Extracellular bacterial lymphatic metastasis drives Streptococcus pyogenes systemic infection

Nat Commun. 2020 Sep 17;11(1):4697. doi: 10.1038/s41467-020-18454-0.


Unassisted metastasis through the lymphatic system is a mechanism of dissemination thus far ascribed only to cancer cells. Here, we report that Streptococcus pyogenes also hijack lymphatic vessels to escape a local infection site, transiting through sequential lymph nodes and efferent lymphatic vessels to enter the bloodstream. Contrasting with previously reported mechanisms of intracellular pathogen carriage by phagocytes, we show S. pyogenes remain extracellular during transit, first in afferent and then efferent lymphatics that carry the bacteria through successive draining lymph nodes. We identify streptococcal virulence mechanisms important for bacterial lymphatic dissemination and show that metastatic streptococci within infected lymph nodes resist and subvert clearance by phagocytes, enabling replication that can seed intense bloodstream infection. The findings establish the lymphatic system as both a survival niche and conduit to the bloodstream for S. pyogenes, explaining the phenomenon of occult bacteraemia. This work provides new perspectives in streptococcal pathogenesis with implications for immunity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bacteremia / microbiology
  • Bacteremia / pathology
  • Disease Models, Animal
  • Female
  • Interleukin-8 / metabolism
  • Lymph Nodes / immunology
  • Lymph Nodes / microbiology*
  • Lymph Nodes / pathology
  • Lymphatic Metastasis* / pathology
  • Lymphatic System
  • Lymphatic Vessels / microbiology*
  • Lymphatic Vessels / pathology
  • Mice
  • Mice, Inbred BALB C
  • Mice, Inbred C57BL
  • Neutrophils / microbiology
  • Phagocytosis
  • Streptococcal Infections / immunology
  • Streptococcal Infections / microbiology*
  • Streptococcal Infections / pathology
  • Streptococcus pyogenes / genetics
  • Streptococcus pyogenes / pathogenicity*
  • Virulence


  • Interleukin-8