Streptococcus Research Articles

Complicated pneumonia caused by group A Streptococcus in children - 2022/2023 infectious season outbreak and update on clinical characteristics

BackgroundAn increased incidence of group A Streptococcus (GAS) infections has been observed in pediatric population post-COVID-19 pandemic. While the majority of reports refer to scarlet fever or invasive GAS disease, detailed data on pulmonary manifestations such as complicated community-acquired pneumonia (CAP) are scarce. The aim of this study was to assess the contribution of GAS to complicated CAP in children during the 2022/2023 infectious season. MethodsWe retrospectively analyzed the etiology and clinical presentation of complicated CAP patients hospitalized in our tertiary care center in Warsaw, Poland, between August 2022 and May 2023. ResultsAmong 91 patients with complicated CAP, GAS was the dominant cause constituting 24.2% (22/91; 95% CI 15.8–34.3%) of the study group. 68.2% of GAS pneumonia patients presented symptoms of scarlet fever, and 27.3% had preceding or concurrent viral infection. GAS complicated CAP was associated with longer hospitalization, higher incidence of chest tube insertion, but shorter duration of chest tube drainage than complicated CAP of other etiology. Children with GAS complicated CAP had higher procalcitonin concentration (28.1 vs. 1.5 ng/dL; p<0.0001) and a lower platelets level (254.5 vs. 422 × 103/μL; p = 0.0031) than those with non-GAS infection. ConclusionsGAS is currently the predominant pathogen of complicated CAP in children. Clinicians should be aware of the current epidemiological situation and a more severe course of GAS pneumonia in this age group, and should monitor patients presenting with symptoms of scarlet fever and preceding viral infection closely.

Surge for narrow-spectrum antibiotics in times of the MDR crisis: Systematic literature review to establish the role of amoxicillin in tonsillopharyngitis

Background: Group A Streptococcus (GAS) is the predominant pathogen accountable for tonsillitis, making it the most prevalent and frequently encountered bacterial cause of upper respiratory infections. Although amoxicillin is a frequently prescribed antibiotic for the treatment of tonsillopharyngitis, alternate agents like macrolides are regularly recommended. The objective of this study was to evaluate and compare the effectiveness of amoxicillin, its side effects, and the associated risk ratio with alternative antibiotic treatments for respiratory tract infections and tonsillopharyngitis in both children and adults. Material and Methods: An initial search was performed via five basic databases PubMed, Medline, Embase, clinicaltrial.gov and the Cochrane Central Register of Controlled Trials, to identify studies meeting the inclusion criteria spanning from July 2012 to June 2023. The primary search of studies resulted in 6260 from four databases during the study period. Results: After the initial scan of titles and abstracts, 06 studies were included in the review, which reported clinical cure rates. Four out of six studies reported adverse events. Conclusion: Our analysis infers that given their narrow spectrum of activity, low incidence of side effects, comparable efficacy and cost-effectiveness, penicillin or amoxicillin can be considered as preferable choice for the management of tonsillopharyngitis and broad-spectrum antibiotics offer no added advantage in disease management. Keywords: Amoxicillin, Tonsillopharyngitis, Tonsillitis, Acute respiratory infection, Streptococcal infection, GAS, SLR, Systematic literature Review, Antibiotics

Oral microbiota imbalance: A predisposing factor for Henoch-Schönlein Purpura in children

Oral microecological dysregulation has been shown to be associated with various immune system disorders. Henoch-schonlein purpura (HSP) is an autoimmune small vessel inflammatory disease in children of uncertain etiology, and studies have suggested that streptococcal infection may be an influential factor in its development. However, the relationship between oral microecological dysregulation and HSP has not been clearly studied so far. In this study, an epidemiological survey on the oral health status of children with HSP was investigated in this paper, and collected dental plaque from four groups of children for 16SrDNA high-throughput sequencing to analyze the composition and changes of oral microbial diversity among different groups. The results showed that the oral health status of children with HSP was poor, except for the incidence of caries in the 5-year-old group, the caries rate and dmfs/DMFS in the 3,4 and 5-year-old groups were higher than the same age in the fourth Chinese Oral Health Epidemiological Survey. Moreover, the development of HSP is accompanied by disturbances in the oral microbiota; a decrease in the number of Firmicutes which producing butyric acid may be closely associated with the development of HSP; changes in the abundance of Streptococcus and Neisseria may be a risk factor for the development of HSP.

The Thousand Faces of Invasive Group A Streptococcal Infections: Update on Epidemiology, Symptoms, and Therapy.

Invasive infections caused by Streptococcus pyogfenes (iGAS), commonly known as Group A Streptococcus, represent a significant public health concern due to their potential for rapid progression and life-threatening complications. Epidemiologically, invasive GAS infections exhibit a diverse global distribution, affecting individuals of all ages with varying predisposing factors. The pathogenesis of invasive GAS involves an array of virulence factors that contribute to tissue invasion, immune evasion, and systemic dissemination. In pediatrics, in the last few years, an increase in iGAS infections has been reported worldwide becoming a challenging disease to diagnose and treat promptly. This review highlights the current knowledge on pathogenesis, clinical presentations, and therapeutic approaches for iGAS in children.

Antimicrobial Activity of Green Synthesized Copper Nanoparticles (CuNPs) Using Aqueous Extract of &lt;i&gt;Psidium guajava&lt;/i&gt; on Clinical Bacteria Isolates

The eco-friendly synthesis of nanoparticles using an aqueous plant extract as a capping and stabilizing agent has garnered substantial attention, particularly in pharmaceuticals and drug delivery applications. This study focused on utilizing copper sulfate pentahydrate (CuSO4·5H2O) as a precursor to synthesize copper nanoparticles at both pH 4-5 and pH 8, with Psidium guajava (leaves and fruits) extract playing a crucial role. Fourier transform infrared (FTIR) spectroscopy identified four major functional groups at distinct peaks, confirming their responsibility for capping and stabilizing the synthesized P.g-CuNPs. Scanning electron microscopy (SEM) revealed spherical shapes with an average particle size range of 20-30 nm. Energy-dispersive X-ray (EDX) analysis confirmed the presence of pure copper (Cu) at 54.15%. The antimicrobial study demonstrated that P.g-CuNPs synthesized at pH 4-5 exhibited complete growth inhibition of all tested bacterial strains at varying concentrations. Furthermore, serially diluted P.g-CuNPs (pH 5) inhibited Salmonella spp, E. coli, and Streptococcus spp at 100 μg/mL, while P.g-CuNPs (pH 8) only inhibited E. coli at the same concentration. Notably, acid-based synthesized P.g-CuNPs exhibited higher efficacy in the antimicrobial study compared to their alkaline-based counterparts. This study suggests the potential biomedical applications of P.g-CuNPs, including therapeutic drugs for microbial infectious diseases, integration into textile coatings, and nanocapsulation for food storage to extend shelf life.

Risk factors and genetic characteristics of the carriage of hypervirulent and carbapenem-resistant Acinetobacter baumannii among pregnant women.

Carbapenem-resistant Acinetobacter baumannii (CRAB) and its emerging evolutionary branch toward hypervirulence have been neglected in pregnancy. From September 2020 to August 2021, an active surveillance culture program encompassed 138 randomly selected pregnant women, with five subjected to sample collection at two different time points. The clinical characterization was explored through statistical analysis. Whole-genome sequencing, a Galleria mellonella infection model, and a global database were used to investigate the genetic characterization, pathogenicity, evolutionary history, and phylogenetic relationships of the isolates. Of the 41 CRAB isolates obtained, they were divided into four ClustersRS and an orphan pattern. ClusterRS 1 (n = 31), with eight complex types in pregnancy, was also the dominant ClusterRS globally, followed by ClusterRS 13 (n = 5), identified as hypervirulent KL49 CRAB, exhibiting phylogeographical specificity to Guangdong. A maternal carriage CRAB rate of 26.09% (36/138) was revealed, with half of the isolates representing novel complex types, prominently including CT3071, as the first KL7 isolates identified in Shenzhen. Both KL49 and KL7 isolates were most commonly found in the same participant, suggesting potential intraspecific competition as a possible reason for CRAB infection without carriers during pregnancy. The independent risk factors for carriers were revealed for the first time, including advanced maternal age, gestational diabetes mellitus, and Group B Streptococcus infection. The significant carriage rate and enhanced virulence of CRAB during pregnancy emphasize the imperative for routine surveillance to forestall dissemination within this high-risk group, especially in Guangdong for ClusterRS 13 isolates.

Quality criteria, chemical composition and antimicrobial activity of the essential oil of Mentha suaveolens Ehrh

The aim of the present study is the valorization of the essential oil of Mentha suaveolens Ehrh. The research plan and methods included 3-axis: the first axis consists of studying the organoleptic and physicochemical characterization of the essential oil, the second is the chemical analysis carried out by Gas Chromatography/Mass Spectrometry (GC/MS) and the third consists of evaluating its antimicrobial activity against selected microorganisms. The results obtained for the organoleptic and physicochemical properties are as follows: appearance: Liquid, mobile and clear, odor: Strong odor characteristic of Mentha suaveolens Ehrh, color: Pale yellow; relative density (0.92), miscibility with ethanol (1V/2V), freezing point (Tfreezing < −10 °C), refractive index (1.5256), rotating power (+0.825), acid index (1.68), ester index (68.44), saponification index (70.13) and iodine index (12.05).Chemical analysis identified 69 compounds which are mostly oxygenated monoterpenes such as piperitenone oxide (32.55%), pulegone (10.14%), piperitone oxide (8.34%), etc. The microbiological tests were carried out by an agar diffusion test using the essential oil of Mentha suaveolens Ehrh. The microbiological tests were carried out by a diffusion test on agar, these tests are carried out on six microbial strains (five bacteria and one yeast).The inhibitory effect of our oil is well marked against bacteria: Proteus mirabilis (17.50 ± 0.70 mm at 50 μL/mL), Enterococcus faecalis (17.00 ± 1.00 mm at 50 μL/mL) and Staphylococcus coagulase negative (16.33 ± 0.57 mm at 50 μL/mL) while it was moderate against Escherichia coli (14.33 ± 1.15 mm at 50 μL/mL) and Streptococcus spp (13.00 ± 0.00 mm at 50 μL/mL) as well as against yeast, Candida albicans (15.33 ± 1.52 mm at 50 μL/mL). It appears from these results that our oil is of high quality and can be used in several areas. The results obtained are therefore promising and thus open the way for manufacturers to use this essential oil of Mentha suaveolens Ehrh in the pharmaceutical, cosmetic, agricultural and food industries.

Multiple Drug Resistant Streptococcus Strains-An Actual Problem in Pig Farms in Western Romania.

Streptococci are a type of bacteria that can cause severe illnesses in humans and animals. Some typical species like S. suis, or atypical species like S. porcinus and, S. dysgalactiae subsp. dysgalactiae, can cause infections like septicemia, meningitis, endocarditis, arthritis, and septic shock. S. suis is considered a newly emerging zoonotic pathogen. Although human streptococcal infection outbreaks are rare, it is appropriate to review the main streptococcal species isolated in pig farms in western Romania, due to the high degree of antibiotic resistance among most isolates commonly used in human treatment. This study examines the resistance patterns of these isolates over 5 years (2018-2023). The research investigated the antimicrobial susceptibility of 267 strains of Streptococcus spp. isolated from pigs, primarily from lung and brain tissues. This report is the first to describe the distribution of atypical Streptococcus species (SDSE, S. porcinus, S. hyovaginalis, S. pluranimalium, S. canis) in Romania, as well as the antibiotic resistance profile of these potentially zoonotic species. It is important to re-evaluate and consider the high rates of resistance of S. suis to tetracyclines, lincosamides, macrolides, and aminoglycosides, as well as the high recovery rates of S. suis from the lungs and brain when treating swine diseases.

A case report on A 12 year male child with guttate psoriasis

Psoriasis is an inflammatory skin condition that causes discoloration and irritation whereas Guttate psoriasis often develops suddenly and may start after an infection such as strep throat. In guttate psoriasis small, droplet shaped patches appears on arms, legs, scalp, torso. Most commonly seen in children and adolescents than adults. It was classically triggered by streptococcal infection (pharyngitis or perianal) and is not contagious (it cannot be transferred to others through skin-to-skin contact). Usually guttate psoriasis subsides within few weeks, after that there are several possible outcomes such as you may never develop it again, it may recur intermittently or may develop into chronic plaque psoriasis. It can be mild, moderate or severe. We came across a case of 12 year old male child presenting with complaints of annular plaques with itching since 5 days all over the body. Based on subjective, objective and laboratory investigations the child was diagnosed with Guttate psoriasis. And child was treated with topical steroids, immunosuppressants, antibiotic and anti ketogenic agents respectively and within 4 weeks the child was recovered.

Effects of Acipenserid herpesvirus 2 on the outcome of a Streptococcus iniae co-infection in white sturgeon (Acipenser transmontanus)

Acipenserid herpesvirus 2 (AciHV-2) is a large double-stranded DNA virus in the family Alloherpesviridae that causes catastrophic outbreaks in young naive white sturgeon (Acipenser transmontanus) populations, with mortalities of up to 80%. Survivors of these infections are suspected to remain latently infected. The gram-positive zoonotic bacterium Streptococcus iniae is another important sturgeon pathogen that causes severe myositis and up to 50% mortality during natural outbreaks. Throughout the last decade, co-infections of AciHV-2 and S. iniae have been reported in cultured white sturgeon in California resulting in severe presentations of piscine streptococcosis. This phenomenon of herpesvirus and streptococcus co-infection appears to span multiple taxa since in humans, it is recognized that a Human herpesvirus 3 infection (VZV) is a negative prognostic indicator for pediatric Invasive Group A Streptococcal infections (IGASI). While a decrease in humoral immunity caused by VZV has been hypothesized as a potentially important factor in IGASI cases, no natural animal model exists to study this process. Moreover, no studies have investigated these reported co-infections in white sturgeon. Therefore, the goal of this study was to investigate the effects of a recent AciHV-2 infection on the outcome of a subsequent S. iniae challenge in white sturgeon fingerlings. When fish were infected with 108 colony forming units (CFU) of S. iniae intramuscularly (IM), a statistically significant decrease in survival of 41% was detected in the co-infection group compared to the S. iniae group (p-value &amp;lt; 0.001). This difference was not observed when fish were infected with 106 CFU of S. iniae IM. At this lower infection dose, however, a statistically significant downregulation of tnfα was observed in the spleen of fish in the co-infection group compared to the S. iniae group (p-value = 0.0098). Analysis of serum from survivors revealed a statistically significant reduction in anti-S. iniae serum IgM and serum serotransferrin in fish from the co-infection group compared to the S. iniae group (p-value = 0.0134 and p-value = 0.0183, respectively). Further studies are indicated to determine what interactions lead to the decreased production of pathogen-specific IgM, serotransferrin, and TNFα in the host.

Proximate and Microbial Analysis of Yellow, White and Spoilt Garri Sold in Owerri, Imo State, Nigeria

This study explored the proximate and microbial composition of garri, a widely consumed starchy food in West Africa, particularly in Nigeria, Ghana, and neighboring countries. Garri, derived from cassava, is esteemed for its extended shelf life, cost-effectiveness, and nutritional value, holding a significant place in West African diets. Samples of yellow and white garri, including spoilt variations, were procured from four distinct local markets (Obinze, Relief, Eke Ukwu, and Ihiagwa) and subjected to thorough analysis using standard methods. Proximate analysis encompassed key components such as ash content, moisture, fiber content, lipids, protein, carbohydrates, and energy in both white and yellow garri from different markets. White garri exhibited a higher ash content (1.70±0.58%) than yellow garri (1.27±0.24%). Moisture content was greater in white garri (15.74±0.23%) compared to yellow garri (12.55±0.57%). Fiber content was 9.12±0.23% in yellow garri and 8.018±0.09% in white garri. Lipid content was 0.33±0.46% in yellow garri and 0.09±0.18% in white garri. Protein content showed values of 0.50±0.89% for yellow garri and 0.66±0.38% for white garri. Carbohydrate content was 76.91±0.71% in yellow garri and 74.91±0.067% in white garri. Energy content (kJ/100g) was 960.59±0.93 for yellow garri and 1268.18±0.39 for white garri. Microbial analysis conducted on the samples from each market revealed bacterial load of various ranges. Fresh white garri bacterial loads ranged from 3.25±0.83 log10 CFU/g (Ihiagwa) to 3.93±0.67 log CFU/g (Eke Ukwu). Fresh yellow garri bacterial loads ranged from 2.27±0.43 log CFU/g (Ihiagwa) to 2.92±0.54 log CFU/g (Eke Ukwu). Statistical analysis indicated no significant difference (P&gt;0.05) in bacterial loads between white and yellow garri. Spoilt white garri bacterial loads ranged from 5.27±0.56 log CFU/g (Ihiagwa) to 5.93±0.43 log CFU/g (Eke Ukwu), and a similar trend was observed for spoilt yellow garri (5.34±0.46 log CFU/g to 5.95±0.16 log CFU/g). The study identified bacteria isolates, including Bacillus spp, Staphylococcus spp, and Streptococcus spp. This study underscores the importance of educating producers and sellers on proper processing and handling procedures to enhance the microbial quality and safety of garri products. The high microbial load and presence of some pathogenic microorganisms in the garri samples should serve as great eye-opener to the consumers of raw garri.

Erythema nodosum in children

Erythema nodosum, which is often associated with infectious diseases, is one of the rare skin manifestations in the practice of pediatricians and pediatric infectious disease specialists. Purpose. The purpose was to study the clinical and laboratory manifestations of erythema nodosum in children. Material and methods. The study included 17 children with erythema nodosum aged 2 to 17 years who were hospitalized at the City Children’s Hospital No. 1 of Kazan. Results. In 6 (35 %) children, elevated values of antistreptolysin-O were detected, in 5 (29 %) — high titers of antibodies to Salmonella, in 2 (12 %) cases — IgM to Chlamidia pneumonia, in 2 (12 %) other children — IgM to capsid antigen of EBV, in one case (6 %) — IgM to Mycoplasma pneumonia. Increased erythrocyte sedimentation rate and C-reactive protein level was observed in 15 (88 %) and 12 (70 %) children, respectively. In 12 (70 %) of 17 children, increased level of soluble fibrin-monomer complex was detected in the blood. Conclusion. Erythema nodosum in children in most cases is associated with streptococcal infection and salmonellosis. The immune-inflammatory process in erythema nodosum is accompanied with an increase in the level of soluble fibrin-monomer complex in the blood.

Carcinoma colorretal e endocardite por Streptococcus gallolyticus: Relato de caso

Bacterial endocarditis is a recurring pathology in health services around the world, and various etiological agents can be involved, which can modify the course of the disease according to the degree of infection and aggressiveness of the pathogen. However, a complex relationship is established when this condition is triggered by a specific bacterium, Streptococcus gallolyticus¸ popularly known as S. bovis, since observational studies have linked the presence of this Gram-positive coccus to colorectal carcinomas1.

Sciatica caused by spinal epidural abscess as the initial clinical presentation of colon cancer: a rare case report and review of literature

BackgroundColorectal cancer is one of the most frequently diagnosed forms of cancer, and it is associated with several common symptoms and signs such as rectal bleeding, altered bowel habits, abdominal pain, anemia, and unintentional weight loss. Sciatica, a debilitating condition in which the patient experiences paresthesia and pain in the dermatome of associated lumbosacral nerve roots or sciatic nerve distribution, is not considered one of these. Here we present a case of colorectal cancer manifesting symptoms of sciatica alone.Case presentationA 68-year-old male presented with progressive lower back pain radiating to his left thigh and calf over L5/S1 dermatome. Sciatica was suspected and initially underwent conservative treatment with analgesics. However, the symptoms progressed and MRI revealed an epidural abscess surprisingly. Surgical debridement was performed and pus culture isolated Streptococcus gallolyticus. Based on the strong association of S. gallolyticus with colorectal cancer, the presence of this pathogen prompted further tumor evaluation, even in the absence of the typical symptoms and signs. This investigation ultimately leads to the diagnosis of sigmoid adenocarcinoma.ConclusionsAlthough rare, sciatica caused by S. gallolyticus infection of the spinal epidural space may serve as the initial presentation of colorectal cancer. Physicians should be aware of the strong association between S. gallolyticus and colorectal cancer. Based on what we currently know about the condition; a thorough systematic assessment of occult neoplasia for patients with S. gallolyticus infection is recommended.

Antibiotic Resistance of Streptococcus spp. Isolated from the Root Surface of Extracted Teeth to Penicillin V and Clindamycin Using E-Test

Background: Antibiotics are used to treat and prevent oral infections. Clindamycin and penicillin are widely used drugs in this field. Poor use of antibacterial agents causes the emergence of antibiotic-resistant bacteria. Objectives: The present study examined and compared the frequency distribution of resistance of streptococci isolated from the root surface of extracted teeth to penicillin V and clindamycin. This study was conducted in 2021 in Yazd, Iran. Methods: This was an analytical cross-sectional study performed in vitro. The samples were taken from the root surfaces of 50 teeth immediately after extraction and transferred to the laboratory in a transfer medium. After cultivation, isolation, and identification, the antibiotic resistance of isolates was measured by the E-test method. The data were analyzed using SPSS software (version 23). Results: Streptococci spp. were isolated from 46 samples (92%) without environmental contamination. The minimum inhibitory concentration (MIC) 50 and MIC 90 for penicillin V were 0.5 μg/mL and 1 μg/mL, respectively, and for clindamycin, 0.125 μg/mL and 0.19 μg/mL, respectively, which was significantly (P = 0.0001) lower for clindamycin. Intermediate sensitivity to penicillin V was 95.6%, and resistance to clindamycin was 21.8%. Conclusions: It seems that except in limited cases where there is resistance to clindamycin, this antibiotic is a more effective drug to control the bacteria in the mouth. However, in some cases, aerobic isolates showed intermediate sensitivity to penicillin V; instead, resistance to clindamycin was observed.

Severe Bullous Erysipelas/Cellulitis, Atypically Caused by Escherichia coli, in Kidney Transplant Recipient – Case Report and Review of Literature

Erysipelas/cellulitis are severe skin infections that are especially dangerous for immunocompromised patients. The most common cause of these diseases is streptococcal infection, but sometimes they may be caused by other Gram-positive or negative bacteria or other factors. Proper diagnosis and treatment should be implemented accurately to prevent dangerous complications. We present a case of severe bullous erysipelas caused by Escherichia coli and discuss the diagnosis, differential diagnosis, and treatment of cellulitis in kidney transplant patients.

Preadmission course and management of severe pediatric group A streptococcal infections during the 2022-2023 outbreak: a single-center experience.

The massive increase of infections with Group A Streptococcus (GAS) in 2022-2023 coincided in Switzerland with a change of the recommendations for the management of GAS pharyngitis. Therefore, the objective of the present study was to investigate whether the clinical manifestations and management before hospitalization for GAS infection differed in 2022-2023 compared with 2013-2022. Retrospective study of GAS infections requiring hospitalization in patients below 16years. Preadmission illness (modified McIsaac score), oral antibiotic use, and outcome in 2022-2023 were compared with 2013-2022. Time series were compared with surveillance data for respiratory viruses. In 2022-2023, the median modified McIsaac score was lower (2 [IQR 2-3] vs. 3 [IQR 2-4], p = < 0.0001) and the duration of preadmission illness was longer (4days [3-7] vs. 3 [2-6], p = 0.004) than in 2013-2022. In both periods, withholding of preadmission oral antibiotics despite a modified McIsaac score ≥ 3 (12% vs. 18%, n.s.) or ≥ 4 (2.4% vs. 10.0%, p = 0.027) was rare. Respiratory disease, skeletal/muscle infection, and invasive GAS disease were significantly more frequent in 2022-2023, but there were no differences in clinical outcome. The time course of GAS cases in 2022-2023 coincided with the activity of influenza A/B. We found no evidence supporting the hypothesis that the 2022-2023 GAS outbreak was associated with a change in preadmission management possibly induced by the new recommendation for GAS pharyngitis. However, clinical manifestations before admission and comparative examination of time-series strongly suggest that viral co-circulation played an important role in this outbreak.

Changing trends in clinical characteristics and in-hospital mortality of patients with infective endocarditis over four decades

BackgroundInfective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition. MethodsWere studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male. Temporal trends in demographic data, comorbidities, predisposing conditions, microorganisms, complications and in-hospital death have been studied over the decades (1978–1988, 1989–1999, 2000–2010 and 2011–2022). The outcomes and clinical characteristics were modeled using nonlinear cubic spline functions. FindingsValve surgery was performed in 50% of the patients and overall in-hospital mortality was 30%. From the first to the fourth decade studied, the average age of patients increased from 29 to 57 years (p < 0.001), with significant declines in the occurrence of rheumatic valvular heart disease (15% to 6%; p < 0.001) and streptococcal infections (46% to 33%; p < 0.001). Healthcare-associated infections have increased (9% to 21%; p < 0.001), as have prosthetic valve endocarditis (26% to 53%; p < 0.001), coagulase-negative staphylococcal infections (4% to 11%; p < 0.001), and related-complications (heart failure, embolic events, and perivalvular abscess; p < 0.001). These changes were associated with a decline in adjusted in-hospital mortality from 34% to 25% (p = 0.019). InterpretationIn the 44 years studied, there was an increase in the mean age of patients, healthcare-related, prosthetic valve, coagulase-negative staphylococci/MRSA infections, and related complications. Notably, these epidemiological changes were associated with a decline in the adjusted in-hospital mortality.

Group A Streptococcus Infections.

Group A Streptococcus causes a variety of clinical manifestations, including pharyngitis and skin and soft tissue infections as well as more invasive disease. There are also multiple nonsuppurative complications of group A Streptococcus infection, including acute rheumatic fever and poststreptococcal glomerulonephritis. Pediatricians should be able to diagnose and treat the various presentations of the infection.

Neurobehavioral Changes Associated with Rheumatic Fever and Rheumatic Heart Disease: A Narrative Review

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune conditions triggered by Group A Streptococcus skin or throat infections. If ARF/RHD is undetected, misdiagnosed or antibiotic treatment is not provided early, patients may develop cardiac failure, leading to premature death. Although it is an easily preventable disease, ARF/RHD remains the most significant cause of heart disease-associated deaths in people under 25 years old, both in low- and middle-income countries and among First Nations in high-income countries. Up to 30% of the patients with ARF/RHD present with a neurobehavioral condition – Sydenham’s chorea (SC). The clinical course of SC is mostly self-limiting and is characterized by the onset of involuntary choreiform movements and neuropsychiatric features such as obsessive-compulsive disorder, tics, depression and anxiety, psychosis, and attention-deficit hyperactivity disorder. While the precise mechanism as to why only a proportion of patients with ARF/RHD develop SC remains unknown, an impaired blood–brain barrier is considered to play a central role in its development. The most well-characterized neurobehavioral outcome is stroke which may occur in isolation or as part of systemic thromboembolism. Both infective endocarditis and mitral valve disease with or without aortic valve disease increase the embolic and ischemic stroke risk. ARF/RHD is known to significantly impact the quality of life with neuropsychiatric consequences. Another neurobehavioral syndrome which occurs in the absence of ARF/RHD is “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections” (PANDAS). PANDAS has been categorized as a subset of pediatric acute-onset neuropsychiatric syndromes. However, establishing a diagnosis of PANDAS has been challenging. In this review, we discuss the current status of our understanding regarding the different manifestations of poststreptococcal neurobehavioral changes. Particular attention is given to ARF/RHD-associated SC, and we highlight the areas for further research to understand the association between poststreptococcal sequelae and neurobehavioral abnormalities.