A 7-month outbreak of 15 cases of postpartum sepsis with group A haemolytic Streptococci (GAS) was stopped when a carrier was identified. Comparing delivery dates with duty rotas revealed that the carrier had been present during delivery in 13 of the 15 cases. The epidemic GAS type, T3-13-B3264, was found in a carbuncle in her groin and in atopic dermatitis lesions behind her ears and on her eyelids. Thus, it was not the microbiological screening of staff that helped detect the carrier. The outbreak went unnoticed for 6 months, as no 2 cases were diagnosed by the same physician and 5 cases were diagnosed by different general practitioners. The main risk factors for infection were presence of the carrier relative risk (relative risk RR 47.8, 95% confidence interval (CI) 10.9-209.5) and suturing of episiotomy (RR 11.0; 95% CI 2.6-47.9). We recommend that a thorough epidemiological investigation should be carried out in every single case of GAS postpartum infection. Despite initial intravenous treatment with penicillin, 8 patients experienced > 15 recurring postpartum GAS infections, such as endometritis, wound infection, tonsillitis, erysipelas and Brodie's abscess. Eradication of GAS should be confirmed after completion of treatment.
During 1981-1993, 229 episodes of bacteraemia due to beta-haemolytic streptococci of groups A, B, C and G were diagnosed in the County of Northern Jutland, Denmark. The annual rates for bacteraemia were quite constant during the 13-year period for each streptococcal group. Group A streptococcal (GAS) bacteraemia was the most frequent, comprising 1.4% of all bacteraemias. The incidence of GAS bacteraemia was 1.8/100,000/year in children 60 years old. With the notable exception of group B streptococcal (GBS) bacteraemia in neonates, beta-haemolytic streptococci of groups B, C (GCS) and G (GGS) were isolated mostly from elderly patients. Except for GBS bacteraemia in neonates, approximately one-third of the bacteraemias in each group was nosocomially acquired. Predisposing factors included operative procedures in GAS and GCS bacteraemia, and diabetes mellitus in GBS bacteraemia. The skin was the most common primary focus in GAC, GCC and GGS bacteraemias, whereas the urinary tract was the commonest focus in GBS bacteraemia in adults. The mortality rates in GAS, GCS, GGS, and adult GBS bacteraemia were 23%, 16%, 17% and 19%, respectively. Of the 23 fatal cases of GAS bacteraemia, 57% died within 24 h after blood cultures had been obtained.
Poststreptococcal acute glomerulonephritis often follows impetigo and can occur in epidemics. From 1975 through 1977, an epidemic of poststreptococcal acute glomerulonephritis occurred in Alaska. Fifty children required hospitalization, while 25 less seriously ill children were treated as outpatients. Sixty-seven percent of these 75 children had direct evidence of recent skin infections. Serotypes 49-14 and NT-14 were the most common streptococcal isolates. In villages in the epidemic area, approximately 15% of children had impetigo and more than 60% of lesions cultured were positive for group A streptococci. Impetigo rates in the epidemic area were similar to those found in nonepidemic areas. However, the introduction of the nephritogenic streptococcal serotypes not recently present in this population apparently led to the development of the epidemic.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 2627.
Streptococcal pharyngitis is a frequently observed condition, but its optimal management continues to be debated.
The goal of this study was to evaluate the available guidelines, developed at the national level, for the management of streptococcal pharyngitis in Western countries, with a focus on their differences.
A literature search was conducted of the Cochrane Library, EMBASE, TRIP, and MEDLINE databases from their inception (1993 for the Cochrane Library, 1980 for EMBASE, 1997 for TRIP, and 1966 for MEDLINE) through April 25, 2010. The following search terms were used: pharyngitis, sore throat, tonsillitis, pharyngotonsillitis, Streptococcus pyogenes, Group A ß-haemolytic Streptococcus pyogenes, and streptococcal pharyngitis. Searches were limited to type of article or document (practice guideline or guideline) with no language restrictions or language limits.
Twelve national guidelines were identified: 6 from European countries (France, United Kingdom, Finland, Holland, Scotland, and Belgium), 5 from the United States, and 1 from Canada. Recommendations differ substantially with regard to the use of a rapid antigen diagnostic test or throat culture and the indications for antibiotic treatment. The North American, Finnish, and French guidelines recommend performing one timely microbiologic investigation in suspected cases, and prescribing antibiotics in confirmed cases to prevent suppurative complications and acute rheumatic fever. According to the remaining European guidelines, however, acute sore throat is considered a benign, self-limiting disease. Microbiologic tests are not routinely recommended by these latter guidelines, and antibiotic treatment is reserved for well-selected cases. The use of the Centor score, for evaluation of the risk of streptococcal infection, is recommended by several guidelines, but subsequent decisions on the basis of the results differ in terms of which subjects should undergo microbiologic investigation. All guidelines agree that narrow-spectrum penicillin is the first choice of antibiotic for the treatment of streptococcal pharyngitis and that treatment should last for 10 days to eradicate the microorganism. Once-daily amoxicillin was recommended by 2 US guidelines as equally effective.
The present review found substantial discrepancies in the recommendations for the management of pharyngitis among national guidelines in Europe and North America.
The data obtained in the study of an explosive outbreak of acute respiratory diseases, tonsillitis and scarlet fever in one of schools in Moscow have made it possible to exclude the alimentary mechanism of its development and to demonstrate the role of the droplet mechanism of transmission in the appearance of its outbreak. The epidemiological analysis of the outbreak has permitted the formulation of the hypothesis on the conditions of the formation and spread of the epidemic variant of the infective agent; this hypothesis corresponds to the available data in literature on the qualitative changes of the infective agent in the course of the epidemic process. The study has shown that the prophylaxis of the explosive outbreaks of respiratory streptococcal infections must be ensured by the system of epidemiological surveillance with timely intervention into the epidemiological process at its early stages.
Altogether 162 cases of tonsillitis were registered in two military units during the period of May 11-16. The disease took an acute course with short-time fever, symptoms of acute intoxication, sore throat, pronounced inflammatory changes in tonsils and swelling of regional (submaxillary and anterocervical) lymph nodes. In some of the patients (1.1%) sickness and vomiting and in 0.2% diarrhea were registered. In 6.7% of the patients scarlatiniform eruptions were observed on days 2-3 of the disease. In the course of the bacteriological examination of the patients group A streptococci, serovar T II, were isolated. The dynamic study of paired sera showed a considerable increase in the number of patients with a high level of antibodies to streptolysin 0 and group A polysaccharide. All patients were fed at the same canteen. The factor of the transmission of this infection could be butter, stored without observation of the required temperature conditions and apportioned by the soldiers of the kitchen police. Experimental study revealed that group A streptococci are capable for proliferation and accumulation in butter.
The largest reported outbreak of infections due to Streptococcus pyogenes, M-type 18, in recent years is described. Ninety persons at institutions for mentally retarded (73% residents) had infections due to the epidemic strain. Pharyngitis and scarlatina were the most common infections. Six patients died, five having a streptococcal toxic shock syndrome. During the outbreak an intensive surveillance was carried out together with improved infection control measures and prompt culturing of residents and employees before antimicrobial treatment. The primary outbreak was confined but a secondary outbreak could not be prevented. This was probably due to difficulties in implementing proper isolation precautions in this setting.