scholarly journals The dynamic nature of group A streptococcal epidemiology in tropical communities with high rates of rheumatic heart disease

2007 ◽  
Vol 136 (4) ◽  
pp. 529-539 ◽  
Author(s):  
M. I. McDONALD ◽  
R. J. TOWERS ◽  
R. ANDREWS ◽  
N. BENGER ◽  
P. FAGAN ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Standard Laboratory ◽  
Dynamic Nature ◽  
Prospective Surveillance ◽  
Aboriginal Communities ◽  
Laboratory Methods ◽  
Group A ◽  
Household Visit ◽  
Rheumatic Heart

SUMMARYProspective surveillance was conducted in three remote Aboriginal communities with high rates of rheumatic heart disease in order to investigate the epidemiology of group A β-haemolytic streptococci (GAS). At each household visit, participants were asked about sore throat. Swabs were taken from all throats and any skin sores. GAS isolates wereemmsequence and pattern-typed using standard laboratory methods. There were 531 household visits; 43 differentemmtypes and subtypes (emmST) were recovered. Four epidemiological patterns were observed. MultipleemmST were present in the population at any one time and household acquisition rates were high. Household acquisition was most commonly via 5- to 9-year-olds. Following acquisition, there was a 1 in 5 chance of secondary detection in the household. Throat detection ofemmST was brief, usually <2 months. The epidemiology of GAS in these remote Aboriginal communities is a highly dynamic process characterized byemmST diversity and turnover.

scholarly journals 853. Epidemiology of Groups A, C, and G β-Hemolytic Streptococcal Pharyngitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S18-S19
Author(s):  
James Ray Mata Lim ◽  
Bobby L Boyanton ◽  
Julie George ◽  
Matthew Sims
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Group A Streptococcus ◽  
Retrospective Chart Review ◽  
Streptococcal Pharyngitis ◽  
Molecular Testing ◽  
Age Difference ◽  
Need For Treatment ◽  
Group A ◽  
Rheumatic Heart

Abstract Background Treatment of Group A Streptococcus (GAS) pharyngitis is imperative to mitigate sequelae such as rheumatic heart disease. The need for treatment of Group C Streptococcus (GCS) and Group G Streptococcus (GGS) pharyngitis is unclear, as rheumatogenic sequelae have not been well documented. Our institution switched from culture to molecular confirmation testing for a negative rapid streptococcal antigen detection test. Cultures reported GAS whereas molecular testing reported GAS, GCS, and GGS. We performed a retrospective chart review to examine the epidemiological differences of GAS, GCS, and GGS pharyngitis. Methods Records were obtained of pharyngeal samples from patients sent for testing at Beaumont Health Laboratory. In all, 92,369 records were analyzed. There were 47,106 records of cultures from May 2012 through December 2014 and 45,263 records of molecular testing from May 2015 to December 2017. Samples positive for either GCS or GGS were reported as positive for Group CG Streptococcus (GCGS). Epidemiological factors were evaluated. If available, electronic records from GCGS positive samples were evaluated for clinical features, antibiotics used, and sequelae or complications reported. Results Molecular testing showed GAS positivity of 9.3% (n = 4,189) and GCGS positivity of 1.5% (n = 687). GCGS pharyngitis was more likely during the summer months and in young adults 13 years and older than children under 13 years. GAS pharyngitis was more likely during spring months and in children aged 4–9 years. Mean age of GCGS pharyngitis was 13 vs. 8.6 years for GAS pharyngitis. Similar results were obtained for GAS between culture and molecular testing records. Amoxicillin was most often prescribed for treatment of GCGS. There were few instances of severe GCGS exudative or recurrent pharyngitis that required hospitalization or tonsillectomy. There were no cases of rheumatic fever or rheumatic heart disease associated with GCGS. Conclusion This is the largest study based on our literature review to evaluate the epidemiology of GAS, GCS, and GGS pharyngitis in children and adults. We found a seasonal and age difference between GAS and GCGS. Complications were rare, and no rheumatogenic sequelae were noted from GCGS infections. Disclosures All Authors: No reported Disclosures.

scholarly journals Cumulative incidence of rheumatic fever in an endemic region: a guide to the susceptibility of the population?

2000 ◽  
Vol 124 (2) ◽  
pp. 239-244 ◽  
Author(s):  
J. R. CARAPETIS ◽  
B. J. CURRIE ◽  
J. D. MATHEWS
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Cumulative Incidence ◽  
Acute Rheumatic Fever ◽  
Northern Australia ◽  
Endemic Region ◽  
Aboriginal Australians ◽  
Group A ◽  
Rheumatic Heart

Aboriginal Australians in northern Australia are subject to endemic infection with group A streptococci, with correspondingly high rates of acute rheumatic fever and rheumatic heart disease. For 12 communities with good ascertainment, the estimated lifetime cumulative incidence of acute rheumatic fever was approximately 5·7%, whereas over the whole population, with less adequate ascertainment, the cumulative incidence was only 2·7%. The corresponding prevalences of established rheumatic heart disease were substantially less than the cumulative incidences of acute rheumatic fever, at least in part because of poor ascertainment. The cumulative incidence of acute rheumatic fever estimates the proportion of susceptible individuals in endemically exposed populations. Our figures of 2·7–5·7% susceptible are consistent with others in the literature. Such comparisons suggest that the major part of the variation in rheumatic fever incidence between populations is due to differences in streptococcal exposure and treatment, rather than to any difference in (genetic) susceptibility.

scholarly journals Throat colonization and antibiotic susceptibility of group A β-hemolytic streptococci among rheumatic heart disease patients attending a cardiac referral hospital in Tanzania, A descriptive cross-sectional study

2019 ◽  
Author(s):  
Sarah Wangilisasi ◽  
Pilly Chillo ◽  
Delila Kimambo ◽  
Mohammed Janabi ◽  
Appolinary Kamuhabwa
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Antibiotic Susceptibility ◽  
Cross Sectional Study ◽  
Secondary Prophylaxis ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Group A ◽  
Rheumatic Heart

Abstract Background: Secondary prophylaxis against repeated attacks of acute rheumatic fever is an important intervention in patients with rheumatic heart disease (RHD) and it aims to prevent throat infection by group A beta-hemolytic streptococcus (GAS), however its implementation faces many challenges. This study aimed to assess throat colonization, antibiotic susceptibility and factors associated with GAS colonization among patients with RHD attending care at Jakaya Kikwete Cardiac Institute in Dar-es-Salaam, Tanzania. Methods: A descriptive cross sectional study of RHD patients attending the Jakaya Kikwete Cardiac Institute was conducted from March to May 2018, where we consecutively enrolled all patients known to have RHD and coming for their regular clinic follow-up. A structured questionnaire was used to obtain patients’ socio-demographic information, factors associated with GAS colonization as well as status of secondary prophylaxis use and adherence. Throat swabs were taken and cultured to determine the presence of GAS, and isolates of GAS were tested for antibiotic susceptibility using Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) version 2015. Antibiotics of interest were chosen according to the Tanzanian Treatment Guidelines. Results: In total 194 patients with RHD were enrolled, their mean age was 28.4 ±16.5 years and 58.2% were females. Only 58 (29.9%) patients were on regular prophylaxis, 39 (20.1%) had stopped taking prophylaxis, while 97 (50.0%) had never been on prophylaxis. Throat cultures were positive for GAS in 25 (12.9%) patients. Patients who stopped prophylaxis were 3.26 times more likely to be colonized by GAS when compared to patients on regular prophylaxis. Majority (96%) of GAS isolates were susceptible to Penicillin, Ceftriaxone and Ciprofloxacin, while the highest resistance (20%) was observed with Vancomycin. No GAS resistance was observed against Penicillin. Conclusion: The prevalence of GAS throat colonization is high among this population and is associated with stopping prophylaxis. The proportion of patients on regular secondary prophylaxis is unacceptably low and interventions should target both patients’ and physicians’ barriers to effective secondary prophylaxis.

scholarly journals Acute rheumatic fever and rheumatic heart disease in Fiji: prospective surveillance, 2005–2007

2009 ◽  
Vol 190 (3) ◽  
pp. 133-135 ◽  
Author(s):  
Andrew C Steer ◽  
Joseph Kado ◽  
Adam W J Jenney ◽  
Michael Batzloff ◽  
Lepani Waqatakirewa ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Acute Rheumatic Fever ◽  
Prospective Surveillance ◽  
Rheumatic Heart
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