Patterns of Illness in the Highly Febrile Young Child: Epidemiologic, Clinical, and Laboratory Correlates

PEDIATRICS ◽  
1981 ◽  
Vol 67 (5) ◽  
pp. 694-700
Author(s):  
Peter F. Wright ◽  
Juliette Thompson ◽  
Kelly T. Mckee ◽  
William K. Vaughn ◽  
Sarah H. W. Sell ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Illness ◽  
Bacterial Disease ◽  
Upper Respiratory Tract ◽  
Care Clinic ◽  
Bacterial Cultures ◽  
Group A ◽  
Bacteremic Episode ◽  
A Site ◽  
Infants And Young Children

Three hundred one episodes of fever ≥103 F were documented in 375 infants and young children observed in a comprehensive care clinic during the period October 1974 to October 1978. Of such highly febrile illnesses 79% were accompanied by respiratory tract signs or symptoms, 7% by disease at a site other than the respiratory tract, and 22% of illnesses had no localizing signs or symptoms. Viral cultures were obtained from the respiratory tract in 178 cases and were positive in 68:57/ 134 from respiratory illness; 2/4 from illness at sites other than the respiratory tract; and 9/40 in children without localizing disease. Bacterial cultures of the upper respiratory tract were obtained in 191 illnesses, but the overall rate of isolation of Haemophilus influenzae, Streptococcus pneumoniae and group A streptococci (46%) did not differ from that in a group of well children (39%). Bacterial cultures of the blood were obtained in 89 patients with fever ≥103 F and in an additional 41 children with lower temperatures. Nine children had documented systemic bacterial disease (eight positive blood cultures and one positive CSF). The rate of clinically apparent systemic bacterial disease in these otherwise normal infants was one bacteremic episode per 94 years of child care.

Influence of Life Events and Family Routines on Childhood Respiratory Tract Illness

PEDIATRICS ◽  
1977 ◽  
Vol 60 (4) ◽  
pp. 609-615 ◽  
Author(s):  
W. Thomas Boyce ◽  
Eric W. Jensen ◽  
John C. Cassel ◽  
Albert M. Collier ◽  
Allan H. Smith ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Life Events ◽  
Psychosocial Problems ◽  
Strong Relationship ◽  
Respiratory Illness ◽  
Etiologic Agent ◽  
Upper Respiratory Tract ◽  
Family Routines ◽  
Respiratory Illnesses ◽  
Group A

Respiratory illnesses account for nearly two thirds of the total illness in a community,1 account for as much as 40% of the problems seen in a pediatric practice,2,3 and are responsible for over one third of school absences.4 Despite major advances in the microbiology of respiratory disease, why and how a child becomes ill remain poorly understood. In over half of respiratory illnesses, complete cultures fail to yield an etiologic agent.5 Conversely, 30% of a school-age population can harbor group A streptococci without developing symptoms,6 three quarters of preschool children infected with Mycoplasma pneumoniae remain asymptomatic,7 and as many as 42% of upper respiratory tract cultures from well children yield pneumococci.8 Furthermore, there is no satisfactory explanation for the observation that certain children are predisposed to more frequent or more severe respiratory illnesses.9 The limited ability of microbiologic data to account for clinical experience has increased interest in studying the influence of social factors upon childhood disease. The family is undoubtedly the most important social context in which illness occurs, and many studies have documented the link between pediatric disease and family dynamics.10-18 Meyer and Haggerty reported a strong relationship between patterns of streptococcal illness and the degree of chronic family stress.19 Another group of observers found an accumulation of major family life events in the year preceding general pediatric hospitalizations.20 Others have demonstrated the prevalence of psychosocial problems in the families of children with repeated accidents and ingestions of poisons.21,22 There has, however, been little study of the general relationship between social environment and respiratory illness in children.

INFLUENCE OF PENICILLINASE-PRODUCING STAPHYLOCOCCI ON THE ERADICATION OF GROUP A STREPTOCOCCI FROM THE UPPER RESPIRATORY TRACT BY PENICILLIN TREATMENT

PEDIATRICS ◽  
1966 ◽  
Vol 37 (3) ◽  
pp. 467-476 ◽  
Author(s):  
Paul G. Quie ◽  
Howard C. Pierce ◽  
Lewis W. Wannamaker
Keyword(s):  
Respiratory Tract ◽  
Respiratory Illness ◽  
Penicillin G ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
Benzathine Penicillin G ◽  
Group A ◽  
Upper Respiratory ◽  
Penicillin Treatment

Penicillinase-producing strains of S. aureus were isolated from the upper respiratory tract of 28% of a group of children presenting with signs or symptoms of respiratory illness and group A streptococci on cultures from the pharynx or anterior nares. Although group A streptococci were found in 10% of the children 14 to 30 days after penicillin treatment, no correlation was found between the presence of penicillinase-producing S. aureus initially or at follow-up and re-isolation of group A streptococci. There was no suggestion from these studies that antibiotic therapy aimed at penicillin-resistant staphylococci would be of any greater value than intramuscular benzathine penicillin G for the treatment of patients with group A streptococci in the upper respiratory tract.

scholarly journals Evidence Update for Clinicians: Narrow- versus Broad-Spectrum Antibiotics for Common Infections in Children

2018 ◽  
Author(s):  
Keyword(s):  
Respiratory Tract ◽  
Broad Spectrum ◽  
Respiratory Tract Infections ◽  
Acute Otitis Media ◽  
Streptococcal Pharyngitis ◽  
Upper Respiratory Tract ◽  
Broad Spectrum Antibiotics ◽  
Group A ◽  
Tract Infections ◽  
Common Infections

Comparing Narrow- vs. Broad-Spectrum Antibiotics for Common Infections in Children. The choice of antibiotic to treat acute bacterial upper respiratory tract infections in children can affect both symptom resolution and the risk of side effects such as diarrhea and vomiting. The findings of a PCORI-funded study published in JAMA can help clinicians treating children for acute respiratory tract infections (ARTIs)—including acute otitis media, Group A streptococcal pharyngitis, and acute sinusitis—make decisions with parents about the medicine that is best for the child. The study, led by Jeffrey Gerber, a pediatrician and researcher at the Children’s Hospital of Philadelphia, included 30,086 children ages 6 months to 12 years taking narrow- and broad-spectrum antibiotics to treat ARTIs.

Significance of Quantitative Salivary Cultures for Group A and Non-group A β-Hemolytic Streptococci in Patients with Pharyngitis and in Their Family Contacts

PEDIATRICS ◽  
1979 ◽  
Vol 64 (6) ◽  
pp. 904-912
Author(s):  
Edward L. Kaplan ◽  
Robert Couser ◽  
Barbara Ballard Huwe ◽  
Carolyn Mckay ◽  
Lewis W. Wannamaker
Keyword(s):  
Antibody Response ◽  
Respiratory Tract ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
C Reactive Protein ◽  
Throat Culture ◽  
Reactive Protein ◽  
Group A ◽  
Bona Fide ◽  
Upper Respiratory

One hundred ninety-six individuals, 86 with clinically overt pharyngotonsillitis and 110 of their clinically negative contacts were studied to evaluate the sensitivity and the specificity of quantitative saliva cultures for group A β-hemolytic streptococci. We also compared this technique with semiquantitative throat cultures as a means of isolating group A streptococci and of differentiating the streptococcal carrier state from patients with bona fide streptococcal upper respiratory tract infection as defmed by the presence of an antibody response. The data indicate that the throat culture is a more reliable means of identifying group A β-hemolytic streptococci in the upper respiratory tract than is the saliva culture. The converse is true for non-group A β-hemolytic streptococci; the saliva culture is a much better means for isolating these organisms. In individuals positive by both techniques we found good correlation between the degree of positivity of the saliva culture and the degree of positivity of the throat culture. Furthermore, while there was a definite trend for individuals with strongly positive cultures to demonstrate more often an antibody rise in either antistreptolysin O and/or antideoxynibonuclease B—indicating bona fide infection—this relationship was not sufficiently constant to provide a clear differentiation. This study also indicates that discordance (one positive, one negative) of simultaneous duplicate semiquantitative throat cultures is much more common among individuals who do not show an antibody response ("carriers") than among those with an antibody response (bona fide infection). This study confirms our previous observations suggesting that the presence of C-reactive protein in the serum of patients with a positive culture for group A streptococci and clinical signs and symptoms of pharyngitis is often an indication of true streptococcal upper respiratory tract infection, and that even with a positive saliva culture at the initial visit, a negative C-reactive protein is only infrequently (25%) associated with an antibody response.

scholarly journals Group A Streptococcus Infection of the Nasopharynx Requires Proinflammatory Signaling Through the Interleukin-1 Receptor

2020 ◽  
Author(s):  
Doris L. LaRock ◽  
Raedeen Russell ◽  
Anders F. Johnson ◽  
Shyra Wilde ◽  
Christopher N. LaRock
Keyword(s):  
Respiratory Tract ◽  
Proinflammatory Cytokine ◽  
Interleukin 1 ◽  
Neutrophil Migration ◽  
High Morbidity ◽  
Invasive Infection ◽  
Upper Respiratory Tract ◽  
Group A ◽  
Upper Respiratory ◽  
Strep Throat

ABSTRACTGroup A Streptococcus (GAS) is the etiologic agent of numerous high morbidity and high mortality diseases which commonly have a highly proinflammatory pathology. One factor contributing to this inflammation is the GAS protease SpeB, which directly activates the proinflammatory cytokine interleukin-1β (IL-1β), independent of the canonical inflammasome pathway. IL-1β drives neutrophil activation and recruitment that limits bacterial growth and invasion during invasive skin and soft tissue infections like necrotizing fasciitis. GAS also causes pharyngitis (strep throat), and the upper respiratory tract is its primary nidus for growth and transmission. Since the fitness selection for the species is likely primarily for this site, we examined the process of IL-1β activation in the murine nasopharynx. SpeB still activated IL-1β, which was required for neutrophil migration, but this inflammation instead increased GAS replication. Inhibiting IL-1β or depleting neutrophils, which both promote invasive infection, prevented GAS infection of the nasopharynx. Prior antibiotic exposure increased GAS growth in the murine nasopharynx, and antibiotics were sufficient to reverse the attenuation previously observed when IL-1β, neutrophils, or SpeB were not present to drive inflammation. Therefore, the same fundamental mechanism has opposing effects on virulence at different body sites. Invasive disease may be limited in part due to specific adaptations for inducing host inflammation that are beneficial for pharyngitis.IMPORTANCEOur previous reports showed that Group A Streptococcus (GAS) protease SpeB directly activates the host proinflammatory cytokine IL-1β and this restricts invasive skin infection. The upper respiratory tract is the primary site of GAS colonization and infection, but the host-pathogen interactions at this site are still largely unknown. We provide the first evidence that IL-1β-mediated inflammation promotes upper respiratory tract infection. This provides experimental evidence that the notable inflammation of strep throat, which presents with significant swelling, pain, and neutrophil influx, is not an ineffectual immune response, but rather is a GAS-directed remodeling of this niche for its pathogenic benefit.

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