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Disease burden due to Streptococcus dysgalactiae subsp. equisimilis (group G and C streptococci; GGS/GCS) is higher than due to S. pyogenes among Mumbai school children

¹ Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore, India;

² Department of Microbiology, KEM Hospital, Mumbai, India;

³ Bacterial Pathogenesis Laboratory, Queensland Institute of Medical Research, Brisbane, Australia

⁴ E-mail: sris{at}qimr.edu.au

Received September 2, 2009
Accepted October 9, 2009

SummaryStreptococcus pyogenes (group A Streptococcus, GAS), a human pathogen and S. dysgalactiae subsp. equisimilis (human groups G and C streptococci; GGS/GCS) are evolutionarily related, share the same tissue niche in humans, exchange genetic material, share up to half of virulence-associated genes and cause similar spectrum of diseases. Yet, GGS/GCS is often considered as commensal bacterium and its role in streptococcal disease burden is under-recognized. While reports of GGS/GCS recovery from normally sterile sites are increasing, studies describing GGS/GCS throat colonization rates relative to GAS in the same population are very few. This study was carried out in India where burden of streptococcal diseases, including rheumatic fever (RF) and rheumatic heart disease (RHD), is high. As part of surveillance study, throat swabs were taken from 1504 children attending seven municipal schools in Mumbai, India during 2006-08. GAS and GGS/GCS were identified on the basis of beta-haemolytic activity, group carbohydrate and PYR-test, and subsequently typed. The GGS/GCS carriage rate (166/1504, 10%) was eight-fold higher than the GAS carriage (22/1504, 1.4%) rate in this population. The 166 GGS/GCS isolates collected represented 21 different emm-types (molecular types), and the 22 GAS isolates represented 15 different emm-types. Although the rate of pharyngitis associated with GGS/GCS is marginally lower than with GAS, high rates of throat colonization by GGS/GCS underscores its importance in the pathogenesis of pharyngitis.