SVIBOR - Project code: 3-01-332

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Project code: 3-01-332


STREPTOCOCCAL INFECTIONS IN CHILDREN IN THE ZADAR AREA: SIGNIFICANCE AND CONSEQUENCES


Main researcher: MOROVIĆ, MIRO (66165)


Assistants
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
Communication
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 carrier state. 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 thisperiod. 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 changeswere seen.

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 pšerido 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


  1. Name of institution: NATIONAL INSTITUTE OF PUBLIC HEALTH CENTRE OF EPIDEMIOLOGY AND MICROBIOLOGY
    Type of institution: University/Faculty
    City: 1oo42 - Praha, Czech Republic
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