Letter | Published:

Emergence of scarlet fever Streptococcus pyogenes emm12 clones in Hong Kong is associated with toxin acquisition and multidrug resistance

Nature Genetics volume 47, pages 8487 (2015) | Download Citation

Abstract

A scarlet fever outbreak began in mainland China and Hong Kong in 2011 (refs. 16). Macrolide- and tetracycline-resistant Streptococcus pyogenes emm12 isolates represent the majority of clinical cases. Recently, we identified two mobile genetic elements that were closely associated with emm12 outbreak isolates: the integrative and conjugative element ICE-emm12, encoding genes for tetracycline and macrolide resistance, and prophage ΦHKU.vir, encoding the superantigens SSA and SpeC, as well as the DNase Spd1 (ref. 4). Here we sequenced the genomes of 141 emm12 isolates, including 132 isolated in Hong Kong between 2005 and 2011. We found that the introduction of several ICE-emm12 variants, ΦHKU.vir and a new prophage, ΦHKU.ssa, occurred in three distinct emm12 lineages late in the twentieth century. Acquisition of ssa and transposable elements encoding multidrug resistance genes triggered the expansion of scarlet fever–associated emm12 lineages in Hong Kong. The occurrence of multidrug-resistant ssa-harboring scarlet fever strains should prompt heightened surveillance within China and abroad for the dissemination of these mobile genetic elements.

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Acknowledgements

We thank the core sequencing and pathogen informatics teams at the Sanger Institute for their assistance. This work was supported by National Health and Medical Research Council of Australia (NHMRC) program grant 565526, Australian Research Council grant DP140102881, a Research Fund for the Control of Infectious Diseases Commissioned Grant from the Hong Kong government and Wellcome Trust grant 098051. M.R.D. is supported by an NHMRC postdoctoral training fellowship (635250). M.J.W. is supported by an NHMRC principal research fellowship (631386).

Author information

Author notes

    • Matthew T Holden

    Present address: School of Medicine, University of St Andrews, St Andrews, UK.

    • Gordon Dougan
    • , Kwok-Yung Yuen
    •  & Mark J Walker

    These authors contributed equally to this work.

Affiliations

  1. Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.

    • Mark R Davies
    • , Carola Venturini
    • , Timothy C Barnett
    • , Nouri L Ben Zakour
    •  & Mark J Walker
  2. Wellcome Trust Sanger Institute, Hinxton, UK.

    • Mark R Davies
    • , Matthew T Holden
    • , Paul Coupland
    •  & Gordon Dougan
  3. Department of Microbiology, Queen Mary Hospital, Hong Kong, China.

    • Jonathan H K Chen
    • , Herman Tse
    •  & Kwok-Yung Yuen
  4. Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, China.

    • Herman Tse
    •  & Kwok-Yung Yuen
  5. State Key Laboratory for Emerging Infectious Diseases, Hong Kong, China.

    • Herman Tse
    •  & Kwok-Yung Yuen

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Contributions

M.R.D., K.-Y.Y., G.D. and M.J.W. were involved in the study design. K.-Y.Y., H.T. and J.H.K.C. provided the assessment of clinical cases and the bacterial samples. M.R.D., M.T.H., P.C., J.H.K.C., C.V., T.C.B. and N.L.B.Z. performed the analyses. M.R.D., P.C. and M.J.W. wrote the manuscript. All authors read and approved the manuscript.

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Mark J Walker.

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    Supplementary Table 1

    Details of S. pyogenes M12 strains used in this study and associated distribution of toxin and antibiotic resistance genes.

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DOI

https://doi.org/10.1038/ng.3147

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