Streptococcal Throat Infection Research Articles

Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP

ObjectiveTo investigate the effect of the covid-19 pandemic on the number of patients with group A streptococcal infections and related antibiotic prescriptions.DesignRetrospective cohort study in England using OpenSAFELY-TPP.SettingPrimary care practices...

Effect of tonsillectomy on ASO titre.

Background: Tonsillitis is one of the common clinical problems in Otolaryngology practice. Tonsillectomy is the preferable treatment for patients not responding to medical treatment. Many patients have increased Antistreptolysin O (ASO) titres which is caused by Group A Beta Haemolytic Streptococci (GABHS). Objectives: To determine the effect of tonsillectomy on ASO titre. Materials and Methods: A prospective study conducted in the Department of Otorhinolaryngology, Regional Institute of Medical Sciences, Imphal, Manipur, India for a period of 2 years from October 2014 to September 2016. 50 patients diagnosed as recurrent tonsillitis with raised ASO titre above 200 IU/ml and undergoing tonsillectomy were enrolled for the study. Results: Most of the patients were in the age group of 11-15 years with male to female ratio of 1: 1.63. One month after tonsillectomy 11 (22%) patients were negative for ASO titre. After 3 months, 6 months and 1 year follow up, patients whose ASO titre became negative were 34 (68%), 44 (88%) and 45 (90%) respectively. 72% patients had no episodes of sore throat after tonsillectomy. Conclusion: Tonsillectomy has a significant role in preventing or reducing recurrent streptococcal throat infections.

Erythema Elevatum Diutinum: A Rare Dermatosis with an atypical Presentation

EED is a form of chronic cutaneous vasculitis of unknown underlying etiology [1]. EED was named by Henry RadcliffCrocker and Williams in 1894 but discovered earlier in 1878 by Hutchinson. It presents clinically as asymptomatic, firm, erythematous to yellowish papules, nodules, or plaques involving the extensor surface of extremities often over joints [1]. Antigeninduced small vessel vasculitis is believed to be the cause. Various infections and systemic disorders like streptococcal throat infection, tuberculosis, HIV 1, HIV 2, Hepatitis B, Rheumatoid arthritis, ankylosing spondylitis, Sarcoidosis, Crohn’s disease, Ulcerative colitis, Pyoderma gangrenosum, Paraproteinemia, Myelodysplasia, Kaposi’s sarcoma have been reported to be associated [1]. The clinical presentation of EED varies as the lesions progress leading to diagnostic difficulties [1].

A Rare Case of Arnold Chiari Malformation Evident after a Streptococcal Throat Infection in a Young Female

Arnold Chiari malformation is a rare neurological developmental disorder that presents at birth. No such cases have been reported in support of microbial infections causing Chiari malformation yet there is evidence how microorganisms can lead to brain abscess, brain empyema, and meningoencephalitis.

Serum Immune Responses to Group A Streptococcal Antigens following Pharyngeal Acquisitions among Children in Cape Town, South Africa.

There is limited information on the human immune response following infection with group A Streptococcus (Strep A). Animal studies have shown, in addition to the M protein, that shared Strep A antigens elicit protective immunity. This study aimed to investigate the kinetics of antibody responses against a panel of Strep A antigens in a cohort of school-aged children in Cape Town, South Africa. Participants provided serial throat cultures and serum samples at two-monthly follow-up visits. Strep A recovered were emm-typed, and serum samples were analyzed by enzyme-linked immunosorbent assay (ELISA) to assess immune responses to thirty-five Strep A antigens (10-shared and 25-M peptides). Serologic evaluations were performed on serial serum samples from 42 selected participants (from 256 enrolled) based on the number of follow-up visits, the frequency of visits, and throat culture results. Among these, there were 44 Strep A acquisitions, 36 of which were successfully emm-typed. Participants were grouped into three clinical event groups based on culture results and immune responses. A preceding infection was most convincingly represented by a Strep A-positive culture with an immune response to at least one shared antigen and M peptide (11 events) or a Strep A-negative culture with antibody responses to shared antigens and M peptides (9 events). More than a third of participants demonstrated no immune response despite a positive culture. This study provided important information regarding the complexity and variability of human immune responses following pharyngeal acquisition of Strep A, as well as demonstrating the immunogenicity of Strep A antigens currently under consideration as potential vaccine candidates. IMPORTANCE There is currently limited information regarding the human immune response to group A streptococcal throat infection. An understanding of the kinetics and specificity of antibody responses against a panel of Group A Streptococcus (GAS) antigens will serve to refine diagnostic approaches and contribute to vaccine efforts, which together will serve to reduce the burden of rheumatic heart disease, a major source of morbidity and mortality especially in the developing world. This study, utilizing an antibody-specific assay, uncovered three patterns of response profiles following GAS infection, among 256 children presenting with sore throat to local clinics. Overall, the response profiles were complex and variable. Of note, a preceding infection was most convincingly represented by a GAS-positive culture with an immune response to at least one shared antigen and M peptide. Also, more than a third of participants demonstrated no immune response despite a positive culture. All antigens tested were immunogenic, providing guidance for future vaccine development.

Prevalence, Antibiotic Susceptibility Profile and Associated Factors of Group A Streptococcal pharyngitis Among Pediatric Patients with Acute Pharyngitis in Gondar, Northwest Ethiopia.

Streptococcus pyogenes (S. pyogenes) or group A streptococcus is a common cause of bacterial pharyngitis in children. Since it is difficult to distinguish between viral and bacterial pharyngitis using solely signs and symptoms, culture-based diagnosis and treatment are critical for avoiding serious complications. Therefore, this study aimed to determine the prevalence, antimicrobial susceptibility patterns, and associated factors of S. pyogenes among pediatric patients with acute pharyngitis. A hospital-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital from April to June 2021. Standard microbiological procedures were used to collect and process throat swabs and to isolate and identify S. pyogenes. The disc diffusion method was used for antimicrobial susceptibility testing (AST). A total of 215 children with acute pharyngitis were included in this study. Of these, 23 (10.7%) were culture positive for S. pyogenes. The presence of an inflamed tonsil, tonsillar exudate, scalariform rash, and dysphagia were associated with streptococcal pharyngitis. Children aged 5 to 15 were more susceptible to streptococcal throat infection than younger children. Penicillin, vancomycin, chloramphenicol, clindamycin, and ceftriaxone were effective against 100%, 95.7%, 95.7%, 91%, and 87% of isolates, respectively. In contrast, 56.5%, 39.1%, and 30.4% of isolates showed at least reduced susceptibility to tetracycline, erythromycin, and azithromycin, respectively. Streptococcus pyogenes is responsible for 10.7% of acute pharyngitis cases among pediatric patients in the study area. Although all isolates remain sensitive to penicillin, many showed reduced susceptibility to tetracycline and macrolides. Therefore, prior to antibiotic prescription, screening children with acute pharyngitis for S. pyogenes and testing the antibiotic susceptibility of isolates is recommended.

Skin IL-17A and IFN-γ Production Correlate with Disease Severity in Patients with Psoriasis and Streptococcal Infection

Psoriasis is a multisystemic inflammatory disorder mainly involving the skin and joints, whose etiopathogenesis is still not completely understood. An association with streptococcal throat infection has been suggested. We aim to investigate a correlation between IL-17A and IFN-γ production by T cells infiltrating skin lesions and PASI in 313 patients with psoriasis, compared with that in 252 healthy controls. The phenotype of β-hemolytic Streptococci-specific infiltrating T cells in skin lesions was evaluated and characterized for IFN-γ, IL-4, and IL-17A production. In addition, PBMCs were tested by ELISpot for IFN-γ and IL-17A after streptococcal antigen exposure. A total of 64 of 313 (20.4%) patients with psoriasis had throat streptococcal infection. Of the 3,868 skin-derived T-cell clones from psoriasis with streptococcal infection, 66% proliferated in response to β-hemolytic Streptococci antigens. Most β-hemolytic Streptococci-specific T cells displayed T helper 17 and T helper 1 phenotypes. The levels of IFN-γ and IL-17A secreted by skin-infiltrating T cells of patients with psoriasis significantly correlated with PASI score. In β-hemolytic Streptococci-positive patients, IFN-γ and IL-17A production by peripheral blood T cells after stimulation with streptococcal antigens was quantified by ELISpot. The results obtained may suggest ELISpot as a useful diagnostic tool to identify patients with psoriasis that may deserve antibiotic treatment.

The Role of Inflammation and Oxidative Stress in Rheumatic Heart Disease.

Rheumatic heart disease (RHD), an acquired valvular disease, remains an important cause of morbidity and mortality in developing countries. This chronic illness starts from untreated streptococcal throat infection, resulting in acute rheumatic fever (ARF) in susceptible individuals. Repeated infections lead to a chronic phase characterized by the damage of heart valves. Inflammation has been found to play important role in the development of this disease. All the studies presented in this review clearly show the involvement of the inflammatory state in the progression of this disease. However, the exact role of cytokines in inflammation sites remains to be examined, since most studies have so far focused on peripheral blood. Such analysis would provide information on inflammatory mechanisms in situ.

Knowledge, attitude, and practice regarding treatment of group a beta haemolytic tonsillo pharyngitis and prevention of rheumatic fever among doctors in Karachi, Pakistan: A perspective study.

To assess knowledge and practices associated with rheumatic fever among medical practitioners in an urban setting. The cross-sectional study was conducted at five major hospitals in Karachi from August to November 2019, and comprised house officers, postgraduate trainees, and general physicians of either gender. The subjects were given a questionnaire assessing their knowledge and perception regarding acute rheumatic fever as well as prophylaxis. Data was analysed using SPSS 25. Of the 247 respondents, 173(70%) were house officers, 31(13%) were postgraduate trainees and 43(17%) were general physicians. Overall, 202(82%) subjects were associated with some teaching hospital. Significantly more postgraduate trainees and general physicians answered correctly when asked to identify clinical and laboratory findings suggestive of Group A streptococcal throat infection than house officers (p<0.001). Among the house officers 49(28.3%), and among the postgraduate trainees 11(35.4%) knew the correct way to prescribe penicillin to prevent rheumatic fever. Among the general physicians, 20(46.5%) had accurate knowledge regarding the prescription. Knowledge and practices of medical practitioners regarding rheumatic fever were less than ideal and may play a part in misdiagnoses of Group A streptococcal infections and, hence, prophylaxis.

A Multi-Layer Acoustic Neural Network-Based Intelligent Early Diagnosis System for Rheumatic Heart Disease

Rheumatic Heart Disease (RHD) is a disorder of heart caused by streptococcal throat infection followed by the organ damage, irreversible valve damage and heart failure. Acute Rheumatic Fever (ARF) is a precursor to the disease. Sometimes, RHD can occur without any signs or symptoms, and if there are any symptoms, they occur with the infection in the heart valves and fever. Due to these issues, respiratory problems occur with chest pain and tremors. Additionally, the symptoms include faint, heart murmurs, stroke and unexpected collapse. The techniques available try to detect the RHD as early as possible. Although the recent medical health care department uses crucial techniques, they are not accurate in terms of symptom classification, precision and prediction. On the scope, we are developing Multi-Layered Acoustic Neural (MLAN) Networks to detect the RHD symptoms using heart beat sound and Electrocardiogram (ECG) measurements. In this proposed MLAN system, the novel techniques such as multi-attribute acoustic data sampling model, heart sound sampling procedures, ECG data sampling model, RHD Recurrent Convolutional Network (RRCN) and Acoustic Support Vector Machine (ASVM) are used for increasing the accuracy. In the implementation section, the proposed model has been compared to the Long Short-Term Memory-based Cardio (LSTC) data analysis model, Cardio-Net and Video-Based Deep Learning (VBDL) techniques. In this comparison, the proposed system has 10%–17% higher accuracy in RHD detection than existing techniques.

Rheumatic heart disease in the heart of Himalayas.

Rheumatic heart disease results from the damage to heart valves caused by one or more episodes of rheumatic fever leading to a variety of cardiac complications. Although less common in developed parts of the world, it is one of the most common acquired heart diseases in low- and middle-income countries including Nepal, affecting children and young people. Primary prevention with prompt treatment of streptococcal throat infections and long-term secondary antibiotic prophylaxis with benzathine penicillin G are the key intervention strategies. Echocardiography based screening in schoolchildren has become an effective measure for early identification of the cases. More coordinated policies and effective interventions are needed to successfully decrease the burden of the rheumatic heart disease in resource limited settings like Nepal.

From Streptococcal Pharyngitis/Tonsillitis to Myocarditis: A Systematic Review.

(1) Background: Myocarditis following group A streptococcal pharyngitis and tonsillitis is a relatively rare medical condition. The aim of this systematic review was to identify specific ECG changes, laboratory parameters and signs, and symptoms associated with this disease. (2) Methods: A systematic literature review was performed in concordance with the current PRISMA guidelines, including the databases PubMed/MEDLINE, Web of Science, CDSR, CENTRAL, CCAs, EBM Reviews, and LILACS. Articles were included if they covered myocarditis after streptococcal pharyngitis/tonsillitis in humans. Exclusion criteria were rheumatic, autoimmune, or toxic myocarditis. (3) Results: Patients that developed myocarditis after group A streptococcal throat infection frequently presented with chest pain, elevated cardiac markers, and ST-segment elevations, making it a condition that shows more similarities to acute coronary syndrome than viral myocarditis. (4) Conclusions: Myocarditis after streptococcal pharyngitis and/or tonsillitis is a rather infrequently described disease; however, it is necessary to consider this condition when investigating streptococcal sore throat because it can be associated with severe adverse events for the individual patient.

O11 Neisseria Meningitidis as a cause of isolated bilateral polyarticular native knee joint septic arthritis

O11 <i>Neisseria Meningitidis</i> as a cause of isolated bilateral polyarticular native knee joint septic arthritis

A Comparison of Diagnostic Accuracy of a Rapid Antigen Detection Test in Screening for Group A Streptococcal Throat Infection Between 3- to 10-Year-Old (Children and Preadolescents) and 11- to 21-Year-Old (Adolescents).

IntroductionPharyngitis is one of the most common childhood diseases worldwide. We intended to compare the performance of one such rapid antigen detection test (RADT) using lateral flow immunoassay technique, between 3- to 10-year-old (children and preadolescent) and 11- to 21-year-old (adolescents).MethodsChildren and adolescents attending the pediatric ED with complaints of throat pain and signs of pharyngeal and tonsillar inflammation were tested by both the RADT and throat culture (TC) directed towards group A streptococcal (GAS) between April and June of 2016. The prevalence, sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated against throat culture, the gold standard for the diagnosis of GAS pharyngitis. Comparisons between the two age groups were made using the Chi-square testResultsOf 202 patients, 123 (61%) patients were between 3-11 and 79 (39%) between 11-21 years of age. A positive throat culture was recorded in 56 patients yielding an overall prevalence of GAS pharyngitis at 28%. For the whole sample, the screening RADT had an SN, SP, PPV and NPV of 79%, 90%, 75%, and 92%, respectively. Also, there was no statistically significant difference between the two groups in terms of SN, SP, PPV and NPV.ConclusionThe RADT in use at our institution, performed comparable to studies reported in the literature using a similar technique in both preadolescent and adolescent age groups.

Using an Indigenous framework to contextualise Immunology education within the Health Sciences setting

Abstract Indigenous Māori and Pacific children and young people remain disproportionately affected by Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD), with rates in Aotearoa/New Zealand and the Pacific Region of significant concern. ARF is the body’s autoimmune response to an untreated Group A Streptococcal (GAS) throat or skin infection. If multiple or severe episodes of ARF occur and are left untreated, this can lead to permanent cardiac damage known as RHD. RHD remains a major cause of morbidity and mortality globally. In the absence of a GAS vaccine, the best recommended treatment and management approach consists of painful monthly intramuscular injections of Benzathine Penicillin G (BPG) administered to the upper thigh area, and given for at least 10 years or more. A new Penicillin for ARF/RHD prevention is urgently needed. The purpose of this work was to employ the use of an Indigenous Pacific framework within the undergraduate Health Sciences education setting to support learning and teaching efforts appropriate to vulnerable communities affected by ARF and RHD. The Talanoa approach was utilised within the classroom setting to support discussions relating to ARF and RHD and vulnerable communities that was appropriate and respectful to the Indigenous cultural setting. Well-received by students, this approach was not only applicable to the cultural setting for those communities affected by ARF/RHD in Aotearoa/New Zealand, but also helped with contextualisation, supporting courteous class discussions with relevant in-class learning opportunities and experiences. This work highlighted the importance of Indigenous frameworks for supporting Immunology education within the Health Sciences education setting.

A Novel approach towards Drug Design

Abstract Acute Rheumatic Fever (ARF) is the body’s autoimmune reaction to an untreated Group A Streptococcal (GAS) throat or skin infection. When recurrent and/or severe ARF episodes occur and are left untreated, this can trigger a condition known as Rheumatic Heart Disease (RHD) - permanent cardiac damage that can result and a major cause of morbidity and mortality worldwide. Without a GAS vaccine, painful monthly injections of Benzathine Penicillin G (BPG) are given intramuscularly to prevent GAS infections that may lead to further ARF episodes and trigger RHD if untreated. These injections are known as secondary prophylaxis and are given for at least 10 years, or sometimes a lifetime. In Aotearoa/New Zealand and the Pacific Region, Indigenous Māori and Pacific children and young people remain disproportionately affected by ARF and RHD. Work is currently underway towards a new Penicillin for ARF/RHD prevention which is more appropriate for children and young people who require these injections. Ideally, a longer lasting Penicillin that is less painful to be given is needed. The purpose of this work was to incorporate the Kakala Indigenous Pacific framework within research efforts involving Indigenous Māori and Pacific communities impacted by ARF and RHD. Application of the Indigenous Kakala research framework supported inclusivity, respect, reciprocity and ensured a strong focus on fostering respectful relationships between researchers and vulnerable communities, appropriate to cultural contexts for Pacific Peoples in Aotearoa/New Zealand. This highlights the importance of Indigenous frameworks and their application within Immunology based research work efforts to improve engagement and applicability within cultural settings.

Acute Rheumatic Fever: Where Do We Stand? An Epidemiological Study in Northern Italy.

Acute rheumatic fever (ARF) is a non-septic complication of group A β-hemolytic streptococcal (GAS) throat infection. Since 1944, ARF diagnosis relies on the Jones criteria, which were periodically revised. The 2015 revision of Jones criteria underlines the importance of knowing the epidemiological status of its own region with updated data. This study aims to describe ARF features in a retrospective cohort retrieved over a 10-year timespan (2009–2018) and to report the annual incidence of ARF among children in the Province of Monza-Brianza, Lombardy, Italy during the same period. This is a multicentric cross-sectional/retrospective study; 70 patients (39 boys) were diagnosed with ARF. The median age at diagnosis was 8.5 years (range, 4–14.2 years). Overall, carditis represented the most reported major Jones criteria followed by arthritis and chorea (40, 27, and 20 cases, respectively). In order to calculate the annual incidence of ARF, only children resident in the Province of Monza-Brianza were included in this part of the analysis. Therefore, 47 patients aged between 5 and 14 years were identified. The median incidence during the study time was 5.7/100,000 (range, 2.8–8.3/100,000). In the Province of Monza-Brianza, we found an incidence rate of ARF among children aged 5–14 years constantly above the threshold of low-risk area as defined in the 2015 revision of Jones criteria. Therefore, the diagnosis of ARF should be based on the moderate–high-risk set of Jones criteria. However, given the burden of secondary prophylaxis, expert opinion is advisable when the diagnosis of ARF is uncertain.

Streptococcal Throat Carriage among Primary School Children Living in Uyo, Southern Nigeria

AbstractSurveillance of the carrier state for β-hemolytic streptococcal (BHS) throat infections remains essential for disease control. Recent published works from Sub-Saharan Africa have suggested a changing epidemiology in the burden of BHS throat infections. The objective of the present study was therefore to determine the prevalence and pattern of BHS throat carriage in school-aged children in Uyo, Akwa Ibom State. This was a prospective cross-sectional study of 276 primary school children in Uyo. Subjects were recruited by multistage random sampling. Obtained throat swabs were cultured on 5% sheep blood agar. Lancefield grouping on positive cultures was done by using the Oxoid Streptococcal Grouping Latex Agglutination Kit, United Kingdom. Antimicrobial susceptibility testing was done with the disk diffusion method. Associations were tested with Fischer's exact test. The prevalence of BHS carriage was 3.3%. Group C Streptococcus was identified in 89% of isolates and Group G Streptococcus in 11%. Younger age and larger household size were associated with asymptomatic streptococcal throat infections. Antimicrobial susceptibility was highest with cefuroxime and clindamycin (89% of isolates each), while 78% of isolates were susceptible to penicillin. None of the tested isolates was susceptible to co-trimoxazole. The prevalence of streptococcal throat carriage in the study area was low. There were no Group A Streptococcus isolates suggesting an evolving epidemiology of BHS disease in the study area.

Diagnostic accuracy of Fever-PAIN and Centor criteria for bacterial throat infection in adults with sore throat: a secondary analysis of a randomised controlled trial.

BackgroundSore throat is a common and self-limiting condition. There remains ambiguity in stratifying patients to immediate, delayed, or no antibiotic prescriptions. The National Institute for Health and Care Excellence (NICE) recommends two clinical prediction rules (CPRs), FeverPAIN and Centor, to guide decision making.AimTo describe the diagnostic accuracy of CPRs in identifying streptococcal throat infections.Design & settingAdults presenting to UK primary care with sore throat, who did not require immediate antibiotics.MethodAs part of the Treatment Options without Antibiotics for Sore Throat (TOAST) trial, 565 participants, aged ≥18 years, were recruited on day of presentation to general practice. Physicians could opt to give delayed prescriptions. CPR scores were not part of the trial protocol but were calculated post hoc from baseline assessments. Diagnostic accuracy was calculated by comparing scores with throat swab cultures.ResultsIt was found that 81/502 (16.1%) patients had group A, C, or G streptococcus cultured on throat swab. Overall diagnostic accuracy of both CPRs was poor: area under receiver operating characteristics (ROC) curve 0.62 for Centor; and 0.59 for FeverPAIN. Post-test probability of a positive or negative test was 27.3% (95% confidence interval [CI] = 6.0% to 61.0%) and 84.1% (95% CI = 80.6% to 87.2%) for FeverPAIN ≥4; versus 25.7% (95% CI = 16.2% to 37.2%) and 85.5% (95% CI = 81.8% to 88.7%) for Centor ≥3. Higher CPR scores were associated with increased delayed antibiotic prescriptions (χ2 = 8.42, P = 0.004 for FeverPAIN ≥4; χ2 = 32.0, P<0.001 for Centor ≥3).ConclusionIn those who do not require immediate antibiotics in primary care, neither CPR provides a reliable way of diagnosing streptococcal throat infection. However, clinicians were more likely to give delayed prescriptions to those with higher scores.

Grisel\u2019s syndrome: a case report on this rare pediatric disease and its anesthetic challenges

BackgroundGrisel’s syndrome is a non-traumatic atlantoaxial subluxation associated with inflammatory conditions of the head and neck, which occurs primarily in children. Increased flexibility of the ligaments during inflammation is implicated in the pathogenesis of the subluxation between the axis and atlas. The potential sequelae may be severe, and early diagnosis and treatment of Grisel’s syndrome can prevent tragic outcomes.Case presentationWe present a case of torticollis in an 8-year-old child. She had a two-week history of a streptococcal throat infection. The patient was treated with several different methods of conservative care, including muscle relaxation, cervical halter traction, and Halo application. However, the torticollis persisted. The patient then required surgical correction involving cervical spine fusion. She had no complications and experienced no reoccurrence of the torticollis to date.ConclusionGrisel’s syndrome is a pathology for which conservative management is successful in most cases. Cases requiring surgical intervention are rarely documented in the literature. Our case is significant, as in spite of aggressive conservative management, the patient required surgical correction. Patients requiring surgical management of Grisel’s syndrome may require additional anesthetic exposure for diagnostic interventions like magnetic resonance imaging or neck manipulations for closed reduction. We discuss the features of Grisel’s syndrome and specific anesthetic management considerations for procedures such as magnetic resonance imaging, application of cervical traction, and surgical correction of torticollis.