Pathogenesis of group A streptococcal infections and their sequelae
Pathogenesis of group A streptococcal infections and their sequelae
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DOI：
10.1007/978-0-387-73960-1_3
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发表时间：
2008-01-01
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影响因子：
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通讯作者：
Cunningham, Madeleine W.
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文献类型：
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作者：
Cunningham, Madeleine W.
化脓性链球菌或 A 组链球菌是革兰氏阳性细胞外细菌病原体，它们定植于喉咙或皮肤，并导致许多化脓性感染和非化脓性后遗症（Cunningham 2000）。作为病原体，它们逃避宿主防御机制并表现出一组毒力决定因素。 A 族链球菌是细菌性咽炎、猩红热或脓疱病的常见原因。不同的喉咙和皮肤菌株的概念源于数十年的流行病学研究，很明显，A 组链球菌的血清型很容易引起喉咙感染，同样，还有其他血清型通常与皮肤感染相关（Bisno 1995b）。 A 族链球菌在链球菌中毒性休克综合征和坏死性筋膜炎中最为人所知，严重时会导致皮肤和软组织的破坏（Stevens 2000）。两种主要的链球菌感染后后遗症是急性风湿热和急性肾小球肾炎（Bisno 1995a）。在影响全球儿童的急性风湿热中，风湿性心脏病是A组链球菌感染最严重的自身免疫后遗症，而关节炎是最常见的。根据 Jones 标准，风湿性心脏炎、游走性多关节炎、西德纳姆舞蹈病、涉及异常运动的神经系统疾病、边缘红斑、环状皮疹和皮下结节都被认为是急性风湿热的主要表现（Jones 1944；Dajani 等，1989）。血清学分型的 Lancefield 分类方案将化脓性β溶血性链球菌鉴定为 A 组链球菌，基于其表面 A 组碳水化合物含有与鼠李糖聚合物主链相连的 N-乙酰基葡萄糖胺 (McCarty 1956)。 A 组链球菌根据其表面 M 蛋白血清型进一步进行血清学分离。目前，已经使用分子方法对 emm（M 蛋白）基因进行测序，鉴定了超过 100 M 的蛋白血清型（Beall 等人，1996）。含有抗吞噬链球菌 M 蛋白以及其他表面成分的疫苗正在研究用于预防链球菌感染及其后遗症（Fischetti 1991；Bessen 和 Fischetti 1997；Dale 1999）。 A 组链球菌 M 蛋白血清型
Streptococcus pyogenes or group A streptococci are Gram positive extracellular bacterial pathogens which colonize the throat or skin and are responsible for a number of suppurative infections and non-suppurative sequelae (Cunningham 2000). As pathogens they evade host defense mechanisms and exhibit a group of virulence determinants. Group A streptococci are a common cause of bacterial pharyngitis, scarlet fever or impetigo. The concept of distinct throat and skin strains arose from decades of epidemiological studies, where it became evident that there were serotypes of group A streptococci with a strong tendency to cause throat infection, and similarly, there were other serotypes often associated with skin infections (Bisno 1995b). The group A streptococcus is most well recognized for streptococcal toxic shock syndrome and necrotizing fasciitis which involves destruction of the skin and soft tissues in severe cases (Stevens 2000). The two major post-infectious streptococcal sequelae are acute rheumatic fever and acute glomerulonephritis (Bisno 1995a). In acute rheumatic fever, which affects children globally, rheumatic heart disease is the most serious autoimmune sequela of group A streptococcal infection, while arthritis is the most common. Rheumatic carditis, migratory polyarthritis, Sydenham’s chorea, a neurologic disorder involving abnormal movements, erythema marginatum, a circinate skin rash, and subcutaneous nodules are all considered to be major manifestations of acute rheumatic fever based on the Jones criteria (Jones 1944; Dajani et al. 1989). The Lancefield classification scheme of serologic typing identified betahemolytic Streptococcus pyogenes as group A streptococci based on their surface group A carbohydrate containing N-acetyl-glucosamine linked to a rhamnose polymer backbone (McCarty 1956). Group A streptococci were further separated serologically based on their surface M protein serotype. Currently, over 100 M protein serotypes have been identified using a molecular approach to sequence the emm (M protein) gene (Beall et al. 1996). Vaccines containing the anti-phagocytic streptococcal M protein as well as other surface components are under investigation for prevention of streptococcal infections and their sequelae (Fischetti 1991; Bessen and Fischetti 1997; Dale 1999). Group A streptococcal M protein serotypes which