Abstract
Necrotizing skin and soft tissue infections (NSTIs) are severe life-threatening and rapidly progressing infections. Beta-hemolytic streptococci, particularly S. pyogenes (group A streptococci (GAS)) but also S. dysgalactiae subsp. equisimilis (SDSE, most group G and C streptococcus), are the main causative agents of monomicrobial NSTIs and certain types, such as emm1 and emm3, are over-represented in NSTI cases. An arsenal of bacterial virulence factors contribute to disease pathogenesis, which is a complex and multifactorial process. In this chapter, we summarize data that have provided mechanistic and immuno-pathologic insight into host-pathogens interactions that contribute to tissue pathology in streptococcal NSTIs. The role of streptococcal surface associated and secreted factors contributing to the hyper-inflammatory state and immune evasion, bacterial load in the tissue and persistence strategies, including intracellular survival and biofilm formation, as well as strategies to mimic NSTIs in vitro are discussed.
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Acknowledgments
Financial support: The work was supported by the European Union Seventh Framework Programme (FP7/2007–2013) under the grant agreement 305340 (INFECT project), the Swedish Governmental Agency for Innovation Systems (VINNOVA) under the frame of NordForsk (Project no. 90456, PerAID), the Swedish Research Council under the frame of ERA PerMed (Project 2018-151, PerMIT), the German Research Foundation (DFG; grant no. 407176682), and the Federal Excellence Initiative of Mecklenburg Western Pomerania and European Social Fund (ESF) grant KoInfekt (ESF_14-BM-A55-0001_16).
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Siemens, N., Snäll, J., Svensson, M., Norrby-Teglund, A. (2020). Pathogenic Mechanisms of Streptococcal Necrotizing Soft Tissue Infections. In: Norrby-Teglund, A., Svensson, M., Skrede, S. (eds) Necrotizing Soft Tissue Infections. Advances in Experimental Medicine and Biology, vol 1294. Springer, Cham. https://doi.org/10.1007/978-3-030-57616-5_9
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