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Pathogenesis, epidemiology and control of Group A Streptococcus infection

Nature Reviews Microbiology volume 21, pages 431–447 (2023)Cite this article

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An Author Correction to this article was published on 03 July 2023

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Abstract

Streptococcus pyogenes (Group A Streptococcus; GAS) is exquisitely adapted to the human host, resulting in asymptomatic infection, pharyngitis, pyoderma, scarlet fever or invasive diseases, with potential for triggering post-infection immune sequelae. GAS deploys a range of virulence determinants to allow colonization, dissemination within the host and transmission, disrupting both innate and adaptive immune responses to infection. Fluctuating global GAS epidemiology is characterized by the emergence of new GAS clones, often associated with the acquisition of new virulence or antimicrobial determinants that are better adapted to the infection niche or averting host immunity. The recent identification of clinical GAS isolates with reduced penicillin sensitivity and increasing macrolide resistance threatens both frontline and penicillin-adjunctive antibiotic treatment. The World Health Organization (WHO) has developed a GAS research and technology road map and has outlined preferred vaccine characteristics, stimulating renewed interest in the development of safe and effective GAS vaccines.

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Fig. 1: GAS virulence factors and their roles in cell adherence, invasion and immune evasion.
Fig. 2: Overview of pathogenic mechanisms of MAIT cell activation during GAS infection.
Fig. 3: Global genetic diversity of GAS.
Fig. 4: Mechanisms of GAS antibiotic resistance.

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Authors and Affiliations

  1. School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia

    Stephan Brouwer, Bodie F. Curren, Nichaela Harbison-Price, David M. P. De Oliveira & Mark J. Walker

  2. Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia

    Stephan Brouwer, Bodie F. Curren, Nichaela Harbison-Price, David M. P. De Oliveira & Mark J. Walker

  3. Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia

    Stephan Brouwer, Nichaela Harbison-Price, David M. P. De Oliveira & Mark J. Walker

  4. Instituto Mexicano del Seguro Social, CONACYT, Mexico City, Mexico

    Tania Rivera-Hernandez

  5. Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    Magnus G. Jespersen & Mark R. Davies

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  2. Tania Rivera-Hernandez
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  3. Bodie F. Curren
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  4. Nichaela Harbison-Price
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  7. Mark R. Davies
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  8. Mark J. Walker
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The authors contributed equally to all aspects of the article.

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Correspondence to Mark J. Walker.

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Brouwer, S., Rivera-Hernandez, T., Curren, B.F. et al. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat Rev Microbiol 21, 431–447 (2023). https://doi.org/10.1038/s41579-023-00865-7

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