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PubMedDate not supplied

Group B Streptococcal infection in neonates: an 11-year review.

Group B Streptococcal (GBS) infection is an important cause of infant morbidity and mortality. The purpose of this study is to evaluate the incidence, clinical characteristics, mortality and complications of this infection. From 1985 through 1995, 66 infants with early onset disease (EOD) and 23 infants with late onset disease (LOD) were treated at Mackay Memorial Hospital (MMH). The occurrence rate of EOD was 3.26-10.08/1000 admissions. The incidence of the disease was 0.11-1.39/1000 live births. Of the 66 EOD infants, 24 (36%) were preterm infants. There were 33 (50%) infants in EOD category with respiratory distress and 40 (60%) infants with sepsis. Among the 23 LOD infants, 3 (13%) were preterm infants. There were 6 (13%) infants in LOD category with respiratory distress and 16 (69%) with sepsis. Nine (13%) EOD infants and 14 (60%) LOD infants had meningitis. Leukopenia occurred in 24 (36%) EOD infants and 5 (21%) LOD infants. Twelve (18%) EOD infants and 9 (39%) LOD infants had a history of prolonged rupture of membrane (PROM). The mortality rate was 14% in EOD and 4% in LOD infants. Four (17%) LOD infants developed neurological seguelae. Clinically, EOD infants were often premature and prone to develop sepsis, respiratory distress and leukopenia, while LOD often presented with meningitis and sepsis. Our estimated occurrence rate and incidence of EOD were similar to the European estimates. The influence of prenatal measures on EOD and the meaning of PROM on LOD need further evaluation.

Age of Onset↗
PubMed2000

Congenital penoscrotal lymphedema complicated by sepsis associated with a streptococcal infection.

Congenital lymphedema is a relatively rare disease caused by congenital abnormality of the lymphatic system. Although bacterial infection frequently causes complications with lymphedema, severe sepsis in congenital lymphedema of the genitalia has not yet been reported. We describe a patient with congenital penoscrotal lymphedema complicated by cellulitis, lymphangitis, and severe sepsis associated with a streptococcal infection. This case represents the importance of obtaining a detailed clinical history and physical findings.

Cellulitis↗
PubMed2000

Host variation in cytokine responses to superantigens determine the severity of invasive group A streptococcal infection.

Cytokines elicited by superantigens have been suggested to play a central role in severe systemic clinical manifestations of gram-positive sepsis. Here we provide evidence for a potent inflammatory cytokine response in acute invasive group A streptococcal infections, and show a direct correlation between the magnitude of this response and the severity of systemic manifestations of the disease. Severe invasive cases suffering from toxic shock and/or necrotizing fasciitis had significantly higher frequencies of IL-2-, IL-6-, and TNF-alpha-producing cells in their circulation as compared to non-severe invasive cases (p=0.05-0.01). This difference was even more accentuated when severe and non-severe cases infected with a clonal M1T1 strain were compared (p=0.03-0. 004). To determine whether host factors were responsible for this difference in magnitude of cytokine responses, paired age- and gender-matched severe and non-severe M1T1 cases (n=8) were tested in vitro during their convalescent phase for immune response to superantigens produced by their infecting isolate. The results showed persistent and inherent differences in the magnitude of proliferative and cytokine responses of severe and non-severe patients to the streptococcal superantigens to which they had been exposed during infection. Thus, the study provides evidence that patients with a propensity to produce higher levels of inflammatory cytokines in response to streptococcal superantigens develop significantly more severe systemic manifestations than patients who have a propensity to produce lower levels of inflammatory cytokines to the same superantigens. We therefore conclude that host factors influence the magnitude of cytokine responses to superantigens and consequently the clinical outcome of the infection.

Cytokines↗
PubMed1998

Obsessive-compulsive disorder in post-streptococcal infection.

OBJECTIVE: We describe the sudden onset of obsessive-compulsive symptoms following a peritoneal infection with alpha-haemolytic streptococci. CLINICAL PICTURE: A 35-year-old woman with no past history or family history of obsessions or compulsions developed these symptoms 2 weeks after a peritoneal infection. TREATMENT: The patient received 80 mg fluoxetine daily. OUTCOME: She responded to treatment with a progressive reduction in symptoms. CONCLUSIONS: It is suggested that these obsessions and compulsions may be related to an autoimmune response to the streptococcal infection.

Adult↗
PubMed1979

[Interest of stimultaneous determination of antistreptolysins and antideoxyribonuclease B in streptococcal infections (author's transl)].

The determination of antistreptolysin O (ASLO) and antideoxyribonuclease B (ADNase B) was carried out on a sample of 199 sera from normal subjects and on a sample of 4019 sera from patients admitted to the Strasbourg University Hospital Center. The sera of hospital origin were divided into two groups. The first group (n = 3889) consisted of sera taken at random, the second group (n = 130) corresponded to patients in whom we isolated a streptococcus of group A. The results obtained show that the distribution of ADNase B and ASLO of normal subjects follow a logarithmic distribution. The geometric averages of the titres DNAase B and ASLO of normal sera and of the first group of hospital origin are scarcely different, whereas the geometrical means of the titres of the second group of sera of hospital origin are quite different and two or three dilutions higher. We noted that the titres of DNAase B and ASLO were in agreement in 84% of cases in the whole group of hospital sera. Among the cases of discrepancy, the negative ASLO and the positive DNAase B corresponded mainly to streptococcal infections.

Antistreptolysin↗
PubMedDate not supplied

Reevaluation of streptococcal infection in the pathogenesis of Kawasaki disease.

Twenty-five sera from forty-nine children with Kawasaki disease (KD) in the convalescent stage, and 191 sera from controls did not disclose a higher anti-streptolysin O titer; 23 bacterial cultures from the throat swab of KD patients during the acute stage did not show a higher rate of streptococcal isolation. It was therefore concluded that there was no relation between the genesis of KD and direct immediate streptococcal infection.

Adolescent↗
PubMed2000

[Prevalence of hemolytic streptococcal infection in Kitakyushu: incidence and characteristics of isolates (1994-1997)].

In the study of prevalence of hemolytic streptococci in Kitakyushu-city from 1994 to 1997, both seasonal variation of the number of group A hemolytic streptococci isolates and their age distribution fitted in well with the cases of streptococcal infection which is monitored in the Japanese infectious disease surveillance system. Dominant serotypes of group A hemolytic streptococci in Kitakyushu-city were T-12 and T-3 from 1994 to 1995, T-28 and T-12 in 1996, T-2 and T-4 in 1997. Compared with prevalent serotypes of group A hemolytic streptococci in the City and those in Japan, the geographically close relation was observed. The epidemic serotypes in the City tended to fall behind those in Honshu, the main land of Japan. Most of the isolates were resistant to kanamycin (KM). Few isolates were resistant to other drugs except tetracycline (TC), to which 14% of the isolates were resistant. Strains of multiple-drug resistant were less than 5%. Gene of speB was detected in all group A strains by PCR method, and a close relationship was observed between T-type and SPE gene type.

Child↗
PubMed1998

Relapsing cutaneous polyarteritis nodosa associated with streptococcal infections.

BACKGROUND: Polyarteritis nodosa is an aggressive, often fatal form of vasculitis associated with multi-organ involvement. Cutaneous polyarteritis nodosa is purported to be a more benign form of this disorder with involvement limited to the skin. METHODS: The identification of a female patient from childhood to adulthood documenting repeated episodes of cutaneous polyarteritis nodosa following bouts of recurrent streptococcal pharyngitis. RESULTS: Repeated bouts of streptococcal pharyngitis at ages 11, 28, and 33 years were followed by episodes of cutaneous polyarteritis nodosa, documented by histopathologic skin changes and clinical presentation, and confirmed by therapeutic management. CONCLUSIONS: Various infectious and non-infectious conditions have been linked both to the initiation and relapse of this disease. We describe a patient with recurrent episodes of cutaneous polyarteritis nodosa spanning a period of over 20 years with each episode appearing to be linked to a prior streptococcal infection.

Child↗
PubMed2002

[Group B streptococcal infection with 2 recurrences in a newborn].

UNLABELLED: Group B III streptococcus (GBS) is a predominant pathogen in neonates in France. Relapse is rare and two successive relapses are exceptional: only three cases have been yet reported. CASE REPORT: A newborn infant of 18 days of age presented a first episode of invasive group B III streptococcal infection with meningitis and ventriculitis. At 53 days of age, a second episode with bacteriemia and parotidis appeared. At 63 days of age, she presented a third episode with meningitis. Genome analysis of the three bacterial strains isolated during the three episodes showed the same clonal origin. COMMENTS: We discuss the incidence of the treatment, the eventual presence of a penicillin-tolerant GBS, the possible relapse or recurrence of the pathogen and the role of the relative immunodeficiency in infant.

Age Factors↗
PubMed2001

Obsessive compulsive disorder: is there an association with childhood streptococcal infections and altered immune function?

During the last few years, an increased interest in the possibility of immune mediated pathophysiology of obsessive compulsive disorder (OCD) and related disorders has been seen. In the late 1980s, the National Institute of Mental Health reported an increase of obsessive compulsive symptoms in patients with Sydenham chorea (SC). Subsequently, a precipitating streptococcal infection in children with sudden onset of OCD symptoms but no chorea led to the coining of PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcus). This association has furthered interest in studying immune parameters in non-PANDAS OCD as well. This article will review the neuropsychiatric findings in OCD and Tourette syndrome (TS) with emphasis placed on PANDAS, and its association with SC, and a review of the existing studies that have assessed immunologic measures in patients with OCD and TS.

Adult↗
PubMed2000

Juvenile relapsing periarteritis nodosa and streptococcal infection.

Classic polyarteritis nodosa is a multisystem inflammatory disease associated with necrotizing vasculitis of small and medium arteries. In most cases, the causes of polyarteritis nodosa remain unknown, but viruses (HBV, HCV, HIV) and microbes (especially streptococcus) have been considered as etiologic or contributing factors. A 13-year-old boy was admitted with fever, skin lesions, polyarthritis and muscle involvement. A muscle biopsy demonstrated a necrotizing vasculitis and antistreptolysin titre was tremendously increased. His condition improved following the administration of oral steroids but he experienced relapses 5 and 12 years later when penicillin withdrawal was attempted. The flares were accompanied by a major increase of antistreptolysin titre and response to corticosteroid was obtained. He is currently 38 years old and he remains well on prophylactic penicillin. Polyarteritis nodosa in children may occur after a streptococcal infection. It may be prudent to consider penicillin prophylaxis in patients with periarteritis nodosa when a streptococcal etiology is documented or highly suspected.

Adolescent↗
PubMed1977

Streptococcal infections that fail to cause recurrences of rheumatic fever.

Prospective studies of recurrences of streptoccal infection and acute rheumatic fever were conducted among patients attending the acute rheumatic fever prophylaxis clinic (City of Memphis Hospitals, Memphis, Tennessee) between 1965 and 1972. The patient population consisted of 124 rheumatic children and adults, two-thirds of whom had evidence of rheumatic heart disease. A total of 104 immunologically documented streptococcal infections occurred during 235 patient-years of follow-up (44.3 infections per 100 patient-years) without a single recurrence of rheumatic fever. Immune responses tended to be modest, and 80% of the infections were subclinical. The majority of our group A streptococcal isolates were obtained from routine cultures of specimens from asymptomatic individuals. Many of these strains were "pyoderma" serotypes, whereas others exhibited a characteristic (production of opacity factor) recently reported to be associated with decreased immunogenicity. Several factors may have contributed to the low recurrence rate of acute rheumatic fever, including the age range of the population under study and immunologically significant infections with strains of Streptococcus that were not group A, but a major reason may be the possibility that the group A strains prevalent in this population have diminished rheumatogenic potential.

Adolescent↗
PubMed1976

Group A streptococcal infections as related to rheumatic fever.

Beta-hemolytic streptococci were recovered frequently, particularly from the throats of children, and the same type of group A strains was isolated from both throats and tonsils. A significant antibody response to streptolysin O was observed in 44.8 to 43.5 % of the children whom group A streptococci were recovered. It is considered that these children had the definite evidence of acute streptococcal infections, and administration of josamycin, penicillin G, and benzyl penicillin V benzathine decreases the frequency of recovery of beta-hemolytic streptococci and prevents rheumatic fever.

Adult↗