Genomic analysis of the Streptococcus anginosus group; taxonomic implications, evolutionary insights and clinical considerations

Background: The Streptococcus anginosus group (SAG) (S. anginosus, S. intermedius, and S. constellatus) causes serious, potentially life-threatening, invasive infections, often in otherwise healthy individuals. However, the group's diversity is still poorly understood, and with it, the ability to identify prognostic markers of severe disease. Methods: Long-read sequencing produced closed genomes for 29 isolates from 25 patients hospitalised primarily for invasive SAG infections, and 21 isolates from 20 non-hospitalised controls. Genomes were classified with GTDB-Tk and combined with 211 reference genomes. After dereplication, 207 SAG genomes (38 isolate, 169 reference) representing 206 strains were analysed using: GTDB classification, average nucleotide identity, multi-marker and core-genome SNP phylogenies, recombination-aware analyses, mobilome, CAZyme and gapseq metabolic profiling, and lineage-aware genome-wide association testing for invasive phenotype. Results: Agreement between GTDB-Tk and MALDI-TOF taxonomic classifications was low (42.8%), including two S. massiliensis cases mis-identified by MALDI-TOF as SAG. S. anginosus resolved into four taxa (S. anginosus, S. hominis, S. whileyi and S. vaginalis). Phylogenies based on core genome single-nucleotide polymorphisms resolved these species into distinct clades, whereas 16S rRNA gene and multilocus sequence analysis phylogenies did not. The four ex-S. anginosus taxa showed a gradient of genomic cohesion, with S. vaginalis being near-clonal, in contrast to S. anginosus, which shared high levels of sequence ancestry with other neighbouring taxa. Carbohydrate utilisation was strongly lineage-associated, as was propensity for invasive disease. A ~15Kbp glycosaminoglycan utilisation locus was found in the three taxa of highest disease severity propensity (S. intermedius, S. constellatus, S. whileyi) which predicts a direct host glycosaminoglycan feeding mechanism that may contribute to invasive disease. No single functional feature, gene or core-genome SNP was associated with invasiveness however after lineage-adjustment. Combined feature analysis suggests S. vaginalis has undergone a niche restriction and has evolved for a primary existence in the female urogenital tract. Conclusions: Under-reported species may be mis-diagnosed as SAG invasive infections. SAG is more diverse than its current three-species definition, with the conventional S. anginosus species proposed to be classed into a complex of four distinct taxa. Invasive capacity appears to be an emergent system-level property rather than from individual features.