Characterization ofStreptococcus milleriGroup Isolates from Expectorated Sputum of Adult Patients with Cystic Fibrosis
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ABSTRACTWith the recent insights into theStreptococcus millerigroup (SMG) as pulmonary pathogens in patients with cystic fibrosis (CF), we sought to characterize 128 isolates from the sputum of adults with CF, along with 45 isolates from patients with invasive diseases for comparison. The tests performed included Lancefield grouping; tests for hemolysis; tests for the production of hyaluronidase, chondroitin sulfatase, DNase, proteases, and hydrogen peroxide; and PCR for the detection of the intermedilysin gene (ily). We also generated biochemical profiles with the Rapid ID Strep 32 API system and tested cell-free supernatants for the presence of the signal molecule autoinducer-2 (AI-2) using aVibrio harveyibioassay with a subset of CF strains. TheS. intermediusisolates from both strain collections were similar, while theS. constellatusandS. anginosusisolates yielded several biotypes that differed in prevalence between the two strain collections. Beta-hemolytic, Lancefield group CS. constellatuscomprised 74.4% of theS. constellatusisolates from patients with CF but only 13.3% of the corresponding isolates from patients with invasive infections. This was the onlyS. constellatusbiotype associated with pulmonary exacerbations. Hyaluronidase-positiveS. anginosuswas detected only among the isolates from patients with CF. Strain-to-strain variability in AI-2 expression was evident, with the mean values being the highest forS. anginosus, followed byS. constellatusand thenS. intermedius. Cluster analysis and 16S rRNA sequencing revealed that the species of SMG could be accurately determined with a minimum of three phenotypic tests: tests for the Lancefield group, hyaluronidase production, and chondroitin sulfatase production. Furthermore, isolates from patients with invasive infections clustered with isolates from the sputum of patients with CF, suggesting that the respiratory tract isolates were equally pathogenic.
