Group A Beta-hemolytic Streptococci Research Articles

Respiratory microorganisms in acute pharyngitis patients: Identification, antibiotic prescription patterns and appropriateness, and antibiotic resistance in private primary care, central Malaysia.

Acute pharyngitis (AP) is a common reason for private primary care consultations, thus providing an avenue for widespread antibiotic intake among the community. However, there is limited data on the antibiotic prescription appropriateness and resistance information in the Malaysian private primary care setting, therefore, this study aimed to investigate the prevalence of isolated viruses and bacteria, antibiotic resistance patterns, antibiotic prescription patterns and appropriateness by general practitioners (GPs) and factors affecting antibiotic resistance and antibiotic prescription patterns. To investigate, a cross-sectional study was conducted among 205 patients presenting with AP symptoms at private primary care clinics in central Malaysia from 3rd January 2016 to 30th November 2016. Throat swabs were collected from 205 AP patients for two purposes: (i) the detection of four common respiratory viruses associated with AP via reverse-transcription real-time PCR (qRT-PCR); and (ii) bacterial identification using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Bacterial isolates were then subjected to antibiotic susceptibility screening and McIsaac scoring was calculated post-prescription based on GP selection of criteria. Generalized estimating equations analysis with multiple logistic regression was conducted to identify factors associated with presence of virus and antibiotic prescription. The results showed that 95.1% (195/205) of patients had at least one of the four viruses, with rhinovirus (88.5%) being the most prevalent, followed by adenovirus (74.9%), influenza A virus (4.6%) and enterovirus (2.1%). A total of 862 non-repetitive colonies were isolated from the culture of throat swabs from 205 patients who were positive for bacteria. From a total of 22 genera, Streptococcus constitutes the most prevalent bacteria genus (40.9%), followed by Neisseria (20%), Rothia (13.0%), Staphylococcus (11%) and Klebsiella (4.9%). Only 5 patients carried group A beta-hemolytic streptococci (GABHS). We also report the presence of vancomycin-resistant S. aureus or VRSA (n = 9, 10.1%) among which one isolate is a multidrug-resistant methicillin-resistant S. aureus (MDR-MRSA), while 54.1% (n = 111) were found to carry at least one antibiotic-resistant bacteria species. Application of the McIsaac scoring system indicated that 87.8% (n = 180) of patients should not be prescribed antibiotics as the majority of AP patients in this study had viral pharyngitis. The antibiotic prescription appropriateness by applying post-prescription McIsaac scoring was able to rule out GABHS pharyngitis in this sample with a GABHS culture-positive sensitivity of 40% (n = 2/5) and specificity of 90% (180/200). In conclusion, antibiotic-resistant throat isolates and over-prescription of antibiotics were observed and McIsaac scoring system is effective in guiding GPs to determine occurrences of viral pharyngitis to reduce unnecessary antibiotic prescription.

Ten-year prevalence of acute hospital ENT infections and the impact of COVID: A large population study.

BackgroundAcute ear, nose and throat (ENT) infections were the commonest referrals from accident and emergency to ENT services. The referral rate changed dramatically with season, year, national outbreaks and during the COVID pandemic.MethodRetrospective longitudinal study of the epidemiology of seven acute ENT infections in secondary care over 10 years. A mixed city and rural population of over 650 000 in central England was studied. The risk factors for each wave of infection during the surge of infection were sought. A statistical analysis of their significance was undertaken. This included analysis and correlation of group A‐beta haemolytic streptococcus (GABHS) in hospital and community. Seasonal variations, hospital admissions and the impact of the COVID were analysed.ResultsThere were 16 883 reported cases of the seven index ENT infections during the 10‐year period. Great seasonal and year‐to‐year variations were recorded. There was an incremental rise in 2018. Spring had the highest season of acute ENT infections. An outbreak of GABHS was noted in the community in 2014. The mean duration of hospital admission was 1.5 days. There was no statistical ethnic or gender predominance. A dramatically lower number of acute ENT infections were recorded during the COVID‐19 pandemic, and this continued after lifting of lockdown restrictions.ConclusionA resurgence in scarlet fever directly and indirectly contributed to an incremental rise in acute ENT infections in the following years. Both hospital and community B‐haemolytic cultures have declined during the COVID‐19 pandemic due to a reduction in infections as opposed to reduced case ascertainment.

Back to the Future: The Role of Infections in Psychopathology. Focus on OCD.

ObjectiveRecently, there has been a resurgence of interest in the relationship between infections and psychopathology, given the increasing data on the neurotropism and neurological/psychiatric morbidity of the SARS-COV2 virus, responsible for the current worldwide pandemic. Although the majority of observations were those obtained in mood and schizophrenic disorders, a few data are also available on the presence of bacterial or viral infections in patients suffering from obsessive-compulsive disorder (OCD). Therefore, given the limited information, the present paper aimed at reviewing the most updated evidence of infections in neuropsychiatric disorders and their possible mechanisms of actions, with a narrow focus on microbes in OCD.MethodThis paper is a narrative review. The databases of PubMed, Scopus, Embase, PsycINFO and Google Scholar were accessed to research and collect English language papers published between 1 January 1980 and 31 December 2021. The data on PANDAS/PANS and those observed during severe brain infections were excluded.ResultsSeveral pathogens have been associated with an increased risk to develop a broad spectrum of neuropsychiatric conditions, such as schizophrenia, mood disorders, autism, attention-deficit/hyperactivity disorder, anorexia nervosa, and post-traumatic stress disorder. Some evidence supported a possible role of infections also in the pathophysiology of OCD. Infections from Herpes simplex virus 1, Borna disease virus, Group A-Beta Hemolytic Streptococcus, Borrelia spp., and Toxoplasma gondii were actually found in patients with OCD. Although different mechanisms have been hypothesized, all would converge to trigger functional/structural alterations of specific circuits or immune processes, with cascade dysfunctions of several other systems.ConclusionsBased on the current evidence, a possible contribution of different types of microbes has been proposed for different neuropsychiatric disorders including OCD. However, the currently available literature is meager and heterogeneous in terms of sample characteristics and methods used. Therefore, further studies are needed to better understand the impact of infectious agents in neuropsychiatric disorders. Our opinion is that deeper insights in this field might contribute to a better definition of biological underpinnings of specific clinical pictures, as well as to promote psychiatric precision medicine, with treatments based on altered pathological pathways of single patients. This might be particularly relevant in OCD, a disorder with a high proportion of patients who are resistant or do not respond to conventional therapeutic strategies.

Accuracy of Centor scoring system in diagnosing group a-beta haemolytic streptococcal (GABHS) infection

ABSTRACTBackground: At present, the standard examination for diagnosing streptococcal upper respiratory tract infection is throat culture. As throat culture is time-consuming and relatively expensive, efforts are made to develop certain criteria that will still lead to proper diagnosis and rational use of antibiotics, that is Centor score. Even so, the accuracy of Centor score is still debatable. Purpose: To provide evidence on the accuracy of Centor scoring system compared to throat culture in diagnosing GABHS upper respiratory tract infection. Case Report: A 25-years old male came to primary health care with primary complain of sore throat. Centor score was used to diagnose GABHS infection and as a guide to give antibiotics. Clinical question: “In patients with sore throat, how accurate is the Centor score compared to throat culture in diagnosing Group A Beta-Haemolytic Streptococcal (GABHS) Infection?” Methods: Literature searching was conducted through 4 databases. Critical appraisal based on the Centre of Evidence-Based Medicine (CEBM)-University of Oxford University, Diagnostic Critical Appraisal Sheet and Systematic Review Sheet. Results: All the selected studies were considered valid. They revealed a high specificity, low sensitivity, high negative predictive value (NPV), and low positive predictive value (PPV) in the importance aspect assessment. The Centor scoring system was applicable to our patient. It was available, affordable, and accurate in adult patients, yet less accurate in children. Conclusion: In conclusion,Patient with sore throat and suspicion of GABHS infection could be diagnosed with Centor scoring system as the first line diagnosis in primary care and as a guide to whether to give giving antibiotics or not.ABSTRAKLatar belakang: Saat ini, kultur tenggorok merupakan pemeriksaan baku emas yang digunakan untukmendiagnosis infeksi saluran napas atas yang disebabkan oleh bakteri Streptococcus. Namun, kulturtenggorok merupakan pemeriksaan yang mahal dan hasilnya memakan waktu yang lama, sehinggaberbagai kriteria dikeluarkan untuk dapat dipakai sebagai alat diagnostik dan sebagai panduanpenggunaan antibiotik yang rasional pada kasus infeksi saluran napas atas. Salah satunya yaitu Centorscore, tetapi akurasinya masih kontroversial. Tujuan: Menyediakan laporan kasus berbasis buktiterhadap akurasi dari Centor score sebagai alat diagnostik infeksi saluran napas atas yang disebabkanoleh bakteri Streptococcus dibandingkan dengan pemeriksaan kultur tenggorok. Laporan kasus: Seorang laki-laki berusia 25 tahun datang ke fasilitas kesehatan tingkat pertama dengan keluhan utama nyeri tenggorokan. Centor score digunakan untuk mendiagnosis pasien ini dan sebagai panduan pemberian antibiotik. Pertanyaan klinis: Pada pasien dengan radang tenggorok,seberapa akurat Centor score dibandingkan dengan kultur tenggorok dalam diagnosis GABHS? Metode: Pencarian literatur dilakukan melalui 4 database dan telaah kritis literatur menggunakan tilikan dari CEBM, University of Oxford University. Hasil: Seluruh studi yang ditelaah valid. Seluruh studi menunjukkan spesifisitas dan negative predictive value (NPV) yang tinggi, serta sensitivitas dan positive predictive value (PPV) yang rendah. Centor score dapat diaplikasikan untuk pasien pada skenario klinis karena bersifat mudah digunakan, biaya yang dikeluarkan terjangkau, dan akurat khususnya pada pasien dewasa. Kesimpulan: Pasien dengan nyeri tenggorok yang dicurigai memiliki infeksi saluran napas atas yang disebabkan oleh bakteri Streptococcus dapat ditegakkan diagnosisnya melalui penilaian Centor score di fasilitas layanan tingkat pertama, serta dapat menjadi panduan dalam pemberian antibiotik.

What is the optimal strategy for managing primary care patients with an uncomplicated acute sore throat? Comparing the consequences of nine different strategies using a compilation of previous studies

ObjectiveIdentifying optimal strategies for managing patients of any age with varying risk of acute rheumatic fever (ARF) attending for an apparently uncomplicated acute sore throat, also clarifying the role of...

FACTORS AFFECTING THE INCIDENCE OF GROUP A Β-HEMOLYTIC STREPTOCOCCI ISOLATED FROM THROAT CULTURE

Group A beta-hemolytic streptococci (GABHS) rank first among bacterial factors causing tonsillopharyngitis. These bacteria are especially common in school-age groups. The incidence increases in winter and seasonal transitions. In this study, we aim to examine the presence of GABHS in throat swab samples of people from different age groups. Therefore, we identified the reproductive frequency of GABHS in the throat culture of patients admitted with tonsillopharyngitis from 2017 to 2019 and then detected differences in the infection across age groups, months, and seasons. It was found that 8.1%, 52.4%, 21.5%, and 11.0% of isolated factors were in the age groups of 0-2, 3-6, 7-9, and 10-14, respectively. Particularly, in the 3-14 age group, the number of cases accounts for 84.9% of the total number of cases. The highest rate of infection was observed in children aged 3-6 years, and the infection was quite high in the spring (34.5%) and winter (29%). Regarding the distribution of the factor across clinics, the Department of Pediatrics was the first, and the Department of Pediatric Nephrology and Rheumatology was the second. In conclusion, controlling the spread of infections at school age is of great importance as GABHS has increased over the years.

Hypothesizing That Pediatric Autoimmune Neuropsychiatric Associated Streptococcal (PANDAS) Causes Rapid Onset of Reward Deficiency Syndrome (RDS) Behaviors and May Require Induction of "Dopamine Homeostasis".

Pediatric autoimmune neuropsychiatric disorders associated with group A streptococcal infections (PANDAS) is a concept that is used to characterize a subset of children with neuropsychiatric symptoms, tic disorders, or obsessive-compulsive disorder (OCD), whose symptoms are exacerbated by group A streptococcal (GAS) infection. PANDAS has been known to cause a sudden onset of reward deficiency syndrome (RDS). RDS includes multiple disorders that are characterized by dopaminergic signaling dysfunction in the brain reward cascade (BRC), which may result in addiction, depression, avoidant behaviors, anxiety, tic disorders, and/or OCD. According to research by Blum et al., the dopamine receptor D2 (DRD2) gene polymorphisms are important prevalent genetic determinants of RDS. The literature demonstrates that infections like Borrelia and Lyme, as well as other infections like group A beta-hemolytic streptococcal (GABHS), can cause an autoimmune reaction and associated antibodies target dopaminergic loci in the mesolimbic region of the brain, which interferes with brain function and potentially causes RDS-like symptoms/behaviors. The treatment of PANDAS remains controversial, especially since there have been limited efficacy studies to date. We propose an innovative potential treatment for PANDAS based on previous clinical trials using a pro-dopamine regulator known as KB220 variants. Our ongoing research suggests that achieving "dopamine homeostasis" by precision-guided DNA testing and pro-dopamine modulation could result in improved therapeutic outcomes.

Abstract- Poster

Background:The term Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) was coined by Swedo et al. in 1998 to describe a subset of childhood obsessive-compulsive disorders (OCD) and tic disorders triggered by group-A beta-hemolytic Streptococcus pyogenes infection.Aims:To sensitise the medical community about the identification of the disease and reduce the morbidity associated with a late diagnosis.Case summary and results:We present a case of a 17 year old male presenting with repetive eye blinking, puckering movement of lips, skin picking behaviour, obsessive thoughts that his head is vibrating and compulsively placing his hand over his head to relieve the same, separation anxiety from mother, urinary incontinence and involuntary, jerky movements of upper limbs. The symptoms persisted over 5 years with relapsing and remitting course. Laboratory investigations including complete blood count, Anti-streptolysin -O(ASO) titres, throat culture sensitivity, C-Reactive Protein levels, Magnetic resonance Imaging(MRI) and Electro-encephalography(EEG) were done. His throat cultures showed Streptococcus pyogenes and raised ASO titres were found, with magnetic resonance imaging revealing no significant findings. Treatment with fluvoxamine, clomipramine and clonazepam along with behavioral therapy, have improved the severity of his condition. This report presents a case of Obsessive- compulsive and related disorders against the background of immunological reaction or PANDAS.Conclusion:In all school-age children presenting with obsessive compulsive and related disorder with other symptoms or not, a possible link to PANDAS should be evaluated and ruled out.

Antibiotic Susceptibility Pattern of Group A Beta-Haemolytic Streptococcal Throat Isolates of Primary School Children in Rivers State, Nigeria

Group A beta-haemolytic streptococcus (GABHS) pharyngitis when untreated can cause non-suppurative sequelae such as acute rheumatic fever and post-streptococcal acute glomerulonephritis. Prompt treatment of infected individuals with appropriate antibiotics that the organism is susceptible to, is important in preventing these untoward complications.
 This study intends to identify the antibiotic susceptibility of GABHS in Rivers State, Nigeria, and to guide health care workers in choosing effective antibiotic for the treatment of GABHS infections in children.
 Methodology: Throat swabs were taken from primary school pupils aged 6 to 12 years in Rivers State between May and July 2015. The throat swabs were cultured using 5% sheep blood agar. Antibiotic susceptibility was carried out on the Group A beta-haemolytic streptococcal isolates. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 using descriptive statistics. Chi square tests of significance were used with a 95% confidence interval (P< 0.05).
 Results: A total of 18 out of 456 pupils had a positive streptococcal throat culture for GABHS giving a prevalence rate of 3.9%. The isolated GABHS were most susceptible to azithromycin (87%) followed by penicillin (81.5%) and ampicillin (64.8%). The pathogens were least susceptible to tetracycline (37%) and co-trimoxazole (18.5%).
 Conclusion: The prevalence of GABHS was low and it was mostly susceptible to Azithromycin and penicillin. These could be used as the drug of choice in the empirical treatment of GABHS throat infection in the locality.

Severe acute otitis media and mastoiditis caused by group A beta-hemolytic streptococcus.

ObjectiveTo describe the characteristics, diagnostics, treatment, and outcome of severe acute otitis media (AOM) and acute mastoiditis (AM) caused by group A beta‐hemolytic streptococcus (GAS).Study designA retrospective cohort study.MethodsThe yearly incidence of inpatient care‐needing GAS AOM/AM patients in our hospital catchment area between 2002 and 2018 was investigated. A detailed analysis was performed for cases treated during the last GAS epidemic in 2017‐2018. Anamnesis, signs and symptoms, pure‐tone audiometry results, treatment, complications, and outcome were collected from medical charts. Patients responded to an otology‐specific health‐related quality of life survey (EOS‐16) 1.5 to 3 years after their treatment.ResultsThe number of GAS infections peaks at approximately 7‐year intervals. During 2017 and 2018, altogether 37 patients (29 adults and 8 children) were hospitalized due to GAS AOM/AM. AM was diagnosed in 14 (38%) patients. The disease progression was typically very rapid. At presentation, all patients had severe ear pain, 68% tympanic membrane perforation and discharge, 43% fever, and 43% vertigo. In pure‐tone audiometry, there was usually a marked mixed hearing loss at presentation. There was a significant recovery in both air and bone conduction thresholds; the pure tone average improvement from presentation was 32.3 ± 14.8 dB. Rapid strep tests (RST) proved to be more sensitive than bacterial culture in identifying GAS as a cause of AOM/AM.ConclusionGAS AOM/AM has a rapid onset. Hearing loss usually includes a sensorineural component, which is usually reversible with adequate treatment. RST seems to be useful in detecting GAS from middle ear discharge.Level of Evidence4.

Symptoms: are they correlated with Centor/McIsaac Score in the diagnosis of pharyngotonsillitis?

Objective: Group A beta hemolytic streptococcus (GABHS) is identified in 20-40% of cases of childhood pharyngitis. The Centor/McIsaac score is an important scoring method used in the early diagnosis of patients presenting with symptoms of Group A beta hemolytic streptococcus (GABHS) pharyngitis. In this study, we aimed to determine the relationship between Centor/McIsaac score and patients’ symptoms, and to investigate any conformity between Rapid Antigen Test positivity and high Centor/McIsaac score. Materials and methods: Data were obtained retrospectively by scanning the files of patients (age 2 to 18 years) diagnosed with GABHS who were hospitalized between May and December 2017. Inclusion criteria were, being between the ages of 2 and 18 years and to be diagnosed with group A beta hemolytic streptococcal pharyngitis. Receiving antibiotic treatment within the last 14 days, being under 2 years of age and over 18 years of age are exclusion criteria. Daily clinical findings and test results (complete blood count, neutrophil and lymphocyte percentages, rapid antigen test, throat culture) were collected from medical records. The Centor/McIsaac scores calculated according to symptoms and rapid antigen test results used for GABHS antigen detection from throat swab samples, used for the initiation of effective treatment and to shorten hospitalization, were recorded from patient files. Student's t test was used to analyze the data that showed normal distribution among independent groups. The chi-square test was used for the analysis of categorical variables. P<0.05 was considered statistically significant. Results: A total of 236 patients were included in the study. The average age of the patients was 7 years. The frequency of pharyngitis symptoms was similar in patients younger and older than 7 years of age. There was no statistically significant difference between those younger and older than 7 years of age in terms of throat culture positivity (p=0.059). There was no statistically significant difference between Centor/McIsaac scores of the two age groups (p=0.063). The Centor/McIsaac score (3.62±1.01) of those with positive rapid antigen test was significantly higher than that of those with negative rapid antigen test (2.78±1.28) (p=0.001). Centor/McIsaac scores of those with and without fever, those with and without tonsillar hypertrophy, those with and without cough were also compared. Centor/McIsaac scores of those with fever (3.53±1.02) were higher compared to those without (1.63±0.89) (p=0.001), scores were higher in those with tonsillar hypertrophy (3.68±1.01) compared to those without (2.10±0.97) (p=0.001), and scores were again higher in those without cough (3.67±1.07) compared to those with cough (2.22±0.99) (p<0.001). Conclusion: The intensity of symptoms seen in GABHS infection leads to higher Centor/McIsaac scores. The correlation between rapid antigen test results and Centor/McIsaac score shows the increasing importance of Centor/McIsaac score in early diagnosis of GABHS pharyngitis.

Different antibiotic treatments for group A streptococcal pharyngitis.

Different antibiotic treatments for group A streptococcal pharyngitis.

Prophylaxis of Rheumatic Fever/Rheumatic Heart Disease–Penicillin or Azithromycin, Who Wins?

Abstract For eradication of rheumatic fever (RF)/rheumatic heart disease (RHD), we must have a simplified diagnosis, and a treatment which is painless, easily available and safe; prophylaxis must be painless, safe, easily available, readily administered, and comprising a weekly oral single dose. Arati's regime for management of RF/RHD (ARMOR) consists of diagnosis and management of RF/RHD in today's context in a very easy and simplified way. ARMOR criteria: Arthritis or arthralgia with typical features suggestive of RF, carditis or cardiac involvement, typical of RF or RHD, and echocardiographic evidence of rheumatic heart valve involvement should essentially be the criteria to diagnose RF and RHD with high specificity and sensitivity. With regard to treatment of RF/RHD, we need a drug which is highly efficacious against Group A Beta Hemolytic Streptococcus (GABHS), which is the causative agent for primary prevention and treatment and secondary prophylaxis. The best drug discovered, to date, for GABHS is azithromycin. ARMOR for primary prevention, treatment and secondary prophylaxis of RF/RHD is as follows: Azithromycin must be given in a dose of 500 mg 1 tablet daily for 5 days, followed by 1 tablet once a week for 1 year. Penicillin for treatment and prophylaxis must be given up due to its lack of availability, side effects, risk of anaphylaxis, parenteral preparation, hazards of administration, need for sensitivity test each time, etc. and replaced by azithromycin.

Therapeutic aspects of Sydenham's Chorea: an update.

Sydenham’s Chorea (SC) is a hyperkinetic movement disorder associated with neuropsychiatric manifestations. It is believed to be caused by the autoimmune response following a group A beta-hemolytic streptococcal (GABHS) pharyngitis, and it is one of the major diagnostic criteria for Acute Rheumatic Fever (ARF) diagnosis. Despite having been known and studied for centuries, there are still no standardized therapies or official guidelines for SC treatment, so that it is necessarily left to physicians’ clinical experience. Antibiotic treatment, symptomatic therapies, and immunomodulatory treatment are the three pillars upon which SC patients’ management is currently based, but they still lack a solid scientific basis. The aim of this writing is precisely to review the state of the art of SC’s treatment, with an overview of the advances made in the last 5 years. However, since the therapeutic uncertainties are a mere reflection of the severe gap of knowledge that concerns SC’s pathogenesis and manifestations, the importance of high-quality research studies based on homogenized methodologies, instruments, and measured outcomes will also be stressed. (www.actabiomedica.it)

For children and adolescents with group A beta-hemolytic streptococcus (GABHS) throat infection, how do short-term late-generation antibiotics compare with longer-term penicillin?

For children and adolescents with group A beta-hemolytic streptococcus (GABHS) throat infection, how do short-term late-generation antibiotics compare with longer-term penicillin?

Streptococcal Infection as a Major Historical Cause of Stuttering: Data, Mechanisms, and Current Importance.

Stuttering is one of the most well-known speech disorders, but the underlying neurological mechanisms are debated. In addition to genetic factors, there are also major non-genetic contributions. It is here proposed that infection with group A beta-hemolytic streptococcus (GAS) was a major underlying cause of stuttering until the mid-1900s when penicillin was introduced in 1943. The main mechanism proposed is an autoimmune reaction from tonsillitis, targeting specific molecules, for example within the basal ganglia. It is here also proposed that GAS infections may have continued to cause stuttering to some extent, to the present date, though more rarely. If so, early diagnosis of such cases would be of importance. Childhood cases with sudden onset of stuttering after throat infection may be particularly important to assess for possible GAS infection. The support for this hypothesis primarily comes from three lines of argument. First, medical record data from the 1930s strongly indicates that there was one type of medical event in particular that preceded the onset of childhood stuttering with unexpected frequency: diseases related to GAS throat infections. In particular, this included tonsillitis and scarlet fever, but also rheumatic fever. Rheumatic fever is a childhood autoimmune sequela of GAS infection, which was a relatively widespread medical problem until the early 1960s. Second, available reports of changes of the childhood prevalence of stuttering indicate striking parallels between stuttering and the incidence of rheumatic fever, with: (1) decline from the early 1900s; (2) marked decline from the introduction of penicillin in the mid 1940s; and (3) reaching a more stable level in the 1960s. The correlations between the data for stuttering and rheumatic fever after the introduction of penicillin are very high, at about 0.95. Third, there are established biological mechanisms linking GAS tonsillitis to immunological effects on the brain. Also, a small number of more recent case reports have provided further support for the hypothesis linking stuttering to GAS infection. Overall, it is proposed that the available data provides strong evidence for the hypothesis that GAS infection was a major cause of stuttering until the mid-1900s, interacting with genetic predisposition.

Corticosteroids for Sore Throat.

In the United States, up to 2% of ambulatory visits are related to sore throats.1 'Sore throat' is a broad term with a wide range of etiologies. Infections are the most common cause, with group A beta-hemolytic streptococcus (GABHS) accounting for 10% of cases in adults and up to 30% in pediatric patients.2,3 A variety of interventions can be used to reduce pain, and while antibiotics are frequently used to treat infection, their overall analgesic effect is likely small and their overuse may lead to bacterial resistance and other adverse events.4,5.

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.

Chorea as the first presenting sign of rheumatic fever in a 12-year-old female child

Rheumatic chorea (RC*) is a movement disorder seen in young children and adolescents with a recent history of incompletely treated group A beta-hemolytic streptococcal (GABHS) pharyngitis. Although, it rarely presents as the first manifestation of the rheumatic fever, physicians should be aware of the disease, so that early diagnosis and prompt treatment may lead to elimination of the pathogen and prevent further disease progression. We present a case of a 12-year-old female child who presented with only RC as the first clinical sign.

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;