Passàli D, Lauriello M, Passàli G C, Passàli F M, Bellussi L
ENT Clinic, University of Siena, Italy.
Acta Otorhinolaryngol Ital. 2007 Feb;27(1):27-32.
Acute pharyngo-tonsillitis caused by beta-haemolytic group A Streptococcus is a common disease in childhood. Epithelial cells are the initial sites of the host invasion by group A Streptococcus. Although group A Streptococcus has been considered an extracellular pathogen, recent studies have demonstrated that strains of this bacterium can internalize into epithelial cells both in vitro and in vivo. As adherence to and internalization into host cells significantly contributes to the pathogenesis of group A Streptococcus infections, internalization of group A Streptococcus by human epithelial cells has been extensively studied during the past decade. Multiple mechanisms are involved in this process. Most strains of Streptococcus pyogenes express the fibronectin-binding proteins F1 and F2, which promote bacterial adherence to and entry into human cells. Strains containing the gene for the protein Fl have been proved to be responsible for the failure of antibiotic treatment to eradicate Streptococcus pyogenes. Thus, in a significant number of cases, streptococcal internalization might contribute to eradication failure and persistent throat carriage. Since treatment failure, asymptomatic group A Streptococcus carriers and recurrent group A Streptococcus infections represent the main group A Streptococcus reservoir, from which the bacteria are spread in the general population, the choice of antibiotic is crucial. Beta-lactams select a large number of F1-positive organisms: therefore, macrolides, and, possibly, last generation molecules, are the best and first choice for antibiotic treatment against group A Streptococcus.
由A组β溶血性链球菌引起的急性咽扁桃体炎是儿童期的常见疾病。上皮细胞是A组链球菌侵入宿主的初始部位。尽管A组链球菌一直被认为是一种胞外病原体，但最近的研究表明，这种细菌的菌株在体外和体内都能内化进入上皮细胞。由于对宿主细胞的黏附和内化显著促进了A组链球菌感染的发病机制，在过去十年中，人类上皮细胞对A组链球菌的内化作用得到了广泛研究。这个过程涉及多种机制。大多数化脓性链球菌菌株表达纤连蛋白结合蛋白F1和F2，它们促进细菌对人类细胞的黏附和进入。已证明含有蛋白F1基因的菌株是抗生素治疗无法根除化脓性链球菌的原因。因此，在相当多的病例中，链球菌的内化可能导致根除失败和咽部持续携带。由于治疗失败、无症状A组链球菌携带者和复发性A组链球菌感染是A组链球菌的主要储存库，细菌由此在普通人群中传播，抗生素的选择至关重要。β-内酰胺类会选择大量F1阳性菌株：因此，大环内酯类药物以及可能的新一代药物是治疗A组链球菌的最佳首选抗生素。
