Streptococcal outbreaks and erythrogenic toxin type A.

Reference strains of Streptococcus pyogenes and strains from recent epidemics and sporadic cases of scarlet fever were examined for their ability to produce erythrogenic toxin type A (ET A) by ELISA and double immunodiffusion (Ouchterlony) using an anti-ET A antibody purified by affinity chromatography. Of the reference strains (most of them isolated before 1945) 16/51 produced more or less ET A (Table 1). ET A synthesis is strain-specific, but not type-specific. Well-known toxin producers like the strains NY-5; 594 or "Smith" produce up to 16.000 micrograms/l under optimal culture conditions. Type 3 strains isolated from scarlet fever patients during the outbreak 1972/73 seem to belong to one clone as evidenced by the uniform SDS-PAGE pattern: They were found to produce 5-200 micrograms/l (mean 68 micrograms/l) ET A only. Type 3 strains from sporadic cases, isolated 10 years later, produced 0-138 micrograms/l (mean 30 micrograms/l). Strains of the type 1 clone, causing the epidemic in 1982/83 produced only 0.75-10 micrograms/l (mean 8 micrograms/l) ET A (Table 3). Only a few strains of S. pyogenes isolated 1984 or later synthesized ET A but they were found more often to produce ET B (proteinase precursor) in batch cultures. S. pyogenes strains seem to have lost their ability to produce large amounts of ET A during the last decades. Because this toxin must be considered as a pathogenicity factor the decrease in toxin production may be one reason for the present mild form of scarlet fever.