Group A Streptococcus Research Articles

Group A Streptococcus Is Still at Large

Group A Streptococcus (GAS) is a major human pathogen that can cause diseases, ranging from mild to severe systemic and invasive diseases [...].

Identifying Group A Streptococcal Pharyngitis in Children Through Clinical Variables Using Machine Learning.

Background Group A Streptococcus(GAS) is the most common bacterial cause of pharyngitis in children.GAS pharyngitis requires antimicrobial agents, and rapid antigen detection tests (RADTs) are currently considered useful for diagnosis. However, the decision to perform the test is based on the pediatrician's examination findings, but the indicators are not clear. Therefore, we used machine learning (ML) to create a model to identify GAS pharyngitis from clinical findings and to explore important features. Methods ML with Python programming language was used for this study. Data from the included study involved 676 children aged 3 to 15 years diagnosed with pharyngitis, with positive results on the RADT serving as exposures, and negative results serving as controls. The ML performances served as the outcome. We utilized six types of ML classifiers, namely, logistic regression, support vector machine, k-nearest neighbor algorithm, random forest, an ensemble of them, Voting Classifier, and the eXtreme Gradient Boosting (XGBoost) algorithm. Additionally, we used SHapley Additive exPlanations (SHAP) values to identify important features. Results Moderately performing models were generated for all six ML classifiers. XGBoost produced the best model, with an area under the receiver operating characteristics curve of 0.75 ± 0.01. The order of important features in the model was palatal petechiae, followed by scarlatiniform rash,tender cervical lymph nodes, and age. Conclusion Through this study, we have demonstrated that ML models can predict childhood GAS pharyngitis with moderate accuracy using only commonly recorded clinical variables in children diagnosed with pharyngitis. We have also identified four important clinical variables. These findings may serve as a reference for considering indicators under the current guidelines recommended for selective RADTs.

Inactivation of the lysine binding sites of human plasminogen (hPg) reveals novel structural requirements for the tight hPg conformation, M-protein binding, and rapid activation.

Accelerated activation of the human plasminogen zymogen (hPg) to two-chain active plasmin (hPm) is achieved following conformational changes induced by ligand-binding at the lysine-binding sites (LBSs) in four of the five hPg kringle domains. In this manner, pattern D skin-trophic strains of Group A streptococci (GAS), through the expression of surface plasminogen-binding M-protein (PAM), immobilize surface hPg, thereby enabling rapid hPg activation by GAS-secreted streptokinase (SK). Consequently, GAS enhances virulence by digesting extracellular and tight cellular junctional barriers using hPm activity. Many studies have demonstrated the singular importance of the kringle-2 domain of hPg (K2hPg) to PAM-binding using hPg fragments. Recently, we showed, using full-length hPg, that K2hPg is critical for PAM binding. However, these studies did not eliminate any modulatory effects of the non-K2hPg LBS on this interaction. Moreover, we sought to establish the significance of the intramolecular interaction between Asp219 of the LBS of K2hPg and its serine protease domain binding partner, Lys708, to conformational changes in hPg. In the current study, selective inactivation of the LBS of K1hPg, K4hPg, and K5hPg revealed that the LBS of these kringle domains are dispensable for hPg binding to PAM. However, the attendant conformational change upon inactivation of K4hPg LBS increased the affinity of hPg for PAM by an order of magnitude. This finding suggests that the native hPg conformation encloses PAM-binding exosites or sterically hinders access to K2hPg. While simultaneous inactivation of the LBS of K1hPg, K4hPg, and K5hPg inhibited hPg/SK association alongside hPg activation, the replacement of Lys708 generated a slight conformational change that optimally accelerated hPg activation. Thus, we accentuate disparate functions of hPg LBS and conclude, using intact proteins, that K2hPg plays a central role in regulating hPg activation.

Isolation and Characterization of Streptococcus pyogenes from Iraqi Children with Pharyngotonsillitis

Background: Streptococcus pyogenes known as group A streptococci (GAS) is the main causative agent of pharyngotonsillitis in children younger than 12 years old. The infection appears mostly in winter and spring. Signs and symptoms of patients with a beta-hemolytic GAS infection, include tonsillar exudate, fever, painful anterior cervical adenopathy, and the lack of a cough. Penicillin and ampicillin are the preferred clinical therapy choice for GAS pharyngitis treatment. Objectives: Isolate and identify GAS in throat swabs among children suffering from acute pharyngotonsillitis to estimate the prevalence rate of bacterial isolates associated with age, sex, and months variation of GAS infection. Also, it is to determine the antibiotic sensitivity patterns such as penicillin, ampicillin, erythromycin, azithromycin, ofloxacin, clindamycin, and rifampicin, which are used for the treatment of GAS associated with the acute pharyngotonsillitis in children. Materials and Methods: Four hundred and ten throat swabs have been obtained from patients who were clinically diagnosed as having acute pharyngotonsillitis of age ranging from (1–12) years of both sexes were admitted to various hospitals and enrolled in a sequential manner from November 2021 to April 2022 in two Governorates (Baghdad and Babylon), Iraq. These throat swabs were exposed to the bacterial culturing, and some other tests. Streptococcus pyogenes isolates were identified depending on the colony properties, beta-hemolysis on sheep blood agar plate, Gram’s stain, catalase production test, in addition to a sensitivity to bacitracin and Pyrrolidinyl arylamidase test to confirm the identification of GAS. Results: The prevalence of identifying GAS isolates was 140 (34.1%) out of 410 samples. GAS strains can cause acute pharyngotonsillitis in children of all ages, but it most frequently occurred between 1 and 6 year age groups, and it was more in men 80 (57.1%) than in women 60 (42.9%). Likewise, it was found that GAS associated with acute pharyngotonsillitis with a high incidence in winter and in early spring, in which the peak of GAS infection has been seen in January (30.7%). On the other hand, some antibiotics were used to show their effect on these GAS isolates. The findings revealed that all isolates were sensitive (100%) to penicillin and ampicillin, and (83.6%) of isolates were sensitive to clindamycin, whereas some isolates shown a lesser degree of sensitivity (75% and 60%) to rifampicin and ofloxacin. However, only 49.3% of the isolates were sensitive to erythromycin, and (46.4%) were sensitive to azithromycin. Conclusion: GAS strains can cause acute pharyngotonsillitis in children of all ages, but it most frequently occurred in the age groups (1–6) year, and more predominant in men than in women. High percentage of infections with GAS have been noticed in winter and spring to reach its peak in January. Additionally, penicillin and ampicillin are preferred antibiotic for treatment, whereas in the most serious cases clindamycin was added to the treatment plan.

Biosynthesis of nisin, antimicrobial mechanism and its applications as a food preservation: A review

This review examines the biosynthesis of nisin, its antimicrobial mechanism, and its applications in food preservation. Nisin is synthesized withinside the ribosome as a pre-peptide which undergoes amendment withinside the post-translational level as a number one metabolite from lactic acid bacteria. Nisin secretion occurs in the exponential phase and is maximally produced at the end of the exponential phase or the beginning of the stationary phase. As an antibiotic in the form of a peptide molecule, nisin is characterized by the presence of lanthionine-type thioester bonds. Nisin has been reported to have the ability to inhibit bacteria, especially Gram-positive bacteria such as Bacillus subtilis, Bacillus stearothermophilus, Clostridium botulinum, Streptococcus hemolyticus, Staphylococcus aureus, and Listeria monocytogenes. Nevertheless, nisin is less effective against Gram-negative bacteria, yeast, and molds. Based on its ability to inhibit bacteria plus the non-toxic nature of nisin, Nisin can be used as bio preservation in food products. Besides being non-toxic, several other factors that can be considered for nisin as bio preservation are that nisin is readily biodegradable. It is a protein compound that does not harm the intestinal flora as it is easily digested by enzymes in the gastrointestinal tract and does not cause bacterial resistance as therapeutic antibiotics are safe for humans.

Parapneumonic effusion in children: Rapid pathogen detection in pleural fluid using multiplex bacterial PCR.

Parapneumonic effusion in children: Rapid pathogen detection in pleural fluid using multiplex bacterial PCR.

A review of penicillin binding protein and group A Streptococcus with reduced-β-lactam susceptibility.

With the widespread use of antibiotics, antimicrobial resistance (AMR) has become a global problem that endangers public health. Despite the global high prevalence of group A Streptococcus (GAS) infections and the global widespread use of β-lactams, β-lactams remain the first-line treatment option for GAS infection. β-hemolytic streptococci maintain a persistent susceptibility to β-lactams, which is an extremely special phenomenon in the genus Streptococci, while the exact current mechanism is not known. In recent years, several studies have found that the gene encoding penicillin binding protein 2X (pbp2x) is associated with GAS with reduced-β-lactam susceptibility. The purpose of this review is to summarize the current published data on GAS penicillin binding proteins and β-lactam susceptibility, to explore the relationship between them, and to be alert to the emergence of GAS with reduced susceptibility to β-lactams.

Estimating predictors of severity of group A Streptococcus infection in pregnancy

Objective To identify the clinical characteristics of pregnancy associated group A streptococcus (GAS) infection and predictors for intensive care unit (ICU) admission. Methods A retrospective cohort study of culture-proven pregnancy-related GAS infections in tertiary hospital Electronic medical records were reviewed, for cases of cultures positive GAS that were identified between January 2008 and July 2021. A GAS infection was defined by the isolation of the pathogen from a sterile liquid or tissue site. Blood and urine cultures were obtained from all patients with peripartum hyperpyrexia (fever >38 °C). Medical Personnel screening included cultures of the throat, rectum, and skin lesions (if present). In cases of hemodynamic instability patients were transferred ad hoc to ICU, according to the obstetrician and intensivist judgment. Results Of the 143,750 who delivered during the study period, 66 (0.04%) were diagnosed as having a pregnancy associated GAS infection. Of these, 57 patients presented postpartum, and represented the study cohort. The most common presenting signs and symptoms among puerperal GAS, were postpartum pyrexia (72%), abdominal pain (33%), and tachycardia (>100 bpm, 22%). 12 women (21.0%) developed streptococcal toxic shock syndrome (STSS. Predictors for STSS and ICU admission were: antibiotic administration >24 h from presentation postpartum, tachycardia, and a C-reactive protein level >200 mg/L. Women that received antibiotic prophylaxis during labor had a significantly lower rate of STSS (0 vs 10, 22.7%; p = .04). Conclusion Deferral of medical intervention >24 h from the first registered abnormal sign had the most important impact on deterioration of women with invasive puerperal GAS. Antibiotic prophylaxis during labor in women with GAS may reduce associated complications.

Predictors of rapidly progressive glomerulonephritis in acute poststreptococcal glomerulonephritis.

Acute post-streptococcal glomerulonephritis (APSGN) is an immune-mediated inflammatory respsonse in the kidneys caused by nephritogenic strains of group A β-hemolytic streptococcus (GAS). The present study aimed to present a large patient cohort of APSGN patients to determine the factors that can be used for predicting the prognosis and progression to rapidly progressive glomerulonephritis (RPGN). The study included 153 children with APSGN that were seen between January 2010 and January 2022. Inclusion criteria were age 1-18years and follow-up of ≥ 1years. Patients with a diagnosis that could not be clearly proven clinically or via biopsy and with prior clinical or histological evidence of underlying kidney disease or chronic kidney disease (CKD) were excluded from the study. Mean age was 7.36 ± 2.92years, and 30.7% of the group was female. Among the 153 patients, 19 (12.4%) progressed to RPGN. The complement factor 3 and albumin levels were significantly low in the patients who had RPGN (P = 0.019). Inflammatory parameters, such as C-reactive protein (CRP), platelet-to-lymphocyte ratio, CRP/albumin ratio, and the erythrocyte sedimentation rate level at presentation were significantly higher in the patients with RPGN (P < 0.05). Additionally, there was a significant correlation between nephrotic range proteinuria and the course of RPGN (P = 0.024). We suggest the possibility that RPGN can be predicted in APSGN with clinical and laboratory findings. A higher resolution version of the Graphical abstract is available as Supplementary information.

Incidence and clinical and microbiological features of invasive and probable invasive streptococcal group A infections in children and adults in the Brussels-Capital Region, 2005–2020

Assess the incidence, risk factors, clinical and microbiological features, and outcome of both probable invasive and invasive group A Streptococcus (GAS) infections in children and adults in the BrusselsCapital Region between 2005 and 2020. A retrospective, multicentric study was performed in three university hospitals in Brussels. Patients were identified through the centralized laboratory information system. Epidemiological and clinical data were collected from patients' hospital records. A total of 467 cases were identified. Incidence has increased from 2.1 to 10.9/100,000 inhabitants between 2009 and 2019 in non-homeless adults while it was above 100/100,000 on homeless in years with available denominators. Most of GAS were isolated from blood (43.6%), and the most common clinical presentation was skin and soft tissue infections (42.8%). A third of all the patients needed surgery, a quarter was admitted to the intensive care unit, and 10% of the adult patients died. Wounds and chickenpox disease were the main risk factors for children. Tobacco, alcohol abuse, wounds or chronic skin lesion, being homeless, and diabetes were identified as major predisposing factors for adults. The most common emm clusters were D4, E4, and AC3; 64% of the isolates were theoretically covered by the 30-valent M-protein vaccine. The burden of invasive and probable invasive GAS infections is on the rise in the studied adult population. We identified potential interventions that could contribute to decrease this burden: appropriate care of wounds, specifically among homeless and patients with risk factors such as diabetes and systematic chickenpox vaccination for children.

A Positive or Negative Connection of Diabetes Mellitus to the Oral Microbiota.

Common noncommunicable diabetes mellitus disease has many complications in several parts of the human body. The oral cavity is one of the areas affected by diabetes mellitus conditions. The most common complications of diabetes mellitus in oral areas include increased drying of the mouth and increased oral diseases resulting from either microbial activity, such as dental caries, periodontal diseases, and oral candidiasis, or physiological problems, such as oral cancer, burning mouth syndrome, and temporomandibular disorders. Diabetes mellitus also has an impact on the diversity and quantity of oral microbiota. Oral infections promoted by diabetes mellitus mainly result from disturbance of the balance between different species of oral microbiota. Some oral species may be positively or negatively correlated with diabetes mellitus, while others may not be affected at all. The most numerous species in the presence of diabetes mellitus are those of phylum Firmicutes of bacteria such as hemolytic Streptococci, Staphylococcus spp., Prevotella spp., Leptotrichia spp., and Veillonella and species of the fungus Candida. Proteobacteria spp. and Bifidobacteria spp. are common microbiota that are negatively impacted by diabetes mellitus. In general, the effect of diabetes mellitus could include all types of oral microbiota, whether it is bacteria or fungi. The 3 types of association between diabetes mellitus and oral microbiota that will be illustrated in this review are increase, decrease, or lack of impact. As final inclusion, a great number of oral microbiota have increased in the presence of diabetes mellitus.

Current scenario of recently rising up cases of invasive group A streptococcal (iGAS) infections in younger children in many European nations: clinical management and prospective counteracting measures – an update

Current scenario of recently rising up cases of invasive group A streptococcal (iGAS) infections in younger children in many European nations: clinical management and prospective counteracting measures – an update

The impact of rapid antigen detection test (RADT) for group A streptococcus on the antibiotic prescription: an observational study from a primary care setting in Lisbon

Introduction: Acute pharyngitis is a common diagnosis in primary care. Although viruses are the most common aetiology, antibiotic therapy is frequently prescribed. The inappropriate antibiotic prescription should be avoided to prevent antibiotic resistance. Many national and international guidelines recommend testing for group A streptococcus (GAS) before antibiotic treatment when clinical presentation suggests GAS infection. Aim: This study aims to describe the feasibility of the implementation of the rapid antigen detection test (RADT) in a primary care setting and its impact on antibiotic prescription. Secondary goals include the evaluation of possible associations between symptoms and RADT results. Methods: From October 2019 to March 2020, patients presenting with acute pharyngitis at USF do Parque were eligible. A questionnaire was applied to divide the individuals into four different groups (clearly viral, probably viral, diagnostic doubt, and probably bacterial), and to assess the previous intention to prescribe antibiotics. We applied 136 questionnaires and performed 133 RADT. Nursing staff classified the specimen collection process and result from interpretation according to its difficulty. The proportion of antibiotics avoided was estimated as the number of times physicians changed their intended antibiotic prescription following a negative RADT result. Results: Among the tests performed, 97.7% were easy to interpret. Without RADT, 45 patients were going to be prescribed an antibiotic. After the test result, 27 antibiotic prescriptions were avoided. Tonsil hypertrophy, palatal petechiae, and fever increased the odds of a positive RADT result. Cough was associated with a negative RADT result. Conclusions: This study showed that RADT is easy to implement and contributed to appropriate antibiotic prescription. Tonsil hypertrophy, palatal petechiae, and fever were significantly associated with a positive RADT result, and cough was associated with a negative RADT result. Primary care centers would benefit from having RADT available when there is strong suspicion or doubt of bacterial pharyngitis.

Identification of an immunodominant region on a group A Streptococcus T-antigen reveals temperature-dependent motion in pili

ABSTRACT Group A Streptococcus (GAS) is a globally important pathogen causing a broad range of human diseases. GAS pili are elongated proteins with a backbone comprised repeating T-antigen subunits, which extend from the cell surface and have important roles in adhesion and establishing infection. No GAS vaccines are currently available, but T-antigen-based candidates are in pre-clinical development. This study investigated antibody-T-antigen interactions to gain molecular insight into functional antibody responses to GAS pili. Large, chimeric mouse/human Fab-phage libraries generated from mice vaccinated with the complete T18.1 pilus were screened against recombinant T18.1, a representative two-domain T-antigen. Of the two Fab identified for further characterization, one (designated E3) was cross-reactive and also recognized T3.2 and T13, while the other (H3) was type-specific reacting with only T18.1/T18.2 within a T-antigen panel representative of the major GAS T-types. The epitopes for the two Fab, determined by x-ray crystallography and peptide tiling, overlapped and mapped to the N-terminal region of the T18.1 N-domain. This region is predicted to be buried in the polymerized pilus by the C-domain of the next T-antigen subunit. However, flow cytometry and opsonophagocytic assays showed that these epitopes were accessible in the polymerized pilus at 37°C, though not at lower temperature. This suggests that there is motion within the pilus at physiological temperature, with structural analysis of a covalently linked T18.1 dimer indicating “knee-joint” like bending occurs between T-antigen subunits to expose this immunodominant region. This temperature dependent, mechanistic flexing provides new insight into how antibodies interact with T-antigens during infection.

Characteristics of hospitalized COVID-19 patients with other respiratory pathogens identified by rapid diagnostic test

Rapid diagnostic tests (RDTs) significantly impact disease treatment strategy. In Japan, information on the use of RDTs for patients with COVID-19 is limited. Here, we aimed to investigate the RDT implementation rate, pathogen detection rate, and clinical characteristics of patients positive for other pathogens by using COVIREGI-JP, a national registry of hospitalized patients with COVID-19.A total of 42,309 COVID-19 patients were included. For immunochromatographic testing, influenza was the most common (n = 2881 [6.8%]), followed by Mycoplasma pneumoniae (n = 2129 [5%]) and group A streptococcus (GAS) (n = 372 [0.9%]). Urine antigen testing was performed for 5524 (13.1%) patients for S. pneumoniae and for 5326 patients (12.6%) for L. pneumophila.The completion rate of M. pneumonia loop-mediated isothermal amplification (LAMP) testing was low (n = 97 [0.2%]). FilmArray RP was performed in 372 (0.9%) patients; 1.2% (36/2881) of patients were positive for influenza, 0.9% (2/223) for the respiratory syncytial virus (RSV), 9.6% (205/2129) for M. pneumoniae, and 7.3% (27/372) for GAS. The positivity rate for urine antigen testing was 3.3% (183/5524) for S. pneumoniae and 0.2% (13/5326) for L. pneumophila. The positivity rate for LAMP test was 5.2% (5/97) for M. pneumoniae. Five of 372 patients (1.3%) had positive FilmArray RP, with human enterovirus being the most frequently detected (1.3%, 5/372).The characteristics of patients with and without RDTs submission and positive and negative results differed for each pathogen. RDTs remain an important diagnostic tool in patients with COVID-19 in whom coinfection with other pathogens needs to be tested based on clinical evaluation.

A view from the floor of the pharmacy: The experience of a severe asthma attack

A view from the floor of the pharmacy: The experience of a severe asthma attack

A Surveillance Study of the Serotypes of Streptococci in the Throat and Skin Lesions in Acute Rheumatic Fever and Rheumatic Heart Disease Patients and their Families

Abstract Objectives: The objectives of this study were to determine the colonization of the throat and skin among patients of rheumatic heart disease (RHD) or acute rheumatic fever (ARF) and to elucidate the different Lancefield serotypes of streptococci (Group A, Group C, and Group G) among them. Methods: The prospective observational surveillance study was conducted from November 2016 to March 2018 among 161 enrolled family members belonging to 30 families with one of their patients being diagnosed with RHD/ARF. The outcome measures were period prevalence of serotypes of streptococci, streptococcal colonization of throat and skin lesions, and association of age and antibody titers with RHD/ARF. Results: Out of 30 families enrolled in our study, positive throat (n = 18)/skin (n = 1) cultures were found in 7 families (n = 19). The cultures were positive only for Group A streptococci (GAS), while none of the samples showed positivity for Group C or G serotypes. Overall period prevalence for our study period was 3.2%. Among the 18 members positive for GAS throat culture, 13 (72.2%) belonged to the age group &lt;15 years (P &lt; 0.025). The positive cultures in the throat sample were more in the ARF families than RHD families (P &lt; 0.001). There was no association of culture positivity with antibody titer (P &gt; 0.05). Conclusion: In conclusion, we found only GAS colonization in significantly higher proportion among the family members of cases of ARF in comparison to RHD. Rather there was no case of Group C and G streptococci colonization in cases or family members of RHD/ARF.

Diagnosis of group A streptococcal pharyngitis in the paediatric emergency department using a fluorescence-based RADT: predicted impact on antibiotic prescription.

Introduction. Using rapid antigen diagnostic tests (RADTs) in clinical practice has shown excellent specificity but often has diminished sensitivity.Gap Statement. Local data for evaluating the diagnostic performance of a new fluorescence-based RADT and its influence on the antibiotic prescription rate are not available.Aim. To evaluate the accuracy of fluorescent immunoassay (FIA)-RADTs for diagnosing group A streptococcal (GAS) pharyngitis among children and its estimated effect as a point of care test (POCT) on the antibiotic prescription rate at the paediatric emergency department.Methodology. A prospective study was conducted, comprising children 3 to 14 years old presenting with pharyngitis. Throat swab culture and FIA-RADTs were performed on all samples. Conventional PCR was performed on the discordant samples.Results. A total of 246 children were included in this study. The sensitivity, specificity, and positive and negative predictive values of the FIA-RADT, based on culture results and PCR detection combined, were 95.6, 96.8, 94.6 and 97.4 %, respectively. Antibiotics have been prescribed to 162 (65.9 %) children; however, if FIA-RADTs had been added in the clinical practice as a POCT, only 92 (37.4 %) children would have received antibiotics in total. Additionally, implementation of FIA-RADTs would significantly reduce the antibiotic prescription rate from 48.8 and 60.6 % to 9.5 and 31.9 % among patients with clinical scores of 2 and 3, respectively.Conclusion. The new FIA-RADT is simple, prompt and reliable. It is helpful in clinical settings and may be used to reduce antibiotic overprescription, especially for children who have a low risk for GAS pharyngitis, according to the clinical score.

Determinant of antibacterial failure in patients with head and neck infections with odontogenic source.

&lt;b&gt;Introduction:&lt;/b&gt; Odontogenic infections are polymicrobial in origin and can be life-threatening. Antibacterial failure is an important issue in the treatment of odontogenic infections. Aim: This study aimed to determine the factors associated with antibacterial failure in patients with head and neck infections of odontogenic origin.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and method:&lt;/b&gt; This retrospective epidemiological study was performed using data collected from 229 patients with head and neck infections of odontogenic origin who were operated on in Shahid Rajaee hospital from March 2014 to December 2019.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; 123 (53.7%) patients were female and there were 106 (46.3%) males. The mean age SD was 33.01 13.37 years (range 7 to 80). The most common offending teeth were lower molars (81.7%) and lower premolars (5.7%). The most common site of infection was the submandibular area (36.4%) followed by the buccal (20.4%) and pterygomandibular (17.1%) regions. The most common pathogen was Streptococcus haemolyticus. The length of hospitalization was higher (4.66 days) in patients with failure of treatment compared to those without it (6.00 days) (P = 0.002). A combination of penicillin G and metronidazole was prescribed for all patients with failure of treatment compared to 57.6% in patients without failure of treatment (P = 0.002). There was no statistically significant difference between the two groups regarding age, duration of illness before hospitalization, WBC, gender, history of chemotherapy, hypertension, smoking, pregnancy, alcohol consumption, diabetes mellitus, the rate of fever, trismus, dysphagia, malaise, antibiotic before hospitalization, or surgical approach.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Possible determinants in this study were not associated with antibacterial failure. Further studies should be conducted to investigate this relationship.

Scarlet fever and the dental team

Scarlet fever is a mild, but highly contagious disease caused by Group A Streptococcus (GAS) bacteria. Scarlet fever begins with flu-like symptoms and, within the first 12-48 hours, it is common for a rash to develop that feels like sandpaper to the touch. In rare cases, GAS bacteria can cause an invasive infection that can be fatal. Invasive GAS (iGAS) infection occurs when the bacteria are in a place of the body where they are not normally found, such as the blood stream. Scarlet fever is usually treated with antibiotics, which can reduce the chances of the patient developing iGAS and reduce the risk of them spreading the infection to others. The World Health Organization and UK Health Security Agency have announced that the number of scarlet fever and iGAS cases observed in children has been several times higher than pre-pandemic levels for the equivalent period of time. As healthcare professionals, it is important that the dental team understand key aspects of scarlet fever. Here, scarlet fever symptoms, transmission, clinical manifestations, antibiotic treatment, and risks to the dental team are reviewed. CPD/Clinical Relevance: To describe epidemiology of scarlet fever and discuss the implications for the dental team.