Why does skin strep pyogenes infection cause glomerulonephritis, but not rheumatic fever?

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Why is it that whereas throat infection by strep. pyogenes can cause both glomerulonephritis AND rheumatic fever, skin infection by the same results in only glomerulonephritis and not rheumatic fever?

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[Jabbed]

Why is it that whereas throat infection by strep. pyogenes can cause both glomerulonephritis AND rheumatic fever, skin infection by the same results in only glomerulonephritis and not rheumatic fever?

Virulence factors.

Strains that cause RF express M protein and N-acetyl-beta-D-glucosamine which produce the immune cross-reaction with myosin and lysoganglioside. M protein prevents opsonization and allows for more invasive infection.

Cutaneous strains lack these virulence factors and are thus not as invasive (nec fasc and toxic shock-like syndrome aside) and, naturally, won't produce the autoimmune response associated with those virulence factors.

Glomerulonephritis is just a result of immune complex deposition. There were two antigens associated with triggering the immune response: one was exotoxin B but I forget the other. These virulence factors are common to both strains of GAS.

 

[goal270]

Virulence factors.

Strains that cause RF express M protein and N-acetyl-beta-D-glucosamine which produce the immune cross-reaction with myosin and lysoganglioside. M protein prevents opsonization and allows for more invasive infection.

Cutaneous strains lack these virulence factors and are thus not as invasive (nec fasc and toxic shock-like syndrome aside) and, naturally, won't produce the autoimmune response associated with those virulence factors.

Glomerulonephritis is just a result of immune complex deposition. There were two antigens associated with triggering the immune response: one was exotoxin B but I forget the other. These virulence factors are common to both strains of GAS.

Thank you so much! very well explained