Streptococcal superantigens: categorization and clinical associations

• The currently confused nomenclature of streptococcal superantigens is clarified.
• Guidelines for future superantigen classification are proposed.
• Evidence for superantigen involvement in clinical disease is summarized.

Superantigens are key virulence factors in the immunopathogenesis of invasive disease caused by group A streptococcus. These protein exotoxins have also been associated with severe group C and group G streptococcal infections. A number of novel streptococcal superantigens have recently been described with some resulting confusion in their classification. In addition to clarifying the nomenclature of streptococcal superantigens and proposing guidelines for their categorization, this review summarizes the evidence supporting their involvement in various clinical diseases including acute rheumatic fever.