Streptococcus pyogenes (Group A)

Paul G. Auwaerter, M.D.
Streptococcus pyogenes (Group A) is a topic covered in the Johns Hopkins ABX Guide.

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MICROBIOLOGY

  • Group A Streptococcus (GAS), beta-hemolytic--grows on blood agar. See Streptococcal species or S. pneumoniae modules for other streptococci.
    • Streptococcus pyogenes, Lancefield group A.
    • Gram-positive cocci in chains [Fig 1].
  • Ecologic niches are pharynx, genital mucosa and skin; colonization rates:
    • Adults 2-3%
    • School children 15-20%
  • Virulence depends on proteins that represent toxins, mimic host macromolecules and after immune responses.
    • M protein gene (emm) ~100 serotypes
      • It may be used to track outbreaks, including invasive infections
      • Certain types (emm1, emm3, emm4, emm6, emm12, emm18, emm89) are associated with most invasive infections.
  • All isolates remain susceptible to beta-lactams; however, worrisome resistance rates to alternative antibiotics are rising (data from 2011-2018 in U.S.).
    • Erythromycin-resistance (macrolides, both inducible and constitutional): 14.5%[4].
    • Clindamycin resistance: 22.0-24.2%[4][5]

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MICROBIOLOGY

  • Group A Streptococcus (GAS), beta-hemolytic--grows on blood agar. See Streptococcal species or S. pneumoniae modules for other streptococci.
    • Streptococcus pyogenes, Lancefield group A.
    • Gram-positive cocci in chains [Fig 1].
  • Ecologic niches are pharynx, genital mucosa and skin; colonization rates:
    • Adults 2-3%
    • School children 15-20%
  • Virulence depends on proteins that represent toxins, mimic host macromolecules and after immune responses.
    • M protein gene (emm) ~100 serotypes
      • It may be used to track outbreaks, including invasive infections
      • Certain types (emm1, emm3, emm4, emm6, emm12, emm18, emm89) are associated with most invasive infections.
  • All isolates remain susceptible to beta-lactams; however, worrisome resistance rates to alternative antibiotics are rising (data from 2011-2018 in U.S.).
    • Erythromycin-resistance (macrolides, both inducible and constitutional): 14.5%[4].
    • Clindamycin resistance: 22.0-24.2%[4][5]

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Last updated: October 9, 2022