ABSTRACT
This study highlights the novel potential of molecular aggregates as inhibitors of a disease-related protein. Enzyme inhibitors have been studied and developed as molecularly targeted drugs and have been applied for cancer, autoimmune diseases, and infections. In many cases, enzyme inhibitors that are used for therapeutic applications interact directly with enzymes in a molecule-to-molecule manner. We found that the aggregates of a small compound, Mn007, inhibited bovine pancreatic DNase I. Once Mn007 molecules formed aggregates, they exhibited inhibitory effects specific to DNases that require divalent metal ions. A DNase secreted by Streptococcus pyogenes causes streptococcal toxic shock syndrome (STSS). STSS is a severe infectious disease with a fatality rate exceeding 30% in patients, even in this century. S. pyogenes disrupts the human barrier system against microbial infections through the secreted DNase. Until now, the discovery/development of a DNase inhibitor has been challenging. Mn007 aggregates were found to inhibit the DNase secreted by S. pyogenes, which led to the successful suppression of S. pyogenes growth in human whole blood. To date, molecular aggregation has been outside the scope of drug discovery. The present study suggests that molecular aggregation is a vast area to be explored for drug discovery and development because aggregates of small-molecule compounds can inhibit disease-related enzymes.
ABSTRACT
Streptococcus dysgalactiae subsp. equisimilis (SDSE) is an emerging cause of human infection with invasive disease incidence and clinical manifestations comparable to the closely related species, Streptococcus pyogenes. Through systematic genomic analyses of 501 disseminated SDSE strains, we demonstrate extensive overlap between the genomes of SDSE and S. pyogenes. More than 75% of core genes are shared between the two species with one third demonstrating evidence of cross-species recombination. Twenty-five percent of mobile genetic element (MGE) clusters and 16 of 55 SDSE MGE insertion regions were shared across species. Assessing potential cross-protection from leading S. pyogenes vaccine candidates on SDSE, 12/34 preclinical vaccine antigen genes were shown to be present in >99% of isolates of both species. Relevant to possible vaccine evasion, six vaccine candidate genes demonstrated evidence of inter-species recombination. These findings demonstrate previously unappreciated levels of genomic overlap between these closely related pathogens with implications for streptococcal pathobiology, disease surveillance and prevention.
Subject(s)
Streptococcal Infections , Streptococcus , Vaccines , Humans , Streptococcus pyogenes/genetics , Gene FlowABSTRACT
The administration of high-dose clindamycin (CLI) along with penicillin is recommended for the treatment of streptococcal toxic shock syndrome (STSS). However, CLI-resistant strains have been identified worldwide. Firstly, in this study, some CLI-resistant strains showed increased extracellular activities of the NAD- glycohydrolase (NADase) exotoxin after CLI treatment. This result supported our previous conclusion that not only CLI-susceptible but also CLI-resistant S. pyogenes strains show the CLI-dependent NADase induction. Secondary, using the 13 types of two- component-sensor knockout strains derived from a CLI-susceptible strain 1529 that has the CLI-dependent NADase induction phenotype, we investigated the mechanism of action. Among the knockout strains, only 1529ΔcovS lost the phenotype. In addition, 1529ΔspeB, 1529Δmga, and 1529Δrgg retained the CLI-dependent NADase induction phenotype. These results suggest that CovS is related to the phenotype in SpeB independent manner.
ABSTRACT
Ultraviolet (UV) irradiation offers an effective and convenient method for the disinfection of pathogenic microorganisms. However, UV irradiation causes protein and/or DNA damage; therefore, further insight into the performance of different UV wavelengths and their applications is needed to reduce risks to the human body. In this paper, we determined the efficacy of UV inactivation of the SARS-CoV-2 omicron BA.2 and BA.5 variants in a liquid suspension at various UV wavelengths by the 50% tissue culture infection dose (TCID50) method and quantitative polymerase chain reaction (qPCR) assay. The inactivation efficacy of 220 nm light, which is considered safe for the human body, was approximately the same as that of health hazardous 260 nm light for both BA.2 and BA.5. Based on the inactivation rate constants determined by the TCID50 and qPCR methods versus the UV wavelength, the action spectra were determined, and BA.2 and BA.5 showed almost the same spectra. This result suggests that both variants have the same UV inactivation characteristics.
Subject(s)
COVID-19 , SARS-CoV-2 , Humans , SARS-CoV-2/genetics , Ultraviolet Rays/adverse effects , Disinfection/methodsABSTRACT
There is a great demand for developing and demonstrating novel disinfection technologies for protection against various pathogenic viruses and bacteria. In this context, ultraviolet (UV) irradiation offers an effective and convenient method for the inactivation of pathogenic microorganisms. The quantitative evaluation of the efficacy of UV sterilization relies on the simple time-dose reciprocity law proposed by Bunsen-Roscoe. However, the inactivation rate constants reported in the literature vary widely, even at the same dose and wavelength of irradiation. Thus, it is likely that the physical mechanism of UV inactivation cannot be described by the simple time-dose reciprocity law but requires a secondary inactivation process, which must be identified to clarify the scientific basis. In this paper, we conducted a UV inactivation experiment with Escherichia coli at the same dose but with different irradiances and irradiation durations, varying the irradiance by two to three orders of magnitude. We showed that the efficacy of inactivation obtained by UV-light emitting diode irradiation differs significantly by one order of magnitude at the same dose but different irradiances at a fixed wavelength. To explain this, we constructed a stochastic model introducing a second inactivation rate, such as that due to reactive oxygen species (ROS) that contribute to DNA and/or protein damage, together with the fluence-based UV inactivation rate. By solving the differential equations based on this model, the efficacy of inactivation as a function of the irradiance and irradiation duration under the same UV dose conditions was clearly elucidated. The proposed model clearly shows that at least two inactivation rates are involved in UV inactivation, where the generally used UV inactivation rate does not depend on the irradiance, but the inactivation rate due to ROS does depend on the irradiance. We conclude that the UV inactivation results obtained to date were simply fitted by one inactivation rate that superimposed these two inactivation rates. The effectiveness of long-term UV irradiation at a low irradiance but the same dose provides useful information for future disinfection technologies such as the disinfection of large spaces, for example, hospital rooms using UV light, because it can reduce the radiation dose and its risk to the human body.
Subject(s)
Escherichia coli , Ultraviolet Rays , Humans , Escherichia coli/radiation effects , Reactive Oxygen Species , Disinfection/methods , Stochastic ProcessesABSTRACT
The administration of high-dose clindamycin (CLI) along with penicillin is recommended for the treatment of streptococcal toxic-shock syndrome (STSS). However, we previously reported that a "subinhibitory dose" of CLI induced the expression of the NAD-glycohydrolase (NADase) exotoxin in an emm1-type Streptococcus pyogenes 1529 strain isolated from an STSS patient. In this study, we examine NADase induction by CLI treatment using an extracellular NADase activity assay instead of the previous two-dimensional gel electrophoresis assay. The examination revealed that CLI administration can induce NADase expression in a dose-dependent manner. We analyzed 23 CLI-susceptible strains (5 emm1 strains, 6 emm3 strains, 3 emm4 strains, 1 emm6 strain, 3 emm12 strains, 1 emm28 strain, and 4 emm89 strains), and 19 of the 23 strains showed similar NADase induction phenotypes to that shown in strain 1529. These results indicate that NADase induction by CLI treatment is not restricted to specific strains and it could be a standard phenotype among CLI-susceptible S. pyogenes strains. We also analyzed four CLI-resistant strains. All four strains showed increased extracellular NADase activities at high concentrations of CLI that did not inhibit bacterial growth. These results indicated that the subinhibitory dose of CLI was not the critical factor for NADase induction.
ABSTRACT
We describe the detailed clinical course of rapidly enlarging infective aneurysms during the treatment of endocarditis and purulent pericarditis caused by Streptococcus pyogenes . We show that S. pyogenes aneurysms can enlarge rapidly within 1-2 days. Moreover, we highlight the benefit of transporting patients to a facility offering multidisciplinary treatment, even if vital signs stabilize to the point.
Subject(s)
Endocarditis , Mediastinitis , Pericarditis , Streptococcal Infections , Child , Humans , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenesABSTRACT
The mef(A)- and its subclass mef(E) systems had long been considered to constitute one of the primary macrolide-resistant mechanisms in Streptococcus pyogenes. However, we have previously demonstrated that the msr(D) gene located immediately downstream of the mef(A)/mef(E) genes plays a predominant role in these systems. In previous studies, furthermore, mef(A)-associated msr(D)10-85 of an S. pyogenes strain (10-85) exhibited a greater increase in clarithromycin minimum inhibitory concentration (MIC) than mef(E)-associated msr(D)13-O-10 of another strain (13-O-10). Both msr(D) genes encode 487 amino acid residues, 13 amino acid residues of which are different from each other. In this study, we performed mutational analysis of the msr(D) genes and showed that a single-nucleotide polymorphism to cause a substitution of Asp238 with Gly is mainly associated with the greater increase in clarithromycin MIC by the msr(D)10-85 than by the msr(D)13-O-10 allele. In addition, another substitution of Ser with Arg at codon 194 is partially associated with the greater increase by the msr(D)10-85 than by the msr(D)13-O-10 allele.
Subject(s)
Clarithromycin , Streptococcus pyogenes , Amino Acids , Anti-Bacterial Agents/pharmacology , Clarithromycin/pharmacology , Drug Resistance, Bacterial/genetics , Macrolides/pharmacology , Microbial Sensitivity Tests , Streptococcus pyogenes/geneticsABSTRACT
There is a great demand for novel disinfection technologies to inactivate various pathogenic viruses and bacteria. In this situation, ultraviolet (UVC) disinfection technologies seem to be promising because biocontaminated air and surfaces are the major media for disease transmission. However, UVC is strongly absorbed by human cells and protein components; therefore, there are concerns about damaging plasma components and causing dermatitis and skin cancer. To avoid these concerns, in this study, we demonstrate that the efficient inactivation of bacteria is achieved by visible pulsed light irradiation. The principle of inactivation is based on transient photothermal heating. First, we provide experimental confirmation that extremely high temperatures above 1000 K can be achieved by pulsed laser irradiation. Evidence of this high temperature is directly confirmed by melting gold nanoparticles (GNPs). Inorganic GNPs are used because of their well-established thermophysical properties. Second, we show inactivation behaviour by pulsed laser irradiation. This inactivation behaviour cannot be explained by a simple optical absorption effect. We experimentally and theoretically clarify this inactivation mechanism based on both optical absorption and scattering effects. We find that scattering and absorption play an important role in inactivation because the input irradiation is inherently scattered by the bacteria; therefore, the dose that bacteria feel is reduced. This scattering effect can be clearly shown by a technique that combines stained Escherichia coli and site selective irradiation obtained by a wavelength tunable pulsed laser. By measuring Live/Dead fluorescence microscopy images, we show that the inactivation attained by the transient photothermal heating is possible to instantaneously and selectively kill microorganisms such as Escherichia coli bacteria. Thus, this method is promising for the site selective inactivation of various pathogenic viruses and bacteria in a safe and simple manner.
Subject(s)
Disinfection , Escherichia coli/growth & development , Gold , Hot Temperature , Lasers , Metal Nanoparticles/chemistry , Gold/chemistry , Gold/pharmacology , Humans , Microbial Viability/drug effects , Microbial Viability/radiation effects , Ultraviolet RaysABSTRACT
Bacteria form biofilms for their protection against environmental stress and produce virulence factors within the biofilm. Biofilm formation in acidified environments is regulated by a two-component system, as shown by studies on isogenic mutants of the sensor protein of the two-component regulatory system in Streptococcus pyogenes. In this study, we found that the LiaS histidine kinase sensor mediates biofilm production and pilus expression in an acidified environment through glucose fermentation. The liaS isogenic mutant produced biofilms in a culture acidified by hydrochloric acid but not glucose, suggesting that the acidified environment is sensed by another protein. In addition, the trxS isogenic mutant could not produce biofilms or activate the mga promoter in an acidified environment. Mass spectrometry analysis showed that TrxS regulates M protein, consistent with the transcriptional regulation of emm, which encodes M protein. Our results demonstrate that biofilm production during environmental acidification is directly under the control of TrxS.
Subject(s)
Bacterial Proteins/physiology , Biofilms/growth & development , Streptococcus pyogenes/physiology , Antigens, Bacterial/biosynthesis , Bacterial Outer Membrane Proteins/biosynthesis , Bacterial Proteins/genetics , Carrier Proteins/biosynthesis , Exotoxins/physiology , Histidine Kinase/physiology , Hydrogen-Ion Concentration , Phosphorylation , Promoter Regions, GeneticABSTRACT
A 69-year-old woman without pre-existing disease visited our hospital due to general malaise, diarrhea, and arthralgia 3 days after a uterine cancer test. We diagnosed her with sepsis of unknown focus and started treatment immediately, but she died 20 hours after the first visit due to multi-organ failure and septic shock. Later, group A streptococcus was detected from the blood culture, and streptococcal toxic shock syndrome (STSS) was diagnosed. The strain had the emm28 genotype and a mutation in csrR with increased NADase activity. These virulence factors were considered to be related to STSS development in this patient.
Subject(s)
Shock, Septic , Streptococcal Infections , Uterine Neoplasms , Aged , Female , Genotype , Humans , Shock, Septic/diagnosis , Shock, Septic/etiology , Streptococcal Infections/diagnosis , Streptococcus pyogenes/genetics , Uterine Neoplasms/diagnosis , Uterine Neoplasms/geneticsABSTRACT
Efficient inactivation of Escherichia coli (E. coli) under visible (532 nm) pulsed light irradiation was achieved by fusion of a visible light-absorbing dye with E. coli. Inactivation experiments showed that 3-log inactivation of E. coli was obtained within 20 min under a 50 kJ/cm2 dose. This treatment time and dose magnitude were 10 times faster and 100 times lower, respectively, than the values previously obtained by using a visible femtosecond laser. The mechanism of bacterial death was modeled based on a transient photothermal evaporation effect, where a quantitative evaluation of the temperature increase was given based on the heat transfer equation. As a result of this theoretical analysis, the maximum temperature of the bacteria was correlated with the absorption ratio, pulse energy, and surface-to-volume ratio. An increase in the surface-to-volume ratio with the decreasing size of organic structures leads to the possibility of efficient inactivation of viruses and bacteria under low-dose and non-harmful-visible pulsed light irradiation. Hence, this method can be applied in many fields, such as the instantaneous inactivation of pathogenic viruses and bacteria in a safe and simple manner without damaging large organic structures.
Subject(s)
Disinfection/methods , Escherichia coli/physiology , Lasers , Light , Coloring Agents , Microbial Viability , Nanotechnology , Photothermal Therapy , TemperatureABSTRACT
Streptococcus pyogenes is a causative agent of streptococcal toxic shock syndrome (STSS). The complete genome sequence of a S. pyogenes strain 10-85 isolated from a STSS patient was recently announced. In this study, the genome sequence was dissected and it was found that the genomic region around 200 kbp (region A) and the genomic region around 1600 kbp (region B) were replaced by each other in strain 10-85, when compared with those in reference strains SF370 and A20. In order to address whether this replacement is unique to 10-85, we further analyzed 163 emm1-type strains. The results indicated that none of the strains isolated before 1990 had the replacement. In contrast, most of the strains isolated at least after 2000 appeared to have the 10-85-type replacement.
Subject(s)
DNA, Bacterial/genetics , Genome, Bacterial/genetics , Shock, Septic/microbiology , Streptococcal Infections/microbiology , Streptococcus pyogenes/genetics , Base Sequence , Humans , Prevalence , Streptococcus pyogenes/isolation & purificationABSTRACT
Here, we announce the complete genome sequence of Streptococcus pyogenes strain 10-85 (type emm1), isolated from a patient with streptococcal toxic shock syndrome (STSS). The strain lacks the genomic regions encoding SalR-SalK, a two-component regulatory system, and the adjacent type I restriction modification system.
ABSTRACT
Streptococcal toxic shock syndrome (STSS) is primarily caused by Streptococcus pyogenes, but it may also be caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE). The analyses of S. pyogenes have revealed the important roles of NAD+ -glycohydrolase (Nga) and CovR/CovS, a two-component regulatory system. We examined these factors in SDSE by analyzing mainly two isogenic SDSE strains (12-10-1 and 12-10-3) from the blood of a patient with STSS. The Nga activities were measured and the nucleotide sequences of covR and covS genes were determined. We detected one nucleotide difference between the covR gene of 12-10-1 and that of 12-10-3, and the Nga activity of 12-10-1 was approximately 6.8-fold more than that of 12-10-3. The introduction of covR of 12-10-3 into 12-10-1 significantly reduced the Nga activity, but the introduction of 12-10-1 covR into itself had only a little effect. In addition, the knockout of covR or covS of 12-10-3 remarkably increased the Nga activity. We are the first to report that strains with wild-type and mutated covR were isolated simultaneously from an SDSE STSS patient and that the CovR/CovS two-component regulatory system is involved in the Nga activity in SDSE as well as in S. pyogenes.
Subject(s)
Bacterial Proteins/genetics , Intracellular Signaling Peptides and Proteins/genetics , NAD+ Nucleosidase/metabolism , Repressor Proteins/genetics , Streptococcal Infections/pathology , Streptococcus pyogenes/metabolism , Bacterial Proteins/metabolism , Histidine Kinase , Humans , Intracellular Signaling Peptides and Proteins/metabolism , Repressor Proteins/metabolism , Shock, Septic/microbiology , Shock, Septic/pathology , Streptococcus pyogenes/enzymology , Streptococcus pyogenes/genetics , Streptococcus pyogenes/isolation & purificationABSTRACT
Although mef(A) and its subclass mef(E) genes have long been considered to play a central role in macrolide efflux-based resistance, we have previously demonstrated that the msr(D) gene located immediately downstream of the mef(A) gene plays a predominant role in Streptococcus pyogenes macrolide resistance. The mef(A) and mef(E) genes are carried by different genetic elements and the resistance associated with mef(A) was reported to be higher than that associated with mef(E); therefore, we further investigated the functional relevance of mef(A)/mef(E) and its associated msr(D). We established additional mef(A)-, mef(E)-, and their associated msr(D)-knockout strains and confirmed the predominance of msr(D) over mef(A)/mef(E). In addition, we performed experiments introducing mef(A), mef(E), and their associated msr(D) genes into mef(A)/mef(E)-msr(D) double-knockout and mef(A)/mef(E) negative strains. Neither mef(A) nor mef(E) genes had effects on erythromycin resistance. However, both associated msr(D) showed significant effects, and the mef(A)-associated msr(D) exhibited more effect than the mef(E)-associated one. These results suggest that an overall functional predominance of msr(D) over mef(A)/mef(E) is conceivable in efflux-based macrolide resistance in at least some S. pyogenes strains. Furthermore, the higher resistance of mef(A) system over mef(E) system could be derived at least in part from functional differences of mef(A)- and mef(E)-associated msr(D).
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Drug Resistance, Bacterial/drug effects , Drug Resistance, Bacterial/genetics , Macrolides/pharmacology , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/genetics , Erythromycin/pharmacology , Membrane Proteins/geneticsABSTRACT
AIM: To analyze the impact of sex on GADD34 function, we studied the aging of female GADD34-deficient mice and compared them with male GADD34-deficient mice. METHODS: We used GADD34-deficient mice on a C57BL/6 background. These mice were fed a normal diet throughout their life. Alternatively, they were fed a high-fat diet at 3 months-of-age. Liver tissues taken from mice were analyzed by hematoxylin-eosin staining and immunohistochemical methods. Fresh liver cells were analyzed by flow cytometry. RESULTS: We found that female GADD34-deficient mice did not develop obesity or fatty livers. However, female GADD34-deficient mice had infiltrations of myeloid cells in the liver, followed by liver atrophy. Many female GADD34-deficient mice developed hepatocellular carcinoma, whereas female wild-type (WT) mice did not show hepatocellular carcinoma during aging. Female GADD34-deficient mice and female WT mice developed the same percentages of lymphoma. Although a high-fat diet induced a higher level of steatosis in young male GADD34-deficient mice compared with WT mice, a high-fat diet induced the same level of steatosis in young female GADD34-deficient mice compared with WT mice. However, GADD34-deficient female young mice had a higher level of infiltration of myeloid cells and myofibroblasts than WT mice. CONCLUSIONS: In contrast to male GADD34-deficient mice, female GADD34-deficient mice did not show obesity as they aged. However, similar to the males, they developed inflammation followed by hepatocellular carcinoma. Geriatr Gerontol Int 2017; 17: 2593-2601.
Subject(s)
Carcinoma, Hepatocellular/etiology , Liver Diseases/etiology , Protein Phosphatase 1 , Sex Factors , Animals , Fatty Liver , Female , Inflammation/etiology , Liver , Liver Neoplasms , Male , Mice , Mice, Inbred C57BL , Mice, Knockout , Myeloid Cells , Neutrophil Infiltration , Obesity/etiologyABSTRACT
The proportion of elderly people rises in the developed countries. The increased susceptibility of the elderly to infectious diseases is caused by immune dysfunction, especially T cell functional decline. Age-related hematopoietic stem cells deviate from lymphoid lineage to myeloid lineage. Thymus shrinks early in life, which is followed by the decline of naïve T cells. T-cell receptor repertoire diversity declines by aging, which is caused by cytomegalovirus-driven T cell clonal expansion. Functional decline of B cell induces antibody affinity declines by aging. Many effector functions including phagocytosis of myeloid cells are down regulated by aging. The studies of aging of myeloid cells have some controversial results. Although M1 macrophages have been shown to be replaced by anti-inflammatory (M2) macrophages by advanced age, many human studies showed that pro-inflammatory cytokines are elevated in older human. To solve this discrepancy here we divide age-related pathological changes into two categories. One is an aging of immune cell itself. Second is involvement of immune cells to age-related pathological changes. Cellular senescence and damaged cells in aged tissue recruit pro-inflammatory M1 macrophages, which produce pro-inflammatory cytokines and proceed to age-related diseases. Underlying biochemical and metabolic studies will open nutritional treatment.
ABSTRACT
PURPOSE: Streptococcus pyogenes causes a variety of diseases, such as pharyngitis and toxic shock syndrome. In addition, this bacterium is a causative agent of balanoposthitis. To reveal the bacteriological characteristics of the isolates from balanoposthitis patients, we analysed 47 isolates. In addition, novel clade genotype emm89 S. pyogenes isolates have been reported to be spreading worldwide recently. Hence, we further analysed eight emm89 isolates. METHODOLOGY: A drug susceptibility experiment was performed and emm types were determined. More detailed experiments, such as PCR analysis for the presence of virulence-associated genes and MLST analysis, were performed especially using emm89 isolates. RESULTS: All isolates were sensitive to ampicillin, but 34â% of the isolates were resistant to at least one antibiotic. The emm types of the isolates varied, with emm89 and emm11 being the most prevalent, but the emm1 type was not detected. The analysis of emm89 isolates revealed that drug susceptibilities varied. All isolates were negative for the hasABC gene and produced active NADase that are characteristics of novel clade genotype emm89 S. pyogenes. MLST analysis demonstrated that six isolates were of the ST101 type, the most predominant type reported thus far, but two isolates were of the ST646 type. According to the PCR analysis used to determine the presence of streptococcal pyrogenic exotoxin-related genes, the six ST101 isolates were further classified into four groups. CONCLUSION: These results suggest that balanoposthitis is caused by a variety of types of S. pyogenes, with novel clade genotype emm89 isolates playing a role in balanoposthitis infections in Japan.
Subject(s)
DNA, Bacterial/genetics , Drug Resistance, Multiple, Bacterial/genetics , Foreskin/microbiology , Streptococcal Infections/microbiology , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/genetics , Ampicillin/pharmacology , Bacterial Proteins/genetics , Base Sequence , Exotoxins/genetics , Humans , Japan , Male , Microbial Sensitivity Tests , Multilocus Sequence Typing , Polymerase Chain Reaction , Sequence Analysis, DNA , Streptococcal Infections/drug therapy , Streptococcus pyogenes/classification , Streptococcus pyogenes/isolation & purificationABSTRACT
Primary abscess of the iliopsoas muscle in children is uncommon, especially due to Streptococcus pyogenes (group A streptococcus: GAS), which causes a variety of diseases ranging from pharyngitis to invasive life-threatening infection. We present primary iliopsoas abscess in a nine-year-old boy presenting with fever, mild disturbance of consciousness, limp, and pain in the right loin. Magnetic resonance imaging and isolation of GAS from both blood and abscess samples led us to the confirmative diagnosis. The patient recovered after treatment comprising drainage and intravenous antibiotics. The CovRS system is one of the best-characterized systems with two-component signal transduction in the GAS, and mutations in covRS induce overproduction of various virulence factors that play a crucial role in invasive GAS infection. RopB, also known as a GAS regulator, influences the expression of multiple regulatory networks to coregulate virulence factor expression in GAS. In the present case, sequence analysis revealed the isolated GAS as emm type 6 with alterations in covS, whereas the covR and ropB genes were intact. The covS alterations might have influenced the virulence of the strain causing this severe GAS infection.