Hemolytic Streptococcal Infections Research Articles

Rheumatic fever - new criteria

Rheumatic fever (RF) is an autoimmune disease associated with group A β-hemolytic streptococcal infection, in the course of which the patient develops carditis, arthritis, chorea, subcutaneous nodules and erythema marginatum.Rheumatic fever diagnosis is based on the Jones criteria, developed in 1944, then revised twice by the American Heart Association (AHA), in 1992 and recently in 2015.The last revision of the Jones criteria consists mainly in the supplementation of the major criteria with echocardiographic examination, the introduction of a concept of subclinical carditis and the isolation of low, medium and high risk populations among the patients.AHA recommends that all the patients with suspected RF undergo Doppler echocardiographic examination after the Jones criteria have been verified, even if no clinical signs of carditis are present.

Detection and analysis on serum antibodies for five common pathogenic microbes in patients with Posner-Schlossmarm syndrome

Background Posner-Schlossman syndrome (PSS) is often recurrent and is a cause of blindness.The etiology of PSS remains to be elucidated.It is reported that there is a certain association between pathogenic microorganisms and PSS in rather small samples. Objective This study was to analyze the related serum antibody levels of cytomegalovirus (CMV), herpes simplex virus (HSV), rubella virus (RV), helicobacter pylori (HP) and anti-streptolysin O (ASO) and provide a clue for the study on pathogenesis and therapy of PSS. Methods A prospective cases-controlled study was carried out in Shenzhen Eye Hospital from December, 2014 to December, 2016 under the approval of Ethic Committee of this hospital and informed consent of each subject prior to initial of any medical examination.Peripheral blood samples were collected from 82 PSS patients as the PSS group and 100 age-and gender-matched healthy blood donors as the normal control group.The positive rates of serum CMV IgG, CMV IgM, HSV IgG, HSV IgM, RV IgG, RV IgM, HP IgG and HP IgM in the subjects were detected by indirect ELISA, and the positive rate of serum ASO antibody was determined by immuno-scatter turbidmetry. Results The positive rates of serum CMV-IgG, CMV-IgM, HP-IgG, HP-IgM and ASO antibody were 22.0%, 17.1%, 22.0%, 17.1% and 17.1% in the PSS group, which were significantly higher than 5.0%, 0.0%, 10.0%, 2.0% and 7.0% in the normal control group (χ2=11.726, 18.496, 4.943, 12.766, 4.479, all at P 0.05). Conclusions CMV, HP and hemolytic streptococcal infection may participate in the occurrence and development of PSS. Key words: Posner-Schlossman syndrome; Etiology; Cytomegalovirus; Herpes simplex virus; Rubella virus; Helicobacter pylori; Anti-streptolysin O; Antibody

Bacteriological and Serological Study of Beta Hemolytic Streptococcal Throat Infection Among School Children In Najaf Governorate

The study presents the findings of bacteriological and immunological examinations of (250) children suffering from throat infection and (350) school children without throat infection as control .one hundred and five (105)infected children and one hundred (100) uninfected children were selected for asessment of ASO titer and CRP level. It was found that group A beta-hemolytic streptococci, a known sore throat pathogens, were significantly detected more often among children with throat infection than among healthy carriers as controls (43.6 % versus. 26 %) respectively. Also there was significant difference (p<0.005) between infected children and healthy carriers in isolation rate of group C beta hemolytic streptococci (16.4 %vs. 8.95 %) respectively.The study indicated that there was significant difference in ASO value 1/200 IU/ml between infected children (57.2 %) and controls (4 %)as well as there was significant relationship between ASO positivity and beta-hemolytic streptococci carriage. There was significant difference in CRP value between infected children (94.3 %) and controls (20 %). the sensitivity and specificity for ASO test was 57 %and 96 % respectively and for CRP test was 94.5 % and 80 % respectively.

The effectiveness of the McIsaac clinical decision rule in the management of sore throat: an evaluation from a pediatrics ward.

Sore throats may be due to either viral or group A beta hemolytic streptococcus (GABHS) infections; but diagnosis of the etiology of a sore throat is difficult, often leading to unnecessary antibiotic prescriptions and consequent increases in bacterial resistance. Scoring symptoms using the McIsaac clinical decision rule can help physicians to diagnose and manage streptococcal infections leading to sore throat and have been recommended by the Ministry of Health, Malaysia. In this paper, we offer the first assessment of the effectiveness of the McIsaac rule in a clinical setting in Malaysia. This study is a retrospective review of 116 pediatric patients presenting with sore throat. Group A comprised patients before the implementation of the McIsaac rule and Group B comprised patients after the implementation. Unnecessary throat swab cultures were reduced by 40% (P = 0.003). Redundant antibiotic prescriptions were reduced by 26.5% (P = 0.003) and the overall use of antibiotics was reduced by 22.1% (P = 0.003). The pediatricians' compliance rate to McIsaac rule criteria was 45% before implementation of the McIsaac rule, but improved to 67.9% (P = 0.0005) after implementation. The McIsaac rule is an effective tool for the management of sore throat in children in Malaysia.

Đặc điểm dịch tễ và di truyền của liên cầu khuẩn gây tan máu β lưu hành ở trẻ em tỉnh Quảng Trị

This study was carried out in 200 children aged 7 ÷ 11 in Gio Chau Primary School, Gio Linh District, Quang Tri Province. The results showed that the rate of ß - hemolytic streptococcal infection was 25.5%, including strains of group A (17,5%) and group G (8,0%). The streptococcal infection in children is not related to their sex but to their parents’ occupation. The types of emm 4.0, emm 12.0, emm 44.0, emm 58.0, emm 104.0 and emm 109.1 were found among 30/35 S. Pyogenes strains. For group G streptococcus 12 S. anginosus and 2 S. dysgalactiae subsp. Equisimilis strains were classified.

Increased incidence of invasive group A beta hemolytic streptococcal infections in children

Group A beta hemolytic streptococci (GAS) can cause a wide range of mild infections but they are associated with severe infections with high morbidity and mortality rates. Risk factors for invasive GAS infections in children include antecedent varicella zoster infection. There is an increasing incidence of invasive GAS infection caused by clonal strains leading to outbreaks in the last decade. We describe four pediatric patients with severe conditions caused by GAS, leading to intensive care support in two patients. Two of the patients had antecedent varicella infection. A single clone of group A streptococcus was responsible in all children. Routine varicella vaccination is not currently part of the health programs of many countries, including The Netherlands. One benefit of universal varicella vaccination would be the prevention of some cases of pediatric invasive GAS disease, leading to a decrease in hospitalization, morbidity and mortality rates.

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus Immunology: A Pilot Study.

To elucidate specific cytokine and chemokine markers in patients diagnosed with pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS). Prospective cohort study. Academic university hospital. Tonsil tissue was collected from 24 patients and organized into 3 groups: experimental PANDAS cohort (12 patients), group A beta hemolytic streptococcus control cohort (6 patients), and obstructive sleep apnea control cohort (6 patients). Each tissue sample was extracted with MSD Tris lysis buffer, and protein lysates were analyzed for human chemokines and cytokines by the Human Cytokine 30-Plex Assay on the Mesoscale System. We identified a significant difference in expression regarding the 8 following cytokines when comparing the experimental PANDAS, group A beta hemolytic streptococcus, and obstructive sleep apnea control cohorts: tumor necrosis factor-α and eotaxin-3. In addition, our group also identified a significant reduction in the expression of interleukin (IL)-8, interferon inducible protein-10, IL-17a, interferon-γ, IL-10, and IL-12 across the aforementioned groups. Patients diagnosed with PANDAS appear to maintain significantly different concentrations of cytokines when compared with patients afflicted by chronic group A beta hemolytic streptococcus infections and obstructive sleep apnea. As a result, one could potentially use the described characterization of immunologic markers as a basis for future mechanistic and epidemiological studies.

The change of macrolide resistance rates in group A Streptococcus isolates from children between 2002 and 2013 in Asahikawa city.

This study targeted patients in the Department of Pediatrics, Asahikawa Kosei Hospital, between January 2002 and December 2013. In patients suspected of having hemolytic streptococcal infection, Group A Streptococcus (GAS) strains isolated from a throat swab were examined for antimicrobial susceptibility testing. The MICs were measured by the broth microdilution method. The annual number of GAS strains examined for antimicrobial susceptibility testing ranged from 28 to 65 strains, for a total of 574 strains. Some of the isolates obtained from 2006 to 2009 and from 2011 to 2013 were analyzed to determine their emm types. An erythromycin (EM) resistant strain was not detected until 2004, but one EM-resistant strain appeared in 2005. Subsequently, EM-resistant strains rapidly increased, and 48 of 65 strains (73.8%) examined in 2009 were resistant. In 2010, the number of EM-resistant strains decreased to 12 of 36 strains (33.3%). However, it gradually increased afterwards, and 37 of 60 strains (61.7%) were resistant in 2013. Out of 574 strains examined, 184 exhibited EM-resistance, and the overall resistance rate was 31.9%. Partitioning the 124 strains examined between 2006 and 2008 according to emm types, only emm28 strains, which exhibited a high resistance rate, and emm12 strains demonstrated resistance. For the 142 strains examined between 2011 and 2013, the resistance rate of emm28 strains was similarly high; the resistance of emm12 strains significantly increased, and emm1 strains exhibited a high resistance rate. The number of emm types associated with the resistant strains increased.

Acute Post-Streptococcal Glomerulonephritis in Children – A Review

Acute post-streptococcal glomerulonephritis (APSGN) is characterized by abrupt onset of hematuria, edema, hypertension, oliguria and impaired renal function following streptococcal group A â hemolytic streptococcal throat and skin infection. There is a declining incidence of APSGN worldwide, particularly in industrialized nations because of easier and earlier access to competent medical treatment of streptococcal infections and the widespread use of fluorination of water since virulence factors in streptococcus pyogens are reduced with fluoride exposure. But in the underdeveloped world, global burden of APSGN continues to be significant with lower estimate of 9.3 to 9.8 cases per 1,00,000 population per year to higher estimates as high as three times these values. Furthermore, clusters of cases are more frequently reported in poor communities in industrialized countries while epidemics of more than 100 cases are reported in the middle ranger countries with mean annual health expenditure per capita of about 550 US dollars. APSGN typically follows 1to2 weeks after pharyngeal infection and 2 to 4 weeks after skin infection by nephritogenic strains of group A â hemolytic streptococcus in a range of 5 – 15 years of age. Subclinical cases are 4 – 10 times higher than symptomatic patients. The acute phase generally resolves within 4-8 weeks but microscopic hematuria may persist for 1-2 yr after the initial presentation. Acute complications of symptomatic patients are hypertensive heart failure, encephalopathy and retinopathy. There can be acute renal failure and rarely rapidly progressive ( crescentic) glomerulonephritis, hyperkalemia, hyperphosphatemia, hypocalcemia and acidosis. Treatment is directed towards reduction of hypertension, but prompt address of complications are essential to avoid immediate mortality. Heart failure is treated with diuretic and anti-hypertensive, digoxin is ineffective. Hypertensive encephalopathy is treated by I.V phenobarbitone for convulsion, supportive measures for unconsciousness and blood pressure control. Acute renal failure is managed by supportive measures, rarely requires dialysis. Short and long term prognosis is excellent, with1% mortality during acute stage and 1% ending up with chronic kidney disease, but in higher age group abnormal urinalysis are present in higher number of patients. DOI: http://dx.doi.org/10.3329/bjch.v38i1.20025 Bangladesh J Child Health 2014; VOL 38 (1) : 32-39

Pediatric invasive streptococcal infection in northern and eastern regions of Hokkaido, Japan from 2010 to 2012

The frequency of occurrence of pediatric invasive streptococcal infection in Japan has not been studied, therefore the aim of this study was to survey the northern and eastern regions of Hokkaido from 2010 to 2012. Survey sheets were sent to the pediatric departments at 17 facilities where children in the subject region can be hospitalized. Responses were obtained from all of the 17 facilities. Seven patients developed group A streptococcal infection over the 3 years, and their ages ranged from 1 day after the birth to 15 years old. Sepsis was diagnosed in five children, and empyema and arthritis in the knee were found in one child each, respectively. The number of cases in children under 15 years old was six excluding the child who was 15 years old, and the incidence rate per 100,000 population was 1.00. Eight children developed group B streptococcal infection, and their ages ranged from 0 days to 2 months after birth. Two cases were the early onset type (age within 7 days) and six cases were the late onset type. Five children developed sepsis and three children developed meningitis. The frequency of occurrence was 0.24 per 1000 births; which was 0.06 per 1000 births for the early onset type and was 0.18 per 1000 births for the late onset type. No reports for group C or group G hemolytic streptococcal infection were obtained. The incidence rates identified in the present survey are similar to those in other advanced countries, and appear to be valid.

Prevalance of Streptococcus pyogenes infection in children aged between 5 to 15 years with acute tonsillopharyngitis and its antibiogram

Objective: To study the prevalence of group A beta haemolytic streptococcal (GABHS) infection among children aged between 5 to 15 years suffering from acute tonsillopharyngitis and its antibiogram. Research Design And Methods: This was a crossectional prospective study done over two years, by procuring data from the total 123 patient records of OPD patients. The clinical settings including history, examination and the throat swab cultures with anti-microbial sensitivity testing performed under standard conditions. Results: In this study, Streptococcus pyogenes was isolated in 21 patients out of the total 123 patients studied (17.1%), out of which 14(11.4%) were isolated from the age group between 11-15 years and only 7(5.7%) in the age group between 5-10 years. Males (10.6%) predominated in comparision to females (6.5%) with male female ratio of 1.6:1 and all the isolates were 100% sensitive to cefaclor, penicillin-G and ampicillin followed by 38.1% resistance to erythromycin, 28.6% to azithromycin and 33.3% to tetracycline respectively. Conclusion: The current study showed 17.1% prevalence of GABHS in the study population suffering from acute tonsillopharyngitis and also showed significant amount of resistance against commonly used antibiotics which were earlier sensitive probably due to injudicious use of antibiotics without undergoing routine culture and sensitivity.

Epidemiology of streptococcal infection with reference to Rheumatic fever

Introduction: Group A hemolytic streptococcal infections have a worldwide distribution among children and it poses an important health problem globally. Group A streptococcal (GAS) serology is used for the diagnosis of post-streptococcal diseases, such as acute rheumatic fever, post-streptococcal Glomerulonephritis and occasionally for the diagnosis of streptococcal pharyngitis. Upper normal limits for streptococcal serology should be determined for individual populations because of differences in the epidemiology of GAS between populations. Material & Methods: Study materials were divided in 3 groups. Group-A (normal children population), group- B (children clinically diagnosed as acute bacterial sore throat) and group-C (children clinically diagnosed rheumatic fever). ASO titer & throat culture were assessed in all three groups. Result: When cut off range of ASO titer is >200 IU/ml, it is positive in 20%, 38% and 54.4% in Group A, B and C respectively. But When titer range increased to >400 IU/ml, it was positive in 40 %, 36.84% and 44.44% cases from Group A, B & C respectively. Conclusion: Cut off point of 200 IU/ml has limitations in our setup. Use of western cut off 200 IU/ml needs to be revised in relation to local epidemiology to get less false positive results.

Case of streptococcal toxic shock syndrome caused by rapidly progressive group A hemolytic streptococcal infection during postoperative chemotherapy for cervical cancer

Streptococcal toxic shock syndrome (STSS) is a severe infectious disease caused by group A hemolytic streptococcus (Streptococcus pyogenes). This condition is a serious disease that involves rapidly progressive septic shock. We experienced a case of STSS caused by primary peritonitis during treatment with paclitaxel and cisplatin (TP therapy) as postoperative chemotherapy for cervical cancer. STSS mostly develops after extremity pain, but initial influenza-like symptoms of fever, chill, myalgia and gastrointestinal symptoms may also occur. TP therapy is used to treat many cancers, including gynecological cancer, but may cause adverse reactions of neuropathy and nephrotoxicity and sometimes fever, arthralgia, myalgia, abdominal pain and general malaise. The case reported here indicates that development of STSS can be delayed after chemotherapy and that primary STSS symptoms may be overlooked because they may be viewed as adverse reactions to chemotherapy. To our knowledge, this is the first report of a case of STSS during chemotherapy.

Acute Cerebellitis Following Hemolytic Streptococcal Infection

Acute cerebellitis is a rare inflammatory syndrome in children, with either infectious or autoimmune etiologies. We describe a 7-year-old girl with a presentation of cerebellitis following group A streptococcal infection. Magnetic resonance imaging showed diffuse symmetrical swelling and edema of the cerebellum resulting in compression of the fourth ventricle and hydrocephalus. Autoantibodies against glutamate receptor δ2 were detected in the cerebrospinal fluid, suggesting that the cerebellum might be injured by postinfectious immunologic reaction. The most common causes of cerebellitis are acute viral infection, postinfection, and following vaccination. No examples of acute cerebellitis following group A streptococcal infection have been documented. Our report demonstrates that group A streptococcal can lead to acute cerebellitis.

Implementation of a cost-effective strategy to prevent neonatal early-onset group B haemolytic streptococcus disease in the Netherlands

BackgroundEarly-onset Group B haemolytic streptococcus infection (EOGBS) is an important cause of neonatal morbidity and mortality in the first week of life. Primary prevention of EOGBS is possible with intra-partum antibiotic prophylaxis (IAP.) Different prevention strategies are used internationally based on identifying pregnant women at risk, either by screening for GBS colonisation and/or by identifying risk factors for EOGBS in pregnancy or labour. A theoretical cost-effectiveness study has shown that a strategy with IAP based on five risk factors (risk-based strategy) or based on a positive screening test in combination with one or more risk factors (combination strategy) was the most cost-effective approach in the Netherlands. IAP for all pregnant women with a positive culture in pregnancy (screening strategy) and treatment in line with the current Dutch guideline (IAP after establishing a positive culture in case of pre-labour rupture of membranes or preterm birth and immediate IAP in case of intra-partum fever, previous sibling with EOGBS or GBS bacteriuria), were not cost-effective. Cost-effectiveness was based on the assumption of 100% adherence to each strategy. However, adherence in daily practice will be lower and therefore have an effect on cost-effectiveness.Method/DesignThe aims are to: a.) implement the current Dutch guideline, the risk-based strategy and the combination strategy in three pilot regions and b.) study the effects of these strategies in daily practice. Regions where all the care providers in maternity care implement the allocated strategy will be randomised. Before the introduction of the strategy, there will be a pre-test (use of the current guideline) involving 105 pregnant women per region. This will be followed by a post-test (use of the allocated strategy) involving 315 women per region. The outcome measures are: 1.) adherence to the specific prevention strategy and the determinants of adherence among care providers and pregnant women, 2.) outcomes in pregnant women and their babies and 3.) the costs of each strategy in relation to the effects.DiscussionThis study will provide recommendations for the implementation of the most cost-effective prevention strategy for EOGBS in the Netherlands on the basis of feasibility in daily practice.Trial registrationDutch Trial Register, NTR3965

Study on the Prevalence of Beta Haemolytic Streptococcus Among School Children

Introduction: Βeta haemolytic streptococcal infections have a worldwide distribution among children and it poses an important health problem globally. So, a five months study was conducted to know the prevalence of beta haemolytic streptococci (BHS) in the throat of school children. Materials and Methods: Throat swabs from 200 school children of Kirtipur were collected, transported to the laboratory and were processed for BHS following standard microbiological procedures. Group A Streptococci (GAS) were identified by beta haemolytic colonies, bacitracin sensitivity and catalase negativity test. ASO test was also performed from serum samples. Result: Altogether 18 (9%) BHS isolates were identified from 200 samples, out of which 11 (5.5%) isolates were from males and 7 (3.5%) were from females. Among the 18 BHS isolates, 10 were identified as GAS isolates. The number of GAS presented only 5% of total sample. There was no significant sex difference in colonization of GAS (p> 0.05). Majority of cases were asymptomatic. All GABHS isolates were sensitive to Penicillin. In Serological examination, i.e. Antistreptolysin O (ASO) titre, all serum samples showed less than 200 IU ASO titre. Conclusion: This result highlights the current situation of GABHS throat infection in school children of Kirtipur. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7004 J Nepal Paediatr Soc. 2013;33(1):45-47

Incidence of Childhood Acute Rheumatic Fever in Malatya Region

Aim: Acute rheumatic fever is a multisystemic disease related to an immun reaction against group A beta hemolytic streptococcus infection, may recur and the social and economic status of the host affects its morbidity and mortality.Acute rheumatic fever is the most common cause of acquired heart disease in children and young adults in the developing countries.There are only a few limited studies in Turkey for incidence of rheumatic fever.

Rheumatic Fever and Post-Group A Streptococcal Arthritis in Children

There are several diseases associated with group A beta hemolytic streptococcal infection; the two most common are acute rheumatic fever (ARF) and poststreptococcal reactive arthritis (PsRA). Epidemiological and clinical data for both diseases are described, as well as current recommendations for treatment and prevention. There is an ongoing debate as to whether these two are different diseases or are parts of the spectrum of the same disease. There are some reports of carditis developing after PsRA, suggesting that PsRA may be part of the spectrum of ARF. However, since there are substantial clinical, immunological, and genetic differences between PsRA and ARF, we believe PsRA to be a distinct entity.

Rheumatic fever in Ireland: the role of Dr Monica Lea Wilson (1889–1971)

In 1869 William Stokes pointed out that the severity of rheumatic fever in Dublin had declined over recent decades. Similar worldwide decline led to the closure of many internationally famous rheumatic fever centres. The discovery by Robert Collis that rheumatic fever was a sequel to haemolytic streptococcal infection and the subsequent discovery of penicillin accelerated the decline. St Gabriel's Hospital in Dublin opened in 1951 under the clinical direction of Dr Monica Lea Wilson. Contrary to contemporary medical opinion a regimen of very prolonged bed rest was enforced. From 1961 the family doctors became concerned at the adverse psychological effects of the unnecessarily prolonged hospital stay. Twenty-seven of the 56 inpatients were re-assessed. None of them showed any evidence of active rheumatic fever and their parents took them home. The hospital closed in 1968. Dr Lea Wilson distanced herself from mainstream medicine and she is best remembered for having presented an unrecognized Caravaggio painting to the Jesuit Order in recognition of their pastoral support at the time of the controversial assassination in 1920 of her husband Percival, an Inspector in the Royal Irish Constabulary.

Acute Otitis Media in Children with and without Group A ^|^beta;-hemolytic Streptococcal Infection

Acute Otitis Media in Children with and without Group A ^|^beta;-hemolytic Streptococcal Infection