STREPTOCOCCAL INFECTIONS IN CHILDREN IN THE ZADAR AREA: SIGNIFICANCE AND CONSEQUENCES
: MOROVIĆ, MIRO (66165) Assistants
GILIĆ, VLASTA (99392)
MOKOVIĆ, IVAN (149314)
SKITARELIĆ, NEVEN (168995)
Type of research: applied Duration from: 01/01/91. to 12/31/93. Papers on project (total): 1
Institution name: Opća bolnica, Zadar (85) Department/Institute: Department of infectology Address: B.Peričića 5 City: 23000 - Zadar, Croatia
Summary: The epidemiological, clinical and microbiological aspects
ofA beta-hemolytic streptococcal (GABHS) infection in children inthe Zadar
area during the period from 1982 to 1992 were analysed.Thw investigationwas
in part retrospective and in part ofprospective character.
The results of clinicoepidemiolgocial survey showed that 5890GABHS
infections were evidenced duribg this period,
includingtonsillitis/pharyngitis, scarlet fever, pyoderma and
erysipelas.The most prevalent disease was streptococcal pharyngitis
(4615,i.e. 78.4%). Only 104 patients (1.8%) with GABHS infections
werehospitalized. It is interestingly that the number of tonsilectomyin the
same period was 3545, i.e. approximately every eighthchild was
tonsillectomized. These results emphasized the problemof tonsillitis
pharyngitis yet more.
The frequency of GABHS positive throat swab cultures has beenincreased
toward the end of the period of the investigation from3.05% at the begining
of the study to 20.7l% at the end of thestudy. The most frequent GABHS
strains isolated were of M4, M12and M78 (Tll) serotypes. Among the 123
GABHS isolates typed, 55were nephritogenic or potentially nephritogenic
(40.1%) with themost predominant strains of M4 serotype (26.01%) and M12
serotype(17.07%). Strains which could be invasive, rheumatogenic
and/ornephritogenic were also determined. M3 (T3) type, which could
behighly virulent, rheumatogenic or nephriotopgenic was isolated in2 cases
(1.62%), while serotype M5, which belongs to the commonrheumatogenic
strains and potentially invasive as well, wasisolated in 3 patients
(2.43%). 83 of the isolates (67.5%) werepositive for serum opacifity
factor, while 4o (32.5%) werenegative.
In 87 patients with GABHS pharyngitis and 20 healthy
contactsantistreptolysin O titer (ASO) was done. The results showed thatASO
titer is a reliable marker of disease activity in GABHSnegative patients as
in GABHS positive as well.Besides, the ASOtiter was shown to be a good
marker of hte time of GABHSacquisition, particularly in the cases of
The effect of the therapeutic regimen on the relaps rate wasevaluated in 32
patients, followed for six months after theinitial streptococcal
pharyngitis. There was no statisticallysignificant difference between the
patients treated within orafter 48 hours of the initial symptoms.
A therapeutic failure was noted in 67 from 707 patients (9.4%)treated
(almost exclusivelly with penicillin) for acute GABHSpharyngitis. In this
group, 48 beta-lactamase producing (BLP)strains were isolated after the
therapy had finished (71.64%).The frequency curve of BLP strains throughout
the year wasclosely similar to those of GABHS isolates. The
predominantstrain was Staphylococcus aureus (56.25%).
uring the period of investigation an outbreak of acutepoststreptococcal
glomerulonephritis (APGN) occurred in 1985/86.The incidence of the disease
rose significantlyt above theaverage value of 2.3 to 8.8 in 1986, and to
4.6 in 1987. Only onecase of acute rheumatic fever (ARF) was registered
During the period 1990-1992, 15 cases of reactive arthritis werenoted. In 8
of them there was a strong evidence of anantecendent GABHS infections.
Seven of the patients could becategoirized as having "poststreptococcal
reactive arhtritis",while one of them fulfilled the Jones criteria for the
diagnosisof ARF. In four patients a significant scintigrafic bone
Keywords: group A beta-hemolytic streptococal (GABHS) infection, epidemiology, serotyping, therapy, acute poststreptococcal glomerulonephritis, acute rheumatic fever, reactive arthritis
Research goals: In recent years the epidemiology of disease
associated with group A beta-hemolytic streptococci (GABHS) has been
cxhanging significantly. An increase in incidence of acute rheumatic fever
(ARF) occurred in saeveral focal geographis areas after a steady decline
since the early 1950s. Along with these reports. reports of severe invasive
streptococcal infections occurred in many areas of the world. Focal
epidemics of streptococcal bacteremias and a streptococcal toxic
shock-lioke syndrome (Strep-TSS) were recognized in our country as well. It
has been shown that re-emergance of these severe streptococcal infections
is associated with reappearance of some highly virulent mucoid M serotypes.
The aims of our study therefore were: (1)to make a review of the
streptococcal disease spectrum and nonsuppurative poststreptococcal
complications in children in the Zadar area during the perido 1982-1992.
(2)to analyse the hallmarks of clinical presentations of the streptococcal
diseases and complications, and the effects of therapeutic regimens, and
(3)to identify the most common streptococcal strains and serotypes,
particularly those of invasive, nephritogenic and rheumatogenic potential.
COOPERATION - INSTITUTIONS
Name of institution
: NATIONAL INSTITUTE OF PUBLIC HEALTH CENTRE
OF EPIDEMIOLOGY AND MICROBIOLOGY Type of institution: University/Faculty City: 1oo42 - Praha, Czech Republic Other information about the project.