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Tonsillectomy is a very common procedure in childhood. Infectious complications after tonsillectomy are infrequently reported. We describe two children with severe group A beta-hemolytic streptococcal infection after tonsillectomy, and we review the literature about bacteremia and infectious complications after tonsillectomy.
The investigation comprises 5,811 litters and 55,641 liveborn pigs. Among the pigs which died before weaning, infection with haemolytic streptococci (HS) was determined in 1,338. This corresponds to 2.4 per cent of the liveborn pigs (Table I). In the examined herds the incidence of fatal cases with HS infections ranged from 1.2 to 3.8 per cent. The highest incidence was observed in litters born by gilts (Table II) and in litters with more tha 11 pigs (Table III). HS infections were identified in 17.5 per cent of the examined litters, and in most of the litters only one pig was lost (Table IV). A marked seasonal variation was observed, with a predominance of HS during the winter period (Table V). Analyses of the influence of some possible determinative factors revealed the highest incidence among the progeny of sows which were housed separately during pregnancy (Table VI), whereas herd size and the hygiene level did not exert any influence on the frequency of HS. The incidence of fatal HS infections was higher in herds where tail docking and clipping of the canine teeth were performed than in herds where these procedures were omitted (Table VII). Most of the death with HS infections (53.8 per cent) occurred among pigs less than 14 days of age (Table VIII). The main diagnoses of the pigs with streptococcal infections are presented in Table IX. A survey of the isolation frequency of HS from various organs is given in Table X. The most frequently isolated serogroups were group-C (40.2 per cent) and group-L (31.3 per cent) (Table XI). Preliminary investigations on the source of infection and the pathogenesis are reported (Tables XII and XIII). In two herds, 8 of 10 sows carried HS on mucosal surfaces at the time of farrowing, and in 6 of 10 examined litters, HS bacteraemias were observed in pigs during the first days of life. Furthermore, an analysis showed that part of the sowa (109) lost pigs with HS infections in several (2-6) subsequent litters (Tables XIV) and XV).
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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In 1996, the Centers for Disease Control and Prevention (CDC) and relevant professional organizations jointly released guidelines for prevention of early-onset neonatal group B streptococcal infections. The guidelines recommended that all obstetric providers and institutions providing intrapartum services follow one of two strategies. This year, on the basis of multistate surveillance data collected since prevention strategies were initiated, the CDC has released revised prevention recommendations. This article reviews the new guidelines and discusses clinical implications for practice in a variety of settings.
Group B Streptococcal bacteraemia seldom behaves as a pyrexia of unknown origin (PUO) except in the context of infective endocarditis. Scleroderma is not known to predispose to Group B streptococcal infection. We report a case of Group B streptococcal bacteraemia presenting as a PUO in a patient with probable scleroderma in whom there was no evidence of endocarditis.
OBJECTIVES: Infective endocarditis (IE) remains a disease associated with high morbidity and mortality. Many epidemiological studies have been reported worldwide; however, data from the Middle East is scarce. Most studies have recently shown a trend towards increasing incidence of Staphylococcus aureus endocarditis and decreasing prevalence of rheumatic heart disease as a predisposing condition. METHODS: We conducted a retrospective review of all recorded cases of IE in adult patients admitted between 1986 and 2001 to the American University of Beirut-Medical Centre. RESULTS: The total number of cases was 91. The mean age was 48 years. Fifty-nine percent of patients had a predisposing cardiac condition, rheumatic heart disease being the most common (33%). Blood cultures were positive in 77.5% of the cases: the most commonly isolated organisms were Streptococcus spp. (51%; of which 57% were viridans streptococci.) and Staphylococcus spp. (36%; of which 72% were S. aureus and 28% were coagulase-negative staphylococci). Transoesophageal echocardiography was performed in 36 patients (40%), of which 32 (89%) showed positive findings. When applying the revised Duke criteria, 82% of the patients were classified as definite and 16.5% as possible endocarditis. Surgery was performed in 32% of cases mostly for valvular regurgitation, followed by heart failure. The complication rate was 69% with congestive heart failure, drug-related toxicities, new valvular regurgitation and systemic embolisation being the most common. The in-hospital mortality rate was 18%. CONCLUSIONS: Unlike data reported from the United States and northern Europe, this study confirms that in Lebanon, a developing country, we continue to have a predominance of streptococci as aetiologic agents in IE, and rheumatic heart disease as the most common underlying heart condition. Application of the revised Duke criteria was useful in confirming the diagnosis of IE.
FROM OBSESSIVE-COMPULSIVE DISORDER TO PANDAS: Obsessive-compulsive disorder (OCD) represents a potentially severe and handicapping disorder that affects several hundreds of thousands of children in France. OCD has, for many years, been considered as a neurosis resulting from mental conflicts. It is currently seen as a neurobiological disorder, the etiological substratum of which is more organic than mental. Recently a sub-type of OCD was isolated in children following infection by Group A b-hemolytic streptococci. This sub-type has been described as Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS). A NEW PHYSIOPATHOLOGICAL APPROACH: The putative dysimmune relationship between bacterial infection and neurotic disorder has led to the development of an original etiopathogenic model that may lead to new therapeutic strategies. The clinical case report of an adolescent presenting with trichotillomania associated with recurrent pharyngitis is a good illustration of this. PUBLISHED DATA: Data published in medical literature over the last 10 years indicates a 10% prevalence in the young suffering from OCD, i.e. 0.1 to 0.3% of the young population.
The capacity of Streptococcus pyogenes, isolated from clinically healthy children in a large organized group, for producing erythrogenic toxin A, B and C was studied. The dynamics of toxin production was compared with changes in the levels of morbidity and carrier state, as well as with some characteristics of the interaction between the populations of the infective agent and the host by such values as virulence and susceptibility. Similarity in the dynamics of the parameters under study was noted. The seasonal dynamics of characteristics which determined the capacity for toxin production significantly influenced the levels and one year morbidity dynamics with respiratory streptococcal infection. The study demonstrated the information value of the characteristics of toxin production for understanding both the interval mechanisms of the epidemic process and the influence of the external ones on subsequent epidemic situation.
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Results are reported of a study of relationship of complement level, unspecific adaptative reactions, number of circulating immune complexes and some cellular parameters of the immunogram in patients with different forms of streptococcal infection. Different changes were found in acute and chronic forms of the disease. The possible mechanisms of development of these disorders are discussed.
Infections of the upper respiratory tract and skin due to group A Streptococcus are common, and the organism is highly transmissible. In industrialized countries and to some extent in developing countries, control efforts continue to emphasize that group A streptococcal pharyngitis should be properly diagnosed and appropriately treated. In developing countries and in indigenous populations where the burden of group A streptococcal diseases appears greatest, the epidemiology is less completely defined and may differ from that in industrialized countries. There is a need for accurately collected epidemiological data from developing countries, which may also further clarify the pathogenesis of group A streptococcal infections and their sequelae. While proper treatment of group A streptococcal pharyngitis continues to be essential in all populations, it may be appropriate in developing countries to consider additional strategies to reduce rates of pyoderma.
Microbiological, immunological and immunohistochemical studies were carried out in 78 children with different clinicomorphological forms of chronic glomerulonephritis (GN). According to the data obtained, the role of streptococcal infection (SI) is inconclusive in certain clinicomorphological forms of chronic GN, suggesting different approaches to the treatment of these patients. The etiological role of SI is most probable in mesangioproliferative and mesangiocapillary GN, manifesting by hematuric and mixed forms of chronic GN. Antibacterial therapy is indicated to patients with a rise of the level of ASL-O and with the clinical signs of acute SI or exacerbation of chronic tonsillitis in the same patients, especially during immunosuppressive therapy.
A prospective, matched, case-control study conducted over a period of 3 years was designed to examine the association of group A beta-haemolytic streptococcal infections and Henoch-Schonlein purpura. Demographic and clinical data were collected as well as measurement of antistreptolysin O titres and throat swab culture on all children admitted with Henoch-Schonlein purpura, as well as their matched controls. Antistreptolysin O titre positivity was associated with a 10-fold increase in the risk of Henoch-Schonlein purpura. Renal involvement was common among cases with positive antistreptolysin O titres (27%) compared with cases with a negative titre (8%) but this difference has no statistical significance.
A 9-year-old girl had an acute encephalopathic illness characterized by disordered consciousness, seizures, and multiple cortical deficits. The acute illness was associated with serologic evidence of an antecedent streptococcal infection and the presence of a mixed cryoglobulin with specific antistreptococcal antibody activity. Although the patient had no other evidence of a systemic or central nervous system vasculitis, computerized tomography demonstrated changes compatible with a vasculitic process. Treatment with corticosteroids was associated with resolution of the cryoglobulinemia and complete clinical recovery.