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She was treated with intravenous amoxicillin 3?g/6?h plus gentamicin 180?mg/day [http://en.wikipedia.org/wiki/TRIB1 TRIB1] for 8?days. She then received an oral course of amoxicillin 2?g/8?h for 15?days and recovered uneventfully. The 82-year-old husband of the index case had a medical history of coronary by-pass surgery and aneurysm of abdominal aorta. He was hospitalized 10?days after his wife with streptococcal toxic shock syndrome, and died several hours after admission. Blood cultures yielded the same S.?pyogenes strain. The 16-year-old grandson presented on the following day with pharyngitis due to the same strain. Throat swab specimens were not obtained from the remaining family members, two adults, 33 and 48?years old, and a 10-year-old girl, who were asymptomatic. They received an antibioprophylactic treatment. Identification and typing techniques, performed as previously described, revealed that all the isolates were identical [3,4]. Biotype 5 was determined by the presence of ��-glucuronidase and fermentation of methyl-��-d-glucopyranoside on rapid ID32 STREP strips (bioM��rieux, Marcy l��Etoile, France). The strain was non T-typeable by slide agglutination with type-specific antisera (Sevapharma, Praha, Czech Republic). Antimicrobial susceptibility was tested by the disk diffusion method according to the Comit�� de l��Antibiogramme de la Soci��t�� Fran?aise de Microbiologie guidelines (http://www.sfm.asso.fr). MICs were determined [http://www.selleckchem.com/products/pci-32765.html Ibrutinib order] by E-test (AES, Chemuney, [http://www.selleckchem.com/products/MK-2206.html selleck inhibitor] Bruz, France). The mefA, ermB, ermTR, tetO, tetM, tetK and tetL genes involved in macrolide or tetracycline resistance were searched by multiplex PCR [5]. The strain was resistant to tetracycline (MIC?=?24?mg/L, in relation to the presence of the tetM gene). It had high levels of resistance to kanamycin (MIC ��?500?mg/L), erythromycin and clindamycin (MICs ��?256?mg/L in relation to the presence of the ermB gene). Genes encoding the toxins or superantigens SpeA, SpeB, SpeC and Ssa were determined by a multiplex PCR method [4]. The strain was positive for genes speB and speC. The identical emm sequence-type 11 and pulsed-field gel electrophoresis pattern of all the isolates, obtained as previously described, confirmed their clonal origin (Fig.?1) [3]. In Europe and in the USA emm11 strains are associated with invasive infections in