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Distribution of moac within a collection of oral streptococci, Vellore, India, and Leipzig, Germany*
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Vellore, a region in southern India, has a high incidence of severe human infections with Beta-hemolytic group C and G streptococci (GCGS). To determine the causative species in these infections, we conducted 16S rRNA gene sequencing: Streptococcus dysgalactiae subsp. equisimilis (81%) and S. anginosus (19%) were the causative organisms in the 2-ye...
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Citations
... The SAG has been considered part of the commensal microbiota, eventually associated with dental abscesses and periodontal diseases, but their pathogenic potential has been vastly underestimated [5]. However, the SAG can cause life-threatening infections, with incidence rates higher than those for Streptococcus pyogenes and Streptococcus agalactiae combined [6][7][8][9]. The number of cases of severe infections caused by SAG bacteria, in both adults and children, has risen over the years, and the SAG is now considered an emerging pathogen instead of a simple commensal species of the human microbiota. ...
... The species S. anginosus can express group A, C, F, and G Lancefield antigens or none at all [10,11]. It is mainly isolated from blood cultures and gastrointestinal and genitourinary tract infections and is often a component of polymicrobial infections in patients with oral, head, neck, and abdominal abscesses [6,12,13]. In addition, S. anginosus is one of most common pathobionts identified in patients with aerobic vaginitis [14]. ...
... While GBS is a recognized agent of invasive neonatal infections worldwide, S. anginosus is an emerging human pathogen. S. anginosus has been associated with pyogenic and systemic infections at any anatomical site in the body, including intra-abdominal areas, the urogenital area, the liver, lungs, the heart, the brain, skin, and soft tissues, with the formation of empyemas and abscesses [6][7][8]21]. S. anginosus is mainly isolated from blood cultures and gastrointestinal and genitourinary tract infections and is often present as part of a polymicrobial infection in patients with oral, head, neck, and abdominal abscesses [6,13,21]. ...
Streptococcus agalactiae (Group B Streptococcus; GBS) is a leading cause of neonatal invasive disease worldwide. GBS can colonize the human gastrointestinal and genitourinary tracts, and the anovaginal colonization of pregnant women is the main source for neonatal infection. Streptococcus anginosus, in turn, can colonize the human upper respiratory, gastrointestinal, and genitourinary tracts but has rarely been observed causing disease. However, in the last years, S. anginosus has been increasingly associated with human infections, mainly in the bloodstream and gastrointestinal and genitourinary tracts. Although anovaginal screening for GBS is common during pregnancy, data regarding the anovaginal colonization of pregnant women by S. anginosus are still scarce. Here, we show that during the assessment of anovaginal GBS colonization rates among pregnant women living in Rio de Janeiro, Brazil, S. anginosus was also commonly detected, and S. anginosus isolates presented a similar colony morphology and color pattern to GBS in chromogenic media. GBS was detected in 48 (12%) while S. anginosus was detected in 17 (4.3%) of the 399 anovaginal samples analyzed. The use of antibiotics during pregnancy and history of urinary tract infections and sexually transmitted infections were associated with the presence of S. anginosus. In turn, previous preterm birth was associated with the presence of GBS (p < 0.05). The correlation of GBS and S. anginosus with relevant clinical features of pregnant women in Rio de Janeiro, Brazil, highlights the need for the further investigation of these important bacteria in relation to this special population.
... 7 Numerous data strongly suggest that Streptococcus anginosus should be regarded as an emerging opportunistic pathogen with substantial clinical significance. [9][10][11] The SAG group found that the average time for pus to form is 18 days; 12 other respiratory rate was 36 breaths/minute. Chest X-ray (CXR) showed right pleural effusion tracks along the oblique fissure suggestive of partial loculation (Fig. 1). ...
... Bacteria of the SAG can frequently be isolated from blood cultures, abscesses, the respiratory tract of cystic fibrosis patients and have recently been associated with gastric cancer (Parkins et al., 2008;Grinwis et al., 2010;Mukae et al., 2016;Kobo et al., 2017;Zhou et al., 2022). Often overlooked in the past, S. anginosus has been increasingly identified in invasive infections during the last years emphasizing its clinical importance as an emerging bacterial pathogen (Laupland et al., 2006;Reissmann et al., 2010;Siegman-Igra et al., 2012). Indeed, the incidence rate of SAG infections (8.65/100,000) even exceeds the combined incidence rates of group A and B streptococci in population-based surveillance studies (Laupland et al., 2006;Jiang et al., 2020). ...
Streptococcus anginosus is a commensal Streptococcal species that is often associated with invasive bacterial infections. However, little is known about its molecular genetic background. Many Streptococcal species, including S. anginosus , harbor clustered regularly interspaced short palindromic repeats (CRISPR)-Cas systems. A CRISPR-Cas type II-A system as well as a type II-C system have been reported for this species. To characterize the CRISPR-Cas type II systems of S. anginosus in more detail, we conducted a phylogenetic analysis of Cas9 sequences from CRISPR-Cas type II systems with a special focus on streptococci and S. anginosus . In addition, a phylogenetic analysis of S. anginosus strains based on housekeeping genes included in MLST analysis, was performed. All analyzed Cas9 sequences of S. anginosus clustered with the Cas9 sequences of CRISPR type II-A systems, including the Cas9 sequences of S. anginosus strains reported to harbor a type II-C system. The Cas9 genes of the CRISPR-Cas type II-C systems of other bacterial species separated into a different cluster. Moreover, analyzing the CRISPR loci found in S. anginosus , two distinct csn2 genes could be detected, a short form showing high similarity to the canonical form of the csn2 gene present in S. pyogenes . The second CRISPR type II locus of S. anginosus contained a longer variant of csn2 with close similarities to a csn2 gene that has previously been described in Streptococcus thermophilus. Since CRISPR-Cas type II-C systems do not contain a csn2 gene, the S. anginosus strains reported to have a CRISPR-Cas type II-C system appear to carry a variation of CRISPR-Cas type II-A harboring a long variant of csn2 .
... The pathogenic potential of S. anginosus has been underestimated in the past, but this species can cause severe infections at all body sites. Isolation from abscesses, urine, blood cultures and cystic fibrosis patients has been reported and the incidence rate of invasive SAG infections is higher than the incidence rate for Streptococcus pyogenes and Streptococcus agalactiae combined (Laupland et al., 2006;Reissmann et al., 2010;Sibley et al., 2010;Kobo et al., 2017;Jiang et al., 2020). Therefore, exploring factors involved in the development of S. anginosus infections is important. ...
... Virulence factors found in other streptococcal species are also present in SAG. 3 Part of the challenge of identifying SAG infections when they occur lies in the wide variety of phenotypes and antigens in the group and their seemingly benign commensal presence. 4 The abscesses commonly attributed to S. constellatus are one causality that may lead to the rare incidence of bacteremia, evolving into septic shock and a fatal outcome. The most common locations of the abscesses include the abdominal cavity, skin, orofacial region, urogenital tract, and the lower respiratory tract. ...
Streptococcus constellatus is usually a benign, commensal bacteria but has increased incidence in blood cultures and abscesses. This pathogenic involvement is most prevalent in individuals with underlying medical conditions, such as solid tumors and type 2 diabetes mellitus, as well as in cases of community-acquired infections. We report a 43-year-old male with a right medial thigh ulcer and necrotic scrotal skin. The wound culture from surgical debridement grew Streptococcus constellatus, and histology was consistent with stage III necrotizing fasciitis. Regardless of etiology, the mortality rate of patients with necrotizing fasciitis is greatly decreased with early intervention and thorough surgical debridement.
Keywords
Bacteremia; Debridement; Diabetic Ketoacidosis; Skin Ulcer; Streptococcus anginosus
... S. anginosus was also recovered from patients in co-infections with other species, e.g., Mycobacterium tuberculosis, and Eikenella corrodens (Rabuñal et al., 2009;Patel et al., 2020). All these data strongly suggest that S. anginosus should be viewed as an emerging opportunistic pathogen of substantial clinical importance (Reißmann et al., 2010;Pilarczyk-Zurek et al., 2022). ...
Streptococcus anginosus together with S. constellatus and S. intermedius constitute the Streptococcus anginosus group (SAG), until recently considered to be benign commensals of the human mucosa isolated predominantly from oral cavity, but also from upper respiratory, intestinal, and urogenital tracts. For years the virulence potential of SAG was underestimated, mainly due to complications in correct species identification and their assignment to the physiological microbiota. Still, SAG representatives have been associated with purulent infections at oral and non-oral sites resulting in abscesses formation and empyema. Also, life threatening blood infections caused by SAG have been reported. However, the understanding of SAG as potential pathogen is only fragmentary, albeit certain aspects of SAG infection seem sufficiently well described to deserve a systematic overview. In this review we summarize the current state of knowledge of the S. anginosus pathogenicity factors and their mechanisms of action.
... The pathogenic potential of S. anginosus has been underestimated in the past, but this species can cause severe infections at all body sites. Isolation from abscesses, urine, blood cultures and cystic fibrosis patients has been reported and the incidence rate of invasive SAG infections is higher than the incidence rate for Streptococcus pyogenes and Streptococcus agalactiae combined (Laupland et al., 2006;Reissmann et al., 2010;Sibley et al., 2010;Kobo et al., 2017;Jiang et al., 2020). Therefore, exploring factors involved in the development of S. anginosus infections is important. ...
In a natural environment, bacteria are members of multispecies communities. To compete with rival species, bacteria produce antimicrobial peptides (AMPs), called bacteriocins. Bacteriocins are small, cationic, ribosomally synthesized peptides, which normally inhibit closely related species of the producing organism. Bacteriocin production is best studied in lactic bacteria (LAB). Streptococcus anginosus , belonging to LAB, produces the potent bacteriocin Angicin, which shows inhibitory activity against other streptococci, Listeria monocytogenes and vancomycin resistant Enterococcus faecium (VRE). Furthermore, Angicin shows a high resistance toward pH changes and heat, rendering it an interesting candidate for food preservation or clinical applications. The inhibitory activity of Angicin depends on the presence of a mannose phosphotransferase system (Man-PTS) in target cells, since L. monocytogenes harboring a deletion in an extracellular loop of this system is no longer sensitive to Angicin. Furthermore, we demonstrated by liposome leakage and pHluorin assays that Angicin destroys membrane integrity but shows only low cytotoxicity against human cell lines. In conclusion, we show that Angicin has a detrimental effect on the membrane of target organisms by using the Man-PTS as a receptor.
... However, these bacterial species also cause highly invasive diseases. These include but are not limited to necrotizing skin and soft tissue infections (NSTIs; S. pyogenes) (Siemens et al., 2020), pneumonia, sepsis, and meningitis (S. pneumoniae, S. suis) (Votsch et al., 2018;Steinert et al., 2020;Palmer and Kimmey, 2022), neonatal sepsis (S. agalactiae) (Armistead et al., 2019), and endocarditis (S. anginosus) (Reissmann et al., 2010). The invasiveness is linked to a plethora of bacterial as well as host factors. ...
... The amplification of fragment of the ily gene and its 3 -flanking region is specific for S. intermedius strains among all other streptococcal species (Teles et al., 2011). In recent studies, authors underline the promising potential of real-time PCR, rapid microarray assay, as well as mass spectrometry (MALDI-TOF-MS) in discriminating between the individual species of the S. anginosus group (Desar et al., 2008;Reißmann et al., 2010;Wenzler et al., 2015). ...
Three distinct streptococcal species: Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus, belonging to the Streptococcus anginosus group (SAG), also known as Streptococcus milleri group, have been attracting clinicians and microbiologists, not only as oral commensals but also as opportunistic pathogens. For years they have been simply classified as so called viridans streptococci, and distinct species were not associated with particular clinical manifestations. Therefore, description of SAG members are clearly underrepresented in the literature, compared to other medically relevant streptococci. However, the increasing number of reports of life-threatening infections caused by SAG indicates their emerging pathogenicity. The improved clinical data generated with the application of modern molecular diagnostic techniques allow for precise identification of individual species belonging to SAG. This review summarizes clinical reports on SAG infections and systematizes data on the occurrence of individual species at the site of infection. We also discuss the issue of proper microbiological diagnostics, which is crucial for further clinical treatment.
... S. anginosus is part of the human microbiota and is found in the oral cavity, the gastro-intestinal and the genito-urinary tracts (Whiley et al., 1992). Since many years, it has been increasingly involved in deep infections, like bacteremia and abscesses (Reißmann et al., 2010;Siegman-Igra et al., 2012), and is therefore considered as an important pathogen. CRISPR loci have been described in S. anginosus previously. ...
Streptococci form a wide group of bacteria and are involved in both human and animal pathologies. Among pathogenic isolates, differences have been highlighted especially concerning their adaptation and virulence profiles. CRISPR-Cas systems have been identified in bacteria and many streptococci harbor one or more systems, particularly subtypes I-C, II-A, and III-A. Since the demonstration that CRISPR-Cas act as an adaptive immune system in Streptococcus thermophilus , a lactic bacteria, the diversity and role of CRISPR-Cas were extended to many germs and functions were enlarged. Among those, the genome editing tool based on the properties of Cas endonucleases is used worldwide, and the recent attribution of the Nobel Prize illustrates the importance of this tool in the scientific world. Another application is CRISPR loci analysis, which allows to easily characterize isolates in order to understand the interactions of bacteria with their environment and visualize species evolution. In this review, we focused on the distribution, diversity and roles of CRISPR-Cas systems in the main pathogenic streptococci.
