Prelabor rupture of membranes at term: A possible hematological triage in addition to vagino-rectal beta-hemolytic streptococcus screening for early labor induction

Introduction A potential complication of term prelabor rupture of membranes (term PROM) is chorioamnionitis with an increased burden on neonatal outcomes of chronic lung disease and cerebral palsy. The purpose of the study was to analyze the efficacy of a standing clinical protocol designed to identify women with term PROM at low risk for chorioamnionitis, who may benefit from expectant management, and those at a higher risk for chorioamnionitis, who may benefit from early induction. Material and methods This retrospective study enrolled all consecutive singleton pregnant women with term PROM. Subjects included women with at least one of the following factors: white blood cell count ≥ 15×100/μL, C-reactive protein ≥ 1.5 mg/dL, or positive vaginal swab for beta-hemolytic streptococcus. These women comprised the high risk (HR) group and underwent immediate induction of labor by the administration of intravaginal dinoprostone. Women with none of the above factors and those with a low risk for chorioamnionitis waited for up to 24 hours for spontaneous onset of labor and comprised the low-risk (LR) group. Results Of the 884 consecutive patients recruited, 65 fulfilled the criteria for HR chorioamnionitis and underwent immediate induction, while 819 were admitted for expectant management. Chorioamnionitis and Cesarean section rates were not significantly different between the HR and LR groups. However, the prevalence of maternal fever (7.7% vs. 2.9%; p = 0.04) and meconium-stained amniotic fluid was significantly higher in the HR group than in LR group (6.1% vs. 2.2%; p = 0.04). This study found an overall incidence of 4.2% for chorioamnionitis, 10.9% for Cesarean section, 0.5% for umbilical artery blood pH < 7.10, and 1.9% for admission to the neonatal intensive care unit. Furthermore, no confirmed cases of neonatal sepsis were encountered. Conclusions A clinical protocol designed to manage, by immediate induction, only those women with term PROM who presented with High Risk factors for infection/inflammation achieved similar maternal and perinatal outcomes between such women and women without any risks who received expectant management. This reduced the need for universal induction of term PROM patients, thereby reducing the incidence of maternal and fetal complications without increasing the rate of Cesarean sections.

Determination of anti-streptolysin – O titer in suspected cases of streptococcal infection

The Group A beta hemolytic streptococcus has remained a major human infective agent for hundreds of years. Group 'A' beta hemolytic streptococcus related ailment and sequelae keep on affecting general public and national economy as they mostly influence kids and youthful grown-ups. Current research aimed to determination of anti-streptolysin –o titer in suspected cases of streptococcal infection. : Determination of anti-Streptolysin-O (ASO) titer in suspected cases of streptococcal infection. The measurement of ASO levels was done by semi-quantitative analyzer analyzer on photometric and colorimetric systems. 107 blood samples were taken in our study. This study was conduct in serological section of microbiology department of Teerthanker Mahaveer Hospital & research centre Moradabad. A total 107 samples were tested in this study. Of these, 23(21.5%) were found to be positive for the presence of ASO having titre of &#62;200IU/mL. This study will be useful to evaluate utility of sero-diagnosis in our catering population and found useful in early diagnosis and treatment of these pathogens. Treatment can be initiated at an early stage leading to reduction in complications and associated mortality.

Antimicrobial Resistance among Beta-Hemolytic Streptococcus in Brazil: An Overview

Streptococcus pyogenes, Streptococcus agalactiae and Streptococcus dysgalactiae subsp. equisimilis (SDSE) are the beta-hemolytic streptococci species with the most clinical relevance to humans. These species are responsible for several infections, ranging from mild to life-threatening diseases. Although resistance to recommended drugs has not been so critical as detected in other species, it has occurred in diverse regions. In Brazil, it is possible to observe an increasing macrolide and lincosamide resistance trend due to the spread of polyclonal strains. Macrolide–lincosamide–streptogramin B (MLS) resistance phenotypes have been prevalent among S. agalactiae and S. pyogenes, while M phenotype (resistance only to macrolides) has prevailed among SDSE resistant isolates. Fluoroquinolone resistance is rare in this country, reported only in S.agalactiae and S.pyogenes. This is due to nucleotide substitutions in gyrA and parC genes. Reduced penicillin susceptibility and vancomycin resistance, detected in other regions, have not yet been reported in Brazil. Tetracycline is not a therapeutical option, and resistance has occurred at high levels, especially among S.agalactiae. These findings highlight the need for continuous monitoring in order to track the occurrence of antimicrobial resistance among beta-hemolytic streptococci species circulating in this country.

Prophylaxis of Rheumatic Fever/Rheumatic Heart Disease–Penicillin or Azithromycin, Who Wins?

For eradication of rheumatic fever (RF)/rheumatic heart disease (RHD), we must have a simplified diagnosis, and a treatment which is painless, easily available and safe; prophylaxis must be painless, safe, easily available, readily administered, and comprising a weekly oral single dose.Arati's regime for management of RF/RHD (ARMOR) consists of diagnosis and management of RF/RHD in today's context in a very easy and simplified way.ARMOR criteria: Arthritis or arthralgia with typical features suggestive of RF, carditis or cardiac involvement, typical of RF or RHD, and echocardiographic evidence of rheumatic heart valve involvement should essentially be the criteria to diagnose RF and RHD with high specificity and sensitivity.With regard to treatment of RF/RHD, we need a drug which is highly efficacious against Group A Beta Hemolytic Streptococcus (GABHS), which is the causative agent for primary prevention and treatment and secondary prophylaxis.The best drug discovered, to date, for GABHS is azithromycin.ARMOR for primary prevention, treatment and secondary prophylaxis of RF/RHD is as follows:Azithromycin must be given in a dose of 500 mg 1 tablet daily for 5 days, followed by 1 tablet once a week for 1 year.Penicillin for treatment and prophylaxis must be given up due to its lack of availability, side effects, risk of anaphylaxis, parenteral preparation, hazards of administration, need for sensitivity test each time, etc. and replaced by azithromycin.

Scarlet fever on the background of toxicodermia in a child: case report and mini-review

The article presents a case of scarlet fever on the background of toxicodermia in a 12-year-old girl. The disease most probably developed in response to a combination of etiological factors such as bacterial infection and allergic reaction to exotoxins. The clinical picture was dubious, involving mucous membranes of the nose, mouth, and skin. Parenteral administration of glucocorticoids, antihistamines, detoxification, antibiotic therapy, and topical treatment led to rapid regression of clinical symptoms and prevented the development of complications. Sometimes, it is difficult to determine the etiology of toxicodermia combined with scarlet fever. Physicians should examine all patients with allergodermatoses for the presence of beta-hemolytic streptococcus and antibodies.