aSection of Infectious Diseases and Immunity, Imperial College London, Hammersmith Campus bDepartment of Haematology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
Curr Opin Infect Dis. 2014 Apr;27(2):155-64. doi: 10.1097/QCO.0000000000000047.
Increasing disease caused by beta-haemolytic streptococci indicates the need for improved understanding of pathogenesis.
Streptococcus pyogenes, or group A Streptococcus (GAS), causes significant disease worldwide. The closely related Streptococcus dysgalactiae subspecies equisimilis (SDSE) is increasingly recognized as causing a similar disease spectrum. Whole-genome sequencing applied to the study of outbreaks may reveal factors that contribute to pathogenesis and changes in epidemiology. The role of quorum sensing in biofilm formation, and interspecies communication with other streptococci, is discussed. GAS has evolved multiple mechanisms to evade the humoral arm of innate immunity, including complement, which is well known in protecting the host from bacteria, and the coagulation-fibrinolytic system, which is increasingly recognized as an innate immune effector.
Molecular biology has enhanced our understanding of the intricate balance of host-pathogen interactions that result in clearance or establishment of invasive streptococcal infection. Although the skin and oropharynx remain the usual ecological niche of GAS and SDSE, occasionally the bacteria find themselves within deeper tissues and blood. Recent research has armed us with better knowledge of bacterial adaptations to this alternative environment. However, the challenge is to translate this knowledge into clinical practice, through the development of novel therapeutic options and ultimately a vaccine against GAS.
β-溶血性链球菌引起的疾病不断增加，表明人们需要更好地了解其发病机制。
化脓性链球菌，又称 A 组链球菌（GAS），在全球范围内可引起严重疾病。与其密切相关的无乳链球菌亚种似马亚种（SDSE）越来越多地被认为可引起类似的疾病谱。对暴发疫情进行全基因组测序的研究可能揭示导致发病机制和流行病学变化的因素。群体感应在生物膜形成中的作用，以及与其他链球菌的种间通讯，也在讨论中。GAS 已经进化出多种逃避先天免疫体液免疫的机制，包括补体，补体是众所周知的宿主抵御细菌的保护因子，以及凝血-纤溶系统，它越来越被认为是先天免疫效应因子。
分子生物学增强了我们对宿主-病原体相互作用的复杂平衡的理解，这些相互作用导致清除或建立侵袭性链球菌感染。尽管皮肤和口咽部仍然是 GAS 和 SDSE 的常见生态位，但细菌偶尔会进入更深的组织和血液。最近的研究使我们更好地了解了细菌对这种替代环境的适应。然而，挑战是将这些知识转化为临床实践，通过开发新的治疗选择，并最终开发出针对 GAS 的疫苗。
