The presence of M protein in nontypeable group A streptococcal upper respiratory tract isolates from Southeast Asia.

Previous studies have suggested that group A streptococcal strains from southeast Asia, serotypically different from temporally related North American and European isolates, may represent unrecognized M serotypes. Sixty non-M typeable group A streptococcal upper respiratory tract isolates from Thailand were evaluated for the presence of M protein using a modification of the direct serum bactericidal test. Of them, 59 (98%) grew rapidly in human blood. Typeability by T agglutination and opacity factor production did not influence their growth in blood. It was concluded that these isolates produce M protein and likely represent previously uncharacterized M serotypes. Identification of such non-M typeable strains is important in understanding the epidemiology and pathogenesis of group A streptococcal infections and their sequelae in areas of the world where they remain a significant health problem and will also be necessary in the development of a vaccine with global efficacy.