Faculty Appointments
Professor of Pediatrics
Edward Claiborne Stahlman Chair #2
Education
M.D., Medicine, University of Rochester, Rochester, New YorkM.P.H., Medicine, University of Rochester, Rochester, New YorkPh.D., MEdicine, University of Rochester, Rochester, New YorkM.S., Medicine, University of Rochester, Rochester, New York
Research Description
Dr. Flores has developed a research program in the study of pathogenic streptococci. His work combines bacterial genomics, microbial pathogenesis, and clinical epidemiology to study the host-pathogen interaction of both group A and B streptococci and has resulted in >80 peer-reviewed publications and multiple independent NIH awards. Current areas of research include:
1. Clinical and genomic epidemiology of group A and B Streptococci. Leveraging ongoing multisite surveillance of disease caused by pathogenic streptococci, the Flores lab uses a combination of clinical epidemiology and bacterial whole genome sequencing to understand the clinical and bacterial strain factors that drive infections caused by group A and B streptococci (GAS, GBS). Such studies serve as the foundation for molecular pathogenesis studies in GAS and GBS.
2. Mechanisms of epidemic clonal emergence in emm4 GAS. Our lab previously described a novel clone emergence event in emm4 GAS strains in North America using GAS population genomics. The novel emergent emm4 strain showed several unique characteristics compared to historical strains including a unique gene regulatory program that promoted persistence within host immune cells (macrophages). Current work seeks to understand the molecular drivers of this phenotype and influence on the host inflammatory response.
3. Cell envelope stress (CES) response to human antimicrobial peptides in GAS. The Flores lab has a long-standing interest in gene regulatory changes through antimicrobials and antimicrobial peptides associated with GAS two-component gene regulatory systems (namely, LiaFSR and Ihk/Irr). Current studies focus on the role of membrane proteins (LiaF and LiaS) in sensing CES through the GAS ExPortal. In addition, as the primary target of the LiaFSR system, we are interested in the contribution of GAS SpxA1/SpxA2 proteins in GAS disease and induction of host inflammation.
4. Evolution and pathogenesis of serotype V GBS in humans. Our laboratory has performed some of the only studies to understand the epidemiology and pathogenesis of serotype V GBS disease in adults. Using local GBS surveillance spanning 50 years, WGS, and phylogenomic analysis, we have discovered stepwise emergence of multiple serotype V subpopulations differing by presence of antimicrobial resistance elements and inactivation of a conserved gene regulatory system. Ongoing studies are aimed at determining the role of TCS3 in GBS pathogenesis and subpopulation emergence.
1. Clinical and genomic epidemiology of group A and B Streptococci. Leveraging ongoing multisite surveillance of disease caused by pathogenic streptococci, the Flores lab uses a combination of clinical epidemiology and bacterial whole genome sequencing to understand the clinical and bacterial strain factors that drive infections caused by group A and B streptococci (GAS, GBS). Such studies serve as the foundation for molecular pathogenesis studies in GAS and GBS.
2. Mechanisms of epidemic clonal emergence in emm4 GAS. Our lab previously described a novel clone emergence event in emm4 GAS strains in North America using GAS population genomics. The novel emergent emm4 strain showed several unique characteristics compared to historical strains including a unique gene regulatory program that promoted persistence within host immune cells (macrophages). Current work seeks to understand the molecular drivers of this phenotype and influence on the host inflammatory response.
3. Cell envelope stress (CES) response to human antimicrobial peptides in GAS. The Flores lab has a long-standing interest in gene regulatory changes through antimicrobials and antimicrobial peptides associated with GAS two-component gene regulatory systems (namely, LiaFSR and Ihk/Irr). Current studies focus on the role of membrane proteins (LiaF and LiaS) in sensing CES through the GAS ExPortal. In addition, as the primary target of the LiaFSR system, we are interested in the contribution of GAS SpxA1/SpxA2 proteins in GAS disease and induction of host inflammation.
4. Evolution and pathogenesis of serotype V GBS in humans. Our laboratory has performed some of the only studies to understand the epidemiology and pathogenesis of serotype V GBS disease in adults. Using local GBS surveillance spanning 50 years, WGS, and phylogenomic analysis, we have discovered stepwise emergence of multiple serotype V subpopulations differing by presence of antimicrobial resistance elements and inactivation of a conserved gene regulatory system. Ongoing studies are aimed at determining the role of TCS3 in GBS pathogenesis and subpopulation emergence.
Research Keywords
group A streptococcus, group B streptococcus, inflammation, epidemiology, whole genome sequencing, cell envelope stress, antimicrobial peptides
Publications
McNeil JC, Bui R, Sommer LM, Walther M, Doan TT, Deguzman M, Sanson M, Flores AR. Acute Rheumatic Fever During a Surge of Group A Streptococcus Disease in a US Children's Hospital System. J Pediatric Infect Dis Soc. 2025 Sep 9/11/2025; 14(9): PMID: 40874568, PII: 8242514, DOI: 10.1093/jpids/piaf078, ISSN: 2048-7207.
Vega LA, Sanson-Iglesias M, Mukherjee P, Buchan KD, Morrison G, Hohlt AE, Flores AR. LiaR-dependent gene expression contributes to antimicrobial responses in group A Streptococcus. Antimicrob Agents Chemother [print-electronic]. 2024 Dec 12/5/2024; 68(12): e0049624. PMID: 39535201, PMCID: PMC11619527, DOI: 10.1128/aac.00496-24, ISSN: 1098-6596.
Hoyer EA, Joseph M, Dunn J, Weiner HL, Dimachkieh A, Flores AR, Sanson MA, Ayele H, Hanson BM, Kaplan SL, Vallejo JG, McNeil JC. Increasing Incidence of Streptococcus anginosus Group Intracranial Infections Associated With Sinusitis, Otitis Media, and Mastoiditis in Children. Pediatr Infect Dis J [print-electronic]. 2024 Aug 8/1/2024; 43(8): e261-e267-e267. PMID: 38621168, PMCID: PMC11254555, PII: 00006454-202408000-00002, DOI: 10.1097/INF.0000000000004346, ISSN: 1532-0987.
Odo CM, Vega LA, Mukherjee P, DebRoy S, Flores AR, Shelburne SA. Emergent emm4 group A Streptococcus evidences a survival strategy during interaction with immune effector cells. Infect Immun [print-electronic]. 2024 Jul 7/11/2024; 92(7): e0015224. PMID: 38888310, PMCID: PMC11238559, DOI: 10.1128/iai.00152-24, ISSN: 1098-5522.
Mercado-Evans V, Mejia ME, Zulk JJ, Ottinger S, Hameed ZA, Serchejian C, Marunde MG, Robertson CM, Ballard MB, Ruano SH, Korotkova N, Flores AR, Pennington KA, Patras KA. Gestational diabetes augments group B Streptococcus infection by disrupting maternal immunity and the vaginal microbiota. Nat Commun. 2024 Feb 2/3/2024; 15(1): 1035. PMID: 38310089, PMCID: PMC10838280, PII: 10.1038/s41467-024-45336-6, DOI: 10.1038/s41467-024-45336-6, ISSN: 2041-1723.
DebRoy S, Shropshire WC, Vega L, Tran C, Horstmann N, Mukherjee P, Selvaraj-Anand S, Tran TT, Bremer J, Gohel M, Arias CA, Flores AR, Shelburne SA. Identification of distinct impacts of CovS inactivation on the transcriptome of acapsular group A streptococci. MSystems [print-electronic]. 2023 Aug 8/31/2023; 8(4): e0022723. PMID: 37358280, PMCID: PMC10470059, DOI: 10.1128/msystems.00227-23, ISSN: 2379-5077.
Shropshire WC, Strope B, Selvaraj Anand S, Bremer J, McDaneld P, Bhatti MM, Flores AR, Kalia A, Shelburne SA. Temporal dynamics of genetically heterogeneous extended-spectrum cephalosporin-resistant Escherichia coli bloodstream infections. MSphere [print-electronic]. 2023 Aug 8/24/2023; 8(4): e0018323. PMID: 37427953, PMCID: PMC10449519, DOI: 10.1128/msphere.00183-23, ISSN: 2379-5042.
Horstmann N, Tran CN, Flores AR, Shelburne SA. Hyperphosphorylation of the Group A Streptococcal Control of Virulence Regulator Increases Promoter Occupancy Specifically at Virulence Factor-Encoding Genes. J Bacteriol [print-electronic]. 2023 Jun 6/27/2023; 205(6): e0011823. PMID: 37289078, PMCID: PMC10294628, DOI: 10.1128/jb.00118-23, ISSN: 1098-5530.
Sabroske EM, Iglesias MAS, Rench M, Moore T, Harvey H, Edwards M, Baker CJ, Flores AR. Evolving antibiotic resistance in Group B Streptococci causing invasive infant disease: 1970-2021. Pediatr Res [print-electronic]. 2023 Jun; 93(7): 2067-71. PMID: 36352262, PMCID: PMC10166762, PII: 10.1038/s41390-022-02375-3, DOI: 10.1038/s41390-022-02375-3, ISSN: 1530-0447.
Aboulhosn A, Sanson MA, Vega LA, Segura MG, Summer LM, Joseph M, McNeil JC, Flores AR. Increases in group A streptococcal infections in the pediatric population in Houston, TX, 2022. Clin Infect Dis [print-electronic]. 2023 Apr 4/3/2023; 77(3): 351-4. PMID: 37011014, PMCID: PMC10425190, PII: 7100619, DOI: 10.1093/cid/ciad197, ISSN: 1537-6591.
McNeil JC, Sommer LM, Vallejo JG, Hulten KG, Kaplan SL, Flores AR. Reduced Ceftaroline Susceptibility among Invasive MRSA Infections in Children: a Clinical and Genomic Investigation. Antimicrob Agents Chemother [print-electronic]. 2022 Oct 10/18/2022; 66(10): e0074522. PMID: 36165630, PMCID: PMC9578395, DOI: 10.1128/aac.00745-22, ISSN: 1098-6596.
Vega LA, Sanson MA, Cubria MB, Regmi S, Shah BJ, Shelburne SA, Flores AR. The Integrative Conjugative Element ICESpyM92 Contributes to Pathogenicity of Emergent Antimicrobial-Resistant emm92 Group A Streptococcus. Infect Immun [print-electronic]. 2022 Aug 8/18/2022; 90(8): e0008022. PMID: 35913172, PMCID: PMC9387263, DOI: 10.1128/iai.00080-22, ISSN: 1098-5522.
Alamarat ZI, Sanson MA, McNeil JC, Baker CJ, Flores AR. Use of whole-genome sequencing to detect transmission of group A Streptococcus in Houston, TX. Access Microbiol. 2022 Aug; 4(5): acmi000351. PMID: 36003355, PMCID: PMC9394528, PII: 000351, DOI: 10.1099/acmi.0.000351, ISSN: 2516-8290.
Horstmann N, Myers KS, Tran CN, Flores AR, Shelburne Iii SA. CovS inactivation reduces CovR promoter binding at diverse virulence factor encoding genes in group A Streptococcus. PLoS Pathog. 2022 Feb; 18(2): e1010341. PMID: 35180278, PMCID: PMC8893699, PII: PPATHOGENS-D-21-02183, DOI: 10.1371/journal.ppat.1010341, ISSN: 1553-7374.
Cubria MB, Vega LA, Shropshire WC, Sanson MA, Shah BJ, Regmi S, Rench M, Baker CJ, Flores AR. Population Genomics Reveals Distinct Temporal Association with the Emergence of ST1 Serotype V Group B Streptococcus and Macrolide Resistance in North America. Antimicrob Agents Chemother [print-electronic]. 2022 Jan 1/18/2022; 66(1): e0071421. PMID: 34633844, PMCID: PMC8765267, DOI: 10.1128/AAC.00714-21, ISSN: 1098-6596.
Sanson MA, Vega LA, Shah B, Regmi S, Cubria MB, Horstmann N, Shelburne SA, Flores AR. The LiaFSR Transcriptome Reveals an Interconnected Regulatory Network in Group A Streptococcus. Infect Immun [print-electronic]. 2021 Oct 10/15/2021; 89(11): e0021521. PMID: 34370508, PMCID: PMC8519277, DOI: 10.1128/IAI.00215-21, ISSN: 1098-5522.
DebRoy S, Sanson M, Shah B, Regmi S, Vega LA, Odo C, Sahasrabhojane P, McGeer A, Tyrrell GJ, Fittipaldi N, Shelburne SA, Flores AR. Population Genomics of emm4 Group A Streptococcus Reveals Progressive Replacement with a Hypervirulent Clone in North America. MSystems [print-electronic]. 2021 Aug 8/31/2021; 6(4): e0049521. PMID: 34374563, PMCID: PMC8409732, DOI: 10.1128/mSystems.00495-21, ISSN: 2379-5077.
Cubria MB, Delgado J, Shah BJ, Sanson MA, Flores AR. Identification of epidemic scarlet fever group A Streptococcus strains in the paediatric population of Houston, TX, USA. Access Microbiol. 2021; 3(10): 274. PMID: 34816093, PMCID: PMC8604173, PII: 000274, DOI: 10.1099/acmi.0.000274, ISSN: 2516-8290.
Lin Y, Sanson MA, Vega LA, Shah B, Regmi S, Cubria MB, Flores AR. ExPortal and the LiaFSR Regulatory System Coordinate the Response to Cell Membrane Stress in Streptococcus pyogenes. MBio. 2020 Sep 9/15/2020; 11(5): PMID: 32934083, PMCID: PMC7492735, PII: mBio.01804-20, DOI: 10.1128/mBio.01804-20, ISSN: 2150-7511.
McNeil JC, Sommer LM, Boyle M, Hogan P, Vallejo JG, Hultén KG, Flores AR, Kaplan SL, Fritz S. Cefazolin Inoculum Effect and Methicillin-Susceptible Staphylococcus aureus Osteoarticular Infections in Children. Antimicrob Agents Chemother [electronic-print]. 2020 Aug 8/20/2020; 64(9): PMID: 32660989, PMCID: PMC7449214, PII: AAC.00703-20, DOI: 10.1128/AAC.00703-20, ISSN: 1098-6596.
Vega LA, Sanson MA, Shah BJ, Flores AR. Strain-Dependent Effect of Capsule on Transmission and Persistence in an Infant Mouse Model of Group A Streptococcus Infection. Infect Immun [electronic-print]. 2020 Mar 3/23/2020; 88(4): PMID: 32014891, PMCID: PMC7093130, PII: IAI.00709-19, DOI: 10.1128/IAI.00709-19, ISSN: 1098-5522.
Sanson M, Flores AR. Group A Streptococcus Transcriptome Analysis. Methods Mol Biol. 2020; 2136: 113-33. PMID: 32430816, DOI: 10.1007/978-1-0716-0467-0_8, ISSN: 1940-6029.
Sanson MA, Macias OR, Shah BJ, Hanson B, Vega LA, Alamarat Z, Flores AR. Unexpected relationships between frequency of antimicrobial resistance, disease phenotype and emm type in group A Streptococcus. Microb Genom. 2019 Nov; 5(11): PMID: 31755853, PMCID: PMC6927302, DOI: 10.1099/mgen.0.000316, ISSN: 2057-5858.
Deniskin R, Shah B, Muñoz FM, Flores AR. Clinical Manifestations and Bacterial Genomic Analysis of Group A Streptococcus Strains That Cause Pediatric Toxic Shock Syndrome. J Pediatric Infect Dis Soc. 2019 Jul 7/1/2019; 8(3): 265-8. PMID: 30085250, PMCID: PMC6601382, PII: 5061965, DOI: 10.1093/jpids/piy069, ISSN: 2048-7207.
Flores AR, Chase McNeil J, Shah B, Van Beneden C, Shelburne SA. Capsule-Negative emm Types Are an Increasing Cause of Pediatric Group A Streptococcal Infections at a Large Pediatric Hospital in Texas. J Pediatric Infect Dis Soc. 2019 Jul 7/1/2019; 8(3): 244-50. PMID: 30085121, PMCID: PMC8938855, PII: 5063600, DOI: 10.1093/jpids/piy053, ISSN: 2048-7207.
DebRoy S, Li X, Kalia A, Galloway-Pena J, Shah BJ, Fowler VG, Flores AR, Shelburne SA. Identification of a chimeric emm gene and novel emm pattern in currently circulating strains of emm4 Group A Streptococcus. Microb Genom [print-electronic]. 2018 Nov; 4(11): PMID: 30412460, PMCID: PMC6321872, DOI: 10.1099/mgen.0.000235, ISSN: 2057-5858.
Flores AR, Olsen RJ, Cantu C, Pallister KB, Guerra FE, Voyich JM, Musser JM. Increased Pilus Production Conferred by a Naturally Occurring Mutation Alters Host-Pathogen Interaction in Favor of Carriage in Streptococcus pyogenes. Infect Immun [electronic-print]. 2017 May; 85(5): PMID: 28264907, PMCID: PMC5400840, PII: IAI.00949-16, DOI: 10.1128/IAI.00949-16, ISSN: 1098-5522.
Vega LA, Sanson-Iglesias M, Mukherjee P, Buchan KD, Morrison G, Hohlt AE, Flores AR. LiaR-dependent gene expression contributes to antimicrobial responses in group A Streptococcus. Antimicrob Agents Chemother [print-electronic]. 2024 Dec 12/5/2024; 68(12): e0049624. PMID: 39535201, PMCID: PMC11619527, DOI: 10.1128/aac.00496-24, ISSN: 1098-6596.
Hoyer EA, Joseph M, Dunn J, Weiner HL, Dimachkieh A, Flores AR, Sanson MA, Ayele H, Hanson BM, Kaplan SL, Vallejo JG, McNeil JC. Increasing Incidence of Streptococcus anginosus Group Intracranial Infections Associated With Sinusitis, Otitis Media, and Mastoiditis in Children. Pediatr Infect Dis J [print-electronic]. 2024 Aug 8/1/2024; 43(8): e261-e267-e267. PMID: 38621168, PMCID: PMC11254555, PII: 00006454-202408000-00002, DOI: 10.1097/INF.0000000000004346, ISSN: 1532-0987.
Odo CM, Vega LA, Mukherjee P, DebRoy S, Flores AR, Shelburne SA. Emergent emm4 group A Streptococcus evidences a survival strategy during interaction with immune effector cells. Infect Immun [print-electronic]. 2024 Jul 7/11/2024; 92(7): e0015224. PMID: 38888310, PMCID: PMC11238559, DOI: 10.1128/iai.00152-24, ISSN: 1098-5522.
Mercado-Evans V, Mejia ME, Zulk JJ, Ottinger S, Hameed ZA, Serchejian C, Marunde MG, Robertson CM, Ballard MB, Ruano SH, Korotkova N, Flores AR, Pennington KA, Patras KA. Gestational diabetes augments group B Streptococcus infection by disrupting maternal immunity and the vaginal microbiota. Nat Commun. 2024 Feb 2/3/2024; 15(1): 1035. PMID: 38310089, PMCID: PMC10838280, PII: 10.1038/s41467-024-45336-6, DOI: 10.1038/s41467-024-45336-6, ISSN: 2041-1723.
DebRoy S, Shropshire WC, Vega L, Tran C, Horstmann N, Mukherjee P, Selvaraj-Anand S, Tran TT, Bremer J, Gohel M, Arias CA, Flores AR, Shelburne SA. Identification of distinct impacts of CovS inactivation on the transcriptome of acapsular group A streptococci. MSystems [print-electronic]. 2023 Aug 8/31/2023; 8(4): e0022723. PMID: 37358280, PMCID: PMC10470059, DOI: 10.1128/msystems.00227-23, ISSN: 2379-5077.
Shropshire WC, Strope B, Selvaraj Anand S, Bremer J, McDaneld P, Bhatti MM, Flores AR, Kalia A, Shelburne SA. Temporal dynamics of genetically heterogeneous extended-spectrum cephalosporin-resistant Escherichia coli bloodstream infections. MSphere [print-electronic]. 2023 Aug 8/24/2023; 8(4): e0018323. PMID: 37427953, PMCID: PMC10449519, DOI: 10.1128/msphere.00183-23, ISSN: 2379-5042.
Horstmann N, Tran CN, Flores AR, Shelburne SA. Hyperphosphorylation of the Group A Streptococcal Control of Virulence Regulator Increases Promoter Occupancy Specifically at Virulence Factor-Encoding Genes. J Bacteriol [print-electronic]. 2023 Jun 6/27/2023; 205(6): e0011823. PMID: 37289078, PMCID: PMC10294628, DOI: 10.1128/jb.00118-23, ISSN: 1098-5530.
Sabroske EM, Iglesias MAS, Rench M, Moore T, Harvey H, Edwards M, Baker CJ, Flores AR. Evolving antibiotic resistance in Group B Streptococci causing invasive infant disease: 1970-2021. Pediatr Res [print-electronic]. 2023 Jun; 93(7): 2067-71. PMID: 36352262, PMCID: PMC10166762, PII: 10.1038/s41390-022-02375-3, DOI: 10.1038/s41390-022-02375-3, ISSN: 1530-0447.
Aboulhosn A, Sanson MA, Vega LA, Segura MG, Summer LM, Joseph M, McNeil JC, Flores AR. Increases in group A streptococcal infections in the pediatric population in Houston, TX, 2022. Clin Infect Dis [print-electronic]. 2023 Apr 4/3/2023; 77(3): 351-4. PMID: 37011014, PMCID: PMC10425190, PII: 7100619, DOI: 10.1093/cid/ciad197, ISSN: 1537-6591.
McNeil JC, Sommer LM, Vallejo JG, Hulten KG, Kaplan SL, Flores AR. Reduced Ceftaroline Susceptibility among Invasive MRSA Infections in Children: a Clinical and Genomic Investigation. Antimicrob Agents Chemother [print-electronic]. 2022 Oct 10/18/2022; 66(10): e0074522. PMID: 36165630, PMCID: PMC9578395, DOI: 10.1128/aac.00745-22, ISSN: 1098-6596.
Vega LA, Sanson MA, Cubria MB, Regmi S, Shah BJ, Shelburne SA, Flores AR. The Integrative Conjugative Element ICESpyM92 Contributes to Pathogenicity of Emergent Antimicrobial-Resistant emm92 Group A Streptococcus. Infect Immun [print-electronic]. 2022 Aug 8/18/2022; 90(8): e0008022. PMID: 35913172, PMCID: PMC9387263, DOI: 10.1128/iai.00080-22, ISSN: 1098-5522.
Alamarat ZI, Sanson MA, McNeil JC, Baker CJ, Flores AR. Use of whole-genome sequencing to detect transmission of group A Streptococcus in Houston, TX. Access Microbiol. 2022 Aug; 4(5): acmi000351. PMID: 36003355, PMCID: PMC9394528, PII: 000351, DOI: 10.1099/acmi.0.000351, ISSN: 2516-8290.
Horstmann N, Myers KS, Tran CN, Flores AR, Shelburne Iii SA. CovS inactivation reduces CovR promoter binding at diverse virulence factor encoding genes in group A Streptococcus. PLoS Pathog. 2022 Feb; 18(2): e1010341. PMID: 35180278, PMCID: PMC8893699, PII: PPATHOGENS-D-21-02183, DOI: 10.1371/journal.ppat.1010341, ISSN: 1553-7374.
Cubria MB, Vega LA, Shropshire WC, Sanson MA, Shah BJ, Regmi S, Rench M, Baker CJ, Flores AR. Population Genomics Reveals Distinct Temporal Association with the Emergence of ST1 Serotype V Group B Streptococcus and Macrolide Resistance in North America. Antimicrob Agents Chemother [print-electronic]. 2022 Jan 1/18/2022; 66(1): e0071421. PMID: 34633844, PMCID: PMC8765267, DOI: 10.1128/AAC.00714-21, ISSN: 1098-6596.
Sanson MA, Vega LA, Shah B, Regmi S, Cubria MB, Horstmann N, Shelburne SA, Flores AR. The LiaFSR Transcriptome Reveals an Interconnected Regulatory Network in Group A Streptococcus. Infect Immun [print-electronic]. 2021 Oct 10/15/2021; 89(11): e0021521. PMID: 34370508, PMCID: PMC8519277, DOI: 10.1128/IAI.00215-21, ISSN: 1098-5522.
DebRoy S, Sanson M, Shah B, Regmi S, Vega LA, Odo C, Sahasrabhojane P, McGeer A, Tyrrell GJ, Fittipaldi N, Shelburne SA, Flores AR. Population Genomics of emm4 Group A Streptococcus Reveals Progressive Replacement with a Hypervirulent Clone in North America. MSystems [print-electronic]. 2021 Aug 8/31/2021; 6(4): e0049521. PMID: 34374563, PMCID: PMC8409732, DOI: 10.1128/mSystems.00495-21, ISSN: 2379-5077.
Cubria MB, Delgado J, Shah BJ, Sanson MA, Flores AR. Identification of epidemic scarlet fever group A Streptococcus strains in the paediatric population of Houston, TX, USA. Access Microbiol. 2021; 3(10): 274. PMID: 34816093, PMCID: PMC8604173, PII: 000274, DOI: 10.1099/acmi.0.000274, ISSN: 2516-8290.
Lin Y, Sanson MA, Vega LA, Shah B, Regmi S, Cubria MB, Flores AR. ExPortal and the LiaFSR Regulatory System Coordinate the Response to Cell Membrane Stress in Streptococcus pyogenes. MBio. 2020 Sep 9/15/2020; 11(5): PMID: 32934083, PMCID: PMC7492735, PII: mBio.01804-20, DOI: 10.1128/mBio.01804-20, ISSN: 2150-7511.
McNeil JC, Sommer LM, Boyle M, Hogan P, Vallejo JG, Hultén KG, Flores AR, Kaplan SL, Fritz S. Cefazolin Inoculum Effect and Methicillin-Susceptible Staphylococcus aureus Osteoarticular Infections in Children. Antimicrob Agents Chemother [electronic-print]. 2020 Aug 8/20/2020; 64(9): PMID: 32660989, PMCID: PMC7449214, PII: AAC.00703-20, DOI: 10.1128/AAC.00703-20, ISSN: 1098-6596.
Vega LA, Sanson MA, Shah BJ, Flores AR. Strain-Dependent Effect of Capsule on Transmission and Persistence in an Infant Mouse Model of Group A Streptococcus Infection. Infect Immun [electronic-print]. 2020 Mar 3/23/2020; 88(4): PMID: 32014891, PMCID: PMC7093130, PII: IAI.00709-19, DOI: 10.1128/IAI.00709-19, ISSN: 1098-5522.
Sanson M, Flores AR. Group A Streptococcus Transcriptome Analysis. Methods Mol Biol. 2020; 2136: 113-33. PMID: 32430816, DOI: 10.1007/978-1-0716-0467-0_8, ISSN: 1940-6029.
Sanson MA, Macias OR, Shah BJ, Hanson B, Vega LA, Alamarat Z, Flores AR. Unexpected relationships between frequency of antimicrobial resistance, disease phenotype and emm type in group A Streptococcus. Microb Genom. 2019 Nov; 5(11): PMID: 31755853, PMCID: PMC6927302, DOI: 10.1099/mgen.0.000316, ISSN: 2057-5858.
Deniskin R, Shah B, Muñoz FM, Flores AR. Clinical Manifestations and Bacterial Genomic Analysis of Group A Streptococcus Strains That Cause Pediatric Toxic Shock Syndrome. J Pediatric Infect Dis Soc. 2019 Jul 7/1/2019; 8(3): 265-8. PMID: 30085250, PMCID: PMC6601382, PII: 5061965, DOI: 10.1093/jpids/piy069, ISSN: 2048-7207.
Flores AR, Chase McNeil J, Shah B, Van Beneden C, Shelburne SA. Capsule-Negative emm Types Are an Increasing Cause of Pediatric Group A Streptococcal Infections at a Large Pediatric Hospital in Texas. J Pediatric Infect Dis Soc. 2019 Jul 7/1/2019; 8(3): 244-50. PMID: 30085121, PMCID: PMC8938855, PII: 5063600, DOI: 10.1093/jpids/piy053, ISSN: 2048-7207.
DebRoy S, Li X, Kalia A, Galloway-Pena J, Shah BJ, Fowler VG, Flores AR, Shelburne SA. Identification of a chimeric emm gene and novel emm pattern in currently circulating strains of emm4 Group A Streptococcus. Microb Genom [print-electronic]. 2018 Nov; 4(11): PMID: 30412460, PMCID: PMC6321872, DOI: 10.1099/mgen.0.000235, ISSN: 2057-5858.
Flores AR, Olsen RJ, Cantu C, Pallister KB, Guerra FE, Voyich JM, Musser JM. Increased Pilus Production Conferred by a Naturally Occurring Mutation Alters Host-Pathogen Interaction in Favor of Carriage in Streptococcus pyogenes. Infect Immun [electronic-print]. 2017 May; 85(5): PMID: 28264907, PMCID: PMC5400840, PII: IAI.00949-16, DOI: 10.1128/IAI.00949-16, ISSN: 1098-5522.