Emergence of uncommon emm types of Streptococcus pyogenes among adult patients in southern Taiwan

Background: Streptococcus pyogenes isolated from adult patients during a 12-year period in southern Taiwan were analyzed to estimate the distribution of emm types and their correlation with disease manifestations and patient age. Methods: Three hundred thirty-four invasive and noninvasive isolates collected from patients older than 20 years between 1997 and 2008 at National Cheng Kung University Hospital were included for emm typing. A correlation between emm type, disease manifestations, and patient ages was analyzed. Results: The nine most prevalent types were emm11, emm12, emm4, emm1, Sp9458/VT8, emm81, emm106, emm13, and emm75. Formerly rare emm types, including emm11, emm81, and emm102, emerged dramatically after 2004 in southern Taiwan. Type emm11 was significantly associated with both superficial infections and cellulitis. In addition, types emm13, emm81, and emm106 were more prevalent in patients older than 50 years and significantly associated with specific invasive disease manifestation. Conclusion: These results suggest new emm types (emm11, emm81, and emm102) of S  pyogenes were introduced into the adult population in southern Taiwan after 2004. The rarely reported emm types, including emm13, emm81, and emm106, caused invasive diseases more often in adult patients.