Positive Culture For Group Research Articles

C-Reactive Protein in Streptococcal Pharyngitis

This study was designed to explore whether the test for C-reactive protein (CRP) is useful in differentiating bona fide streptococcal infection from the symptomatic carrier at the time of the acute visit to the physician. Serial blood samples from 157 children with symptomatic pharyngitis and a positive culture for group A streptococci were analyzed for the presence or absence of CRP. These data were compared with the patients' antibody responses to two streptococcal extracellular antigens (antistreptolysin O and antistreptococcal deoxyribonuclease B). Seventy-eight percent of patients with serologically confirmed streptococcal pharyngitis had a positive CRP test at the initial visit. Conversely, if the CRP test was negative at the acute visit, only about 25% later showed an antibody response. This latter finding held regardless of the degree of positivity of the initial culture, the presence of exudate or adenitis, or the presence of a temperature greater than 38.3 C (101 F) or coryza. These data suggest that the CRP test may be helpful to the clinician, especially if this abnormal protein is absent at the time of the acute visit.

Possible nosocomial transmission of group B streptococci in a newborn nursery

Within a six-day period in March, 1974, three infants born at a hospital in central Arkansas developed meningitis caused by group B, type III Streptococci. Three factors suggested nosocomial transmission of the organism in the nursery: (1) the three infants were born in a six-day period, (2) four weeks after their infants' births, none of the parents had positive cultures for group B streptococci, and (3) 31% of infants born in the hospital in March were colonized with group B, type III streptococci, while in April, after control measures in the nursery were instituted, only 2% of infants were colonized with this type (p less than 0.0002). Colonized infants were treated with penicillin, but follow-up cultures at two and six weeks showed that half the infants tested were still colonized. The number of personnel colonized with group B streptococci was not significantly different in personnel exposed to infants when compared with those that were not, and handwashing and environmental cultures were negative for group B streptococci. The results of this investigation give additional support to the concept that nosocomial transmission of group B streptococci can occur and may be effectively interrupted by control measures in the nursery.

Letter: Sore throats: cultures and treatment.

To the Editor.— The reply to the question on Throat Cultures in Students With 'Scratchy' Sore Throats by Evans and Stewart (226:799, 1973) contained much misinformation. One supposes the authors are giving their own personal experience, since no references are cited. The advice to withhold therapy from students with minimal symptoms and positive throat cultures is antithetical to published recommendations. Most, if not all, students of streptococcal pharyngitis have indicated that it is impossible to predict with greater than a 50% accuracy those symptomatic individuals from whom a positive culture for group A streptococci will be obtained.1-3Of even greater significance is the lack of correlation between signs and symptoms and antibody responses in those who are group A-positive. Kaplan et al2have shown that one third of all cases of pharyngitis in childhood (scratchy throats included) are associated with a positive throat culture, and between 50% and

EPIDEMIOLOGY OF A STREPTOCOCCAL OUTBREAK IN A SCHOOL: ATTEMPT AT CONTROL BY MASS PROPHYLAXIS WITH PENICILLIN V

An attempt was made to abort an epidemic of streptococcal infection in a rural school including kindergarten through third grade by the use of mass, oral penicillin V prophylaxis for 10 days. Half of the classes received 200,000 units of penicillin V once daily and the others received two doses daily. In both instances, there was a decline in the carrier rates but neither regimen was entirely satisfactory. Unusual resistance to penicillin could not be demonstrated in streptococci isolated after the treatment period. Carrier studies were conducted in 124 families of children in the school sample. Prior to the prophylaxis regimen the carrier rate for Group A streptococci was 7% for adults more than 24 years of age and 24% in their children in the school being studied. Forty families which did not have children in the school also were cultured. None of the adults more than 24 years of age in this group was found to have streptococci in contrast with 4% of adults (cultured the same day) in the school-associated families. These observations tend to support the hypothesis that the school is the focus of infection and that families with children in school have a higher rate of infection than families without children in school. However, in both groups of families the adults appeared to be relatively resistant to infection. Within the school, the focus of infection appeared to be the individual classroom rather than the grade level. Rates of positive cultures for Group A streptococci in different classrooms within the same grade ranged from 0 to 71%. Numerous isolations of Group C streptococci were made in the school population. The age distribution paralleled the age distribution of the children from whom Group A organisms were isolated. In addition, titers of antistreptolysin-O in persons from whom Group C organisms were isolated were similar to those in persons with Group A strains. It is suggested that Group C infections may have contributed to the course of the epidemic.