PIGG and rheumatic fever: Three of our SDSE isolates demonstrated a very high level of adherence to collagen, whereof two belonged to the emm-type stG10, and one to stG120. These emm-types encoded a consensus motif in the N-terminal hypervariable region of the M-protein, (A/T/E) XYLXX(L/F) N, reported to mediate strong binding to collagen and postulated to be involved in the development of acute rheumatic fever [23].