A fatal pediatric case of meningitis and streptococcal toxic shock syndrome caused by emm12 Streptococcus pyogenes strain in Jiangsu, China, 2024.

A 23-month-old boy was admitted to our hospital with onset of fever and paroxysmal cough but progressed to death on Day 9. Streptococcus pyogenes was positive in cerebrospinal fluid and blood by next-generation sequencing, and was cultured from sputum. The isolate was resistant to erythromycin, clindamycin, and tetracycline. By genomic analysis, the isolate was identified to be emm12 of global Clade II and harbor mobile genetic elements of ICE-emm12 and ΦHKU.vir, carrying resistance genes ermB and tetM. We report a fatal case of meningitis case complicated with streptococcal toxic shock syndrome caused by emm12 S. pyogenes in China, which is rare in this country.