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Severe pulmonary hemorrhage in patients with serious group A streptococcal infections: report of two cases.

Severe pulmonary hemorrhage was observed in two patients who died of serious group A streptococcal infections. These two patients initially presented with fever and sore throat. This was followed by sudden onset of septicemia caused by the bacteria and by the subsequent development of severe pulmonary hemorrhage. Hemoptysis, cyanosis, and dyspnea were observed prior to death in both cases. This pulmonary lesion resulted in asphyxia and sudden death in one patient. Pathological examinations of the lung revealed severe intraalveolar hemorrhage, with no evidence of inflammation or necrosis of the pulmonary tissue. There was no evidence of aspiration of blood due to hemorrhage in the upper respiratory or alimentary tract. This visceral lesion appears to be an hitherto undescribed, novel clinicopathologic feature of patients with serious group A streptococcal infections.

Adult↗

[Use of tomicid in prophylaxis of respiratory streptococcal infection in the organized groups of children of pre-school age].

The results of the approbation of the use of Tomicid for the prophylaxis of scarlet fever and other manifestations of streptococcal infection in an organized group of children of pre-school age are presented. The pronounced prophylactic effect of Tomicid, manifested by a reliable decrease of group A streptococcal carrier state, as well as in a decrease in morbidity in respiratory streptococcal infection among children in the test group in comparison with those in the control one. The simplicity of the use of the preparation (as throat gargle for 5 days) makes it possible to regard this preparation as a promising remedy for the urgent prophylaxis of scarlet fever.

Anti-Bacterial Agents↗

Molecular epidemiology of impetiginous group A streptococcal infections in aboriginal communities of northern Australia.

Group A streptococcal infections among the Aboriginal communities of the Northern Territory of Australia are endemic, with a concurrently high rate of the postinfection sequelae of rheumatic fever and acute post-streptococcal glomerulonephritis. The majority of the group A streptococcal isolates from the Northern Territory are not typeable by M typing. We recently developed a novel genotyping method, Vir typing. A preliminary study using this method discriminated all the M-nontypeable (MNT) isolates. Vir typing is based on restriction fragment length polymorphisms of the 4- to 7-kb Vir regulon of group A streptococci, which contains a number of genes, including emm (the gene for M protein). A total of 407 isolates of group A streptococci obtained from four Aboriginal communities over a 4-year period were typed by this genotyping method. Forty-two distinct genotypes were found among the isolates, including 22 among the MNT isolates. The correlation between Vir type and M type was good. This genotyping method allows the characterization of all group A streptococcal isolates from Aboriginal communities in the Northern Territory. We also propose that Vir typing be used in conjunction with M typing for epidemiological surveillance in geographical regions where the majority of isolates are MNT.

Antigens, Bacterial↗

Neonatal group B streptococcal infection.

Group B streptococcus is now recognized as a major cause of serious neonatal infection. Between January 1973 and July 1979 35 infants with 'early onset' group B streptococcal infection were admitted to the Special Nursery, Aberdeen Maternity Hospital. Ten infants died, nine of whom were of low birth weight. Current research is directed towards defining 'high risk' groups and establishing an effective means of prevention. The concept of early administration of antibiotics to 'high risk' infants, particularly those of low birth weight, is recommended. While there is already evidence in support of the effectiveness of such an antibiotic policy, the nature of protective immunity and the place of immunoprophylaxis have yet to be clarified. Analysis of our data suggests that vaginal carriage of group B streptococcus is not associated with the mother's blood group but there appears to be an increased incidence of neonatal group B streptococcal infection in infants of mothers of blood group B.

Female↗

[Streptococcal infections in adults].

The paper presents the morbidity through streptococcal angina, acute rheumatic fever and acute glomerulonephritis in two industrial enterprises with different working conditions. This study was performed between 1968 and 1977. In enterprise A, where rheumatogenic conditions were present, streptococcal angina had an yearly attacks vaeried between 0,13 and 0,7 percent, and acute glomerulonephritis between 2,3 and 5,4 percent. In enterprise B, with usual working conditions, angina showed an yearly variation between 2,3 and 5,8 percent, acute rheumatic fever varied between 0,0 and 0,84 percent and there were no cases of acute glomerulonephritis. In two units (collectivities of students) where angina was detected by active methods and prophylactic measures were applied rigurously no post-streptococcal complications were recorded. The authors stress the effects of morbidity through streptococcal infections in adults and recommend an extension of targeted prophylactic programs in high-risk units.

Absenteeism↗

Beta haemolytic streptococcal infection does not cause right diaphragmatic eventration.

Numerous case reports in the literature have suggested a causal link between beta-haemolytic streptococcal infection and delayed-onset right-sided diaphragmatic hernia/eventration in the perinatal age group. We report a child with antenatally documented right diaphragmatic eventration 4 weeks before birth who subsequently developed a beta-haemolytic streptococcal infection in the neonatal period.

Abnormalities, Multiple↗

Inherited deficiency of the ninth component of complement associated with streptococcal infection.

A 7 year old boy, who presented with streptococcal infection, was found to have a low serum complement level (CH50). The C9 component was undetectable. His CH50 rose to the normal value and remained normal for at least three weeks, but decreased to one-third of the normal level three months later. Family studies were consistent with a familial C9 deficiency, with autosomal co-dominant inheritance.

Child↗

Acute urticaria associated with streptococcal infection.

Eighty-one cases of acute urticaria were treated in our institution over a two-year period. In 13 of 32 cases screened for streptococcal pharyngitis, either positive throat culture, significant streptococcal exoenzyme antibodies (Streptozyme test), or both were found. Other causative factors for the acute urticaria had been excluded. It is our feeling that beta-hemolytic streptococcal infection may be a causative agent in many cases of acute urticaria, and that the infection may not always be clinically apparent. We therefore recommend a throat culture and determination of streptococcal enzyme level as routine procedures in evaluating acute urticaria. We also suggest, based on the findings in one case, that discontinuing therapy for a streptococcal infection when urticaria develops, even though necessary, might be inappropriate.

Acute Disease↗

Population-based surveillance of invasive pyogenic streptococcal infection in a large Canadian region.

Pyogenic streptococci are a major cause of invasive infection. This study presents the results of a population-based laboratory surveillance for invasive pyogenic streptococcal infections among residents of the Calgary Health Region (population 1 million) between 1 July 1999 and 30 June 2004. The overall annual incidence rate was 18.65/100,000 population, with isolates belonging to the Streptococcus milleri group forming the most important aetiology (incidence of 8.65/100,000 population). Invasive infection with groups A, B, G and C streptococci occurred at annual rates of 4.27, 3.13, 1.83 and 0.41/100,000 population, respectively. There was a close relationship between increasing age and development of an invasive pyogenic streptococcal infection, and the incidence of infection was higher among males than among females. Differences in the seasonal occurrence and focus of infection occurred between the different groups.

Adolescent↗

Role of adherence in the pathogenesis of neonatal group B streptococcal infection.

The ability of group B streptococci to attach to buccal epithelial cells from adult volunteers, healthy neonates, and infants with invasive group B streptococcal infection was assessed by using (3)H-labeled bacteria incubated at a bacteria-to-cells ratio of 1,000:1. Type III group B streptococcal clinical isolates adhered significantly better to the epithelial cells of healthy neonates than to those of adults (mean bacteria per cell of 31 versus 7, respectively; P < 0.005). In contrast, no statistically significant differences in adherence of type Ia or type II strains to cells of neonates and adults were noted. The adherence of strains isolated from 15 infants with invasive group B streptococcal infection was significantly greater to the cells of infected infants than to those of age-matched controls (mean bacteria per cell of 39 versus 18, respectively; P < 0.005). In contrast, no significant difference was noted in the adherence of a usually adherent type Ia strain and a nonadherent type III strain to the cells of infected infants compared with control infants. These results indicate that the serotype of group B streptococci with the greatest virulence for neonates (type III) adheres better to neonatal than to adult epithelial cells. Infants who develop invasive infection may have an increased number of epithelial cell surface receptor sites for attachment of group B streptococci, the bacteria may elaborate products which unmask receptor sites, or both.

Adhesiveness↗

Immunoprophylaxis and immunotherapy of neonatal group B streptococcal infections.

With emphasis on work from our laboratory, this paper briefly reviews previous studies which have established the basis for immunity to group B streptococcal infections. Quantitative data are presented on the concentration of antibody to the type-specific polysaccharides of group B streptococci in normal adults and infected infants, the protective level in experimental animals, and the influence of prematurity on transplacental passage of antibody. The role of the polymorphonuclear leukocyte in immunity to group B streptococcal infections is critical as supported by in vitro and in vivo experiments as well as clinical observations. Strategies for prevention include antimicrobial chemoprophylaxis and active immunization. Alternative approaches to adjunctive therapy such as administration of specific immune globulin, polymorphonuclear leukocytes, and exchange transfusions are discussed.

Age Factors↗

Immunoprophylaxis and immunotherapy of neonatal group B streptococcal infections.

With emphasis on work from our laboratory, this paper briefly reviews previous studies which have established the basis for immunity to group B streptococcal infections. Quantitative data are presented on the concentration of antibody to the type-specific polysaccharides of group B streptococci in normal adults and infected infants, the protective level in experimental animals, and the influence of prematurity on transplacental passage of antibody. The role of the polymorphonuclear leukocyte in immunity to group B streptococcal infections is critical as supported by in vitro and in vivo experiments as well as clinical observations. Strategies for prevention include antimicrobial chemoprophylaxis and active immunization. Alternative approaches to adjunctive therapy such as administration of specific immune globulin, polymorphonuclear leukocytes, and exchange transfusions are discussed.

Animals↗

Early-onset group B streptococcal infection after a combined maternal and neonatal group B streptococcal chemoprophylaxis strategy.

OBJECTIVE: In January 1995, a combined maternal and neonatal protocol for prevention of early-onset group B streptococcal (GBS) infection was implemented that consisted of a risk factor-based approach for maternal intrapartum chemoprophylaxis using ampicillin combined with a single intramuscular dose of penicillin given to all newborns within 1 hour of delivery. The objective of this study was to review the cases of early-onset GBS infections that occurred from 1995 to 1999 to identify factors associated with their continued occurrence despite implementation of a GBS chemoprophylaxis protocol. METHODS: Infants or=2 doses of intrapartum chemoprophylaxis, and among those with intrapartum fever, 25% received >or=2 doses. None of the 32 infants with early-onset GBS infection received the combination of intrapartum ampicillin and postnatal penicillin. CONCLUSIONS: A combined obstetric and neonatal chemoprophylaxis protocol significantly reduced early-onset GBS infection. Maternal intrapartum fever was the most frequent risk factor associated with failure of chemoprophylaxis.

Ampicillin↗

Group A streptococcal infection in patients presenting with a sore throat at an accident and emergency department: prospective observational study.

OBJECTIVES: To determine the prevalence of group A streptococcal infection and to evaluate the predictive value of clinical findings and rapid streptococcal antigen detection testing in patients presenting with a sore throat or suspected clinically to have acute pharyngitis. DESIGN: Prospective observational study. SETTING: Accident and emergency department of a public hospital, Hong Kong. PATIENTS: All patients presenting with a sore throat as the chief complaint, or suspected clinically to have acute pharyngitis, from April to September 2000. MAIN OUTCOME MEASURES: Demographic data, clinical features, microbiological throat culture results, and rapid streptococcal antigen detection (Accustrip) test results. RESULTS: Of 1449 patients recruited during the 6-month study period, only 44 (3.0%) had positive throat cultures for group A beta-haemolytic streptococcus. The majority of group A beta-haemolytic streptococci were isolated from patients between the age of 3 and 60 years. Clinical findings other than an absence of cough were found to be unhelpful in predicting group A beta-haemolytic streptococcal throat infection. The sensitivity of the rapid group A streptococcal antigen detection test was 52.6% and the specificity was 98.2%. CONCLUSIONS: The prevalence of group A beta-haemolytic streptococcus in patients presenting with a sore throat, or suspected clinically of having acute pharyngitis, was low. If empirical antibiotics were given to all such patients, 97% of them would be unnecessarily treated. Age and absence of cough were the only clinical findings helpful in predicting the presence of group A beta-haemolytic streptococcal throat infection. The rapid group A streptococcal antigen detection test can provide a quick guide to clinicians on the necessity of antibiotic therapy. However, a confirmatory throat culture backup is recommended for patients with a negative test result.

Acute Disease↗

[The manifestations of an epidemic process in a respiratory streptococcal infection among ships' crews under commercial sailing conditions].

Morbidity in respiratory streptococcal infection in 6 ships of the State Fishery Amalgamation "Dal'ryba" during 8 voyages was analyzed. During voyages morbidity rate is determined by sporadic cases, seasonal rises at the time of the voyage and epidemic outbreaks. Spring and summer months constitute the period of risk for seasonal morbidity rises during voyages and epidemic outbreaks at the time of the formation of the crew. The minimal size of the crew in which the activation of the epidemic process took place was 350 persons. In lesser crews (250-300 persons) seasonal rises in morbidity were observed only in the presence of frequent and intensive change-over of crew members.

Disease Outbreaks↗