Streptococcal Illness Research Articles

Early-onset neonatal sepsis due to Streptococcus Pneumoniae: A rare causative organism in neonates

Streptococcus pneumoniae (pneumococcus) is a common respiratory tract pathogen in children causing otitis media, sinusitis, bacteremia, and meningitis. Although comparatively rare, this pathogen can also cause early-onset neonatal sepsis (EONS) as well as late-onset neonatal sepsis and can mimic Group B streptococcal sepsis-like illness in neonates. S. pneumoniae can be transmitted vertically from maternal vaginal tract colonization or from the placenta through hematogenous spread. Two consecutive case reports of EONS are reported. Vaccination of the mother with pneumococcal polysaccharide vaccine during the third trimester may provide protection to infants by enhancing the transplacental transfer of active immunoglobulin (IgG) to the fetus, as well as improving the availability of secretory antibodies for the fetus through mother's milk. Immunization of the mother may also prevent genital colonization through resulting high levels of IgG plus mucosal CD17 lymphocytes.

An Outbreak of Group A Streptococcus Invasive Infections among Pediatric Patients in Columbus, Ohio

BackgroundA cluster of invasive disease caused by group A Streptococcus (GAS) was detected among children admitted to Nationwide Children’s Hospital (NCH) in Columbus, Ohio. Clinical characteristics and molecular epidemiology of this cluster were studied to find out whether the observed cases were caused by closely related GAS strains.MethodsPatient electronic medical records were reviewed for demographic, epidemiologic and clinical data. Cases were defined as patients with GAS isolated from a normally sterile site, or from a non-sterile site in combination with clinical signs of severe streptococcal illness. Susceptibility testing (E-test), analysis of the GAS emm types, multilocus sequence typing (MLST) and pulse field gel electrophoresis (PFGE) from isolates were performed.ResultsThirteen children were admitted to NCH with invasive GAS disease between February 19 and March 23, 2017, from seven different Ohio counties (total population of approximately 1.8 million). The spectrum of illness was broad, including STSS (3 patients), GAS sepsis (3), orbital cellulitis with epidural abscess (3), bacteremia and subdural empyema (2), peritonsillar abscess (1), and septic arthritis (1). One patient with STSS died. Only two patients had chronic illnesses. One patient was diagnosed with acute myeloid leukemia on admission. Median age was eight years (range 0.1–16 years). Of six patients with STSS and sepsis only one received clindamycin and four were given IVIG. Hypocalcemia (67%) was common. Isolates from 12 patients were available for emm gene analysis and belonged to nine different emm types: 1, 2, 3, 6, 12, 22, 89, 118, 227. Two emm 1 and one emm 227 isolates had the same PFGE pattern. All isolates were susceptible to macrolides.ConclusionIn a population of 1.8 million, 13 pediatric patients with invasive GAS disease during a five-week period represented an apparent outbreak with polyclonal GAS isolates. There was no reported epidemiologic association among the patients and the outbreak was not preventable. A proposed 30-valent M-protein vaccine would have provided protection against 93% of outbreak isolates.Disclosures A. Leber, BioFIre Diagnostics: Research Contractor and Scientific Advisor, Research support, Speaker honorarium and Travel expenses

Staphylococcal and Streptococcal Superantigen Exotoxins

SUMMARY This review begins with a discussion of the large family of Staphylococcus aureus and beta-hemolytic streptococcal pyrogenic toxin T lymphocyte superantigens from structural and immunobiological perspectives. With this as background, the review then discusses the major known and possible human disease associations with superantigens, including associations with toxic shock syndromes, atopic dermatitis, pneumonia, infective endocarditis, and autoimmune sequelae to streptococcal illnesses. Finally, the review addresses current and possible novel strategies to prevent superantigen production and passive and active immunization strategies.

Lupus nephritis following a streptococcal illness

Presentation This 15 year old boy with mild cerebral palsy (Right Hemiplegia) was referred with a history of cold and swollen hands and increasing athetoid movements of his left arm. While waiting to be seen and following a streptococcal like illness he presented to the renal team with frank haematuria, proteinuria and oedema. He had developed acute glomerulonephritis with a nephritic and nephrotic picture and a peak of Creatinine 224 umol/L. Investigations Investigations showed low C3, C4 levels and raised ANA. Renal biopsy was undertaken which showed mesangiocapillary glomerulonephritis with glomerular deposition of IgG, IgM, IgA, C3 and C1q. All these features were consistent with lupus nephritis class IV. Diagnosis of Systemic Lupus Erythematosus He fulfilled the American College of Rheumatology (ACR) criteria for a diagnosis of Systemic Lupus Erythematosus. On multisystem review, he did have Raynaud9s phenomenon and a vasculitic rash over his palms. He was generally tired and had a disturbed sleep pattern. He had mild thrombocytopenia, lymphopenia and was dsDNA positive. An MRI did not show any evidence of central venous vasculitis. The athetoid movements were attributed to the Cerebral Palsy. Treatment He was treated with pulsed intravenous Cyclophosphamide (initially two weekly and then monthly) and pulsed intravenous Methyl Prednisolone for 12 months. He was also commenced on Methotrexate which was continued after Cyclophosphamide. Other medications included Hydroxychloroquine and Aspirin. Penicillin was used at a prophylactic dose to prevent any recurrence of Streptococcal illness. The athetoid movements were treated with Carbamazepine. Progress The complement protein levels normalised over the next few months and autoantibodies disappeared, including dsDNA. Eventually, all lupus disease modifying treatment was weaned off with him remaining well for over two years. He has recently developed persistent low-grade proteinuria and mild hypertension and has been commenced on Enalapril with good effect. The renal function remains normal with a GFR>120 ml/min/1.73m 2 . Conclusion It is well recognised that infections can act as environmental triggers that induce or promote SLE. We have described a case of lupus with predominant renal involvement, presenting following a recent streptococcal illness. It is interesting to note the almost complete resolution of symptoms such as sometimes seen in drug- induced lupus.

A year in the life of the streptococcus

Introduction Mild streptococcal infections infection are extremely common, however invasive infections can lead to high mortality. Described in 1982, post streptococcal reactive arthritis (PSRA) has been reported with increasing frequency. Aim We aimed to look at the number of children presenting to a Tertiary Children9s Hospital, with serological significant streptococcal illnesses, diagnoses and antibiotic treatment of those patients. We aimed to identify the patient population with possible Rheumatological conditions, and those who were seen in Rheumatology clinic. Method We looked at the number of patients where Antistreptolysin O test (ASOT) were performed. Results > 400 were reviewed. Patient case notes were reviewed for diagnosis, antibiotics prescribed and duration of treatment. Results Department & Number of patients seen in 2009 Emergency Department 46 700 GP referral unit 4861 General medical clinic new referrals 9776 General medical clinic follow-up 39 915 Rheumatology clinic new referral 19 Rheumatology clinic follow-up 338 ASOT9s ASOT9s January 2009–December 2010=645 N patients=359 N ASOT9s >400=100 (28%) Notes reviewed=95/100 patients Diagnoses & Number of patients Urticaria 11 Tonsillitis 9 Pneumonia/empyema 8 Lymphadenopathy 8 Rheumatological (2 SoJIA, 3 JIA, 2 PSRA, 1 irritable hip) 8 Nephritis/haematuria 7 Dermatology other 7 Recurrent streptococcal illness 5 Vasculitis (HSP 4 Wegeners 1) 5 Asthma/WAVE 4 Chronic Fatigue 3 Meningitis/encephalitis 3 Kawasaki 2 Immunological (PFAFA, Autoimmune) 2 Neurological 2 Fever Unspecified 2 Gastroenterology 2 EBV 2 TB 2 UTI 1 Endocarditis 1 Osteomyelitis 1 N° patients with conditions commonly seen in Rheumatology clinics (Bold above )=25 N° patients seen in the Rheumatology clinic=12 Antibiotics 65/95 were prescribed antibiotics. Length of Antibiotic & Number of Patients 48hrs 1 Up to7 days 15 8–14 days 37 2 weeks–6 weeks 4 >6 weeks 8 Conclusions Less than 1/3 of those patients in whom ASOT9s were performed were significantly raised. 1/4 of patients with positive streptococcal serology had a rheumatological diagnosis, suggesting it is a significant trigger in rheumatological conditions. Learning points ▶Need for education on rational antibiotic policies, allowing appropriate treatment for streptococcal eradication. ▶Possible need for streptococcal screening in rheumatological patients ▶Paediatricians should consider rheumatological conditions in patients with positive results.

A year in the life of the streptococcus

IntroductionMild streptococcal infections infection are extremely common, however invasive infections can lead to high mortality. Described in 1982, post streptococcal reactive arthritis (PSRA) has been reported with increasing frequency.AimWe aimed...

PANDAS (Pediatric Autoimmune Neuropsychiatric Disease Associated with Streptococcus) in Autism?: A Case History

Pediatric Autoimmune Neuropsychiatric Disease Associated with Streptococcus is a recently described neuropsychiatric disorder in children, characterised by the onset of psychiatric symptoms accompanied by abnormal streptococcal serology in prepubertal children. A case of a young boy diagnosed with autism, with symptoms and serology previously described as consistent with this disorder but no apparent history of streptococcal illness, is discussed. In this case, colonic dysbiosis with overgrowth of streptococcal and enterococcal species is identified and the child is treated with probiotics and supplemental nutrients with good clinical response. Keyword s: PANDAS, Autism, Colonic Dysbiosis, Streptococcus, Enterococcus, Probiotics.

Management of Patients with Invasive Group A Streptococcal Illness and Their Household Contacts: Experience of Infectious Disease Consultants

Management of Patients with Invasive Group A Streptococcal Illness and Their Household Contacts: Experience of Infectious Disease Consultants

Use of pulsed-field gel electrophoresis for investigation of a cluster of invasive group a streptococcal illness—Spokane, Washington, 1999

[Centers for Disease Control and Prevention. Use of pulsed-field gel electrophoresis for investigation of a cluster of invasive group A streptococcal illness—Spokane, Washington, 1999. MMWR Morb Mortal Wkly Rep. 1999;48:681-683.]

Use of Pulsed-Field Gel Electrophoresis for Investigation of a Cluster of Invasive Group A Streptococcal Illness—Spokane, Washington, 1999

Use of Pulsed-Field Gel Electrophoresis for Investigation of a Cluster of Invasive Group A Streptococcal Illness—Spokane, Washington, 1999

Detection of streptococcal pyrogenic exotoxin genes by a nested polymerase chain reaction

Severe invasive disease associated with group A Streptococcus (GAS) has recently increased in frequency. Isolates of GAS from normally sterile sites were examined for the streptococcal pyrogenic exotoxin genes spe A, spe B and spe C to determine if they play a role in this disease. Four primers for each gene were used in a nested polymerase chain reaction (PCR) configuration. The first PCR generated fragments of 818, 1106, and 801 bp, respectively, for the extotoxin genes. The second PCR generated fragments of 500, 912 and 654 bp for the spe A, spe B and spe C genes using the fragments from the first PCR as template. Of 62 strains tested, 35 (56%) contained the spe A gene, and 17 (27%) contained the spe C gene. All GAS strains studied, regardless of disease association, contained the spe B gene. These data corroborate accumulating evidence that the genes encoding pyrogenic exotoxin types B and C are not associated with severe invasive streptococcal illness including streptococcal toxic shock-like syndrome. This PCR-based gene detection system has clinical and epidemiologic applications because of its ease of performance, non-isotope labelling, high specificity and sensitivity, and lack of requirement of purified DNA.

The throat carrier rate of group A and other beta hemolytic streptococci among patients in general practice.

In a one-year multicenter study in general practice the rate of asymptomatic throat carriage of group A beta hemolytic streptococci (GABHS) was investigated. 2,626 patients, none of whom had had sore throat or any other streptococcal illness during the preceding three months, were evaluated. The GABHS carrier rate was 2.2% with no sex or season dependent variation, and it was 10.9% in patients less than or equal to 14 years of age, 2.3% in patients between 15 and 44 years old, and 0.6% in patients greater than or equal to 45 years old. An additional 7.2% of the patients carried beta hemolytic streptococci of groups B, C, or G. For groups C and G the influence of age on carrier rates was similar to that found for GABHS. Tetracycline resistance was found in 21% of the group A strains, in 61% of the group B strains, and in 28% of the group C and group G strains.

Glomerulonephritis

The term glomerulonephritis is used to identify a group of renal disorders in which the major injury involves the glomerulus rather than the tubules, interstitial tissue, or vasculature. Primary glomerulonephritis (GN) refers to disorders that occur solely or primarily in the kidney in contrast to those associated with systemic diseases (ie secondary GN) (see Table 1).The adjective acute (acute glomerulonephritis [AGN]) defines a characteristic clinicopathologic association with distinctive features of etiology, pathology, course, and prognosis. The majority of instances of AGN appear to occur after infection, and a number of bacterial and viral infections have been etiologically incriminated (Table 2).Post streptococcal AGN (PSAGN) is the most common type. The clinical picture of AGN due to other infections may be indistinguishable from that usually associated with PSAGN. Only the absence of a prior streptococcal illness as evidenced by bacteriologic and serologic studies, and the temporal association with a viral syndrome distinguish such a patient. As the immediate and long-term prognosis of nonstreptococcal AGN is not as well known as that of PSAGN, a diligent effort should be made to identify the etiologic agent.CLINICAL CHARACTERISTICSAGN can be asymptomatic and only evident by laboratory findings. This has been the presentation in at least 50% of cases of PSAGN.

Glomerulonephritis

The term glomerulonephritis is used to identify a group of renal disorders in which the major injury involves the glomerulus rather than the tubules, interstitial tissue, or vasculature. Primary glomerulonephritis (GN) refers to disorders that occur solely or primarily in the kidney in contrast to those associated with systemic diseases (ie secondary GN) (see Table 1). The adjective acute (acute glomerulonephritis [AGN]) defines a characteristic clinicopathologic association with distinctive features of etiology, pathology, course, and prognosis. The majority of instances of AGN appear to occur after infection, and a number of bacterial and viral infections have been etiologically incriminated (Table 2). Post streptococcal AGN (PSAGN) is the most common type. The clinical picture of AGN due to other infections may be indistinguishable from that usually associated with PSAGN. Only the absence of a prior streptococcal illness as evidenced by bacteriologic and serologic studies, and the temporal association with a viral syndrome distinguish such a patient. As the immediate and long-term prognosis of nonstreptococcal AGN is not as well known as that of PSAGN, a diligent effort should be made to identify the etiologic agent. CLINICAL CHARACTERISTICS AGN can be asymptomatic and only evident by laboratory findings. This has been the presentation in at least 50% of cases of PSAGN.

Streptococcus pyogenes in the throat: a study in a small population, 1962-1975.

A general practice population of around 6700 was kept under clinical and laboratory surveillance from 1962 to 1975. Illnesses totalled 18703 in three morbidity classes: sore throat (Throats) 4451, acute febrile respiratory diseases (FRD) 4934, acute non-febrile respiratory diseases (Non-FRD) 9318. Specimens were examined for beta-haemolytic streptococci (BHS) from 37.1% of these illnesses: from Throats 33.3%, from FRD 67.8%, from Non-FRD 22.6%, and 515 specimens were collected from a miscellaneous ("Other') class consisting of healthy persons and ailments that could not have had a streptococcal component. Strains of BHS were isolated from 7448 specimens as follows: group A (Streptococcus pyogenes) 353, group C 36, group G 15, other groups 274. Group A strains were isolated from specimens at the following rates: Throats 16.7%, FRD 2.4%, Non-FRD 0.9%. Other 1.4%. The last two classes reflect the carrier rate in the general community, which must be deducted to obtain the streptococcal morbidity in the other classes. Carriers thus accounted for 6% of the strains isolated from the Throats class and for 42% of those from FRD illnesses. No consistent seasonal trend of prevalence was detected. Long-term fluctuations in prevalence over several years affected all groups and most group A serotypes. Serotyping was performed on 304 strains from 1963 to 1975. The commonest types found were T-types 4 and 12 and M-type 12. Immunity against re-infection by identical strains appeared to be fairly strong and also against heterotypic strains that shared a T-antigen, but little protection was conferred against re-infection by group A strains with no shared M- or T- antigen. R-28 antigen is considered here as a marker epidemiologically equivalent to an M-antigen. Epidemicity, as measured by a simple estimate of aggregation, appeared to be low and there were differences between and within serotypes. The infecting organism appeared to linger in the pharynx, sometimes for several months, after a streptococcal illness.

β-Hemolytic Streptococcus

In the management of β-hemolytic streptococcal illness, the use of bacteriologic methods is essential. These methods can and should be simple and inexpensive, but adequate diagnosis and follow-up depends on their use. Although many streptococcal infections other than those in the neonate may be recognized or excluded on clinical grounds, errors are commonplace. Results of a culture provide the only reasonably sure means of diagnosis within several days of the onset of illness. In the vast majority of streptococcal illnesses, the organism can be isolated in appreciable numbers. Sometimes, they are missed for a variety of reasons, including the use of antibiotics. Second, because streptococcal carriers exist, the presence of streptococci on culture does not necessarily mean that they are the causal agent. However, the finding of a strongly positive culture is of great diagnostic value and most clinicians depend on it as the best guide to proper diagnosis.

Influence of Life Events and Family Routines on Childhood Respiratory Tract Illness

Respiratory illnesses account for nearly two thirds of the total illness in a community,1 account for as much as 40% of the problems seen in a pediatric practice,2,3 and are responsible for over one third of school absences.4 Despite major advances in the microbiology of respiratory disease, why and how a child becomes ill remain poorly understood. In over half of respiratory illnesses, complete cultures fail to yield an etiologic agent.5 Conversely, 30% of a school-age population can harbor group A streptococci without developing symptoms,6 three quarters of preschool children infected with Mycoplasma pneumoniae remain asymptomatic,7 and as many as 42% of upper respiratory tract cultures from well children yield pneumococci.8 Furthermore, there is no satisfactory explanation for the observation that certain children are predisposed to more frequent or more severe respiratory illnesses.9 The limited ability of microbiologic data to account for clinical experience has increased interest in studying the influence of social factors upon childhood disease. The family is undoubtedly the most important social context in which illness occurs, and many studies have documented the link between pediatric disease and family dynamics.10-18 Meyer and Haggerty reported a strong relationship between patterns of streptococcal illness and the degree of chronic family stress.19 Another group of observers found an accumulation of major family life events in the year preceding general pediatric hospitalizations.20 Others have demonstrated the prevalence of psychosocial problems in the families of children with repeated accidents and ingestions of poisons.21,22 There has, however, been little study of the general relationship between social environment and respiratory illness in children.

Identification and Treatment of Group A Beta-Hemolytic Streptococcal Infections: Role of the Pediatrician and the Nurse-Practitioner

The risk of rheumatic fever in childhood continues to be high in the United States, especially where crowded living conditions promote epidemic spread of streptococcal pharyngitis. Early identification and appropriate penicillin therapy shorten the acute streptococcal illness and greatly reduce the occurrence of sequelae. Florid disease usually presents no therapeutic dilemma, but a firm scientific basis for definitive diagnosis and treatment of the carrier state, inapparent infection, mild clinical disease, or relapse is lacking. Appreciation of these unresolved issues is helpful in developing practical therapeutic guidelines for physicians and assistants. Public health throat culture programs may provide the initiative for effective community streptococcal control, but centralization of facilities on a large scale may delay institution of therapy because of slow reporting of culture results. Although delay in treatment may engender increased risk of rheumatic fever, institution of appropriate penicillin therapy may prevent rheumatic fever even if started after an untreated streptococcal tonsillitis has run its usual 5 day symptomatic course. Throat cultures are necessary in diagnosis, but clinical judgment must be exercised in initiating penicillin therapy before the culture is reported. The relative morbidity and ultimate mortality of the sequelae to streptococcal disease suggest assignment of national health priority to the development of preventive programs. Utilization of nurse-practitioners or similarly trained medical assistants seems necessary to effective delivery of care in the crowded areas of highest rheumatic fever incidence.

β-Hemolytic Streptococcal Infection

THIS study was designed to determine whether lincomycin hydrochloride monohydrate is superior to penicillin G potassium in treating recurrent streptococcal illnesses or the streptococcal carrier state or both. In our first study on the comparative effectiveness of lincomycin and penicillin against β-hemolytic streptococci, we showed that the treatment of these infections with lincomycin resulted in fewer bacteriologic recurrences than was the case when penicillin was used. To our surprise no of β-hemolytic streptococci occurred among 100 children treated with lincomycin whereas 12 occurred among 102 children treated with penicillin. 1 The experience of Martin F. Randolph, MD, and Raymond M. L. De Haan, MD (unpublished data) with lincomycin was similar to ours in that carriers were only infrequently found after lincomycin treatment of the initial streptococcal illness. This suggested that lincomycin might therefore be more effective than penicillin in one of the most common therapeutic problems faced by the

Throat Culture Processing

To the Editor:— I have followed with interest the letters by Drs. Mondzac and Tubbs ( 201 :781, 1967) concerning throat culture processing in the office, and I cannot help feeling that we are not taking advantage of methods which have recently proved to be preferable for mass screening for streptococcal illness to those described. I refer to fluorescent antibody screening for group A β-hemolytic streptococci infections offered on a city-wide or state-wide basis. The article by Jackson et al ( 197 :385, 1966) details the method of identifying streptococcal pharyngitis in rural practice as currently used in Colorado. This is an inexpensive and perfectly feasible way of providing culture benefits to all doctors. It does not require the private physician to operate his own laboratory at prohibitive expense, nor does it require that he attempt to screen his patients by means of vest pocket cultures. After the Colorado experience was published,