Abstract
BackgroundAmong children diagnosed to have chronic rheumatic valvular heart disease (RHD) in Ethiopia, many have been observed to develop recurrence of rheumatic fever (RF) despite secondary prophylaxis. This study determined the throat culture positivity rate and drug susceptibility pattern of beta hemolytic streptococci (BHS) isolated from children attending a specialized cardiac clinic in Ethiopia.MethodsThroat swabs were collected from 233 children receiving benzathine penicillin injection as secondary prophylaxis for RHD and cultured. The bacterial isolates were characterized using Matrix Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) mass spectrometry. Drug susceptibility was tested with the Kirby Bauer disc diffusion method. Anti-streptolysin O (ASO) titers were determined using ASO latex reagents.ResultsThe throat culture positivity rate for BHS was 24 % (56/233). Among the BHS bacterial strains isolated, four were characterized as S. pyogenes and another four as S. dysgalactiae subsp. equisimilis (Lancefield group A, C and G). All BHS were susceptible to penicillin except one isolate of S. agalactiae. Among 233 children enrolled, 46(19.7 %) showed increased ASO titer. Children who received antibiotic prophylaxis within 2-weeks of last injection had significantly lower BHS throat culture positivity rate than those injected every 4-weeks (p = 0.02). Children who missed at least one prophylaxis within the last 6 months had a higher BHS culture positivity rate than those who did not miss any (p = 0.0003).ConclusionsThe presence of groups A, C and G streptococci in the throat of children under secondary prophylaxis for RHD and increased ASO titer suggests failure of the regimen. This calls for further investigation into the causes of inadequate prophylaxis (including bioavailability of drugs used, optimal duration and patient compliance) and intervention.
Highlights
Among children diagnosed to have chronic rheumatic valvular heart disease (RHD) in Ethiopia, many have been observed to develop recurrence of rheumatic fever (RF) despite secondary prophylaxis
Streptococcus dysgalactiae subsp. equisimilis expressing Lancefield group A (GAS), C (GCS) or G (GGS) antigen is phylogenetically related to S. pyogenes
Socio-demographic characteristics of the study participants Two hundred and thirty-three children in the age range of 5–15 years who were on secondary prophylaxis for RHD participated in this study
Summary
Among children diagnosed to have chronic rheumatic valvular heart disease (RHD) in Ethiopia, many have been observed to develop recurrence of rheumatic fever (RF) despite secondary prophylaxis. Rheumatic fever (RF) is a non-suppurative, autoinflammatory multi-system response following infection by group A beta hemolytic streptococci (BHS) known as Streptococcus pyogenes [1]. Equisimilis expressing Lancefield group A (GAS), C (GCS) or G (GGS) antigen is phylogenetically related to S. pyogenes It has recently emerged as a potential pathogen and there is concern that it might cause human infections similar to S. pyogenes including RF [2,3,4,5]. Eleven nongroup A-BHS strains have previously been recovered from RF and/or rheumatic valvular heart disease (RHD) patients in Ethiopia [6]. Güntheret al. reported 125.3 per 1000 person-year mortality rate during 7 years of follow up of RHD patients at Dabat Health Centre in North Gondar, which amounted to 12.5 % annual mortality rate among RHD patients seen in this community [14]
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