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PubMed2005

Invasive group A streptococcal infections, clinical manifestations and their predictors, Montreal, 1995-2001.

We identified 306 invasive group A streptococcal infections (IGASI) by passive population-based surveillance in Montreal, Canada, from 1995 to 2001. The average yearly reported incidence was 2.4 per 100,000 persons, with a 14% death rate. Among clinical manifestations, incidence of pneumonia increased from 0.06 per 100,000 in 1995 to 0.50 per 100,000 in 2000. Over a span of 7 years, the odds of developing pneumonia increased (odds ratio [OR] = 1.21, 95% confidence interval [CI] 1.0-1.5), while they decreased for soft-tissue infections (OR = 0.86, 95% CI 0.7-1.0). Serotypes M1 and M3 accounted for 30% of IGASI. However, neither serotype was significantly associated with specific clinical manifestations, which suggests that manifestation development among IGASI might be attributable to host or environmental factors rather than the pathogen. In our study, these factors included age, gender, underlying medical conditions, and living environment, yet none explained temporal changes in risk for pneumonia and soft-tissue infections.

Adolescent↗
PubMedDate not supplied

[Sero-epidemiological surveillance, a method of prevention of complications of streptococcal infections].

In order to find methods for the prevention and control of streptococcal infections of 711 day schoolchildren and boarders, aged 7 to 14 years, were followed up during the 1969-1973 period. The clinical and epidemiologic investigations revealed a great number of acute infections with varied clinical manifestations and high proportions of the acute articular rheumatism (3.1%) in the boarding schools as compared to the day schools (0.5%). The bacteriologic examinations confirmed and established the etiology of the cases, revealing moreover the role of carriers in maintaining and spreading the infection. The ASLO test showed persistent and high gammaglobulin titers in the children of the boarding schools, pointing to a state of hypersensitivity consequent to repeated streptococcal infections.

Adolescent↗
PubMed1972

Antibody responses to group A streptococcal infections in the hamster.

The immune response after streptococcal infections of the skin and of the joints was studied in an experimental animal model. Hamsters were challenged intradermally or intra-articularly with different streptococcal serotypes, and antibodies for streptolysin O (ASO), deoxyribonuclease B (anti-deoxyribonuclease B), and group A carbohydrate (anti-group A CHO) were determined. After a single injection at either site, 7 of 48 animals (14%) developed group A-CHO antibodies; however, none of the animals developed detectable levels of ASO or anti-deoxyribonuclease B. After repeated infections of the skin or joint, anti-deoxyribonuclease B antibodies were detectable in 13% (4 of 30) and 30% (5 of 17) of the animals, respectively. Elevations of ASO occurred after repeated joint infections in 4 of 16 animals (25%), whereas none of 30 hamsters repeatedly infected intradermally developed antibodies against streptolysin O. For all three antibodies tested, elevated levels were more frequently noted after repeated joint infections than after repeated skin infections with the same streptococcal serotype. These data, similar to ones previously noted in human impetigo, indicate that ASO responses are feeble after streptococcal skin infections and that the site of infection per se, rather than the infecting strain, appears to be responsible for this poor response.

Animals↗
PubMed1979

Prophylaxis of streptococcal infections and rheumatic fever: a comparison of orally administered clindamycin and penicillin.

Orally administered clindamycin and penicillin were compared for effectiveness in preventing streptococcal infections in 202 randomly assigned patients with previous rheumatic fever (RF). Among 143 patients aged 21 years or younger observed for 537 patient-years, the number of streptococcal infections (and number per patient-year) was 23 (0.084) in the penicillin group and 12 (0.045) in the clindamycin group. Excluding uncooperative patients, the rate of streptococcal infection remained less, though not statistically significant, in the clindamycin group than in the penicillin group. Two RF recurrences occurred in the penicillin group, and no recurrence occurred in the clindamycin group. Clindamycin was well tolerated except for possible mild gastrointestinal symptoms in six patients. Clindamycin can be substituted for penicillin for RF prophylaxis when there is allergy to penicillin or concern about the development of penicillin-resistant mouth organisms.

Administration, Oral↗
PubMed2003

Fulminant liver failure in a child with invasive group A streptococcal infection.

UNLABELLED: Liver involvement is mentioned in streptococcal toxic shock syndrome, but never as fulminant liver failure (FLF). We report the case of a 2-year-old child who developed isolated FLF secondary to invasive group A streptococcal infection without shock due to a M1T1-type strain expressing speA, speB and speC toxin genes. On antibiotics, he recovered rapidly without liver transplantation. CONCLUSION: A streptococcal pyrogenic exotoxin likely constituted the initial insult leading to FLF. This etiology can be included in the differential diagnosis of FLF and would support early introduction of antibiotics.

Anti-Bacterial Agents↗
PubMed1975

Host factors in the susceptibility of rheumatic patients to streptococcal infections.

In children and adolescents who each had at least one previous episode of rheumatic fever and who were not maintaining effective anti-streptococcal prophylaxis, the attack rates of subsequent streptococcal infections declined with advancing age, but were unaffected by gender, cardiac status, or multiplicity of antecedent rheumatic episodes. The rate of rheumatic recurrence per streptococcal infection fell with advancing age, but rose with increasing amounts of cardiac damage and with multiplicity of previous rheumatic attacks. The results suggest that the underlying clinical features of the host have a greater effect on the rheumatogenicity of an acquired streptococcal infection than on the ability to avoid the infection.

Acute Disease↗
PubMed1998

Group B streptococcal infections in children: the changing spectrum of infections in infants.

During a 9-year period from January 1988 to December 1996, 36 patients less than 18 years of age with Lancefield group B streptococcal infections were seen in the National Cheng Kung University Hospital. Among 33 infants with invasive group B streptococcal infections, 3 (9%) were early onset disease (EOD), 27 (82%) late onset disease (LOD) and 3 (9%) onset beyond the third month of life. All cases of EOD were detected during the first day of life and 2 of them were premature births. In the infants with LOD, a high incidence of meningitis occurred (78%). The most common clinical presentation in group B streptococcal infections was fever (81%), followed by irritable crying (42%) and poor feeding (39%). Seizure was noted in 57% of meningitis cases. Obstetric and neonatal risk factors were compared between EOD and LOD, with prematurity and low birth weight significantly (P=0.01) more common among infants with EOD compared with LOD. Of the strains tested, the sensitivity to penicillin, ampicillin and erythromycin were 83%, 74%, and 75%, respectively. All strains were resistant to tetracycline and gentamicin. There were 2 case fatalities (6%) and 6 (17%) had major neurologic sequelae. These data provide that the vast majority of EOD are recognized on the first day of life and prematurity is an important risk factor. In comparison to the previous report in Taiwan, a changing spectrum of GBS infections in infants occurs during the study period. The observed incidence of EOD is decreased and meningitis is still predominantly in LOD. It is suggested early recognition and aggressive therapy have resulted in a much lower mortality rate than previously reported.

Adolescent↗
PubMed2003

Community outbreak of perianal group A streptococcal infection in Denmark.

BACKGROUND: Perianal group A streptococcal infection (PASI) occurs primarily in children. There is limited information on the incidence, transmission and treatment of PASI. We report a cluster of cases connected to a Danish kindergarten and observations of the incidence of PASI in the local population. SETTING: A Danish rural community with 1765 children 15 years and younger registered with two general practice clinics. METHODS: After being alerted of a possible cluster of PASI cases, all isolates of group A beta-hemolytic streptococci were collected and subjected to T typing and pulsed field gel electrophoresis (PFGE) if grown from either a rectal swab or an accompanying throat swab obtained in the offices of local general practitioners during the ensuing 4-month period. Clinical data were obtained from the files of the local general practitioners. RESULTS: Twelve cases of PASI were caused by group A beta-hemolytic streptococci T type 28 with an identical PFGE profile: 6 of the cases were in children attending the same kindergarten, 4 were connected otherwise to the cluster and 2 cases seemed to be unrelated. Five cases of PASI with different T types and PFGE profiles were diagnosed during the same period giving an estimated annual incidence of 2 to 7 per 1000 children. Penicillin V was ineffective in 3 cases, and no recurrence was seen after change of the treatment to oral clarithromycin. CONCLUSIONS: A clone of T type 28 seemed to be the cause of the largest cluster of PASI cases described thus far. Clarithromycin was effective as second line treatment. An estimated annual baseline incidence of 2 to 7 per 1000 in the local population indicates that PASI may not be as rare as previously estimated.

Adolescent↗
PubMed2003

PANDAS: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections--an uncommon, but important indication for tonsillectomy.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, also know as "PANDAS," is well described in the neurologic and psychiatric literature. PANDAS is associated with obsessive compulsive disorders (OCD) and tic disorders. The streptococcal infections may trigger an autoimmune reaction that exacerbates these conditions. Recurrent streptococcal tonsillitis is one of the recurrent infections associated with PANDAS. This paper reviews the case reports of two brothers, one with OCD and the other with a tic disorder, both of whom improved significantly after undergoing adenotonsillectomy for treatment of their recurrent tonsillitis. A review of the pathophysiology and current understanding of PANDAS is presented.

Autoimmune Diseases of the Nervous System↗
PubMedDate not supplied

[Results of the use, for a period of 3 years (1974-1977), in pilot districts, of the complex program of measures for prevention of streptococcal infections and their complications].

Starting with the year 1974 a total 11 pilot units have been organized, in as many counties in which a complex program of surveillance of streptococcal infections was applied, that had the following objectives: 1. Prevention and fight against acute streptococcal infection ; 2. Prevention of severe complications of acute rheumatic fever of rheumatic carditis and acute glomerulonephritis ; 3. Prevention of relapses of acute rheumatic fever. The establishment and verification of methods for clinical and laboratory diagnosis was followed, as well as of therapeutic techniques and dispensarization. The analysis of results obtained after the application for a period of 3 years of the program in high-risk collectivities, and in the conditions of an intensive circulation of some epidemic strains of streptococcus has shown the decrease each year of the incidence of scarlet fever, the increased efficiency of detection of acute non-eruptive (non-rash) streptococcal infections, as well as a significant decrease in the number of cases that developed a first attack of acute rheumatic fever and acute glomerulonephritis. A significant decrease was also obtained in the number of relapses and of severe evolution of rheumatic carditis, due to active detection, continuous evidence, prophylaxis and periodic control of cases with acute rheumatic fever.

Anti-Bacterial Agents↗
PubMed1994

An outbreak of group C streptococcal infection in a maternity unit.

An outbreak of Group C streptococcal infection (Streptococcus equisimilis serotype T204) occurred in a Maternity Unit in Durham over a 2-week period. The outbreak strain possessed an M-protein antigen identical to that found in a previously reported Maternity Unit outbreak. Seven patients in total were affected, and in two patients infected perineal wounds took several weeks to heal. The source of the outbreak appeared to be a patient who developed a perineal wound infection and who subsequently returned to the ward for reassessment. Environmental contamination is likely to have been the reservoir of infection for the subsequent patients. The outbreak was controlled by applying strict infection control procedures and establishing a high standard of routine cleaning.

Cross Infection↗
PubMed1989

Waning significance of anti-streptolysin O (ASO) titres in diagnosing streptococcal infections in Lagos, Nigeria.

A total of 200 serum specimens comprising 100 specimens from patients with streptococcal disease conditions, 50 from patients with other diseases and another 50 specimens from apparently healthy individuals were collected from Lagos University Teaching Hospital and from various areas of Lagos metropolis and screened for the presence of anti-streptolysin O (ASO). For streptococcal disease conditions, other diseases and for apparently healthy persons, anti-streptolysin O titres above 250 iu/ml recorded for each category of clinical conditions in terms of the number examined were 34%, 36% and 28% respectively. It is therefore suggested that high anti-streptolysin O (ASO) titres occur in apparently healthy individuals with no history of streptococcal infection and individuals with disease conditions other than those of streptococcal origin. Consequently the diagnosis of streptococcal diseases based on high titres of ASO in Lagos, is not pathognomonic, should be interpreted with caution and must not be definitive since healthy individuals and others without streptococcal infections develop high ASO titres.

Antistreptolysin↗
PubMed1994

Beta-haemolytic streptococcal infections in burned patients.

Colonization of burn wounds by beta-haemolytic streptococci can lead to the loss of autografts. The present study investigated the beta-haemolytic streptococcal infections in burned patients treated in the Burns Centre of the Emergency Medical Institute 'N. I. Pirogov'. Sofia during a 12-month period (March 1991-March 1992). As many as 117 beta-haemolytic streptococcal strains were isolated in 114 burned patients (52 children and 62 adults). The distribution of the streptococcal strains according to their serogroup was 64 strains (54.7 per cent) group A; 34 strains (29.1 per cent) group B; nine strains (7.7 per cent) group G; five strains (4.25 per cent) group C and five other strains (4.25 per cent) group F. Antibiotic sensitivity tests demonstrated the presence of some differences among the serogroups, especially between groups A and B. The sources of the streptococcal infections were found in 26 (29.2 per cent) of the patients. Epidemiological relationships were established between the strains from one source and the wound swab. For the successful treatment of beta-haemolytic streptococcal infections in burns it is essential to bear in mind the role of non-group A beta-haemolytic streptococci (45.3 per cent according to our study).

Adolescent↗