Beta-hemolytic Streptococci Research Articles

Diagnostic value of laboratory parameters for the discrimination between erysipelas and limited cellulitis.

Erysipelas, caused by beta-hemolytic streptococci, and limited cellulitis, frequently caused by Staphylococcus aureus or other bacteria, are skin and soft tissue infections characterized by typical clinical signs. However, despite the therapeutical relevance they are often not differentiated (e.g in clinical trials). Erysipelas are efficiently treated with penicillin, while limited cellulitis is treated with more wide-spectrum antibiotics. This study investigates whether parameters such as CRP, blood counts or novel parameters like immature granulocytes could serve as biomarkers to distinguish between these entities. For this retrospective analysis 163 patients were included. We compared laboratory markers in patients with erysipelas (n=68) to those with limited cellulitis (n=41) of the leg. Both erysipelas and limited cellulitis were defined clinically, with an additional aspect for erysipelas being a prompt response to penicillin. Erysipelas were characterized by higher levels of inflammation. CRP and leukocyte counts are the best parameters to discriminate between both infections. A CRP value ≥3.27mg/dl indicated the diagnosis of erysipelas with 75% sensitivity and 73.2% specificity. Our results support the thesis that erysipelas and limited cellulitis are distinct infections as defined in the German guidelines and that an assessment of CRP and leukocytes is useful for differential diagnosis.

A RARE PRESENTATION OF GROUP C STREPTOCOCCUS ENDOCARDITIS WITH DIFFUSE SEPTIC EMBOLI

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Group C beta-hemolytic Streptococcus (GCS) typically causes skin and soft tissue infections, pharyngitis, and wound infections. However, the incidence of bacteremia from GCS has increased significantly over the past decade1. Most cases of GCS bacteremia and complications including endocarditis, meningitis, and septic arthritis occur in older adults with underlying chronic illnesses2. We present the unusual case of GCS endocarditis with diffuse septic emboli causing multi-organ failure in a young female. CASE PRESENTATION: A 24-year-old female with a history of intravenous drug use was admitted with altered mental status after IV drug use. On presentation, patient was afebrile with no leukocytosis, and examination was significant for tachycardia, extreme agitation, hyperalgesia, and hallucinations. Preliminary workup revealed thrombocytopenia, acute kidney injury, acute liver injury, and troponinemia. Chest radiographs showed cardiomegaly with concern for mild pulmonary edema. Toxicology screen was positive for amphetamines and cannabinoids but negative for opioids. Echocardiogram revealed a 1.9cm x 1.8cm echodensity attached to the basal free wall of the right ventricle near the level of the tricuspid valve. Blood cultures were positive for GCS, meeting 2 major Duke criteria for infective endocarditis. Her clinical course was complicated by septic shock and acute hypoxic respiratory failure requiring intubation. Repeat chest imaging revealed diffuse patchy airspace opacities with superimposed interstitial predominance. Computed tomography of the chest showed a bronchovascular distribution of wedge-shaped consolidative opacities scattered diffusely throughout bilateral lungs. Imaging findings also included hepatosplenomegally and evidence of embolization to the kidneys. She showed clinical improvement with intravenous antibiotics and mechanical ventilation and is under evaluation by cardiothoracic surgery for valve repair and vegetation excision. DISCUSSION: Though GCS bacteremia and endocarditis are typically seen in older adults with comorbidities, this case highlights the rapid progression and clinical sequelae of GCS bacteremia in a young female with IV drug use. Tricuspid valve vegetations are commonly seen in IV drug use-associated endocarditis, however a vegetation in the right ventricle arising from the basal free wall is exceedingly rare. The location of the vegetation likely contributed greatly to the rapid showering of emboli and severity of symptoms in this case. CONCLUSIONS: Though GCS is not an organism frequently associated with IV drug use, it should now be considered given the rising incidence of GCS bacteremia and the severity of disease it may cause1. Reference #1: Lother S, Jassal D, Lagacé-Wiens P, Keynan Y. Emerging Group C and Group G Streptococcal Endocarditis: A Canadian Perspective. Int J Infect Dis 2017; 65: 128-132 Reference #2: Berenguer J, Sampedro I, Cercenado E, et. al. Group-C Beta-Hemolytic Streptococcal Bacteremia. Diagn Microbiol Infect Dis 1992; 15(2): 151-155 DISCLOSURES: No relevant relationships by Gold Adkins, source=Web Response No relevant relationships by Aria Bryan, source=Web Response No relevant relationships by Shine Raju, source=Web Response No relevant relationships by Pallavi Sharma, source=Web Response No relevant relationships by Catalina Teba, source=Web Response

PHAEOHYPHOMYCOTIC OSTEOMYELITIS AFTER BILATERAL LUNG TRANSPLANTATION

SESSION TITLE: Fellows Transplantation Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Phaeohyphomycoses are a heterogenous group of infections caused dematiaceous fungi, which are characterized by melanin pigmentation in the cell wall. While rare, these infections are being increasingly seen in both immunocompromised and immunocompetent individuals.1 Transplant patients are at a higher risk due to prolonged immunosuppression. We present a case of Bipolaris spp. osteomyelitis in a lung transplant recipient. CASE PRESENTATION: A 43 year-old female status post bilateral lung transplant for interstitial lung disease secondary to dermatomyositis on tacrolimus and prednisone, with a history of multiple surgical debridements of a chronic polymicrobial open chest wall wound infected with Vancomycin-resistant Enterococcus (VRE) and Enterobacter spp., presented with poor wound healing of the chest wound. She was taken to the operating room, and areas of devitalized tissue and purulence were debrided to create a single wound. Her empiric antibiotics were adjusted to daptomycin, and liposomal amphoptericin B upon identification of VRE and a mold. Final fungal cultures demonstrated Bipolaris, so voriconazole was substituted for amphotericin. After a fourteen day course of daptomycin, the patient was discharged with voriconazole and wound dressings with Iodasorb. Three weeks later, the patient was readmitted and started on broad spectrum antibiotics and continued on voriconazole after a CT Chest concerning for osteomyelitis was performed. She underwent surgical debridement by thoracic and plastic surgery of the chest wound and sternum. Bone specimens were noted to have invasive fungal elements in the bone consistent with osteomyelitis. Fontana-Masson staining was positive for melanin. Bacterial wound cultures grew VRE, Methicillin-sensitive Staphylococcus aureus, and Beta-Hemolytic Streptococci. She was discharged on oral linezolid and voriconazole for at least 6 weeks. DISCUSSION: Phaeohyphomycosis accounts for approximately for 2.6% of all fungal infections seen and are evenly distributed between stem cell and solid organ transplant patients.2 Bipolaris is an environmental mold associated with allergic fungal sinusitis with a higher prevalence in Southwest United States. Other less common presentations include cutaneous, subcutaneous skin infections, osteomyelitis and keratitis.1 Bipolaris in wound infections is rare, with cases reported only in cardiothoracic surgical patients, typically associated with delayed sternal closures. CONCLUSIONS: Bipolaris infection has not been reported in any other surgery except cardiac in literature. No standardized therapy exists, but in vitro sensitivity study show that itraconazole and voriconazole have excellent activity against Bipolaris.1 This case highlights the importance of considering phaeohyphomycotic infections in lung transplant recipients. Reference #1: Revankar S. G. (2015). Phaeohyphomycosis in Transplant Patients. Journal of fungi (Basel, Switzerland), 2(1), 2. https://doi.org/10.3390/jof2010002. Reference #2: McCarty, T. P., Baddley, J. W., Walsh, T. J., Alexander, B. D., Kontoyiannis, D. P., Perl, T. M., Walker, R., Patterson, T. F., Schuster, M. G., Lyon, G. M., Wingard, J. R., Andes, D. R., Park, B. J., Brandt, M. E., Pappas, P. G., & TRANSNET Investigators (2015). Phaeohyphomycosis in transplant recipients: Results from the Transplant Associated Infection Surveillance Network (TRANSNET). Medical mycology, 53(5), 440–446. https://doi.org/10.1093/mmy/myv018. DISCLOSURES: No relevant relationships by Sravya Brahmandam, source=Web Response No relevant relationships by Sruti Brahmandam, source=Web Response No relevant relationships by Dibson Gondim, source=Web Response No relevant relationships by ALLAN RAMIREZ, source=Web Response

Profile of invasive group A and group B Streptococcal infections in patients hospitalized at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević“ during the period from 2011 to 2018

Aim: Beta-haemolytic streptococci (BHS) rarely cause invasive disease (ID). Usually the most common cause of ID is group B BHS (BHS-B). However, in our recent routine work higher number of group A BHS (BHS-A) isolates from blood was noted. The aim of this study was to report trends and findings by group BHS-A and BHS-B causing laboratory confirmed disease from 2011 to 2018 at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević”. Methods: Data on patients from the electronic database of microbiological laboratory at UHID for the period 2011-2018 was collected and analysed. Results: During the period 2011-2018, 151 BHS A and B were identified from normally sterile body sites. Most isolates were from blood cultures (96.7%). BHS-A and BHS-B were isolated almost equally. The highest number of isolates was recorded in 2012 and 2017. The number of BHS A isolates peaked in 2012, 54% more than BHS-B, and 50% more in 2016. Children presented 19.9% of patients, and were mostly isolated with BHS-A. 80.1% patients were adults. Adults predominated in the age group >65 years. 12 children and 18 adults were hospitalised in intensive care unit. Conclusion: Invasive group A and group B streptococcal infections predominantly affect most vulnerable age groups, children and elderly. In this study invasive BHS disease is most common among adults above 65 years of age. BHS-A was most common cause of invasive disease among paediatric patients as well as in the age group above 65 years. Typing and characterization of BHS-A isolates due to its characteristics should be foreseen as important diagnostic tool, especially to monitor changes in virulence and to prevent potential outbreaks.

Fulminant orbital cellulitis with compartment syndrome and vision loss due to streptococcus pyogenes: A case report

: To describe an unusual case of fulminant orbital cellulitis with complete vision loss despite timely medical and surgical management. Orbital cellulitis is an infective condition of the ocular adnexal structures (fat, periorbita, and muscles) behind the orbital septum. A 22-year-old female presented with rapidly progressing orbital cellulitis and was started on empirical intravenous antibiotics. Orbital imaging showing marked proptosis with optic nerve stretching and an extraconal abscess in the medial aspect of left orbit. Emergency lateral canthotomy and orbital decompression was done. Streptococcus pyogenes was isolated on culture and antibiotics changed according to the sensitivity pattern. Lid edema, proptosis, and extraocular movements improved but vision deteriorated to absent light perception. Fundus showed disc pallor on follow up. A case of fulminant orbital cellulitis with compartment syndrome and ischemic necrosis of optic nerve is reported, which led to permanent vision loss despite timely antibiotics and surgical management.Despite prompt surgical intervention and administration of intravenous antibiotics, the patient may develop compartment syndrome, ischemic necrosis or infiltration of the optic nerve leading to complete vision loss.Orbital cellulitis is an infective condition of the ocular adnexal structures (fat, periorbita, and muscles) behind the orbital septum. This condition is more common in children and young adults and usually results from a paranasal sinus or any facial infection. The majority of the organisms isolated are Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae B and Moraxella catarrhalis. Beta-hemolytic streptococci are rarely implicated. Bacterial cellulitis usually responds well to antibiotics but rarely may result in vision or life-threatening complications.

Systematic Review and Meta-analysis of the Change in Pharyngeal Bacterial Cultures After Pediatric Tonsillectomy.

To review all available biomedical literature to assess published data regarding the effect of pediatric tonsillectomy on the culture results of potentially pathogenic respiratory pharyngeal bacteria before and after surgery. Biomedical literature databases (PubMed, Embase, Web of Science) from January 1970 to December 2019. A systematic review of the literature was performed with the assistance of a medical librarian. Inclusion criteria consisted of pediatric patients and extractable data regarding respiratory bacteria culture data before and after tonsillectomy. Meta-analysis with random effects modeling was used on a limited basis. Only 5 studies met the inclusion criteria. The grand mean age was 5.9 years; the sample size range was 31 to 134; and the range of follow-up was 1 to 12 months. Group A beta hemolytic Streptococcus was generally the least commonly cultured pathogenic bacteria on preoperative cultures. Qualitative culture data generally showed an overall decrease in potentially pathogenic bacteria and some increase in nonpathologic respiratory flora after tonsillectomy. Meta-analysis showed significant reductions in postoperative culture rates for group A beta hemolytic Streptococcus (positive post- vs preoperative culture: risk ratio [RR], 0.144; 95% CI, 0-0.342), Haemophilus influenzae (RR, 0.437; 95% CI, 0.266-0.608), and Streptococcus pneumoniae (RR, 0.268; 95% CI, 0-0.567) and mixed results for Moraxella catarrhalis (0.736; 95% CI, 0.446-1.03) but no significant reduction for Staphylococcus aureus (RR, 0.774; 95% CI, 0.157-1.39). The majority of published evidence shows that pediatric tonsillectomy appears to reduce the quantity of most cultured potentially pathogenic respiratory bacteria in the pharynx after surgery. The implications and possible benefits of this favorable change in the microbiologic environment after surgery require further study.

Infectious Flexor Tenosynovitis Following Trigger Finger Release: Incidence and Risk Factors.

Background: Trigger finger release (TFR) is one of the most commonly performed hand procedures and typically results in restoration of normal finger function. However, uncommon postoperative complications such as deep infection can have devastating consequences. The goal of this study was to evaluate the incidence, risk factors, and characteristics of infectious flexor tenosynovitis occurring after TFR. Methods: We searched billing records for the Current Procedural Terminology code for TFR to identify all adult patients who underwent TFR at our institution over a 10-year period. We defined infectious tenosynovitis as any case where the patient underwent tendon sheath drainage or postoperative wound debridement within 6 months of the index TFR procedure. Medical records were reviewed to obtain patient demographic information, body mass index (BMI), tobacco use, history of diabetes mellitus, surgical setting (clinic vs outpatient surgery center), and surgical digit for all patients. In those patients treated for infection, we recorded hospital length of stay, number of operative procedures, and any culture results. Results: We identified a total of 18 infections out of 2307 procedures (1827 patients), for an incidence of 0.99%. Current smokers had a significantly higher incidence of infection than nonsmokers (1.77% vs 0.29%). On univariate analysis, smoking was closely associated with infection (P ≤ .05). All infections occurred in overweight or obese patients by BMI criteria, but there was no difference in average BMI between patients with and without infection. History of diabetes, in-office surgery, patient age, and patient sex were not associated with a higher incidence of infection. Patients with infections spent an average of 4.1 days in the hospital, and 40% required multiple surgical procedures. The most common infectious organism cultured was Staphylococcus aureus, which was present in 67% of infections. Patients with isolated methicillin-sensitive S aureus on culture showed signs of infection within 3 weeks of the index procedure, whereas polymicrobial, coagulase-negative staphylococci or beta hemolytic streptococci were identified in patients presenting with infectious symptoms later. Conclusion: Infections after TFR are uncommon but are more likely to occur in patients who are current smokers and overweight or obese by BMI criteria. Methicillin-sensitive S aureus is the most likely causative organism, especially in patients presenting during the early postoperative course.

Prevalence and antibiotic susceptibility of group A beta-haemolytic streptococcal isolates in children presenting with acute pharyngitis in Lusaka, Zambia

Background. Group A beta-haemolytic streptococci (GABHS)-associated pharyngitis can complicate into rheumatic fever and rheumatic heart disease (RHD). Objectives. To determine the prevalence and antibiotic susceptibility of GABHS isolates in children presenting with acute pharyngitis and assess the utility of Zambian Treatment Guideline (ZTG) criteria as a local clinical scoring system. Methods. This descriptive cross-sectional study was conducted at the paediatric outpatient department of the University Teaching Hospital in Lusaka, Zambia. The study cohort, comprising children aged 3 - 15 years ( n =146), were recruited as presenting with symptoms of pharyngitis. The children underwent a clinical assessment that included a detailed case history, presenting symptoms and a throat swab that was subsequently cultured. Microbial isolates were typed and the antibiotic sensitivity of cultured GABHS to penicillin and erythromycin determined. Results. GABHS were cultured from 22 (15.1%) children within this study. All the GABHS isolates ( n =22) were susceptible to penicillin G; however, 19% of isolates displayed reduced susceptibility to erythromycin. None of the ZTG criteria, when used individually, was sufficiently sensitive to detect GABHS pharyngitis among this cohort. Conclusion. The prevalence of GABHS pharyngitis is similar that been described elsewhere. While GABHS remains highly susceptible to penicillin, which is used in the local RHD control programmes, concern remains for children treated with erythromycin owing to the resistance noted in some of the isolates. The ZTG clinical criteria displayed poor sensitivity in identifying GABHS pharyngitis. This has significant implications for effective diagnosis and treatment of pharyngitis and associated complications within this high RHD endemic area.

The antibiotic prescribing behaviors of physicians are changed via rapid antigen test practice in the context of rational drug use

Background/aimRapid antigen test (RAT) is a practical test to detect the presence of Group A beta hemolytic streptococcus antigens in throat swab samples. The aim of this study is to investigate the changes in the empiric antibiotic prescribing behavior of 10 family physicians in Kırıkkale Province after using RAT in 2017. Materials and methods RAT test practice started in Family Medicine in February 2017. Family Medicine Information System (FMIS) includes clinical and prescription records of 10 family physicians, providing health service to approximately 35,000 residents in Kırıkkale. The numbers of antibiotics prescribed by the physicians according to the ICD-10 codes (including upper respiratory tract infections) in February, March, and April of 2015, 2016, 2017 were determined. The number and group of antibiotics prescribed by the family physicians with the determined diagnosis and time periods were specified in the FMIS and recorded.Results Antibiotic prescription behaviors of family physicians do not show a significant difference between 2015 and 2016. There was a dramatic and significant decrease in the number of prescribed antibiotics in 2017 compared to 2015 and 2016 (P < 0.05).Conclusion This study shows that there has been a significant decrease in antibiotic prescription in 10 Family Medicine departments in 2017 in comparison to February, March, and April 2015 and 2016. The use of RAT resulted in a decrease in antibiotic prescription rates in 2017.

Prescription patterns of Antibiotics in Acute tonsillitis: Hospital-based study

Introduction: Acute tonsillitis is caused by either viruses or bacteria and is characterized by a sore throat and painful swallowing. About 49% of cases are thought to be caused by Group A beta-hemolytic streptococci. Penicillin should be given empirically after the diagnosis of acute tonsillitis. This study was carried out to find out the prescription pattern of antibiotics among the admitted cases of acute tonsillitis.&#x0D; Materials and Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, Gandaki Medical College Teaching Hospital and Research Centre (GMCTH), Pokhara. All the patients who were admitted for acute tonsillitis in the ENT ward were enrolled in this study. Age, gender, the average number of drugs per prescription, and the most commonly prescribed drug was recorded.&#x0D; Results: There were 320 patients with acute tonsillitis and the mean age was 27.44 ± 11.1 years. Most of the cases were in their twenties. The average number of drugs per prescription was four while the total number of antibiotics used was 520. The single antibiotic was used in 170 (53%) cases and a two-drug combination was used in 91(28.4%) cases. Ceftriaxone was the most commonly prescribed drug. There were 78 (24.3%) cases under monotherapy and 69 (21%) in multitherapy.&#x0D; Conclusion: Among the various effective antimicrobials, ceftriaxone was the most commonly prescribed antimicrobial. The injectable route of antibiotics administration was a widely used method in hospitalized patients in our setting.

Influence of Intestinal Microorganisms on Anastomotic Leakage after Colorectal Surgery

Introduction. One of the most common and serious complications of near-postoperative surgery after colon resection with anastomosis is intestinal leakage with a frequency of 1 to 24%. Therefore, it is very important to evaluate the factors that may determine the development of this complication. One of the etiological factors behind the development of this complication is the intestinal microbiota, which is playing an increasingly important role in this process. Nevertheless, there is still a lack of comprehensive clinical evidence on the influence of the intestinal microbiota on postoperative complications such as anastomotic leakage. Purpose. To evaluate the influence of intestinal microorganisms on anastomotic leakage after elective intestines surgery. Methods. A prospective study was performed at the Lithuanian University of Health Sciences Hospital, Kaunas Clinics, Clinic of Surgery. There were included patients who underwent colon surgery (right hemicolectomy, left hemicolectomy, sigmoid resection and closure of ileostomy). Intestinal mucosal biopsy performed before restoring intestinal integrity and sent for microbiological and antibiotic examination. Patients were also observed postoperatively for anastomotic leakage. Results. The majority of patients were treated for colon cancer – 46 (92.0%). In 19 patients crop (38.0%) grown one microorganism, in 12 (24.0%) – 2 microorganisms, in 5 (10.0%) – 3 microorganisms, in 1 (2.0%) – 4 types of bacteria. In the most of the crops were observed growth by E. coli – 30 (60.0%), Enterococcus spp. – 12 (24.0%), Bacteroides spp. – 4 (8.0%), Klebsiella oxytoca – 2 (4.0%), Beta hemolytic streptococcus – 2 (4.0%) patients. Citrobacter fundii, Citrobacter brakii, Parabacteroides distasonis, Proteus mirabilis, Klebsiella pneumoniae, Enterobacteriaceae daacea grew only in 1 (2.0%) patients crop. Postoperative anastomotic leakage diagnosed in 2 (4.0%) patients. Conclusions. The major microorganisms that grown were E. coli. Due to the small sample, tendency can not be predicted, but microorganisms that promote small blood vessels thrombosis may be one of the factors that cause anastomotic leakage.

Group A Streptococcus Testing in Pediatrics: the Move to Point-of-Care Molecular Testing.

Each year, there are an estimated 11 million visits to ambulatory care centers for pharyngitis in children between the ages of 3 and 18 years. While there are many causes of pediatric pharyngitis, group A streptococcal pharyngitis represents 15 to 30% of infections and is the only cause for which treatment is recommended. Unfortunately, clinical suspicion is insufficient for the accurate diagnosis of group A streptococcal pharyngitis, and laboratory testing for confirmation of Streptococcus pyogenes infection is required to prevent complications of infection. Traditionally, throat swabs are inoculated onto agar plates for isolation of the large-zone beta-hemolytic streptococcus. However, traditional culture methods present a potential delay in treatment due to turnaround times of 18 to 48 h. In order to improve turnaround times and enhance antimicrobial stewardship, multiple point-of-care assays have been developed. This review describes current point-of-care testing for group A streptococcal pharyngitis, including rapid antigen detection tests and more recent molecular methods. Additional attention is given to the diagnostic considerations when choosing a method for group A streptococcal point-of-care testing, implementation of molecular group A streptococcal testing, and the institutional cost of immunoassays compared to those of newer molecular methods.

Microbiology and antibiotic sensitivity pattern of peritonsillar abscess

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Peritonsillar abscess is a life threatening infection which requires immediate attention and care. If not treated immediately it may lead to several complications. But the culture and sensitivity results can be obtained after a minimum of 72 hours and hence empirical antibiotic therapy is needed. The objective of the study was to study the microbiological profile of peritonsillar abscess and the antibiotic sensitivity pattern of peritonsillar abscess.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross sectional study was carried out on 47 quinsy patients who attended the ENT OPD of a tertiary care hospital. Abscess was drained and the pus was sent for culture and sensitivity. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 65.95% of the study population were males. prevalence of peritonsillar abscess was high in the age group of 21-30 (42.55%). Only one patient had bilateral abscess. Group-A beta hemolytic streptococcus was the common organism isolated followed by &lt;em&gt;Staphyloccus aureus&lt;/em&gt;. Fluroquinolones and cefotaxime had a better sensitivity to nearly all the organisms.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;em&gt;Staphylococcu&lt;/em&gt;s and &lt;em&gt;Streptococcus&lt;/em&gt; were the highly prevalent organisms. Immediate empirical antibiotic therapy must be advocated after draining the collection.&lt;/p&gt;

Group C beta hemolytic Streptococci as a potential pathogen in patients presenting with an uncomplicated acute sore throat – a systematic literature review and meta-analysis

Objective: The pathogenicity of beta-hemolytic Streptococcus group C (GCS) in patients attending for an uncomplicated acute sore throat is unknown and it was the objective to clarify this.Design: Systematic literature review with meta-analysis. Setting Medline and Scopus were searched from inception to February 2019, with searches of reference lists, Subjects case-control studies stating prevalence of GCS in patients as well as healthy controls presented for children and adults separately. Studies including patients already treated with antibiotics and studies focused on patients with HIV, malignancy or immunosuppression were not included. Main outcome measures Pooled prevalence of GCS was compared between patients and controls using chi-square and was further explored by calculating the positive etiologic predictive value (P-EPV) showing the post-test probability of a link between a sore throat and the bacterial finding. P-EPV for GCS was compared with that for group A Streptococci (GAS) using figures from the same publications and patients.Results: Eleven studies were included. The prevalence of GCS among patients versus controls was similar in children (3.15 versus 2.87%, p = .44) but for adults higher in patients (11%) than in controls (5.6%) (p < .0001). The P-EPV for finding GCS in children with a sore throat was 9.3% (0.0–41%). The corresponding P-EPV for GCS in adults with a sore throat was 53% (36–67%) while the corresponding P-EPV for GAS in adults was 94% (90–96%).Conclusions: GCS do not seem associated with the uncomplicated acute sore throat in children but there is support for an association in adults being weaker than for GAS. A possible consequence is to ignore GCS in otherwise healthy patients at their first visit for an uncomplicated sore throat. This would enable a stronger focus on the use of modern point of care tests (POCTs) to detect GAS.Key pointsThere is no current consensus on the pathogenicity of group C beta-hemolytic Streptococcus (GCS) in patients attending for an uncomplicated acute sore throat.This systematic literature review concludes it is unlikely that GCS is involved in the uncomplicated sore throat in otherwise healthy children.This meta-analysis found a moderate link between GCS and the uncomplicated sore throat in adults.The link in adults between GCS and the sore throat is much weaker than the corresponding link for group A beta-hemolytic Streptococcus.

Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds.

BackgroundCentor and McIsaac scores are both used to diagnose group A beta-haemolytic streptococcus (GABHS) infection, but have not been compared through meta-analysis.AimTo compare the performance of Centor and McIsaac scores at diagnosing patients with GABHS presenting to primary care with pharyngitis.Design and settingA meta-analysis of diagnostic test accuracy studies conducted in primary care was performed using a novel model that incorporates data at multiple thresholds.MethodMEDLINE, EMBASE, and PsycINFO were searched for studies published between January 1980 and February 2019. Included studies were: cross-sectional; recruited patients with sore throats from primary care; used the Centor or McIsaac score; had GABHS infection as the target diagnosis; used throat swab culture as the reference standard; and reported 2 × 2 tables across multiple thresholds. Selection and data extraction were conducted by two independent reviewers. QUADAS-2 was used to assess study quality. Summary receiver operating characteristic (SROC) curves were synthesised. Calibration curves were used to assess the transferability of results into practice.ResultsTen studies using the Centor score and eight using the McIsaac score were included. The prevalence of GABHS ranged between 4% and 44%. The areas under the SROC curves for McIsaac and Centor scores were 0.7052 and 0.6888, respectively. The P-value for the difference (0.0164) was 0.419, suggesting the SROC curves for the tests are equivalent. Both scores demonstrated poor calibration.ConclusionBoth Centor and McIsaac scores provide only fair discrimination of those with and without GABHS, and appear broadly equivalent in performance. The poor calibration for a positive test result suggests other point-of-care tests are required to rule in GABHS; however, with both Centor and McIsaac scores, a score of ≤0 may be sufficient to rule out infection.

Antibiotic resistance pattern of bacteria isolated from outdoor patients in Dhaka city: a single center study

Bacterial infections are often found to cause morbidity and mortality around the globe. Indiscriminate use of antibiotic for treatment of such infections is reported to cause selective pressure and increase in drug resistance. Emergence of antibiotic resistance is a growing concern for people of all age having bacterial infections. It is important to determine the trend of antibiotic resistance patterns of pathogenic bacteria isolated from clinical samples for appropriate treatment of patients. A retrospective study was conducted on patient samples collected from 1 July 2018 to 15 March 2019. A total of 500 urine, 136 blood, 120 stool, 172 swab, 90 Sputum and 60 pus samples were randomly collected from both male and female patients of different age groups who reported to a diagnostic centre in Dhaka city. Pathogenic bacteria were isolated and identified from the collected samples following standard methods. Antibiotic sensitivity patterns of isolated bacteria were also determined by disc diffusion test. Proportion of UTI in female patients (71.67%) was found to be higher than the male (28.33%) patients and mostly caused by Escherichia coli (73.33%). Among Gram negative bacteria, E. coli (51%) was found to be predominant followed by Pseudomonas spp. (11.47%), Klebsiella (9.84%) and Salmonella Typhi (9.84%). Among Gram positive organism Staphylococcus aureus (9.0%), beta haemolytic streptococci (5.74%) and enterococci (3.28%) were found to be present. Among the tested antibiotics imipenem was found to be the most effective (93.02%) followed by gentamycin (76.03%) against all isolated bacteria. Amoxycillin was found to be least effective (21.29%) against all isolated bacteria. Increase in antibiotic resistance was possibly due to indiscriminate use of antibiotic for treatment of various infections. Prudent use of antimicrobial drugs will help reduce spread of resistant bacteria and complication of treatment of infected patients.&#x0D; Stamford Journal of Microbiology, Vol.9(1) 2019: 1-4

Risk, Prevention, Diagnosis, and Management of Cellulitis and Erysipelas

This review summarises the most recent evidence which will inform therapeutic guidance and discusses areas of uncertainty which might benefit from further investigation. There are variable definitions of cellulitis and erysipelas, and of recovery and cure, which make it difficult to combine results from studies. The etiology of cellulitis is more clearly associated with beta-hemolytic streptococci. The diagnosis can be more accurately made using scoring systems and measurements of skin surface temperature. Antibiotic therapy should be oral in most cases and need not be prolonged despite extensive skin damage. Prevention using antibiotic prophylaxis works but there is no sustained benefit after cessation. There are areas of uncertainty which would benefit from further research: the roles of adjuvant therapies, the best analgesia, the best way of preventing recurrences whilst limiting antibiotic exposure, the dosing of antibiotics, and what criteria to use in deciding on hospital admission and parenteral therapy.

Investigation of the Prevalence of Group A Beta-Haemolytic Streptococcus and Efficiency of Streptococcus Rapid Antigen Test in Patients Prediagnosed With Acute Tonsillopharyngitis in a University Hospital

Investigation of the Prevalence of Group A Beta-Haemolytic Streptococcus and Efficiency of Streptococcus Rapid Antigen Test in Patients Prediagnosed With Acute Tonsillopharyngitis in a University Hospital

Construction and characterization of a chimeric lysin ClyV with improved bactericidal activity against Streptococcus agalactiae in vitro and in vivo.

The emergence of antibiotic-resistant beta-hemolytic Streptococcus agalactiae strains poses increasing threat to human beings globally. As an attempt to create a novel lysin with improved activity against S. agalactiae, a chimeric lysin, ClyV, was constructed by fusing the enzymatically active domain (EAD) from PlyGBS lysin (GBS180) and the cell wall binding domain (CBD) from PlyV12 lysin (V12CBD). Plate lysis assay combined with lytic kinetic analysis demonstrated that ClyV has improved activity than its parental enzymatic domain GBS180 against multiple streptococci. Biochemical characterization showed that ClyV is active from pH7 to 10, with the optimum pH of 9, and is stable under NaCl concentration of < 500mM. In a S. agalactiae infection model, a single intraperitoneally administration of 0.1mg/mouse of ClyV protected 100% mice, while it was observed that ~ 29% survive in group that received a single dose of 0.1mg/mouse of GBS180. Moreover, a high dose of 0.8mg/mouse ClyV did not show any adverse effects to the health or survival rate of the mice. Considering the robust bactericidal activity and good safety profile of ClyV, it represents a potential candidate for the treatment of S. agalactiae infections.

Prevalence and pattern of beta-haemolytic streptococcal throat infections among primary school children in a rural community in rivers state

Background: Group A beta-haemolytic Streptococcus (GABHS) remains a major cause of morbidity and mortality in humans where it causes symptomatic pharyngitis and the non-suppurative sequelae of acute rheumatic fever and post-streptococcal acute glomerulonephritis. Regional evaluation of streptococcal throat infections may be helpful in disease surveillance. The aim of this study was to evaluate the prevalence and pattern of GABHS throat infections among primary school children in a rural community in Rivers State, Nigeria. Methodology: This cross-sectional study was carried out between May and July 2015 in Emohua local government area of Rivers State, Nigeria. Pupils were recruited using a multistaged random sampling technique. Throat swabs obtained were cultured using sheep blood and sent for microscopy and Lancefield grouping. Results: A total of 456 pupils aged 6–12 years were recruited, of which 54 (11.8%) had a positive throat culture of beta-haemolytic Streptococcus (BHS). The isolates were Lancefield Groups B (23; 42.6%), A (18; 33.3%), D (9; 19.6%), C (3; 5.6%) and F (1; 1.8%). No Group G BHS was isolated. Age, sex, socioeconomic class, classroom and household overcrowding did not significantly influence the prevalence of BHS throat infections. Conclusion: The prevalence of BHS throat infections in this rural community was similar to that in the urban areas in Nigeria. There was no significant difference between the prevalence of BHS in symptomatic and asymptomatic pupils.