Beta-hemolytic Streptococcal Isolates Research Articles

Prevalence and Molecular Characterization of Macrolide Resistance in Clinical Isolates of Beta Hemolytic Streptococci from a Tertiary Care Teaching Hospital in Kerala, India

Background: Beta-hemolytic streptococci (BHS) are responsible for both invasive and noninvasive infections, and the preferred treatment for these infections is penicillin due to the distinctive characteristics of these bacteria. However, in patients who cannot tolerate β-lactam antibiotics, macrolides and clindamycin are important alternative options for treating BHS infections. This study aimed to analyse the pattern of macrolide resistance among clinical strains of beta-hemolytic streptococci (BHS).
 Methods: Beta hemolytic streptococci isolated from clinical specimens during December 2018 to May 2020 were included in this study. Identification of the isolates were done by conventional and Vitek 2 method. All isolates were subjected to serogrouping. Antibiotic susceptibility testing done by disc diffusion method. Genes encoding macrolide resistance were detected by conventional multiplex polymerase chain reaction.
 Results: A total of 129 beta hemolytic streptococcal isolates were obtained which included 27 S. pyogenes (20.9%), 77 S.agalactiae (59.7%), 23 S.dysgalactiae spp equisimilis (17.8%) and one isolate of S.anginosus and S. porcinus each (0.8%). Erythromycin, clindamycin, quinuprisitn and tetracycline resistance were found to be 20.2%, 12.1%, 16.3% and 51.2% respectively. Among the 26 erythromycin resistant isolates, 12(46.2%) were inducible clindamycin resistant phenotype. Out of 26 erythromycin resistant isolates, 7(26.9%) isolates were harbouring erm(A) gene, 10(38.5%) erm(B) and 9(34.6%) mef(A) gene.
 Conclusion: Our study highlights the importance of routine antibiotic susceptibility testing for betahaemolytic streptococci, as well as the detection of inducible resistance to prevent therapeutic failure.

Throat Swab Culture Positivity and Antibiotic Resistance Profiles in Children 2-5 Years of Age Suspected of Bacterial Tonsillitis at Hargeisa Group of Hospitals, Somaliland: A Cross-Sectional Study.

Tonsillitis is the third most frequently diagnosed infection in the pediatric age and is associated with significant morbidity and loss of school attendance. Throat swab cultures are useful for the confirmation of children with a clinically suspected tonsillitis. However, Somaliland is one of the underdeveloped countries with a low standard of sanitation and poor health seeking culture. Treatment of tonsillitis with antibiotics is irrational and not empirical. This study determined the bacterial throat swab culture positivity and antibiotic resistance profiles of the bacterial isolates among children 2-5 years of age with suspicion of tonsillitis at Hargeisa Group of Hospital, Somaliland. A cross-sectional study was conducted from March to July 2020. A total of 374 children from 2 to 5 years of age suspicion of tonsillitis was included using a convenient sampling method. Throat swabs were collected, and bacterial isolation and identification were done using standard bacteriological procedures. Antimicrobial susceptibility testing was done using the disk diffusion method. Data on demographic variables and clinical profiles were collected using structured questionnaires. Logistic regression analysis was computed to identify factors associated with bacterial tonsillitis. Overall, 120 (32.1%) (95% CI 27.4-36.8%) of children were positive for bacterial throat cultures. Of these, 23 (19.2%) were mixed bacterial isolates. The most frequent bacterial isolates were beta-hemolytic streptococci 78 (55%), Staphylococcus aureus 42 (29%), and Streptococcus pneumoniae 10 (7%). Isolates revealed 83.3-100% rate of resistance to ampicillin. Beta-hemolytic streptococci isolates were 94.9% resistant to ampicillin. S. aureus was resistant to clarithromycin (38%) while S. pneumoniae isolates were 100% resistant to ampicillin. History of tonsillitis (AOR = 0.12; 95% CI = 0.06-0.21), difficulty in swallowing (AOR = 6.99; 95% CI = 3.56-13.73), and attending schools (AOR = 2.98; 95% CI = 1.64-5.42) were found to be associated with positive throat culture. Resistance to ampicillin and MDR among beta-hemolytic streptococci and other isolates of throat colonizers in children with clinically suspected of bacterial tonsillitis are major concerns in Hargeisa, Somaliland. Therefore, treatments of cases are recommended to be guided by regular culture and antimicrobial susceptibility testing to prevent complications of tonsillitis and associated antibiotic resistance.

Prevalence and the risk factors for the carriage of beta-haemolytic streptococci among women visiting a tertiary care hospital in South India

Streptococci are gram positive cocci arranged in chains and are part of normal flora of humans and animals. The present study is carried out to determine the prevalence and risk factors for the carriage of beta-haemolytic streptococci (BHS) among women visiting Dr. VRK Women’s Teaching Hospital & Research Centre, Hyderabad. Vaginal swabs were collected from 250 patients attending outpatient department (OPD) of Dr. VRK Women’s Teaching hospital. Swabs were inoculated onto 5% sheep blood agar plates and incubated for 24 h at 37°C in a candle jar. BHS isolates were phenotypically identified by standard microbiological techniques, all the isolates presumptively identified as BHS were tested for Bacitracin susceptibility. Sensitive isolates were presumptively identified as GAS and resistant isolates were identified as non-group A BHS (NGABHS). Presumptively identified GAS & NGABHS isolates were serogrouped by Lancefield grouping using a commercially available latex agglutination test. BHS were isolated from 12.4% of samples. As many as 12 BHS isolates were identified as GAS and 19 were identified as NGABHS. Ten of nineteen were identified as group B (GBS), 4 (12.9%) were identified as group C (GCS) and 5 (16.12%) were identified as group G (GGS). Among six clinical groups, the prevalence of GAS is highest i.e. 7.5% in female patients visiting Gynaecology OPD with history of white discharge. Prevalence of NGABHS was more among post insertion (18%) IUCD group compared to pre insertion (8%) IUCD group. GBS were isolated from 7% of samples from IUCD group and 4% of samples from prostitutes.This study reports the prevalence of BHS among women visiting a tertiary care hospital in Hyderabad. This study also identified certain risk factors such as IUCD usage and working as a FSW are associated with the increased prevalence of NGABHS especially GBS.

English

BACKGROUND Pharyngotonsillitis is defined as a spectrum of conditions ranging from inflammation primarily confined to the tonsils to pharyngitis implying generalized inflammation of the whole of pharynx. Children are more prone to get several episodes of pharyngotonsillitis per year during their school years. Pharyngitis caused by Streptococcus pyogenes can cause two non-suppurative complications, acute rheumatic fever and acute glomerulonephritis which is responsible for significant morbidity and mortality. The present study was conducted to identify the prevalence of bacterial pathogens causing pharyngotonsillitis and to study their antibiotic sensitivity pattern that would indicate the optimum line of treatment. METHOD A total of 200 children at the age group of 2 - 12 years who had clinical features of pharyngotonsillitis according to the inclusion criteria were recruited for this study over a period of one year. With the help of a disposable wooden spatula, pus from the pharyngo tonsillar region was collected and processed. Predominant isolates obtained were identified and antibiotic sensitivity was done. RESULTS Bacteria was isolated from 70 samples. Pharyngotonsillitis was found most prevalent at the age group of 8 – 10 years. Intake of cold food stuffs and passive smoking at home was found to have statistically significant association as risk factor for pharyngotonsillitis. Staphylococcus aureus was the most common organism isolated followed by Streptococcus pyogenes. The other organisms isolated were group G and C streptococci, Streptococcus pneumoniae, Pseudomonas aeruginosa and Klebsiella pneumonia sub species (spp) aerogenes. CONCLUSIONS Staphylococcus aureus was the most common organism isolated, followed by Streptococcus pyogenes. All the isolates of beta haemolytic streptococci were found to be sensitive to penicillin. There was increased incidence of resistance to macrolides among the gram-positive isolates except Streptococcus pneumoniae and it may be due to the wide spread use of macrolides injudiciously. All the bacterial pharyngotonsillitis cases were cured with the antibiotic given according to the sensitivity except one case. KEYWORDS Pharyngotonsillitis, Acute Rheumatic Fever, Acute Glomerulonephritis, Bacterial Pathogens, Antibiogram

A retrospective analysis of clinical characteristics and management of perianal streptococcal dermatitis in children and adults

Due to the paucity of recent literature on perianal streptococcal disease (PSD), we performed a comprehensive analysis of clinical characteristics of PSD and its management. We conducted a retrospective search in the laboratory information system of the Institute of Microbiology and Immunology, Ljubljana, Slovenia, between January 2006 and December 2016 and identified patients with suspected PSD. We reviewed patients' medical records and obtained data on patient age and sex, concomitant illnesses, duration of complaints, signs and symptoms of PSD, epidemiological history, date of diagnosis, microbiological characteristics of beta-hemolytic streptococcal isolates, additional laboratory findings, duration and type of systemic and/or topical therapy, and recurrence of PSD. We identified 64 pediatric and eight adult PSD cases in total. The most common signs and symptoms were perianal erythema (67/72; 93.1%), anal fissures (28/72; 38.8%), itching (22/72; 30.6%), and blood-streaked stools (19/72; 26.4%). The duration of symptoms varied from < 1 week to > 1 year, with 58.3% of patients experiencing symptoms between 1 week and 6 months. The majority of patients received systemic (63/72; 87.5%) and topical (56/72; 77.8%) treatment. Although the signs and symptoms of PSD are non-specific, clinicians should be highly suspicious of the disease in adults and especially in preschool children with perianal complaints. Despite being a common disease, there is still considerable delay in correct diagnosis and treatment, prolonging the discomfort of PSD patients.

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 &amp;gt;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.

Differences in gram-positive bacterial colonization and antimicrobial resistance among children in a high income inequality setting

BackgroundStaphylococcus aureus and beta-hemolytic streptococci (BHS) diseases disproportionately affect populations in middle/low-income countries. To assess if this disparity is reflected in colonization by these organisms, we compared their colonization frequency among children from different socioeconomic status (SES) communities in a city with high income inequality.MethodsBetween May–August 2014, we collected nasal and throat swabs to investigate S. aureus and BHS colonization among children who attended private and public pediatric clinics. Patients were classified as high SES, middle/low SES, and slum residents. We investigated the antimicrobial resistance profile, the SCCmec types and the presence of PVL genes among methicillin-resistant S. aureus (MRSA). We also examined the antimicrobial resistance profile and serogroups of BHS.ResultsOf 598 children, 221 (37%) were colonized with S. aureus, of which 49 (22%) were MRSA. MRSA colonization was higher in middle/low SES (n = 18; 14%) compared with high SES (n = 17; 6%) and slum (n = 14; 8%) residents (p = 0.01). All MRSA strains were susceptible to clindamycin, nitrofurantoin, and rifampin. The highest non-susceptibility frequency (42.9%) was observed to erythromycin. SCCmec type V was only found in isolates from high SES children; types I and II were found only in middle/low SES children. Ten (20%) MRSA isolates carried PVL genes. Twenty-four (4%) children were BHS carriers. All BHS (n = 8) found in high SES children and six (67%) isolates from slum patients belonged to group A. All group B streptococci were from middle/low SES children, corresponding to five (71%) of the seven BHS isolated in this group. BHS isolates were susceptible to all drugs tested.ConclusionsChildren from different SES communities had distinct bacterial colonization profiles, including MRSA carriage. Public health officials/researchers should consider SES when assessing disease transmission and control measures.

Comparison of Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry with VITEK2 Gram Positive System for Identification of Beta Haemolytic Streptococci

Background: Matrix–assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) is known as a successful tool for bacterial identification and suitable for clinical diagnostics. The aim of our study was to evaluate diagnostic accuracy of MALDI-TOF MS system and VITEK2 Gram Positive Identification (GP ID) system for the identification of Beta Hemolytic Streptococci (BHS). Materials and Methods: A total 148 BHS which were isolated from various clinical specimens were included in the study. Isolates were identified by Bruker Biotyper 3.4 and VITEK2 GP ID coupled to the agglutination test. Identification results for Bruker Biotyper 3.4 and VITEK2 GP ID systems were classified in three different categories as follows: correct identification, low level of discrimination, no identification/misidentification. Identification results of BHS were evaluated according to these categories. Results: BHS isolates were defined as Streptococcus pyogenes (n: 69), Streptococcus agalactiae (n: 59), Streptococcus dysgalactiae serogroup C (n: 5), and Streptococcus dysgalactiae serogroup G (n: 15) according to latex agglutination assay. MALDI-TOF MS analysis of 148 BHS isolates yielded correct identification for 89.9% of S. pyogenes , 64.4% of S. agalactiae , and 95.0% S. dysagalactiae serogroup C and G; while VITEK2 GP ID gave correct identification for 62.3% of S. pyogenes , 67.8% of S. agalactiae , and 65.0% of S. dysagalactiae serogroup C and G. Conclusions: MALDI-TOF MS-based identification provides faster and more accurate identification of beta-hemolytic streptococcal species than VITEK2 GP ID system.

Incidence of macrolide\u2013lincosamide\u2013streptogramin B resistance amongst beta-haemolytic streptococci in The Gambia

BackgroundIn West Africa, penicillin, macrolide and lincosamide resistance among beta-haemolytic streptococci (BHS) isolates has rarely been described. However, such data are critical to detect and track the emergence of antibiotic resistance.MethodsBeta-haemolytic streptococci were cultured from clinical specimens from patients attending the clinic at the Medical Research Council Unit The Gambia (n = 217) and kept at −70 °C. Of these, 186 were revived and tested for penicillin susceptibility by disc diffusion and E-test methods, and the D-test for determination of constitutive and inducible macrolide–lincosamide (MLSB) resistance phenotypes.ResultsThe majority of BHS isolates from infections were group A streptococci (GAS) (126/186, 67.7%). Of these, 16% were from invasive disease (30/186). Other BHS isolated included lancefield groups B (19, 10.2%); C (9/186, 4.8%), D (3/186, 1.6%), F (5/186, 2.7%), G (16/186, 8.6%) and non-typeable (8/186, 4.3%). Prevalence of BHS isolated from blood cultures ranges from 0% (2005) to 0.5% (2010). Most (85, 45.7%) of the isolates were from wound infections. Of the 186 BHS isolates, none was resistant to penicillin and 14 (6.1%) were resistant to erythromycin. Of these, 8 (4.3%) demonstrated constitutive MLSB resistance, and 5 (2.7%) were inducible MLSB resistant. All the inducible MLSB isolates were GAS, and majority of the constitutive MLSB isolates (6/8, 75.0%) were non-GAS.ConclusionsBeta-haemolytic streptococci, predominantly GAS are associated with a wide range of infections in The Gambia. It is reassuring that macrolide and lincosamide resistance is relatively low. However, monitoring of MLSB resistance is necessary with the global spread of resistant BHS strains.

Microbiological characteristics of perianal streptococcal dermatitis: a retrospective study of 105 patients in a 10-year period.

Beta-hemolytic streptococci (BHS) are the most common causative agents of perianal streptococcal dermatitis (PSD). This study evaluates the distribution of BHS isolates in perianal bacterial cultures. We retrospectively reviewed microbiological results for perianal BHS that were isolated in our laboratory between 2006 and 2015. We identified a total of 105 BHS isolates from rectal swabs and swabs of clinically intact perianal skin. The majority of BHS were of group A (GABHS) (73/105; 69.5%), followed by group B BHS (GBBHS) (27/105; 25.7%), and non-group A or B BHS (5/105; 4.8%). The distribution of GABHS was age-specific, with the majority of GABHS obtained from young children. All BHS isolates were susceptible to penicillin. GABHS were universally susceptible to clindamycin, whereas 1.4% were resistant to erythromycin. GBBHS were resistant to erythromycin and clindamycin in 14.8% and 7.4% of cases. In addition, we wanted to emphasize the importance of correct diagnosis of PSD. Hence, we provide a review of protocols that can decrease the time to diagnosis and treatment of PSD, reduce patients' discomfort, and prevent unnecessary diagnostic procedures.

Identification of Streptococcus pyogenes - Phenotypic Tests vs Molecular Assay (spy1258PCR): A Comparative Study.

Traditionally Group A Streptococcus pyogenes (GAS) is differentiated from other beta haemolytic streptococci (BHS) by certain presumptive tests such as bacitracin sensitivity and production of Pyrollidonyl Aryl Sulfatase (PYR). The phenotypic and genotypic confirmatory tests are Lancefield grouping for cell wall carbohydrate antigen and PCR for spy1258 gene respectively. Reliance on presumptive tests alone may lead to misidentification of isolates. To compare the predictive values of routine phenotypic tests with spy1258 PCR for the identification of Streptococcus pyogenes. This comparative analytical study was carried out in the Department of Microbiology, JIPMER, Puducherry, over a period of 18 months (1(st) November 2013 to 30(th) April 2015). Two hundred and six consecutive BHS isolates from various clinical samples were subjected to phenotypic tests such as bacitracin sensitivity, PYR test and Lancefield grouping. The results were compared with spy1258 PCR which was considered 95 the confirmatory test for identification. The sensitivity and specificity of phenotypic tests were as follows; Susceptibility to bacitracin - 95.42%, 70.96%, PYR test - 95.42%, 77.41%, Lancefield grouping- 97.71%, 80.64%. Clinical laboratories should not depend on bacitracin sensitivity as a single presumptive test for the routine identification of GAS but should use supplemental tests such as PYR test or latex agglutination test and for best results use spy1258 PCR.

English

Colonization of the upper respiratory tract of children by beta-haemolytic streptococci (BHS) is imperative in spreading the infection in households and in community settings. The present study was designed to investigate the prevalence of throat carriage of diverse antigenic groups of BHS and the influence of age on carrier rates in healthy children in Calabar. Throat swabs of 450 children’s were taken randomly from some government and private elementary schools and were visually examined and collected for further investigations.. The swabs were cultured aerobically on goat blood agar. Antimicrobial sensitivity testing was carried out on all BHS isolates on Muller Hinton blood agar by using the Kirby-Bauer disc diffusion method after standardizing the inoculums with a 0.5 McFarland. A total of 18(4%) BHS pharyngeal carriers were detected. BHS belonging to four streptococcal groups were isolated, groups C, F and G. The fourth group was not identified by the available grouping kit (UIDS). Group C streptococci (GCS) had the highest percentage carriage of 5/18(27.8%). Other groups were F 3/18(16.7%), G 2/18(11.2%) and the UIDS 8/18(44.4%). Carrier rate increased as age group increased and peaked at age group 10-12 years 7(36.8%). The percentage of BHS pharyngeal carriage was higher in Government aided schools (6.7%) than in private schools (1.7%). The BHS were highly resistant to Penicillin and Ceftazidime with a resistivity rate of 94.7% while Augmentine showed the lowest resistivity rate of 15.8%. The study established a high carriage of diverse antigenic groups in the throat of children with age influencing the rate of carriage in this community. A throat carrier rate of 39% of GGS/GCS among 450 children from this population indicated the etiological importance of streptococcal pharyngitis in this population. Therefore, there is need for further studies to identify the specific serotype of the group C/G streptococci circulating in this community.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for the identification of beta-hemolytic streptococci.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has emerged as promising technology for species identification. The purpose of this investigation was to compare the performance of MS and the traditional method for identification of beta-hemolytic streptococci (BHS). Clinical BHS isolates were identified by the BD Phoenix SMIC/ID Streptococcal panels, and two MALDI-TOF MS platforms: the VITEK MS and the Bruker MALDI Biotyper systems respectively. In case of discordant results, 16sRNA sequencing was performed to provide the reference ID. A total of 96 isolates of BHS were analyzed. Thirty-six isolates (20.8%) were re-tested by BD Phoenix for identification failure; and four isolates (4.2%) were rerun on the Bruker system for low identification score. No isolate need a second run for identification by Vitek MS system. Overall, BD Phoenix, BioTyper and Vitek MS automated system accurately identified 76 strains (79.2%), 91 (94.7%) strains and 92 (95.8%) strains, respectively. Our study suggests that MALDI-TOF MS is a superior method to conventional phenotypic methods for BHS identification.

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for the identification of beta-hemolytic streptococci

Objective: Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has emerged as promising technology for species identification. The purpose of this investigation was to compare the performance of MS and the traditional method for identification of beta-hemolytic streptococci (BHS). Methods: Clinical BHS isolates were identified by the BD Phoenix SMIC/ID Streptococcal panels, and two MALDI-TOF MS platforms: the VITEK MS and the Bruker MALDI Biotyper systems respectively. In case of discordant results, 16sRNA sequencing was performed to provide the reference ID. Results: A total of 96 isolates of BHS were analyzed. Thirty-six isolates (20.8%) were re-tested by BD Phoenix for identification failure; and four isolates (4.2%) were rerun on the Bruker system for low identification score. No isolate need a second run for identification by Vitek MS system. Overall, BD Phoenix, BioTyper and Vitek MS automated system accurately identified 76 strains (79.2%), 91 (94.7%) strains and 92 (95.8%) strains, respectively. Conclusions: Our study suggests that MALDI-TOF MS is a superior method to conventional phenotypic methods for BHS identification.

Profile of fatal Streptococcal bacteraemia at a tertiary care Indian hospital

Streptococcus pyogenes causes mild to acutely life-threatening diseases. Herein, we report our experience with five cases of fatal bacteraemia due to various groups of Streptococci, three of them due to Group G Streptococcus and one case each due to Group A Streptococcus and Group F Streptococcus. The peculiarity of all these cases was the rapidity of deaths occurring in these patients despite all the strains being sensitive to Penicillin. Hence, timely intervention in all suspected cases is strongly advocated. All isolates of beta-haemolytic Streptococci should be identified up till the species level and antimicrobial susceptibility be performed so that proper and early management can be done.

Nationwide laboratory-based surveillance of invasive beta-haemolytic streptococci in Denmark from 2005 to 2011

The aim of this work was to describe national surveillance of invasive beta-haemolytic streptococci (BHS) in Denmark and to report overall trends and major findings by groups and types of BHS causing laboratory-confirmed disease from 2005 to 2011. A total of 3063 BHS isolates were received from 2872 patients. Based on confirmed cases the overall annual incidence increased from 6.2 to 8.9 per 100 000 persons between 2005 and 2011. In 2011 the incidences of group A, B, C and G streptococci were 3.1, 2.3, 0.9 and 2.6 per 100 000 persons, respectively. An increase was observed for all groups of BHS, but in particular for group G in men above 65 years of age. Among group A streptococci (GAS), five T-types (1, 28,12, 3,13,B3264 and B3264) represented 71% and five emm-types (1, 28, 3, 89 and 12) 76% of all isolates. Among group B streptococci (GBS) four types (III, Ia, V, Ib) represented 79% of the isolates. Potential coverage for future vaccines against GAS and GBS disease was 76% compared with the 26-valent GAS vaccine and 89% based on GBS serotypes Ia, Ib, II, III and V. The number of reported cases of invasive BHS disease increased in Denmark from 2005 to 2011. Nationwide laboratory-based surveillance of BHS is required to monitor epidemiological changes, explore potential outbreaks and determine potential vaccine coverage.

Outbreak of Streptococcus pyogenes emm type 58 in a high dependency unit of a level-1 trauma center of India

Background and Aims:Group A Streptococcus (GAS) can cause illnesses ranging from self-limited to severe, life-threatening, invasive infections. The objective of the following study was to investigate a suspected Streptococcus pyogenes outbreak in a high dependency unit (HDU) of our trauma center.Materials and Methods:All the isolates of beta hemolytic Streptococci were identified by standard microbiological methods, Vitek 2 system and latex agglutination tests. Antimicrobial susceptibility testing was performed as recommended by Clinical Laboratory Standards Institute. Exotoxin genes, including speA, speB, speC, speF, smeZ, ssa, speG, speH, speJ, speL, speM and speI were detected by polymerase chain reaction (PCR). The emm types of isolates of S. pyogenes were determined by sequencing the variable 5’ end of emm gene after amplification by PCR.Results:In a 28 bedded poly-trauma ward with a four bedded HDU three out of four patients developed S. pyogenes emm type 58 infection. The strain was macrolide and tetracycline resistant and produced the Streptococcal pyrogenic exotoxins speB, speC, speG, speF and smeZ. Surveillance sampling was done for investigation from patients, health-care workers and environmental samples.Conclusion:An outbreak of GAS infections was established caused by the uncommonly reported emm type 58. The outbreak was controlled by prompt treatment, intensive surveillance, feedback and training.

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&gt; 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

The prevalence of group a streptococci carriers among asymptomatic school children.

The Group A Streptococci (GAS) cause several suppurative and nonsuppurative infections. GAS frequently gets colonized in the throat of asymptomatic school children. A preliminary study was conducted to identify the GAS carrier state in apparently healthy children who belonged to various schools which were located in and around the rural village, B.G.Nagara, Mandya Dist, Karnataka state, India. Throat swabs were collected from 2000 asymptomatic school children who were aged 5-15 years. The beta haemolytic streptococci isolates were sero-grouped by agglutination tests by using specific antisera (HiStrep Latex Test, Hi-Media, Mumbai, India). Out of the 44 (2.2%) beta haemolytic which were isolated, 38 (86.36%) were GAS, 5 (11.36%) were Group C Streptococci and one (2.27%) was Group G Streptococcus. Among the 38 GAS positive children, 24 (63.16%) were transient carriers, 10(26.32%) were recurrent carriers and 4 (10.52%) were chronic carriers. The GAS chronic carriers were of the age group of 9-12 years. The present study showed the prevalence of GAS among the asymptomatic school children in this location. The chronic carriers were treated with azithromycin for 3 days. A bacteriological cure was confirmed by doing throat swab cultures at intervals of one month and four months after the treatment. Identification of the GAS carriers and treating them, not only prevents them from developing non -suppurative complications, but they also prevent the spread of GAS to their family members and other children.

Antimicrobial susceptibility pattern of beta-haemolytic group A, C and G streptococci isolated from North India

The objective of this study was to determine the antibiotic resistance amongst beta-haemolytic streptococci (BHS) from North India. A total of 155 BHS isolates, comprising group A streptococci (GAS) (102), group C streptococci (GCS) (25) and group G streptococci (GGS) (28), collected from patients with pharyngitis, rheumatic fever, skin disease and invasive disease were analysed for their antimicrobial susceptibility to 20 antibiotics using the Kirby-Bauer disc diffusion method. The MICs of penicillin, tetracycline, clarithromycin, azithromycin and erythromycin were also determined using the HiComb test, following the Clinical and Laboratory Standards Institute guidelines. The results showed that 37.4% of BHS isolates were susceptible to all antibiotics and 19.4% were highly resistant to tetracycline; however, only 2.6-5.2% were resistant to macrolides. The tetracycline resistance (P<0.05) of BHS was found to be statistically significant. GAS isolates from different sources of infection also showed statistically significant antibiotic resistance to azithromycin (P=0.029). Multi-drug resistance was found irrespective of streptococcal emm types. No association between GAS emm types and drug resistance was seen. MIC determination showed all isolates to be susceptible to the five antibiotics tested, except for two GAS and one GGS isolates that were resistant to clarithromycin, and one GAS skin isolate that was resistant to tetracycline. This study suggests that the variation in antibiotic resistance amongst BHS isolates from North India is independent of the isolation source and emm type distribution, hence emphasizing the need for a longitudinal surveillance in different regions of India.