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Infection and Immunity, May 2000, p. 2880-2887, Vol. 68, No. 5
0019-9567/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Humanized In Vivo Model for Streptococcal Impetigo

Dominick A. Scaramuzzino,1 Jennifer M. McNiff,2 and Debra E. Bessen1,*

Departments of Epidemiology and Public Health1 and Dermatology,2 Yale University School of Medicine, New Haven, Connecticut

Received 29 October 1999/Returned for modification 9 December 1999/Accepted 1 February 2000

An in vivo model for group A streptococcal (GAS) impetigo was developed, whereby human neonatal foreskin engrafted onto SCID mice was superficially damaged and bacteria were topically applied. Severe infection, indicated by a purulent exudate, could be induced with as few as 1,000 CFU of a virulent strain. Early findings (48 h) showed a loss of stratum corneum and adherence of short chains of gram-positive cocci to the external surface of granular keratinocytes. This was followed by an increasing infiltration of polymorphonuclear leukocytes (neutrophils) of mouse origin, until a thick layer of pus covered an intact epidermis, with massive clumps of cocci accumulated at the outer rim of the pus layer. By 7 days postinoculation, the epidermis was heavily eroded; in some instances, the dermis contained pockets (ulcers) filled with cocci, similar to that observed for ecthyma. Importantly, virulent GAS underwent reproduction, resulting in a net increase in CFU of 20- to 14,000-fold. The majority of emm pattern D strains had a higher gross pathology score than emm pattern A, B, or C (A-C) strains, consistent with epidemiological findings that pattern D strains have a strong tendency to cause impetigo, whereas pattern A-C strains are more likely to cause pharyngitis.

* Corresponding author. Mailing address: Yale University School of Medicine, Dept. of Epidemiology & Public Health, 60 College St., Box 208034, New Haven, CT 06520. Phone: (203) 785-4480. Fax: (203) 737-4285. E-mail: debra.bessen{at}yale.edu.

Infection and Immunity, May 2000, p. 2880-2887, Vol. 68, No. 5
0019-9567/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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