Streptococcal superantigens and the return of scarlet fever

Streptococcus pyogenes (group A Streptococcus) is a globally disseminated and human-adapted bacterial pathogen that causes a wide range of infections, including scarlet fever. Scarlet fever is a toxin-mediated disease characterized by the formation of an erythematous, sandpaper-like rash that typically occurs in children aged 5 to 15. This infectious disease is caused by toxins called superantigens, a family of highly potent immunomodulators. Although scarlet fever had largely declined in both prevalence and severity since the late 19th century, outbreaks have now reemerged in multiple geographical regions over the past decade. Here, we review recent findings that address the role of superantigens in promoting a fitness advantage for S. pyogenes within human populations and discuss how superantigens may be suitable targets for vaccination strategies.

Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018–2019

ObjectivesIn response to increasing incidence of scarlet fever and wider outbreaks of group A streptococcal infections in London, we aimed to characterise the epidemiology, symptoms, management and consequences of scarlet fever, and to identify factors associated with delayed diagnosis.Design and settingCross-sectional community-based study of children with scarlet fever notified to London’s three Health Protection Teams, 2018–2019.ParticipantsFrom 2575 directly invited notified cases plus invitations via parental networks at 410 schools/nurseries with notified outbreaks of confirmed/probable scarlet fever, we received 477 responses (19% of those directly invited), of which 412 met the case definition. Median age was 4 years (range <1 to 16), 48% were female, and 70% were of white ethnicity.Outcome measuresPreplanned measures included quantitative description of case demographics, symptoms, care-seeking, and clinical, social, and economic impact on cases and households. After survey completion, secondary analyses of factors associated with delayed diagnosis (by logistic regression) and consequences of delayed diagnosis (by Cox’s regression), and qualitative analysis of free text comments were added.ResultsRash was reported for 89% of cases, but followed onset of other symptoms for 71%, with a median 1-day delay. Pattern of onset varied with age: sore throat was more common at onset among children 5 years and older (OR3.1, 95% CI 1.9 to 5.0). At first consultation, for 28%, scarlet fever was not considered: in these cases, symptoms were frequently attributed to viral infection (60%, 64/106). Delay in diagnosis beyond first consultation occurred more frequently among children aged 5+ who presented with sore throat (OR 2.8 vs 5+without sore throat; 95% CI 1.3 to 5.8). Cases with delayed diagnosis took, on average, 1 day longer to return to baseline activities.ConclusionsScarlet fever may be initially overlooked, especially among older children presenting with sore throat. Raising awareness among carers and practitioners may aid identification and timely treatment.

Public Health Measures During the COVID-19 Pandemic Reduce the Spread of Other Respiratory Infectious Diseases

Background: Public health measures (such as wearing masks, physical distancing, and isolation) have significantly reduced the spread of the coronavirus disease-2019 (COVID-19), but the impact of public health measures on other respiratory infectious diseases is unclear.Objective: To assess the correlation between public health measures and the incidence of respiratory infectious diseases in China during the COVID-19 pandemic.Methods: We collected the data from the National Health and Construction Commission in China on the number of patients with six respiratory infectious diseases (measles, tuberculosis, pertussis, scarlet fever, influenza, and mumps) from 2017 to 2020 and assessed the correlation between public health measures and the incidence of respiratory infectious diseases. Finally, we used the data of the six respiratory infectious diseases in 2021 to verify our results.Results: We found public health measures significantly reduced the incidence of measles (p = 0.002), tuberculosis (p = 0.002), pertussis (p = 0.004), scarlet fever (p = 0.002), influenza (p = 0.034), and mumps (p = 0.002) in 2020, and prevented seasonal peaks. Moreover, the effects of public health measures were most marked during the peak seasons for these infections. Of the six respiratory infectious diseases considered, tuberculosis was least affected by public health measures.Conclusion: Public health measures were very effective in reducing the incidence of respiratory infectious diseases, especially when the respiratory infectious diseases would normally have been at their peak.

About nitrogen metabolism with a lacto-vegetable diet

In one of our reports, we were able to show that a milk diet, which does not satisfy the energy needs of scarlet fever patients, leads to a negative nitrogen balance. Since in the milk diet, along with a moderate content of protein and fat, there were extremely few carbohydrates, it was natural to assume that an increase in the amount of the latter could have a significant effect on protein metabolism. To replenish food with carbohydrates, we included in the diet, in addition to milk, vegetable purees, cereals, jelly. The menu was composed in such a way that for breakfast and dinner, patients were given porridge with milk, and for lunch, vegetable puree and cranberry jelly. In addition, children received 200 grams twice a day. milk as a drink. The well-known schematization of dishes was carried out in order to facilitate the technical conditions of work. According to a preliminary calculation, the total caloric value of our lacto-vegetable diet was 2086 calories, with a content of 56 grams in food. squirrel, 294 gr. carbohydrates and 70 gr. fat. Of the 10 children put on this menu, only one 12-year-old patient with a mild form of scarlet fever ate the whole food offered to him, while the rest of the children were content with more or less of the dishes they were given. Patients aged 4-5 years drank an average of 600-700 grams. milk and ate 150-300 gr. porridge, 75-150 gr. mashed potatoes and 150-200 gr. jelly; older children ate 400-500 grams. porridge, 150-300 gr. puree, 250-300 gr. jelly and about 800 gr. milk.

Hypogammaglobulinemia and therapeutic use of gamma globulin

In the Soviet Union, gammaglobulin was first obtained in 1946 by Kholchev and Kolesnikova from the blood serum of donors. At first, it was used to prevent measles, and then, as the content of various antibodies in it was studied, it began to be used for poliomyelitis (Leitman, Strakhova, Denisenko, Bogdanov), Botkin's disease (Ananiev, Grachev, Fabrikantov), ​​whooping cough (Khropetskaya), scarlet fever ( Kaushanskaya, Zhagullo, Mauerman). Gammaglobulins were also obtained from the blood serum of animals, which were successfully used for rabies (Selimov, Durasova, Kovalevskaya. Kobrinsky, Chun-syun), plague (Semenova, Ponomareva), smallpox (Mirosennikova). Gammaglobulin in industrial conditions is prepared from the placental serum of healthy women in labor.

Identification of epidemic scarlet fever group A Streptococcus strains in the paediatric population of Houston, TX, USA

Scarlet fever (SF) has recently been associated with group A streptococcal (GAS) strains possessing multidrug resistance and specific streptococcal exotoxins. We screened a local surveillance collection of GAS emm12 strains in Houston, TX, USA for antimicrobial resistance and identified a single isolate matching the antimicrobial resistance pattern previously reported for SF clones. Using whole-genome sequencing and combining genome sequence data derived from national surveillance databases, we identified additional emm12 GAS clones similar to those associated with prior SF outbreaks, emphasizing the need for continued surveillance for epidemic emergence in the USA.

Immunogenesis and blood reactivity in early childhood Prof. Nasso (Klin. Woch. No. 7, 1932)

Prof. Nasso (Klin. Woch. No. 7, 1932) considers it possible to assume, on the basis of his own experiments and the observation of a number of other authors, that many febrile diseases of early childhood, with an unknown etiology, can be measles, scarlet fever, and rubella etc., in which the absence of a skin symptom, a rash, must be attributed to insufficient reactivity of the skin.

On the issue of relapses of the primary complex of scarlet fever

The three case histories published in this report are of fundamental interest.

The association between ambient air pollution and scarlet fever in Qingdao, China, 2014–2018: a quantitative analysis

Background We conducted a distributed lag non-linear time series analysis to quantify the association between air pollution and scarlet fever in Qingdao city during 2014–2018. Methods A distributed lag non-linear model (DLNM) combined with a generalized additive mixed model (GAMM) was applied to quantify the distributed lag effects of air pollutions on scarlet fever, with daily incidence of scarlet fever as the dependent variable and air pollutions as the independent variable adjusted for potential confounders. Results A total of 6316 cases of scarlet fever were notified, and there were 376 days occurring air pollution during the study period. Scarlet fever was significantly associated with air pollutions at a lag of 7 days with different relative risk (RR) of air pollution degrees [1.172, 95% confidence interval (CI): 1.038–1.323 in mild air pollution; 1.374, 95% CI 1.078–1.749 in moderate air pollution; 1.610, 95% CI 1.163–2.314 in severe air pollution; 1.887, 95% CI 1.163–3.061 in most severe air pollution]. Conclusions Our findings show that air pollution is positively associated with scarlet fever in Qingdao, and the risk of scarlet fever could be increased along with the degrees of air pollution. It contributes to developing strategies to prevent and reduce health impact from scarlet fever and other non-vaccine-preventable respiratory infectious diseases in air polluted areas.