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Infection and Immunity, April 1999, p. 1871-1877, Vol. 67, No. 4
0019-9567/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Risk Factors in the Pathogenesis of Invasive Group A Streptococcal Infections: Role of Protective Humoral Immunity

Hesham Basma,1,2 Anna Norrby-Teglund,1 Yajaira Guedez,2 Allison McGeer,3 Donald E. Low,3 Omar El-Ahmedy,1 Benjamin Schwartz,4 and Malak Kotb1,2,*

Veterans Affairs Medical Center, Research Service, Memphis, Tennessee 381041; Departments of Surgery and of Microbiology and Immunology, University of Tennessee, Memphis, Tennessee 381632; Department of Microbiology, Mount Sinai Hospital, and the University of Toronto, Toronto, Ontario, Canada M5G 1X53; and Centers for Disease Control and Prevention, Atlanta, Georgia 303334

Received 1 October 1998/Returned for modification 29 October 1998/Accepted 10 January 1999

An impressive change in the epidemiology and severity of invasive group A streptococcal infections occurred in the 1980s, and the incidence of streptococcal toxic shock syndrome cases continues to rise. The reason for the resurgence of severe invasive cases remains a mystery---has there been a change in the pathogen or in host protective immunity? To address these questions, we have studied 33 patients with invasive infection caused by genotypically indistinguishable M1T1 strains of Streptococcus pyogenes who had different disease outcomes. Patients were classified as having severe (n = 21) and nonsevere (n = 12) invasive infections based on the presence or absence of shock and organ failure. Levels of anti-M1 bactericidal antibodies and of anti-streptococcal superantigen neutralizing antibodies in plasma were significantly lower in both groups than in age- and geographically matched healthy controls (P < 0.01). Importantly, the levels of these protective antibodies in plasma samples from severe and nonsevere invasive cases were not different. Together the data suggest that low levels of protective antibodies may contribute to host susceptibility to invasive streptococcal infection but do not modulate disease outcome. Other immunogenetic factors that regulate superantigen responses may influence the severity of systemic manifestations associated with invasive streptococcal infection.

* Corresponding author. Mailing address: University of Tennessee, Memphis, 956 Court Ave., Suite A-202, Memphis, TN 38163. Phone: (901) 448-7247. Fax: (901) 448-7208. E-mail: mkotb{at}utmem1.utmem.edu.

Infection and Immunity, April 1999, p. 1871-1877, Vol. 67, No. 4
0019-9567/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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