scholarly journals Preceding group A streptococcus skin and throat infections are individually associated with acute rheumatic fever: evidence from New Zealand

2021 ◽  
Vol 6 (12) ◽  
pp. e007038
Author(s):  
Jane Oliver ◽  
Julie Bennett ◽  
Sally Thomas ◽  
Jane Zhang ◽  
Nevil Pierse ◽  
...  
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Throat Swab ◽  
Group A Streptococcus ◽  
Population Level ◽  
Gas Detection ◽  
Positive Skin ◽  
Group A ◽  
Dispensing Data

IntroductionAcute rheumatic fever (ARF) is usually considered a consequence of group A streptococcus (GAS) pharyngitis, with GAS skin infections not considered a major trigger. The aim was to quantify the risk of ARF following a GAS-positive skin or throat swab.MethodsThis retrospective analysis used pre-existing administrative data. Throat and skin swab data (1 866 981 swabs) from the Auckland region, New Zealand and antibiotic dispensing data were used (2010–2017). Incident ARF cases were identified using hospitalisation data (2010–2018). The risk ratio (RR) of ARF following swab collection was estimated across selected features and timeframes. Antibiotic dispensing data were linked to investigate whether this altered ARF risk following GAS detection.ResultsARF risk increased following GAS detection in a throat or skin swab. Māori and Pacific Peoples had the highest ARF risk 8–90 days following a GAS-positive throat or skin swab, compared with a GAS-negative swab. During this period, the RR for Māori and Pacific Peoples following a GAS-positive throat swab was 4.8 (95% CI 3.6 to 6.4) and following a GAS-positive skin swab, the RR was 5.1 (95% CI 1.8 to 15.0). Antibiotic dispensing was not associated with a reduction in ARF risk following GAS detection in a throat swab (antibiotics not dispensed (RR: 4.1, 95% CI 2.7 to 6.2), antibiotics dispensed (RR: 4.3, 95% CI 2.5 to 7.4) or in a skin swab (antibiotics not dispensed (RR: 3.5, 95% CI 0.9 to 13.9), antibiotics dispensed (RR: 2.0, 95% CI 0.3 to 12.1).ConclusionsA GAS-positive throat or skin swab is strongly associated with subsequent ARF, particularly for Māori and Pacific Peoples. This study provides the first population-level evidence that GAS skin infection can trigger ARF.

Acute Rheumatic Fever After Group A Streptococcus Pyoderma and Group G Streptococcus Pharyngitis

2017 ◽  
Vol 36 (7) ◽  
pp. 692-694 ◽  
Author(s):  
Lance O’Sullivan ◽  
Nicole J. Moreland ◽  
Rachel H. Webb ◽  
Arlo Upton ◽  
Nigel J. Wilson
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Group A Streptococcus ◽  
Group A

scholarly journals Characterization of Two Novel Pyrogenic Toxin Superantigens Made by an Acute Rheumatic Fever Clone of Streptococcus pyogenes Associated with Multiple Disease Outbreaks

2002 ◽  
Vol 70 (12) ◽  
pp. 7095-7104 ◽  
Author(s):  
Laura M. Smoot ◽  
John K. McCormick ◽  
James C. Smoot ◽  
Nancy P. Hoe ◽  
Ian Strickland ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Mononuclear Cells ◽  
Group A Streptococcus ◽  
Human Peripheral Blood ◽  
Disease Outbreaks ◽  
Peripheral Blood Mononuclear ◽  
Human T Cells ◽  
Group A

ABSTRACT The pathogenesis of acute rheumatic fever (ARF) is poorly understood. We identified two contiguous bacteriophage genes, designated speL and speM, encoding novel inferred superantigens in the genome sequence of an ARF strain of serotype M18 group A streptococcus (GAS). speL and speM were located at the same genomic site in 33 serotype M18 isolates, and no nucleotide sequence diversity was observed in the 33 strains analyzed. Furthermore, the genes were absent in 13 non-M18 strains tested. These data indicate a recent acquisition event by a distinct clone of serotype M18 GAS. speL and speM were transcribed in vitro and upregulated in the exponential phase of growth. Purified SpeL and SpeM were pyrogenic and mitogenic for rabbit splenocytes and human peripheral blood mononuclear cells in picogram amounts. SpeL preferentially expanded human T cells expressing T-cell receptors Vβ1, Vβ5.1, and Vβ23, and SpeM had specificity for Vβ1 and Vβ23 subsets, indicating that both proteins had superantigen activity. SpeL was lethal in two animal models of streptococcal toxic shock, and SpeM was lethal in one model. Serologic studies indicated that ARF patients were exposed to serotype M18 GAS, SpeL, and SpeM. The data demonstrate that SpeL and SpeM are pyrogenic toxin superantigens and suggest that they may participate in the host-pathogen interactions in some ARF patients.

scholarly journals Risk Factors for Acute Rheumatic Fever: Literature Review and Protocol for a Case-Control Study in New Zealand

2019 ◽  
Vol 16 (22) ◽  
pp. 4515 ◽  
Author(s):  
Michael G Baker ◽  
Jason Gurney ◽  
Jane Oliver ◽  
Nicole J Moreland ◽  
Deborah A Williamson ◽  
...  
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Group A Streptococcus ◽  
Case Control ◽  
Case Definition ◽  
First Episode ◽  
The North ◽  
Wide Range

Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease (RHD), have largely disappeared from high-income countries. However, in New Zealand (NZ), rates remain unacceptably high in indigenous Māori and Pacific populations. The goal of this study is to identify potentially modifiable risk factors for ARF to support effective disease prevention policies and programmes. A case-control design is used. Cases are those meeting the standard NZ case-definition for ARF, recruited within four weeks of hospitalisation for a first episode of ARF, aged less than 20 years, and residing in the North Island of NZ. This study aims to recruit at least 120 cases and 360 controls matched by age, ethnicity, gender, deprivation, district, and time period. For data collection, a comprehensive pre-tested questionnaire focussed on exposures during the four weeks prior to illness or interview will be used. Linked data include previous hospitalisations, dental records, and school characteristics. Specimen collection includes a throat swab (Group A Streptococcus), a nasal swab (Staphylococcus aureus), blood (vitamin D, ferritin, DNA for genetic testing, immune-profiling), and head hair (nicotine). A major strength of this study is its comprehensive focus covering organism, host and environmental factors. Having closely matched controls enables the examination of a wide range of specific environmental risk factors.

scholarly journals Delayed Diagnosis of Acute Rheumatic Fever in a Patient with Multiple Emergency Department Visits

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Inna Kaminecki ◽  
Renuka Verma ◽  
Jacqueline Brunetto ◽  
Loyda I. Rivera
Keyword(s):  
Emergency Department ◽  
Rheumatic Fever ◽  
Health Care Providers ◽  
Acute Rheumatic Fever ◽  
Group A Streptococcus ◽  
The United States ◽  
Emergency Department Visits ◽  
Penicillin G ◽  
Care Providers ◽  
Group A

While the incidence of acute rheumatic fever (ARF) in the United States has declined over the past years, the disease remains one of the causes of severe cardiovascular morbidity in children. The index of suspicion for ARF in health care providers may be low due to decreasing incidence of the disease and clinical presentation that can mimic other conditions. We present the case of a 5-year-old boy with a history of intermittent fevers, fatigue, migratory joint pain, and weight loss followinggroup A Streptococcuspharyngitis. The patient presented to the emergency department twice with the complaints described above. On his 3rd presentation, the workup for his symptoms revealed the diagnosis of acute rheumatic fever with severe mitral and aortic valve regurgitation. The patient was treated with penicillin G benzathine and was started on glucocorticoids for severe carditis. The patient was discharged with recommendations to continue secondary prophylaxis with penicillin G benzathine every 4 weeks for the next 10 years. This case illustrates importance of primary prevention of acute rheumatic fever with adequate antibiotic treatment ofgroup A Streptococcuspharyngitis. Parents should also receive information and education that a child with a previous attack of ARF has higher risk for a recurrent attack of rheumatic fever. This can lead to development of severe rheumatic heart disease. Prevention of recurrent ARF requires continuous antimicrobial prophylaxis. Follow-up with a cardiologist every 1-2 years is essential to assess the heart for valve damage.

scholarly journals M-Protein Analysis of Streptococcus pyogenes Isolates Associated with Acute Rheumatic Fever in New Zealand

2015 ◽  
Vol 53 (11) ◽  
pp. 3618-3620 ◽  
Author(s):  
Deborah A. Williamson ◽  
Pierre R. Smeesters ◽  
Andrew C. Steer ◽  
John D. Steemson ◽  
Adrian C. H. Ng ◽  
...  
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Streptococcus Pyogenes ◽  
Acute Rheumatic Fever ◽  
Skin Infection ◽  
Protein Analysis ◽  
M Protein ◽  
Content Type ◽  
Typing System ◽  
Group A

We applied anemmcluster typing system to group AStreptococcusstrains in New Zealand, including those associated with acute rheumatic fever (ARF). We observed few so-called rheumatogenicemmtypes but found a high proportion ofemmtypes previously associated with pyoderma, further suggesting a role for skin infection in ARF.

scholarly journals The effect of group A streptococcal carrier on the epidemic model of acute rheumatic fever

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Natsuda Yokchoo ◽  
Nichaphat Patanarapeelert ◽  
Klot Patanarapeelert
Keyword(s):  
Public Health ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Group A Streptococcus ◽  
Sufficient Conditions ◽  
Health Impact ◽  
Epidemic Threshold ◽  
Asymptomatic Carriers ◽  
Group A ◽  
Endemic State

Abstract Background Group A streptococcus (GAS) is the most frequent cause of bacterial pharyngitis in school-aged children. The postinfection sequel as acute rheumatic fever (ARF) and rheumatic heart disease that cause morbidity and mortality among young people is public health concerns in several developing countries. Asymptomatic carriage state of GAS is not fully understood in terms of host and bacterial factors. Although the ability of transmitting GAS of the asymptomatic carriers is relatively low, they may present the reservoir of the epidemic. A fraction of GAS carriers is difficult to estimate in practice and may greatly vary between populations. Understanding the role of carriage on the transmission dynamic of GAS is important for assessing the public health impact of the ARF. Method This study investigates the effect of GAS carriers on both the transmission and dynamic of ARF cases by using a mathematical model. Result We derive the sufficient conditions for which the GAS can spread or extinct from the naive population under the variation of the fraction of symptomatic cases over the incidence of GAS. The threshold is possible to occur in general, but the last condition which is rather restrictive and involves parameter uncertainty. The increasing of carriers in the endemic state leads to the reduction in magnitude of the reproduction number and the number of ARF patients. We demonstrate that the adjustment of parameters can be carried out by the use of endemic state and some specific data. Conclusion We show theoretically that the presence of asymptomatic carriers may induce the epidemic threshold and reduce the virulence of GAS and the prevalence of ARF.

scholarly journals Multicenter Evaluation of the Solana Group A Streptococcus Assay: Comparison with Culture

2016 ◽  
Vol 54 (9) ◽  
pp. 2388-2390 ◽  
Author(s):  
Timothy S. Uphoff ◽  
Blake W. Buchan ◽  
Nathan A. Ledeboer ◽  
Paul A. Granato ◽  
Judy A. Daly ◽  
...  
Keyword(s):  
Throat Swab ◽  
Group A Streptococcus ◽  
Gas Detection ◽  
Content Type ◽  
Group A

We compared group AStreptococcus(GAS) culture with a rapid helicase-dependent amplification (HDA) method using 1,082 throat swab specimens. The HDA method demonstrated 98.2% sensitivity and 97.2% specificity. GAS prevalence by culture was 20.7%, and it was 22.6% using the HDA method. In 35 min, the HDA method provided rapid, sensitive GAS detection, making culture confirmation unnecessary.

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