Streptococcal Throat Carriage among Primary School Children Living in Uyo, Southern Nigeria

Kevin B Edem,Enobong E Ikpeme,Mkpouto U Akpan

doi:10.1055/s-0040-1722274

Kevin B Edem, Enobong E Ikpeme + Show 1 more

Open Access

https://doi.org/10.1055/s-0040-1722274

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Abstract

AbstractSurveillance of the carrier state for β-hemolytic streptococcal (BHS) throat infections remains essential for disease control. Recent published works from Sub-Saharan Africa have suggested a changing epidemiology in the burden of BHS throat infections. The objective of the present study was therefore to determine the prevalence and pattern of BHS throat carriage in school-aged children in Uyo, Akwa Ibom State. This was a prospective cross-sectional study of 276 primary school children in Uyo. Subjects were recruited by multistage random sampling. Obtained throat swabs were cultured on 5% sheep blood agar. Lancefield grouping on positive cultures was done by using the Oxoid Streptococcal Grouping Latex Agglutination Kit, United Kingdom. Antimicrobial susceptibility testing was done with the disk diffusion method. Associations were tested with Fischer's exact test. The prevalence of BHS carriage was 3.3%. Group C Streptococcus was identified in 89% of isolates and Group G Streptococcus in 11%. Younger age and larger household size were associated with asymptomatic streptococcal throat infections. Antimicrobial susceptibility was highest with cefuroxime and clindamycin (89% of isolates each), while 78% of isolates were susceptible to penicillin. None of the tested isolates was susceptible to co-trimoxazole. The prevalence of streptococcal throat carriage in the study area was low. There were no Group A Streptococcus isolates suggesting an evolving epidemiology of BHS disease in the study area.

Highlights

Rheumatic heart disease affects over 15 million persons worldwide, causing about a quarter of a million deaths annually, with highest prevalence recorded in SubSaharan Africa.[13,14]
While rheumatic fever is described in carriers, recurrent rheumatic fever episodes, with higher risk of rheumatic heart disease, have been reported in some throat carriers.[15,16]
The BHS carriage rate in our study, though slightly lower than the mean rate of 5.6% reported in low and middle-income countries worldwide, compares favorably with the prevalence of 4% reported by Baki et al in Calabar, Nigeria.[19,20]

Summary

Introduction

Group A Streptococcus (GAS) is an important cause of infectious disease mortality, accounting for up to half a million deaths annually.[1,2,3] It is the most commonly isolated bacterial agent in acute pharyngitis and accounts for 15 to 30% of all throat infections.[3,4,5,6] β hemolytic streptococci (BHS) have been isolated from asymptomatic individuals, who serve as reservoirs of infection in the community.[7,8] Active surveillance of BHS disease may be achieved by periodic evaluation of the prevalence of streptococcal throat carriage in a community.[8,9,10]Streptococcal throat infection may be complicated by early suppurative as well as medium and long-term nonsuppurative sequelae such as acute rheumatic fever and poststreptococcal glomerulonephritis, with high morbidity and mortality.[11,12] Rheumatic heart disease affects over 15 million persons worldwide, causing about a quarter of a million deaths annually, with highest prevalence recorded in SubSaharan Africa.[13,14] While rheumatic fever is described in carriers, recurrent rheumatic fever episodes, with higher risk of rheumatic heart disease, have been reported in some throat carriers.[15,16] Some authors have stated an immune response in association with asymptomatic infections.[17,18].

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