Molecular epidemiologic comparison of 2 unusual clusters of group A streptococcal necrotizing fasciitis in Hawaii

Two clusters of necrotizing fasciitis (NF) due to group A streptococcus (GAS) were identified on the Hawaiian islands of Kauai and Maui during 1997 and 2002, respectively. The emm gene sequence types and the pulsed-field gel electrophoresis patterns were determined for 6 isolates recovered from patients with NF and for 116 isolates recovered from patients with temporally associated community-acquired GAS infection. No predominant emm type was identified, and the emm types of 64 (52.5%) of the isolates were considered to be uncommon in the continental United States. These findings suggest that unusual emm types might be responsible for invasive GAS infections in patients from Hawaii.