Streptococcal Test Research Articles

421. Acute Rheumatic Fever at a US Children's Hospital During a Period of Fluctuating Group A Streptococcus Incidence

Abstract Background Several centers have reported shifts in the incidence of invasive Group A Streptococcus (GAS) in children with a decline in the early SARS-CoV 2 pandemic followed by a surge in disease in 2022-2023. Acute rheumatic fever (ARF) is a well-known complication of GAS pharyngitis with low incidence in North America. We reviewed cases of ARF at a tertiary US children’s hospital during a period of changing GAS activity. Methods Cases of ARF from Jan 2018-Mar 2024 at Texas Children’s Hospital (TCH) were identified using ICD10 codes. Cases with initial diagnosis of ARF at an outside institution were excluded. Hospital admissions data were used to estimate ARF incidence. We also reviewed all culture positive infections captured by an active GAS surveillance study at TCH. This was supplemented by enumeration of positive GAS antigen tests across the TCH system (3 hospitals, 12 urgent cares and 51 primary care offices). Temporal trends in GAS disease were examined. Quarterly Trends in ARF and Throat Streptococcal Antigen Positivity Positive streptococcal antigen testing represents that across the entire Texas Children's Hospital system including inpatient, outpatient, emergency room and urgent care encounters. Results 1,839 culture positive GAS infections and 803 culture positive GAS pharyngitis were identified. 210,104 throat streptococcal antigen tests were positive in the study period. Significant shifts occurred in GAS culture and rapid antigen test positivity during the study period with a decline in 2020-2021 (p=0.003 and p=0.006, respectively), followed by an increase in cases in the subsequent years (p=0.01 and p=0.03). During the study period, seven cases of ARF were identified. No cases occurred during the interval from 2020-2022 followed by five cases (71.4%) in 2023-Q1 2024 (Figure 1), mirroring overall trends in GAS (Figures 2-3). The median age of ARF cases was 8.3 years. All cases were associated with carditis (Figure 4), mostly commonly involving the mitral valve. All cases in 2023-2024 had severe, symptomatic mitral regurgitation. Two subjects required cardiac surgery. Three subjects had chorea. Culture positive pharyngitis cases are those captured by the GAS surveillance study at Texas Children's Hospital. All culture positive pharyngitis cases were reviewed to confirm diagnosis. Conclusion While ARF remains an uncommon diagnosis in North American populations, we observed a cluster of severe ARF in late 2023-early 2024 coinciding with an increase in GAS pharyngitis. Although the overall risk remains small, clinicians should remain vigilant for this complication particularly during the global increase in GAS activity. Additional work utilizing multicenter data sets are needed to further assess these findings. Disclosures Jonathon C. McNeil, MD, Nabriva: site investigator on clinical trial Anthony R. Flores, MD, MPH, PhD, GlycosBio, Inc: Grant/Research Support

Patterns of Viral Pathogens Causing Upper Respiratory Tract Infections in Children Under 13 Years Old: A Retrospective Analysis

Background: Respiratory viral infections strain healthcare globally, accounting for 15% of encounters in the UAE. However, seasonal prevalence in the region remains unclear. This hospitalbased study aims to understand viral causes of upper respiratory tract infections (URTIs) in children under 13, focusing on influenza and RSV. Methods: We conducted a retrospective chart review at Hatta Hospital in Dubai, collecting data from pediatric patients under 13 years old with URTI diagnoses from 2022 to 2023. Nasopharyngeal aspirate samples were analyzed using a multiplex chain reaction (mPCR) assay to identify viral pathogens. Data were collected from the hospital’s emergency department, walk-in clinic, and admitted patients. Results: During the study period, 2714 samples were analyzed, with 1870 (69%) testing positive for any respiratory pathogen. Most infected individuals were males (56.7%), aged between 1 and 3 years (37.9%). Single viral infections were predominant (85.3%), with 27.3% attributed to Human Enterovirus/Rhinovirus, 26.6% to Influenza A, and 10.2% to respiratory syncytial virus (RSV). The RSV season was observed to span from August to December, peaking in October, while Influenza A had semi-seasonal peaks in June and October. Hospital admissions varied significantly between single (21%) and multiple viral infections (27%). Of 340 children hospitalized with single viral infections, 28.2% were infected with Human Enterovirus/Rhinovirus, 16.7% with RSV, and 13.5% with Influenza A. Conclusion: The study provides insights into viral epidemiology among children in the UAE, highlighting the high prevalence and seasonal peaks of viral pathogens. Awareness of these trends can reduce unnecessary streptococcal testing and antibiotic overuse. Understanding the seasonal patterns aids in optimizing prophylactic measures and vaccination strategies for RSV and influenza, benefiting high-risk infants and children.

Use of McIsaac Scoring and Rapid Streptococcal Antigen Detection Test for Diagnosis of Group A Streptococcal Pharyngitis in Children

Use of McIsaac Scoring and Rapid Streptococcal Antigen Detection Test for Diagnosis of Group A Streptococcal Pharyngitis in Children

Comparison Between the Effect of Lincomycin and Azithromycin on Streptococcal Pharyngitis

Acute follicular tonsillitis is a common disorder that affects mainly pediatric and teenage age groups. Although it is highly curable, there are still many complications (like rheumatoid arthritis, valvular heart disease, middle ear infection, meningeal infection, and sinusitis) that make this infection in group A streptococci (G.A.S.) require proper and fast treatment. Azithromycin macrolide antibiotics have been used for a long time as a substitute for lincomycin antibiotics, whereas penicillins were shown to be allergic for some patients. Aim of the study: to assess the potency of either azithromycin or lincomycin on G.A.S. pharyngitis Patients and method: 84 patients with acute pharyngeal infection with G.A.S. were enrolled in this study and divided randomly into two equal groups. Group A received azithromycin, and group B received lincomycin. Both groups received their treatment for 5 days, after which rapid strep test (RST), leucocyte count WBC, and C-reactive protein (CRP) were done and compared to the 1st day of identification. Statistical analysis was done to evaluate the statistical significance of tested drugs. Results: Overall, the results demonstrate that lincomycin has a higher rate of curing G.A.S. tonsillitis than azithromycin, making it a preferred antibiotic agent.

6472 Methimazole Induced Agranulocytosis: Uncommon Complication of a Common Medication

Abstract Disclosure: R. Kaur: None. L. Kaur: None. A. Sridhar: None. T. Chaudhary: None. N. Patel: None. Methimazole (MMI) induced agranulocytosis is a rare and life threatening adverse effect that usually occurs within 3 months of drug initiation and can rapidly lead to overwhelming infection. It is reported in 0.1 to 0.5 % of patients on treatment with methimazole. MMI is a standard drug used in graves disease and toxic multinodular goiter. We report a case of MMI induced agranulocytosis in an elderly female with recently diagnosed toxic multinodular goiter. A 66 year old female with past medical history of recently diagnosed toxic multinodular goiter for which she was started on methimazole 80mg/day two months ago presented to the emergency department with chief complaint of severe sore throat associated with rapidly increasing pharyngeal pain and fever over the past 24 hours. She was lethargic, febrile with temperature of 102 F, tachycardic with heart rate of 115/minute and hypotensive with blood pressure of 108/64 mm Hg. Physical examination revealed diffuse pharyngeal and tonsillar erythema with bilateral purulent exudate with tender anterior cervical lymphadenopathy. Thyroid was enlarged, firm, irregular and nontender. Pulmonary, cardiac and abdominal exam was unremarkable. Lab work showed severe leukopenia with WBC count of 1,600/mm3, neutropenia with absolute neutrophil count of 0.0 x 1000/ul (normal range 1.8-7.3 x 1000/ul) and erythrocyte sedimentation rate and C reactive protein were both elevated. Blood cultures and fungal cultures showed no growth. Urinalysis and urine culture were both unremarkable. She had an extensive haematological, rheumatological and infectious disease workup for neutropenia, which was largely unrevealing. Rapid streptococcal testing was negative but throat cultures grew beta haemolytic streptococci. Treatment included suspending methimazole, administering antimicrobial therapy with piperacillin - tazobactam, acyclovir and fluconazole. She was also started on a granulocyte colony stimulating factor. Patient presented satisfactory evolution with progressive increase in leukocyte count and remission of symptoms by day 5 of treatment, rendering further bone marrow testing unnecessary. Antibiotics were changed to oral amoxicillin-clavulanic acid after throat culture results were available and the patient was discharged in stable condition. One month after discharge she underwent total thyroidectomy for definitive cure and is currently followed up as an outpatient by endocrinology. The objective of this case report is to present an uncommon case of agranulocytosis secondary to use of methimazole and to increase awareness among the physicians about the need to consider this diagnosis in patients on this medication. It is also advised that these patients be educated about the drugs side effects, a practice that may avert suffering and unnecessary costs. Presentation: 6/3/2024

Frequency of Group A Streptococcus Infection and Analysis of Antibiotic Use in Patients with Pharyngitis-A Retrospective, Multicenter Study.

Streptococcus pyogenes is responsible for 20-30% of pharyngitis in children and 5-15% in adults. The ineffective treatment of group A Streptococcus (GAS) infections can result in postinfectious sequelae. This study aims to evaluate the frequency of GAS pharyngitis and assess the management of patients with pharyngitis and antibiotic use. We conducted a multicenter, retrospective analysis of medical records from nine primary care centers in Poland. The study enrolled 1949 medical records of patients (children 67.4%, adults 32.6%). An infection of Streptococcus pyogenes, based on a rapid strep test, was diagnosed in 830 patients (42.6%). In the comprehensive study group of 1949 patients, 1054 (54.1%) were given antibiotics. Notably, 224 patients had a negative rapid strep test result but still received antibiotic treatment, underscoring the complexity of treatment decisions. The most commonly used antibiotics were oral penicillin V in 431 cases (41%) and amoxicillin in 219 cases (20.8%). We observed no significant difference between positive rapid strep test results and patients' sociodemographic data and comorbidities. The prevalence of GAS was 42.6% in the analyzed records of patients with pharyngitis, and 54.1% were prescribed antibiotics. Antibiotics were overprescribed for sore throats. Strategies are needed to promote rational antibiotic use.

Childhood Opportunity Index and Low-Value Care in Children's Hospitals.

Few studies have explored the relationship between social drivers of health and pediatric low-value care (LVC). We assessed the relationship between Childhood Opportunity Index (COI) 2.0 and LVC in children's hospitals. We applied the Pediatric Health Information System LVC Calculator to emergency and inpatient encounters from July 2021 through June 2022. Proportions with LVC in highest (greatest opportunity) and lowest COI quintiles were compared. Generalized estimating equation logistic regression models were used to analyze LVC trends across COI quintiles. 842 463 encounters were eligible for 20 LVC measures. Across all measures, odds of LVC increased across increasing COI quintiles (adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.08). For 12 measures, LVC was proportionally more common in highest versus lowest COI quintile, whereas the reverse was true for 4. Regression modeling revealed increasing LVC as COI increased across all quintiles for 10 measures; gastric acid suppression for infants had the strongest association (OR 1.22, 95% CI 1.17-1.27). Three measures revealed decreasing LVC across increasing COI quintiles; Group A streptococcal testing among children <3 years revealed the lowest OR (0.85, 95% CI 0.73-0.99). The absolute volume of LVC delivered was greatest among low COI quintiles for most measures. Likelihood of LVC increased across COI quintiles for 10 of 20 measures, whereas 3 measures revealed reverse trends. High volumes of LVC across quintiles support a need for broad de-implementation efforts; measures with greater impact on children with lower opportunity warrant prioritized efforts.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) in a two-year-old

Streptococcal pharyngitis testing and treatment is not routinely recommended in children under the age of 3 because of the unlikely occurrence of infection and negligible risk of serious complications. However, streptococcal pharyngitis and its resulting complications are not uncommon in this age group and can have serious consequences. We report a case of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections in a 2-year-old with streptococcal pharyngitis. Testing and treatment for streptococcal pharyngitis should be strongly considered when there is evidence of infection and/or an immune-mediated streptococcal complication to prevent and/or decrease the severity of short- and longterm complications.

Appropriateness of Use of Streptococcal Pharyngitis Testing and Associated Antibiotic Prescribing in the Urgent Care Setting.

The primary objective was to evaluate Group A streptococcal (GAS) tests performed with a Modified Centor Criteria (MCC) Score < 3 at Urgent Care Clinics (UCC). Secondary objectives included evaluating the MCC sensitivity and specificity, antibiotics prescribed with an MCC score < 3, and association between palatal petechiae and GAS pharyngitis infections. This was a retrospective review from July 1, 2018, to June 30, 2019, of Rapid Antigen Detection Tests (RADTs) on patients with ICD codes associated with pharyngitis. Fifteen hundred patient charts were reviewed. The majority of MCC scores were < 3 at 60.0% (878/1464). Sensitivity of GAS testing (RADT/culture) slightly increased for MCC scores ≥ 3 and was better than the specificity of those scores. In comparison, MCC scores < 3, showed better specificity compared to sensitivity. Over 50% of RADTs performed were inappropriate per clinical guidelines. MCC score < 3 had higher rates of negative test results.

Point-of-care testing and antibiotics prescribing in out-of-hours general practice: a register-based study in Denmark

BackgroundPoint-of-care testing may reduce diagnostic uncertainty in case of suspicion of bacterial infection, thereby contributing to prudent antibiotic prescribing. We aimed to study variations in the use of point-of-care tests (C-reactive protein test, rapid streptococcal antigen detection test, and urine dipstick) among general practitioners (GPs) and the potential association between point-of-care testing and antibiotic prescribing in out-of-hours general practice.MethodsWe conducted a population-based observational register-based study, based on patient contacts with out-of-hours general practice in the Central Denmark Region in 2014–2017. The tendency of GPs to use point-of-care testing was calculated, and the association between the use of point-of-care testing and antibiotic prescribing was evaluated with the use of binomial regression.ResultsOut-of-hours general practice conducted 794,220 clinic consultations from 2014 to 2017, of which 16.1% resulted in an antibiotic prescription. The GP variation in the use of point-of-care testing was largest for C-reactive protein tests, with an observed variation (p90/p10 ratio) of 3.0; this means that the GPs in the 90th percentile used C-reactive protein tests three times as often as the GPs in the 10th percentile. The observed variation was 2.1 for rapid streptococcal antigen detection tests and 1.9 for urine dipsticks. The GPs who tended to use more point-of-care tests prescribed significantly more antibiotics than the GPs who tended to use fewer point-of-care tests. The GPs in the upper quintile of the tendency to use C-reactive protein test prescribed 22% more antibiotics than the GPs in the lowest quintile (21% for rapid streptococcal antigen detection tests and 8% for urine dipsticks). Up through the quintiles, this effect exhibited a positive linear dose–response correlation.ConclusionThe GPs varied in use of point-of-care testing. The GPs who tended to perform more point-of-care testing prescribed more antibiotics compared with the GPs who tended to perform fewer of these tests.

Streptococcus agalactiae Associated with "Dark Body" Disease on Snakeskin Gourami Farmed in the Mekong Delta, Vietnam

Streptococcosis, due to Streptococcus agalactiae, has become a serious challenge for aquaculture around the world. Therefore, the main purpose of this work was to confirm the etiological agent that caused "dark body" disease in snakeskin gourami (Trichogaster pectoralis) cultured in the Mekong Delta, Vietnam. Infected fish displayed clinical signs, including anorexia, lethargic swimming on the water surface, corneal opacity, and hemorrhage in the base of the fin. Remarkably, abnormal black coloration on the body and serious hemorrhage at the base of the pectoral fin, and on the body were found in infected fish. In total, 75 bacterial strains were isolated from different diseased fish farms. Based on morphological and physiological characteristics, the API 20 Strep test, and 16S rRNA sequence analysis, the result illustrated that the bacterial isolates were identified as S. agalactiae. Additionally, antibiotic sensitivity testing revealed that all the S. agalactiae isolates were sensitive to amoxicillin, rifampicin, clarithromycin, erythromycin, doxycycline, cephalexin, novobiocin, and sulfamethoxazole-trimethoprim. Interestingly, S. agalactiae strains were only resistant to gentamycin in this study. Two strains, SRT41 and SRT43, carried out an experimental challenge with concentrations from 104 to 107 CFU/ml in healthy snakeskin gourami, and the LD50 values of the isolates, SRĐT41 and SRĐT43, were determined to be 2.15 × 105 and 3.59 × 103 CFU/ml, respectively, after 7 days. To our knowledge, this is the first report of S. agalactiae derived from intensively cultured snakeskin gourami in the Mekong Delta, Vietnam.

Reducing prescribing of antibiotics for acute respiratory infections using a frontline nurse-led EHR-Integrated clinical decision support tool: protocol for a stepped wedge randomized control trial

BackgroundOverprescribing of antibiotics for acute respiratory infections (ARIs) remains a major issue in outpatient settings. Use of clinical prediction rules (CPRs) can reduce inappropriate antibiotic prescribing but they remain underutilized by physicians and advanced practice providers. A registered nurse (RN)-led model of an electronic health record-integrated CPR (iCPR) for low-acuity ARIs may be an effective alternative to address the barriers to a physician-driven model.MethodsFollowing qualitative usability testing, we will conduct a stepped-wedge practice-level cluster randomized controlled trial (RCT) examining the effect of iCPR-guided RN care for low acuity patients with ARI. The primary hypothesis to be tested is: Implementation of RN-led iCPR tools will reduce antibiotic prescribing across diverse primary care settings. Specifically, this study aims to: (1) determine the impact of iCPRs on rapid strep test and chest x-ray ordering and antibiotic prescribing rates when used by RNs; (2) examine resource use patterns and cost-effectiveness of RN visits across diverse clinical settings; (3) determine the impact of iCPR-guided care on patient satisfaction; and (4) ascertain the effect of the intervention on RN and physician burnout.DiscussionThis study represents an innovative approach to using an iCPR model led by RNs and specifically designed to address inappropriate antibiotic prescribing. This study has the potential to provide guidance on the effectiveness of delegating care of low-acuity patients with ARIs to RNs to increase use of iCPRs and reduce antibiotic overprescribing for ARIs in outpatient settings.Trial registrationClinicalTrials.gov Identifier: NCT04255303, Registered February 5 2020, https://clinicaltrials.gov/ct2/show/NCT04255303.

Faringoamigdalitis y estreptococo, ¿enemigo o colonizador?

Introduction: the main etiology of acute pharyngotonsillitis (AAT) is viral, and among the bacterial etiology, Streptococcus pyogenes is a non-negligible colonizer of the healthy pediatric population. The aim of this study is to know how the rapid streptococcal diagnostic test (RDT) is used in pediatric emergency departments in order to optimize its use, reduce the overdiagnosis of streptococcal AAP and the prescription of antibiotics. Material and methods: we collected retrospective information on the number of RDTs performed on patients seen in the Pediatric Emergency Department of a tertiary hospital, from January 2022 to January 2023 (both inclusive). Information was also collected on the number of patients who underwent more than one RDT and the time elapsed. Results: during the 13 months studied, a total of 1610 TDRs were performed (43% in &lt; 5 years). More than one TDR was performed in 89 patients (53% in &lt; 5 years) and 40% of these were performed in the first 40 days. Discussion: microbiological tests for Streptococcus pyogenes are not able to differentiate between active infection and healthy carrier state. According to the results of our study there seems to be an inadequate use of RDTs; most tests are performed in &lt; 5 years, where streptococcal etiology is less frequent and healthy carrier status predominant. This leads to overdiagnosis of FAAE, antibiotic overtreatment, occurrence of adverse effects and bacterial resistance.

Abstract 13153: Non-Rheumatic Streptococcal Myocarditis Manifesting as Acute Non-ST-Elevation Myocardial Infarction

Case presentation: A 24-year-old healthy man presented with acute, constant, non-radiating, chest pain with pleuritic quality. Three days prior, he had developed fever, sore throat, cervical lymphadenopathy, and tachycardia. Amoxicillin was given for a positive rapid streptococcal test. He was afebrile and bradycardic at 50 bpm. Lab showed leukocytosis (WBC 20,000/μL, neutrophil 80%), elevated ESR 70 mm/hr, CRP 23 mg/dL, and rising hs-cTn from 800 to 1,700 ng/L. Anti-streptolysin O and anti-DNase-B were normal. Tests for adenovirus, EBV, CMV, and other respiratory viruses were negative. Initial EKG showed sinus bradycardia with ST depression and T-wave inversion in V1-V2 and III. CXR and echo were unremarkable. He received intravenous penicillin G and indomethacin. Chest pain resolved on the following day. Repeat EKG showed resolution of bradycardia, ST depression, and T-wave inversion in V2. Indomethacin, colchicine, and amoxicillin were given upon discharge. Discussion: In contrast to acute rheumatic fever (ARF), a condition caused by molecular mimicry leading to cross-reactive humoral and cellular immune responses between cardiac and Streptococcus pyogenes antigens, the pathophysiology of non-rheumatic streptococcal myocarditis is presumably toxin-mediated. Although the revised Jones criteria were fulfilled in our patient, the temporal relationship between pharyngitis and the onset of carditis must be taken into account to distinguish these two entities. Concurrent myocarditis and pharyngitis suggest non-rheumatic streptococcal myocarditis, as opposed to a delayed presentation in ARF. Latency from pharyngitis to chest pain was reportedly around 3 days. The absence of valvular heart disease and streptococcal antibodies, such as anti-streptolysin O and anti-DNase B, are a clue to diagnosis. A recent case-series also suggested male-predominance. There has been an increase in a diagnosis of non-rheumatic streptococcal myocarditis due to a widespread use of diagnostic modalities such as MRI. Clinicians should consider this condition in a differential diagnosis of acute coronary syndrome, particularly in any young individuals with chest pain, elevated cardiac biomarkers, EKG changes, and simultaneous streptococcal pharyngitis.

HLH Secondary to Influenza

Introduction Hemophagocytic lymphohistiocytosis (HLH) is a pathological condition characterized by excessive inflammation and tissue damage resulting from an aberrant immune system response. HLH can be classified into two distinct categories: primary HLH and secondary HLH. Secondary hemophagocytic lymphohistiocytosis (HLH) is an acquired condition that can be precipitated by various infections, malignancies, or rheumatological disorders. Herein, we present a rare case of HLH secondary to influenza B infection. Case Presentation A 37-year-old who routinely vapes and smokes cannabis presented to the emergency department with subjective fevers, body pains, fatigue, productive cough, shortness of breath, nausea, non-bloody, non-bilious vomiting, and watery diarrhea for one week. He was tachypneic, tachycardic, and febrile (101.1 F). He had loud bibasilar crackles on auscultation. Hb 14.8, total WBC 2.2, platelets 170, AKI with serum creatinine 1.9, and transaminitis with AST/ALT/ALP 130/56/122 U/L were the patient's initial lab results. Rapid influenza, strep, and COVID-19 antigen tests were negative. He exhibits hypoxemia with pH 7.46, pCO2 32.5, pO2 52.1, HCO3 22.9, and FIO2 40%. Urinalysis showed nonsignificant. CRP was 8.3 mg/dL. Negative procalcitonin. chest x-ray and ct showed bilateral diffuse patchy airspace infiltration, suggesting infectious process with mild pleaural effusion. In the critical care unit, he received Antibiotics and inhaled therapy for acute hypoxic respiratory failure with severe ARDS. After deteriorating, he was intubated. The respiratory pathogen panel detected Influenza B. Blood cultures and remaining pneumonia workup were negative. The lab results suggested HLH (table 1). Autoimmune tests were negative. Oseltamivir was given for 5 days. Repeat chest x-rays showed stable pulmonary infiltrates in the right middle and lower lobes, but the patient decompensated clinically with increasing ventilator requirements and dyssynchrony despite heavy sedation, paralytics, and proning and was transferred to a different hospital for ECMO evaluation on day 12. Discussion Primary and secondary HLH: Secondary HLH is caused by infections, malignancies, or rheumatological illnesses, while primary HLH is hereditary. The mortality outcome of HLH is extremely dependent on early detection and treatment 1. Due to the rarity of this disease entity, difficult diagnostic criteria, and concern for alternate diagnoses, internists may be less aware of it. Further complicating the diagnosis is the fact that the first bone marrow biopsy may not always show hemophagocytosis 2. This is why it is important to be cognizant of this diagnosis and it's diagnostic criteria. Our patient was suspected of HLH based on HScore for reactive hemophagocytic syndrome and the newest updated HLH diagnostic criteria (5 of 8 criteria should be met) 6. EBV is the most common viral infection which can cause HLH. CMV, Parvo, HSV, and H1N1 are other infections. HLH-Influenza B connection is poorly documented 7 Only one case of HLH induced by influenza B in a healthy patient was found in literature. To our knowledge, Our 38-year-old patient is the second known case of secondary HLH secondary to Influenza B in a healthy patient. Influenza B seldom causes HLH. This connection in adulthood is poorly researched. Patients with influenza virus infections have significant intestinal apoptosis and reactive hemophagocytic activity in bone marrow, lungs, and liver3. Influenza variants reduce CD8+ T cell cytotoxicity and perforin expression, likely causing HLH syndrome 4. A study suggests that virus-associated hemophagocytic syndrome (VAHS) is a common consequence of severe 2009 influenza A (H1N1) infection and contributes to multiorgan failure and mortality. 9 (36%) of 25 severely ill patients with confirmed 2009 influenza A (H1N1) infection developed VAHS, and 8 (89%) died 5. Conclusion: We present this case to raise awareness among physicians regarding the potential occurrence of hemophagocytic lymphohistiocytosis (HLH) as a complication in adult patients who present with influenza B virus infection accompanied by fever and pancytopenia. The aim is to emphasize the importance of considering HLH as a differential diagnosis in order to facilitate timely identification and initiation of appropriate treatment for this condition.

Idiopathic UV-Induced Steven Johnson Syndrome: A Case Report

A 31 year old male presented to the emergency room with a full body rash and sores in the mouth and groin. The patient also admitted to a fever of 101 degrees Fahrenheit, sore throat, and body aches four days prior to presentation. Strep test was negative and patient was suspected for mononucleosis due to presence of a nutmeg rash. Upon examination, the patient exhibited erythema in his eyes, suggesting ocular involvement. Examination of the lips and oropharynx revealed heme crusting and erosions. The patient’s trunk displayed central scattered erythema, with photodistributed erythema on his neck and head. The patient was not currently on any medication. Previous cases have shown SJS as a result of medication or infections, however the manifestation of SJS after sun exposure is unique to the literature. This case provides valuable insights into idiopathic UV-induced SJS and the impact/importance of rapid treatment on various forms of SJS.

Development over time in point-of-care test use in Danish daytime and out-of-hours general practice: a register-based study

Objective To describe the development over time of the use of C-reactive protein (CRP) and rapid streptococcal detection test (RADT) point-of-care tests (POCT) in Danish general practice and to explore associations between patient characteristics and POCT use (i.e. CRP and RADT). Design and settings A register-based study including all general practice clinic consultations in daytime and out-of-hours (OOH) settings in Denmark between 2003 and 2018. Subjects All citizens who had at least one clinic consultation in daytime or OOH general practice within the study period. Main outcome measures We estimated the total and relative use of CRP and RADT POCTs and described the development over time. Crude and adjusted proportion ratios (PRs) were calculated to explore associations between patient characteristics and POCT use. Results Overall, the relative use of CRP POCTs increased. At OOH, a steep increase was noticed around 2012. The relative use of RADT decreased. Patient age 40–59 years and existing comorbidity were significantly associated with a higher use of CRP testing in both settings. A significantly lower use of CRP testing was found for patients with higher educational level. We found a significantly higher use of RADT testing for patients aged 0–19 years and with higher household educational level, whereas comorbidity was associated with a lower use of RADT testing. Conclusion The use of CRP POCT increased over time, whereas the use of RADT POCT decreased. Perhaps the success of implementing CRP as a tool for reducing antibiotic use has reached it limit. Future studies should focus on how and when POCT are used most optimal. Key points CRP POC tests and RADT POCTs are frequently used diagnostic tools in general practice, both in daytime and in the out-of-hours setting. There was an increased use of CRP POCTs, particularly in out-of-hours general practice, whereas the use of RADT POCTs declined between 2003 and 2018. CRP POCTs were associated with age of 40–59 years and co-morbidity, while the use of RADT was mostly associated with younger age.

Clinical case of isolation and identification of &lt;I&gt;Streptococcus equi subsp. Zooepidemicus&lt;/I&gt;

Streptococci manifest their pathogenic properties by reducing the overall resistance of the organism or individual tissues.Purpose of the work: isolation, identification and study of the biological properties of isolates isolated from the foal.A pure culture was obtained, morphological, cultural and biochemical properties were studied.For the subsequent identification of streptococci to species, two api 20 Strep test systems (BIOMERIEUX, France) were used. To determine the serological group of streptococci, a latex agglutination test was used using a kit for diagnosing streptococci of groups A, B, C, D, F, and G (OXOID, UK).Laboratory methods of diagnostics for the identification of causative agents of streptococcosis and their species differentiation have been studied. Virulent Streptococcus equi subsp. zooepidemicus caused abscesses in the area of the elbow joint of the foal. Isolation of bacterial cultures was carried out by the bacteriological method. Isolated Streptococcus equi subsp. zooepidemicus had the fermentation of a number of carbohydrates: sorbitol, there was no splitting of lactose, tregolose. Streptococcus equi subsp. zooepidemicus hydrolyzed esculin, no D-ribose fermentation was noted. However, the fermentation of carbohydrates is not a stable and clear sign, therefore it is not used for differentiation and identification of streptococci.When inoculated on blood agar with 5% sheep blood after cultivation for 24 hours at 37 0C, small gray-white colonies were found, surrounded by a wide transparent zone of beta-hemolysis. Catalase test is negative.As a result, it was found that the isolated culture belongs to the species Streptococcus equi subsp. zooepidemicus belonging to group C according to Lancefield.Modern laboratory diagnostics requires an integrated approach to identification, which includes bacteriological and serological methods - polyphase analysis. When identifying streptococci, the determination of their serological group according to Lancefield is of great importance. For this purpose, a latex agglutination reaction is convenient using a kit for diagnosing streptococci of groups A, B, C, D, F and G (OXOID, UK), coagglutination "Streptotest A, B, C, D, G" (AQUAPAST).

Throat infections and use of streptococcal antigen test and antibiotic treatment in general practice; a web-based survey

Objective The aim of this study was to investigate the use of streptococcal antigen tests and antibiotic prescription in general practice in Norway in relation to the national guidelines for sore throat. Design This study was based on a web-based survey. Setting Norwegian general practice. Subjects 4700 members of the Norwegian College of General Practice received the survey by E-mail. Main outcome measures General practitioner (GP) adherence to national guidelines. Results In total, 807 GPs responded and were included in the study. According to the guidelines, 20% and 30% of the GPs would perform unnecessary streptococcal antigen testing when presented with mild and severe infections respectively, while 52% would not perform the test at moderate infection. Phenoxymethylpenicillin was recommended by 95% of the GPs. Conclusion In this survey of self-selected GPs, we identified some non-adherence to National guidelines for streptococcal antigen testing and antibiotic prescribing. However, when antibiotic treatment was offered, the correct antibiotics were prescribed. Key points Norwegian guidelines for diagnosis and treatment of throat infections include the use of Centor criteria as a clinical tool to limit the unnecessary use of antibiotics. In this web-based survey, we investigated the use of streptococcal antigen tests and antibiotic prescription in general practice in relation to the national guidelines. •Streptococcal antigen tests were not always performed according to Norwegian guidelines, causing inappropriate antibiotic prescribing. •National guidelines were followed in the choice of antibiotics for sore throat.

RARE CASE OF SEVERE NECROTIZING PNEUMONIA DUE TO STREPTOCOCCUS PYOGENES RESULTING IN REFRACTORY HYPOXEMIA

RARE CASE OF SEVERE NECROTIZING PNEUMONIA DUE TO STREPTOCOCCUS PYOGENES RESULTING IN REFRACTORY HYPOXEMIA