Invasive streptococcal infections: report of four cases occurring in Trinidad

Many countries are reporting a resurgence of virulent streptococcal strains but there is little information from the Caribbean. Four cases of severe invasive streptococcal infections, three of them fatal, are reported. The portal of entry was infected scabatic lesions in one patient and infected mosquito bites in another patient who developed cellulitis and gangrene; but no portal of entry was detected in the other patients. Group A B haemolytic Streptococcus (GAS) was isolated from the blood of three patients, one of them GAS M type 3, which had the genome for streptococcal pyrogenic exotoxins A (SPeA)and B (SPeB). GAS M type 72, which had the genome for SPeB and SPeC, were isolated from the tissues (but not from the blood) of the patient who developed cellulitis and who was the sole survivor. Physicians in the Caribbean must be alerted to the presence of these virulent streptococcal strains, and must be prepared to manage serious invasive disease.

A clinical comparison of budesonide nasal aerosol, terfenadine and a combined therapy of budesonide and oxymetazoline in adult patients with perennial rhinitis.

The efficacy of budesonide, terfenadine and a combination of budesonide and oxymetazoline in the treatment of perennial rhinitis was evaluated by a double blind, parallel group study. Adult patients with perennial rhinitis were randomized into three groups. Group 1 patients received budesonide nasal aerosol 400 micrograms/day for 21 days and oxymetazoline nasal drops for the first three days. Group 2 and 3 patients received budesonide 400 micrograms/day and terfenadne tablet 60 mg twice/day respectively. Nasal symptoms were assessed by the patients before and daily during the treatment period using a simple scoring system. One hundred and forty-two patients were recruited and 130 completed the study. Budesonide, but not terfenadine, significantly reduced all nasal symptoms from baseline (p less than 0.05). Terfenadine could significantly relieve the nasal blockage (p less than 0.05) more than other nasal symptoms. Budesonide with or without oxymetazoline nasal drops provided a better control of nasal symptoms than terfenadine (p less than 0.05). Budesonide with oxymetazoline for the first three days showed a faster relief of nasal blockage than budesonide alone (p less than 0.05). Mild and transient adverse effects were encountered in all three groups. It is concluded that nasal symptoms of perennial rhinitis are more adequately controlled by budesonide than by terfenadine.