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Mortality Among Patients With Invasive Group A Streptococcal Infections Caused by the M1UK Lineage: A Retrospective

Ho Kwong Li1,2, Nina Zhu2,3,4, Olivia Waddell2

  • 1Centre for Bacterial Resistance Biology, Imperial College London, London, UK.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|October 16, 2025
PubMed
Abstract

Insights

Mortality rates for invasive group A streptococcal (iGAS) infections caused by the M1UK sublineage did not significantly differ from other emm1 lineages. Rapid progression to death highlights the urgent need for faster diagnostics and interventions for iGAS disease.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Epidemiology

Background:

  • The M1UK sublineage of Streptococcus pyogenes is linked to increased invasive group A streptococcal (iGAS) disease.
  • Recent surges in iGAS necessitate understanding the impact of specific emm1 sublineages on patient outcomes.

Purpose of the Study:

  • To assess the case fatality rate (CFR) of emm1 iGAS in England and Wales.
  • To compare patient outcomes between the M1UK sublineage and ancestral emm1 lineages.

Main Methods:

  • Linked emm1 iGAS cases (2009-2022) with mortality records.
  • Determined lineage using whole-genome sequencing or PCR for isolates from 2010, 2013-2016, and 2020.
  • Estimated 7- and 30-day CFRs and used statistical models to assess lineage-associated mortality risk.

Main Results:

  • Among 1356 emm1 iGAS cases with assigned lineage, 30-day CFRs varied: M1UK (24.4%), M1global (22.3%), M123SNP (10.5%), M113SNP (10.3%).
  • Lineage was not a significant predictor of mortality after adjusting for age and sex.
  • Rapid progression to death was observed, with over 63% of deaths occurring within 1 day of diagnostic sampling, particularly in children.

Conclusions:

  • No significant difference in mortality was found between M1UK and M1global lineages.
  • Overall mortality from emm1 Streptococcus pyogenes remains high.
  • The rapid time to death emphasizes the need for rapid diagnostics and preventive strategies for iGAS.
Keywords:
M1UKStreptococcus pyogeneslineagemortalitysepsis

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