis\/pharyngitis in young children","volume":"7","author":"Norton","year":"2021","journal-title":"World J. Otorhinolaryngol. Neck Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/INF.0000000000003708","article-title":"Acute Rheumatic Fever: Recent Advances","volume":"42","author":"Hardefeldt","year":"2023","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_13","unstructured":"Ferretti, J., Stevens, D., and Fischetti, V. (2022). Post-Streptococcus pyogenes Glomerulonephritis. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, University of Oklahoma Health Sciences Center. [2nd ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ohashi, A., Murayama, M.A., Miyabe, Y., Yudoh, K., and Miyabe, C. (2024). Streptococcal infection and autoimmune diseases. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1361123"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"016851","DOI":"10.1161\/JAHA.120.016851","article-title":"Contemporary Incidence and Prevalence of Rheumatic Fever and Rheumatic Heart Disease in Australia Using Linked Data: The Case for Policy Change","volume":"9","author":"Katzenellenbogen","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","unstructured":"Prinzi, A. (2023). Scarlet Fever: A Deadly History and How it Prevails. Am. Soc. Microbiol., Available online: https:\/\/asm.org\/articles\/2023\/january\/scarlet-fever-a-deadly-history-and-how-it-prevails."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12982-024-00144-7","article-title":"Scarlet fever epidemics, deaths, efects on society and precautions taken in the Ottoman Empire and the Early Turkish Republic","volume":"21","author":"Erkmen","year":"2024","journal-title":"Discov. Public Health"},{"key":"ref_18","unstructured":"Ferretti, J., Stevens, D., and Fischetti, V. (2022). Severe Streptococcus pyogenes Infections. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, University of Oklahoma Health Sciences Center. [2nd ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/S2666-5247(23)00318-X","article-title":"Global Streptococcus pyogenes strain diversity, disease associations, and implications for vaccine development: A systematic review","volume":"5","author":"Smeesters","year":"2024","journal-title":"Lancet Microbe"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hasso-Agopsowicz, M., Hwang, A., Hollm-Delgado, M.G., Umbelino-Walker, I., Karron, R.A., Raman, R., Sparrow, E., and Giersing, B. (2024). Identifying WHO global priority endemic pathogens for vaccine research and development (R&D) using multi-criteria decision analysis (MCDA): An objective of the Immunization Agenda 2030. eBioMedicine, 110.","DOI":"10.1016\/j.ebiom.2024.105424"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3916","DOI":"10.1038\/s41467-024-47929-7","article-title":"Rapid expansion and international spread of M1UK in the post-pandemic UK upsurge of Streptococcus pyogenes","volume":"10","author":"Vieira","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_22","first-page":"001152","article-title":"Insights gained from sequencing Australian non-invasive and invasive Streptococcus pyogenes isolates","volume":"10","author":"Butler","year":"2024","journal-title":"Microb. Genom."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/S1473-3099(19)30622-X","article-title":"Identification of Streptococcus pyogenes M1UK clone in Canada","volume":"19","author":"Demczuk","year":"2019","journal-title":"Lancet. Infect. Dis."},{"key":"ref_24","first-page":"351","article-title":"Increases in group A streptococcal infections in the pediatric population in Houston, TX, 2022","volume":"77","author":"Aboulhosn","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","first-page":"2200941","article-title":"Increase in invasive group A streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022","volume":"1","author":"Marchal","year":"2023","journal-title":"Eurosurveillance"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2300291","DOI":"10.2807\/1560-7917.ES.2023.28.26.2300291","article-title":"Increase in invasive group A streptococcal infections and emergence of novel, rapidly expanding sub-lineage of the virulent Streptococcus pyogenes M1 clone, Denmark, 2023","volume":"28","author":"Johannesen","year":"2023","journal-title":"Eurosurveillance"},{"key":"ref_27","first-page":"2400129","article-title":"Increase in invasive Streptococcus pyogenes M1 infections with close evolutionary genetic relationship, Iceland and Scotland, 2022 to 2023","volume":"28","author":"Beres","year":"2024","journal-title":"Eurosurveillance"},{"key":"ref_28","first-page":"2300422","article-title":"Increase in bloodstream infections caused by emm 1 group A Streptococcus correlates with emergence of toxigenic M1UK, Belgium, May 2022 to August 2023","volume":"28","author":"Lin","year":"2023","journal-title":"Eurosurveillance"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2300427","DOI":"10.2807\/1560-7917.ES.2023.28.36.2300427","article-title":"Sustained increase of paediatric invasive Streptococcus pyogenes infections dominated by M1UK and diverse emm 12 isolates, Portugal, September 2022 to May 2023","volume":"28","author":"Gouveia","year":"2023","journal-title":"Eurosurveillance"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s13052-023-01494-9","article-title":"Invasive Group A streptococcal infections: Are we facing a new outbreak? A case series with the experience of a single tertiary center","volume":"49","author":"Garancini","year":"2023","journal-title":"Ital. J. Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ram\u00edrez de Arellano, E., Saavedra-Lozano, J., Villal\u00f3n, P., Jov\u00e9-Blanco, A., Grandioso, D., Sotelo, J., Gamell, A., Gonz\u00e1lez-L\u00f3pez, J.J., Cervantes, E., and G\u00f3nzalez, M.J. (2024). Clinical, microbiological, and molecular characterization of pediatric invasive infections by Streptococcus pyogenes in Spain in a context of global outbreak. mSphere, 9.","DOI":"10.1128\/msphere.00729-23"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s15010-023-02137-1","article-title":"Population of invasive group A streptococci isolates from a German tertiary care center is dominated by the hypertoxigenic virulent M1UK genotype","volume":"52","author":"Wolters","year":"2024","journal-title":"Infection"},{"key":"ref_33","unstructured":"CDC (2023, February 10). Increase in Invasive Group A Strep Infections, 2022\u20132023, Available online: https:\/\/archive.cdc.gov\/#\/details?q=Increase%20in%20Invasive%20Group%20A%20Strep%20Infections&start=0&rows=10&url=https:\/\/www.cdc.gov\/groupastrep\/igas-infections-investigation.html."},{"key":"ref_34","unstructured":"ECDC (2023, February 10). Increase in Invasive Group A streptococcal Infections Among Children in Europe, Including Fatalities. Available online: https:\/\/ecdc.europa.eu\/en\/news-events\/increase-invasive-group-streptococcal-infections-among-children-europe-including."},{"key":"ref_35","unstructured":"WHO (2023, February 10). Disease Outbreak News: Increased Incidence of Scarlet Fever and Invasive Group A Streptococcus Infection\u2014Multi-Country. WHO. Available online: https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON429."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.3201\/eid2908.230569","article-title":"Increase of severe pulmonary infections in adults caused by M1UK Streptococcus pyogenes, central Scotland, UK","volume":"29","author":"Davies","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Adamkova, V., Adamkova, V.G., Kroneislova, G., Zavora, J., Kroneislova, M., Huptych, M., and Lahoda Brodska, H. (2024). Increasing Rate of Fatal Streptococcus pyogenes Bacteriemia-A Challenge for Prompt Diagnosis and Appropriate Therapy in Real Praxis. Microorganisms, 12.","DOI":"10.3390\/microorganisms12050995"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/978-1-0716-0467-0_2","article-title":"Closed-Tube Multiplex Real-Time PCR for the Detection of Group A Streptococcal Superantigens","volume":"2136","author":"Gammoh","year":"2020","journal-title":"Methods Mol. Biol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.3201\/eid2905.221887","article-title":"Emerging Invasive Group A Streptococcus M1UK Lineage Detected by Allele-Specific PCR, England, 2020","volume":"29","author":"Zhi","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Feldgarden, M., Brover, V., Gonzalez-Escalona, N., Frye, J.G., Haendiges, J., Haft, D.H., Hoffmann, M., Pettengill, J.B., Prasad, A.B., and Tillman, G.E. (2021). AMRFinderPlus and the Reference Gene Catalog facilitate examination of the genomic links among antimicrobial resistance, stress response, and virulence. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-91456-0"},{"key":"ref_41","unstructured":"Durmishev, A., Iliev, B., Baev, V., Mitov, G., Angelov, L., Radev, M., and Balabanov, P. (1994). Scarlatina. Epidemiology of Infectious and Noninfectious Diseases, Medicine and Physical Culture. (In Bulgarian)."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/S1473-3099(19)30446-3","article-title":"Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: A population-based molecular epidemiological study","volume":"19","author":"Lynskey","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Yu, D., Liang, Y., Lu, Q., Meng, Q., Wang, W., Huang, L., Bao, Y., Zhao, R., Chen, Y., and Zheng, Y. (2021). Molecular Characteristics of Streptococcus pyogenes Isolated From Chinese Children with Different Diseases. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2021.722225"},{"key":"ref_44","first-page":"151","article-title":"Distribution of Super-Antigens and Toxins in Bulgarian Invasive and Non-Invasive Clinical Isolates Streptococcus pyogenes","volume":"33","author":"Muhtarova","year":"2017","journal-title":"Acta Microbiol. Bulg."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Karapati, E., Tsantes, A.G., Iliodromiti, Z., Boutsikou, T., Paliatsiou, S., Domouchtsidou, A., Ioannou, P., Petrakis, V., Iacovidou, N., and Sokou, R. (2024). Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic. Pathogens, 13.","DOI":"10.3390\/pathogens13111007"},{"key":"ref_46","first-page":"001277","article-title":"Molecular characterization of Streptococcus pyogenes (StrepA) non-invasive isolates during the 2022\u20132023 UK upsurge","volume":"10","author":"Hall","year":"2024","journal-title":"Microb. Genom."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.eimc.2023.09.004","article-title":"Epidemiological changes in invasive Streptococcus pyogenes infection during the UK alert period: A molecular comparative analysis from a tertiary Spanish hospital in 2023","volume":"42","author":"Bloise","year":"2024","journal-title":"Enfermedades Infecc. Microbiol. Cl\u00ednica"},{"key":"ref_48","first-page":"2400242","article-title":"Increase in invasive group A streptococcal infections (iGAS) in children and older adults, Norway, 2022 to 2024","volume":"29","author":"Cyr","year":"2024","journal-title":"Eurosurveillance"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Bertram, R., Itzek, A., Marr, L., Manzke, J., Voigt, S., Chapot, V., van der Linden, M., Rath, P.M., Hitzl, W., and Steinmann, J. (2024). Divergent effects of emm types 1 and 12 on invasive group A streptococcal infections-results of a retrospective cohort study, Germany 2023. J. Clin. Microbiol., 62.","DOI":"10.1128\/jcm.00637-24"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S2352-4642(23)00295-X","article-title":"Invasive group A streptococcal infections in children and adolescents in Denmark during 2022-23 compared with 2016\u201317 to 2021\u201322: A nationwide, multicentre, population-based cohort study","volume":"8","author":"Nygaard","year":"2024","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3831","DOI":"10.1128\/JCM.40.10.3831-3834.2002","article-title":"Erythromycin-Resistant Group A Streptococcal Isolates Recovered in Sofia, Bulgaria, from 1995 to 2001","volume":"40","author":"Detcheva","year":"2002","journal-title":"J. Clin. Microbiol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Gherardi, G., Vitali, L.A., and Creti, R. (2018). Prevalent emm Types among Invasive GAS in Europe and North America since Year 2000. Front. Public Health, 6.","DOI":"10.3389\/fpubh.2018.00059"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1038\/nrmicro2366","article-title":"Molecular mechanisms of complement evasion: Learning from staphylococci and meningococci","volume":"8","author":"Serruto","year":"2010","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1038\/s41467-022-28335-3","article-title":"Immune signature of acute pharyngitis in a Streptococcus pyogenes human challenge trial","volume":"13","author":"Anderson","year":"2022","journal-title":"Nat. Commun."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/1\/179\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:29:43Z","timestamp":1759919383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/1\/179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["microorganisms13010179"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13010179","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]}}}