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PubMed2001

Genetic control of susceptibility to group A streptococcal infection in mice.

The influence of genetic background on the ability to control infection with group A streptococci was investigated in different inbred strains of mice. Whereas BALB/c, C57BL/10, and DBA/2 mice were the most resistant strains, with lower bacteria loads and higher survival times, C3H/HeN and CBA/J mice exhibited substantially higher bacterial growth and 100% mortality. Differences in susceptibility were not dependent on the inoculum size. Resistance was influenced by sex, with males being much more susceptible than females. B cell- and T cell-deficient mice from the resistant background were as resistant to infection as were immunocompetent mice, which suggests that the effector mechanisms are independent of adaptive immunity. These results demonstrate for the first time the influence of genetic background and sex on susceptibility to infection with Streptococcus pyogenes in mice. The use of this mouse model of group A streptococcal infection will allow for a better definition of parameters involved in the outcome of the disease.

Animals↗
PubMed1998

The impact of mucositis on alpha-hemolytic streptococcal infection in patients undergoing autologous bone marrow transplantation for hematologic malignancies.

BACKGROUND: Antibacterial prophylaxis with quinolone antibiotics has resulted in an increase in streptococcal infections among bone marrow transplantation (BMT) recipients with myelosuppression. Oral ulceration (mucositis), which frequently occurs as a consequence of chemotherapy, has been implicated as a significant portal of entry for streptococci. The objectives of this study were to confirm the correlation between mucositis and streptococcal bacteremia, determine the risk associated with this correlation, and evaluate the impact of mucositis and streptococcal bacteremia on hospital course and costs associated with autologous BMT. METHODS: This was a retrospective, case-control study in which the charts of autologous BMT recipients treated for hematologic malignancies between 1990 and 1996 were reviewed. Twenty-four patients were identified who met the criteria of autologous BMT; their blood cultures confirmed (x2) alpha-hemolytic streptococcal sepsis. A control group of 45 without positive cultures was matched by gender, age, diagnosis, and treatment to the study group. RESULTS: The results confirm that ulcerative mucositis is a significant risk factor for alpha-hemolytic streptococcal bacteremia among autologous BMT patients. Of the 24 patients with bacteremia, 15 of 24 (62%) had ulcerative mucositis, compared with 16 of 45 (36%) of patients in the control population (P < 0.05). Patients with ulcerative mucositis were found to be three times as likely to develop alpha-hemolytic streptococcal bacteremia as those without ulcerative mucositis (odds ratio=3.02). Both independently and as a cofactor associated with bacteremia, mucositis adversely affected the length of hospital stay (LOS). Of all the patients studied, those with oral ulcerations had a LOS of 34 days, compared with 29 days for patients without oral ulcerations (P < 0.05). Of patients in the study group, those with oral ulcerations stayed in the hospital 6 days longer than patients without oral ulcerations (40 days vs. 34 days, P < 0.05). CONCLUSIONS: Oral ulcerative mucositis is a significant, common, and important risk factor for alpha-hemolytic streptococcal bacteremia in BMT recipients with myelosuppression; it results in longer hospital stay and increased costs.

Adult↗
PubMed1994

An analysis of the cost-effectiveness of selected protocols for the prevention of neonatal group B streptococcal infection.

OBJECTIVE: To determine the expected neonatal outcome in a hypothetical obstetric population with various screening and intrapartum management protocols for the prevention of neonatal group B streptococcal infections. METHODS: We used decision analysis to investigate the performance of various antenatal and intrapartum group B streptococcal screening protocols combined with selective or universal intrapartum antibiotic prophylaxis in preventing neonatal early-onset group B streptococcal disease. Population characteristics, screening test performance, and treatment efficacy profiles were abstracted from previous investigations. RESULTS: In the absence of screening or treatment, the estimated neonatal attack rate and mortality rate were 3.6 and 0.60 cases per 1000 neonates, respectively. Universal antenatal screening at 26-28 weeks' gestation and selective intrapartum prophylaxis (treatment of colonized women with risk factors) or nonselective prophylaxis (treatment of all colonized women) had attack rates of 1.64 and 1.08 and mortality rates of 0.21 and 0.18 cases per 1000 neonates, respectively. Rapid intrapartum screening and selective prophylaxis had an estimated attack rate of 1.92-2.58 and a mortality rate of 0.26-0.40 cases per 1000 neonates, with results dependent upon the time required to attain test results. Similarly, rapid intrapartum screening and nonselective prophylaxis had an attack rate of 1.44-2.30 and a mortality rate of 0.24-0.38 cases per 1000 neonates. Empirical prophylaxis of all women delivering prematurely, regardless of culture status, had an attack rate of 2.40 and mortality rate of 0.36 cases per 1000 neonates. CONCLUSIONS: Under ideal circumstances, antenatal group B streptococcal screening at 26-28 weeks' gestation with vaginal-rectal cultures and subsequent intrapartum prophylaxis is associated with lower projected neonatal attack and mortality rates than protocols using rapid intrapartum screening methods. However, in a non-research population, difficulties frequently encountered with antenatal screening procedures may minimize these differences.

Clinical Protocols↗
PubMed2004

Immune response to superoxide dismutase in group A streptococcal infection.

Extracellular localisation of manganese-dependent superoxide dismutase (SodA) by group A streptococcus (GAS) may have a role in protection of this pathogenic bacterium from exogenously produced reactive oxygen species. In this study we show that SodA is found both in surface protein extracts and in culture supernatants of GAS. To investigate whether SodA is a possible vaccine candidate outbred Quackenbush mice were subcutaneously vaccinated with recombinant SodA. Strong antibody responses which were moderately opsonic were elicited. These antibodies were unable to protect mice from intraperitoneal challenge with M1 GAS. We also show that SodA and p145 (a conserved peptide from the M-protein) antibodies are present at significantly higher levels amongst patients with rheumatic heart disease than in control subjects from the same endemic region. The higher SodA antibody levels in patients may be indicative of a role for this protein in pathogenesis of rheumatic heart disease but are more likely to be a marker of recent or recurrent streptococcal infection.

Animals↗
PubMed1988

'Toxic strep syndrome'. A manifestation of group A streptococcal infection.

Three patients presented with multisystem disease that shared many of the features of toxic shock syndrome. Bacteriologic and serologic evidence strongly suggested that group A beta-hemolytic Streptococcus had caused the illnesses. Group A streptococcal infection may be an underdiagnosed cause of a toxic streptococcal syndrome, a syndrome of multisystem disease apparently mediated by toxins.

Acute Kidney Injury↗
PubMed2000

Psychiatric disorders in first-degree relatives of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

OBJECTIVE: To determine the rates of psychiatric disorders in the first-degree relatives of children with infection-triggered obsessive-compulsive disorder (OCD) and/or tics (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; PANDAS). METHOD: The probands of this study were 54 children with PANDAS (n = 24 with a primary diagnosis of OCD; n = 30 with a primary diagnosis of a tic disorder). One hundred fifty-seven first-degree relatives (100 parents [93%] and 57 siblings [100%]) were evaluated for the presence of a tic disorder. One hundred thirty-nine first-degree relatives (100 parents [93%] and 39 of 41 siblings over the age of 6 [95%]) were evaluated with clinical and structured psychiatric interviews to determine the presence of subclinical OCD, OCD, and other DSM-IV Axis I disorders. RESULTS: Twenty-one probands (39%) had at least one first-degree relative with a history of a motor or vocal tic; 6 mothers (11%), 9 fathers (19%), and 8 siblings (16%) received this diagnosis. Fourteen probands (26%) had at least one first-degree relative with OCD; 10 mothers (19%), 5 fathers (11%), and 2 siblings (5%), received this diagnosis. An additional 8 parents (8%) and 3 siblings (8%) met criteria for subclinical OCD. Eleven parents (11%) had obsessive-compulsive personality disorder. CONCLUSIONS: The rates of tic disorders and OCD in first-degree relatives of pediatric probands with PANDAS are higher than those reported in the general population and are similar to those reported previously for tic disorders and OCD. Further study is warranted to determine the nature of the relationship between genetic and environmental factors in PANDAS.

Adolescent↗
PubMed2000

[Prophylaxis of group B beta-hemolytic streptococcal infections].

Group B streptococcus is a possible cause of chorioamnionitis, endometritis and urinary tract infections in pregnant woman. Maternal risk factors and the vertical transmission of GBS and neonatal GBS infection occur through the following fever during labor, the rupturing of membranes more than 18 hours before delivery, prematurity and chorioamnionitis. GBS can induce early-onset neonatal disease (sepsis, meningitis or pneumonia) during the first week of life and late-onset neonatal infection (leptomeningitis) within the first 12 weeks of life. Numerous strategies for preventing neonatal group B streptococcal infection were investigated: 1) the treatment of GBS-colonized women during the third trimester of pregnancy did not prove to be effective because it does not reduce maternal colonizzation rates at delivery; 2) the neonatal universal post-partum prophylaxis with penicillin G was ineffective and increased neonatal mortality due to penicillin-resistant bacterial infection; 3) the intrapartum maternal chemoprophylaxis with penicillin G or ampicillin in GBS-colonized women, in women with risk factors, or in women with both GBS colonization and risk factors. The latter strategy proved to be the most effective because it reduces the risk of early-onset GBS infection by 75% and 95% when associated with post-neonatal prophylaxis. To date, there are no guidelines on the management of the asymptomatic neonate whose mothers have been treated with chemopropylaxis intra-partum.

Humans↗
PubMed2002

Acute streptococcal infection of the gingiva, lower lip, and pharynx--a case report.

BACKGROUND: Streptococcal gingivostomatitis is a rare phenomenon in a non-compromised host and not commonly reported in the dental literature. Early diagnosis and distinction from viral infections, especially HSV infection, are of the utmost importance. The early use of penicillin is essential in preventing a cascade of events, resulting in severe fasciitis, destruction of tissues, and subsequent rheumatic fever and rheumatic heart disease. METHODS: A unique case of group A beta-hemolytic streptococcal infection affecting the pharynx, lower lip, and gingiva of a healthy 19-year-old male is presented. RESULTS: The streptococcal infection was responsive to penicillin treatment. CONCLUSIONS: In view of the increased use of antibiotics and the development of aggressive strains, the dental clinician has to consider streptococcal infection in the differential diagnosis of gingival and soft tissue infections.

Acute Disease↗
PubMedDate not supplied

Response of C-reactive protein in neonatal Group B streptococcal infection.

Preliminary evidence (n = 15) with semiquantitative (latex) determinations of C-reactive protein (CRP) suggested an unreliable CRP response in systemic Group B streptococcal infection. Recent experience with sequential, quantitative determinations of CRP in 10 infants surviving GBS infection documents that CRP can rise rapidly with systemic infection and fall rapidly with appropriate treatment. One infant with asymptomatic bacteremia had no increase in CRP, but in nine others with sepsis and/or meningitis the peak concentrations were from 4.2 to 31.9 mg/dl. Duration of elevated CRP ranged from 2 days in benign illness to 17 days in severe meningitis. Two infants with neurologic sequelae had concentrations greater than 20 mg/dl. Leukopenia, neutropenia and elevated immature neutrophil:total neutrophil ratio were frequently observed at the onset of infection. Leukocyte counts may be most helpful in making an early diagnosis, whereas CRP concentrations may document response, influence duration of antibiotic therapy and provide prognostic information.

C-Reactive Protein↗
PubMedDate not supplied

[Genotypic emm-typing of streptococcal cultures, group A, isolated from patients with different clinical manifestations of streptococcal infection in Moscow].

The results of the intraspecific typing of group A streptococci (SGA), isolated from patients with different manifestations of group A streptococcal infection, carried out in Russia for the first time, are presented. The genotypic method of emm-typing, based on sequencing the DNA area coding the variable part of the molecule of SGA M-protein was used. The data obtained in this study made it possible to follow changes in the pattern of SGA M-types in Moscow and the specific features of SGA in comparison with the analogous data on other territories. New emm-types of SGA circulating on the territory of Russia were detected and described.

Antigens, Bacterial↗
PubMed1990

[The OF characteristics of streptococci group A and immunity to streptococcal infection based on the results of OF and anti-OF tests].

The influence of the OF activity of group A streptococci on their specific pathogenic properties has been shown, which is manifested by increased virulence of these streptococci for children of younger age groups and by a two times higher isolation rate of OF+ strains in tonsillitis than in scarlet fever. The possibility of the indirect evaluation of the content of anti-M-antibodies by the results of the anti-OF test has been revealed, which permits using this test instead of the bactericidal test, more complicated, in the study of immunity to infection induced by group A OF+ streptococci. Among the main methods of laboratory support of epidemiological surveillance on streptococcal infection, the introduction of the highly discriminating OF typing and the anti-OF test into practical use is recommended.

Antibodies, Bacterial↗
PubMed1977

Prevalence of haemolytic streptococcal infection in rhesus monkeys.

Seventy-six monkeys arriving in 10 batches were investigated within a day or two of their arrival for beta-haemolytic streptococcal infections. 10.53 per cent of monkeys yielded group A beta haemolytic streptococcus. Majority of the isolates were T pattern I. With ASO test, 44.7 per cent monkeys had low titres while with A-DNase 'B' 'test, 64.5 per cent of the monkeys had low titres.

Animals↗
PubMed2005

Invasive group A streptococcal infection in high school football players, New York City, 2003.

After being notified that 2 high school football teammates from New York City were hospitalized with confirmed or suspected invasive group A streptococcal infections, we conducted an investigation of possible spread among other team members. This investigation highlights a need for guidelines on management of streptococcal and other infectious disease outbreaks in team sport settings.

Adolescent↗
PubMed1990

Rheumatic fever and streptococcal infections in an isolated population group in eastern Siberia.

During a two-week expedition, the prevalence of rheumatic heart disease (RHD) and the prevalence of group A streptococcal infections was investigated in a group of Yakut families of about 600 persons. In the 478 examined persons no clear-cut RHD was identified, but possible participation of rheumatic etiology in heart changes was not excluded in one adult. Group A streptococci were grown from pharyngeal swabs from 13.3% of the 202 persons examined, in the absence of any overt streptococcal disease in the settlement at the time of screening. Streptococci of at least six M-types were present among the population. Titres of antistreptolysin 0 greater than or equal to 250 u. and of antideoxyribonuclease-B greater than or equal to 1200 u. were found in 21% and 18%, respectively, of the 205 examined individuals. The bacteriological and serological data combined suggested a rather high streptococcal transmission rate in the settlement in the recent past, the pattern of which was reminiscent of the pattern of streptococcus spread in heavily interconnected population groups of the moderate climate. Possible reasons for the absence of definite RHD are discussed.

Adolescent↗
PubMed1996

Disseminated encephalitis following streptococcal infection.

Various neurological disorders have been related to Streptococcus pyogenes infection. Only recently, and for the first time, it has been suggested that acute disseminated encephalitis may also complicate a streptococcal infection. The case reported in this paper seems to confirm this hypothesis.

Adolescent↗
PubMed2001

Group A streptococcal infections and tic disorders in an Italian pediatric population.

BACKGROUND: The relationship between childhood tic disorders and group A streptococcal (GAS) infections has been recently investigated by several research groups, but no systematic evaluation of laboratory indicators of GAS infections has been provided. OBJECTIVE: The aim of our study was to seek clinical and laboratory evidence of GAS infections in a large population of children affected with tic disorders. STUDY DESIGN: This investigation was a case-control study: 150 consecutive children presenting with tics were investigated for clinical and laboratory signs of streptococcal infections on the occasion of their first neuropsychiatric consultation. To compare the rate of exposition to GAS in a similar population, a control group of 150 children without tic disorders was examined during the same period. RESULTS: In children with tics, mean antistreptolysin O (ASO) titer (434 +/- 338 IU) was significantly higher compared with that of control subjects (155 +/- 126 IU); 38% of the children with tics compared with 2% of the control subjects (P <.001) had ASO titers > or =500 IU. Twenty-six children with tics (17%) had throat cultures positive for GAS, but in all cases, only few colonies per plate were isolated. Among the strains isolated, no prevalent T pattern or M type was observed. In children with tics a positive correlation between ASO titers and severity of tic disorder (measured by the Yale Global Tic Severity Scale) was found. CONCLUSION: Our results suggest that children with tic disorder could be a unique population in which GAS infection, or at least the exposure to streptococcal antigens, is correlated to the neurobehavioral disorder. Moreover, our data indicate a relationship between the severity of tic disorder and the magnitude of the serologic response to GAS antigens.

Antistreptolysin↗