Foreigners To Pulp And Periodontium - Report Of 2 Cases

Presence of a foreign object embedded in and around a tooth is unusual. Such object may get lodged and become a source of pain and infection, causing the patient to present to the dentist. This paper present two such case reports of foreign body imbedded within or around the tooth. One of the reported cases is the first case in which staple pin is present in primary molar. Present article emphasizes upon maintenance of oral hygiene and regular dental check up can prevent such undesirable situation.

Rapid Antigen Testing For Strep Sore Throat

This was a cross sectional study to estimate the prevalence of Group AStreptococcal (GAS) infection among children with acute sore throat and to compare results of Rapid antigen detection test (RADT) with throat culture. Children aged 3-15 years who presented with acute sore throat (throat pain ± redness of pharynx, palate, tonsils), whose parents were willing to participate in the study by giving a written consent were included. Two sterile throat swabs were taken by vigorously rubbing the tonsils or posterior pharyngeal wall, one for RADT (cerTEST Strep Acard test) and 2nd for bacterial culture. The samples were sent to the in-hospital NABLcertified laboratory (SRLLtd). The results of RADT were obtained within 15 minutes while the culture report was available after 72 hours. During the 7 months study period we took 90 throat samples from 86 children. Of these 26 were RADT positive and 22 were culture positive. The prevalence of GAS by RADT was 28.88% and by culture was 25.56%. The sensitivity and specificity of RADTwas 95.65% and 94.02 % respectively. Since the RADThad high sensitivity and specificity and the results were available within 15 minutes, the need for throat swab culture (with additional cost and delay in results) could be avoided. Appropriate antibiotic may be started on the basis of RADT. If RADTis negative culture should be sent.

Antimicrobial resistance in beta-haemolytic streptococci in India: A four-year study

Background & objectives: The incidence and severity of invasive and non-invasive infections demonstrate variability over time. The emerging resistance of Group A streptococci (GAS) to commonly used antibiotics is of grave concern. This study was conducted to assess the antimicrobial resistance of beta-haemolytic streptococci (?HS) in India and to ascertain the molecular mechanisms of resistance. Methods: All isolates of ?HS from the Trauma Centre of All India Institute of Medical Sciences (AIIMS) (north India), and heavily populated area of old Delhi from 2010 to 2014 and Yashoda Hospital, Secunderabad (in south India, 2010-2012) and preserved isolates of ?HS at AIIMS (2005-2009) were included. Phenotypic confirmation was done using conventional methods and the Vitek 2. Antibiotic sensitivity testing was done by disc diffusion and E-test. Detection of resistance genes, erm(A), erm(B), mef(A), tet(M) and tet(O), was done by polymerase chain reaction (PCR). Results: A total of 296 isolates of ?HS (240 from north and 21 from south India) were included in the study. Of the 296 ?HS, 220 (74%) were GAS, 52 (17.5%) were Group G streptococci and 11 (3.7%), 10 (3.3%) and three (1%) were Group B streptococci, Group C streptococci and Group F streptococci, respectively. A total of 102 (46%) and 174 (79%) isolates were resistant to tetracycline and erythromycin, respectively; a lower resistance to ciprofloxacin (21, 9.5%) was observed. A total of 42 (14%) and 30 (10%) isolates, respectively, were positive for tet(M) and erm(B) genes. Only 13 (5%) isolates were positive for mef(A). None of the isolates were positive for erm(A) and tet(O). There was discordance between the results of E-test and PCR for erythromycin and tetracycline. Interpretation & conclusions: A high level of resistance to erythromycin and tetracycline was seen in ?HS in India. Discordance between genotypic and phenotypic results was reported. Absence of erm(A) and tet(O) with high prevalence of tet(M) and erm(B) was observed.

Profi le of fatal Streptococcal bacteraemia at a tertiary care Indian hospital.

Streptococcus pyogenes causes mild to acutely life-threatening diseases. Herein, we report our experience with fi ve cases of fatal bacteraemia due to various groups of Streptococci, three of them due to Group G Streptococcus and one case each due to Group A Streptococcus and Group F Streptococcus. The peculiarity of all these cases was the rapidity of deaths occurring in these patients despite all the strains being sensitive to Penicillin. Hence, timely intervention in all suspected cases is strongly advocated. All isolates of beta-haemolytic Streptococci should be identifi ed up till the species level and antimicrobial susceptibility be performed so that proper and early management can be done.

Antibiotic Susceptibility Evaluation of Group A Streptococcus Isolated from Children with Pharyngitis: A Study from Iran

BACKGROUND: The aim of this study was to evaluate the antibiotic susceptibility of Group A streptococcus (GAS) to antibiotics usually used in Iran for treatment of GAS pharyngitis in children. MATERIALS AND METHODS: From 2011 to 2013, children 3-15 years of age with acute tonsillopharyngitis who attended Mofid Children's Hospital clinics and emergency ward and did not meet the exclusion criteria were enrolled in a prospective study in a sequential manner. The isolates strains from throat culture were identified as GAS by colony morphology, gram staining, beta hemolysis on blood agar, sensitivity to bacitracin, a positive pyrrolidonyl aminopeptidase (PYR) test result, and the presence of Lancefield A antigen determined by agglutination test. Antimicrobial susceptibility was identified by both disk diffusion and broth dilution methods. RESULTS: From 200 children enrolled in this study, 59 (30%) cases were culture positive for GAS. All isolates were sensitive to penicillin G. The prevalence of erythromycin, azithromycin, and clarithromycin resistance by broth dilution method was 33.9%, 57.6%, and 33.9%, respectively. Surprisingly, 8.4% of GAS strains were resistant to rifampin. In this study, 13.5% and 32.2% of the strains were resistant to clindamycin and ofloxacin, respectively. CONCLUSION: The high rate of resistance of GAS to some antibiotics in this study should warn physicians, especially in Iran, to use antibiotics restrictedly and logically to prevent the rising of resistance rates in future. It also seems that continuous local surveillance is necessary to achieve the best therapeutic option for GAS treatment.

Prevalence of Group A beta- hemolytic streptococcal carriers in school going children.

Group A Streptococci (GAS) are one of the common pathogens responsible for causing tonsillitis and pharyngitis in both children and young adults. The asymptomatic pharyngeal carriage of GAS in children may lead to spread of respiratory infection in the community. Children aged 5 to 15 years with no signs and symptoms of upper respiratory tract infections and no history of antibiotic therapy within last two weeks were included in study. Throat swabs collected were cultured on blood agar. GAS was identified by conventional method and serogrouped using latex agglutination assay. GAS was isolated from 7 children, out of 250 children. The carrier rate was 3.6% which correlated well with other South Asian studies. Our study showed the importance of surveillance programme to keep carriers in check.

A Controlled Trial of Oral Rifampin in Chronic Plaque Psoriasis.

Group A Streptococcal infection in the throat is responsible for causing initial and recurrent attacks of acute guttate psoriasis (AGP). Up to 70% of these AGP patients go on to develop chronic plaque psoriasis (CPP). We hypothesized that chronic sub-clinical, on-going streptococcal infection might solely be responsible for CPP in a genetically predisposed individual. Rifampin, a useful drug for several types of bacterial infections including Group A Streptococci (GAS) because of its broad spectrum, excellent tissue penetration, low sideeffect profile and its salivary concentrations after oral administration greatly exceeds the minimum inhibitory concentration for most GAS, thus helpful in eradicating pharyngeal carriage of GAS, was considered for long term use in CPP. Fifty patients with moderate to severe CPP were enrolled. Of these 25 were randomly selected to receive rifampin for 36 weeks as a single oral morning dose of 10 mg/kg body weight (approx. patient weighing <50 kg received 450mg per day and patients >50 kg received 600mg per day). Remaining 25 patients received placebo. Rifampin group was further followed-up to one more year. Significant improvement in PASI score was noted from 12 weeks in majority of patients in Rifampin group. Relevant investigations and clinical assessment was done at regular intervals to observe any side effects and check progress of the disease. Data were analyzed statistically using the t-test. As psoriasis is a chronic disorder that waxes and wanes over time, withdrawal of treatments usually is accompanied by relapse of skin manifestations so a follow-up with one year drug-free period was added to verify treatment consistency. Patients tolerated the therapy well.

Virulence potential of Group A streptococci isolated from throat cultures of children from north India.

Background & objectives: Rheumatic fever (RF)/rheumatic heart disease (RHD) caused by Group A streptococcus (GAS) are more prevalent in north India as compared to the western world, where invasive diseases are common. This could be due to variation in the virulence of GAS in different geographic locations. Hence, we studied the virulence potential of GAS isolated from the throat of children from north India. Methods: Fifty GAS isolated consecutively, from children with mild pharyngitis (20), severe pharyngitis (24) and asymptomatic pharyngeal carriers (6), were characterized by emm typing and opacity factor (OF). Adherence and internalization of GAS in HEp-2 cells and opsonophagocytosis in convalescent serum samples were studied. Results: Twenty emm types, six sequence types, and one non-typeable GAS were circulating in the community. emm type 74, 11, 68, StI129 and NS292 were most prevalent. Twenty seven (54%) GAS isolates were OF negative. Sixty five per cent of the most prevalent emm types were OF negative indicating their rheumatogenic potential. Adhesion of GAS ranged from 0.1 to 100 per cent. Forty eight per cent of GAS were highly adherent. Invasion of GAS in HEp-2 cells ranged between 0 to 30 per cent. Only 20 per cent isolates exhibited highest invasion. GAS were opsonophagocytosed with highly divergent efficiency ranging from 0 to 91.7 per cent. Nineteen GAS were not opsonophagocytosed and 15 multiplied during the assay. Isolates of the same emm type also varied in their virulence potential. Interpretation & conclusions: GAS isolates from the throat of children from north India belonged to several emm types, majority were OF negative, excellent adherents but poor invaders. This explains why throat infections in these children tend to lead to ARF/RHD rather than invasive diseases. A few isolates exhibiting high invasion efficiency indicate that GAS throat cultures can also lead to invasive diseases.

Epidemiology and Erythromycin Resistance of Streptococcus pyogenes in the Last 20 Years / 대한임상미생물학회지

Serological methods for the epidemiological study of Streptococcus pyogenes, such as T-, or M-typing, were replaced by emm typing in the 2000s. The frequency of emm types may differ according to ographical area and study period. Erythromycin resistance rates and the prevalence of erythromycin-resistant phenotypes in several countries are surveyed, and common emm genotypes associated with erythromycin resistance are described for each country. There is no correlation between erythromycin resistance and macrolide use in Korea. S. pyogenes is thought to cause severe illness, such as streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis. The mortality rate of STSS is about 50%, and there have been several hundred victims of STSS in Japan in the last 2 decades. The resistance rate to macrolides peaked at 50% in 2002, and currently, <10% of strains exhibit macrolide resistance in Korea. However, the erythromycin resistance rate recently exceeded 90% in China. Considering increases of travel between neighboring countries, a vigilant survey to monitor these highly virulent and antibiotic-resistant strains is necessary.

Decline in Erythromycin Resistance in Group A Streptococci from Acute Pharyngitis due to Changes in the emm Genotypes Rather Than Restriction of Antibiotic Use / 대한진단검사의학회지

BACKGROUND: Group A streptococcus (GAS) is the most common cause of bacterial pharyngitis in children. Antibiotic resistance rates and emm genotypes of GAS isolated from patients with acute pharyngitis were studied in 2009. METHODS: Throat cultures were taken from 499 children with acute pharyngitis in Jinju, Korea, in 2008-2009. A total of 174 strains (34.9%) of GAS were isolated, and antimicrobial susceptibility testing was performed using the disk diffusion method. The phenotypes of macrolide resistance and macrolide resistance genes were determined. The emm genotypes were identified using PCR and sequencing. The data were compared with those acquired in 2002 in the same region. Data on the annual macrolide production were collected between 1999 and 2008. RESULTS: The resistance rates of GAS to erythromycin, clindamycin, and tetracycline were 4.6%, 2.9%, and 2.3%, respectively. The constitutive resistance rate was 62.5% for the erm(B) gene and 37.5% for the M phenotype of the mef(A) gene. emm4 was most frequently detected (28.2%), followed by emm89 (20.1%). Most of the erythromycin resistant strains had the emm28 genotype. We noted a gradual increase in macrolide production during the study period. CONCLUSIONS: The erythromycin resistance rate of GAS isolated from children with acute pharyngitis was significantly lower in 2009 (4.6%) than in 2002 (44.8%). We observed a remarkable change in the distribution of emm genotypes during the 7-yr period. The significant decline in erythromycin resistance in 2009 might be associated with a prominent decrease in the resistant genotype emm12 (3.4% in 2009 vs. 28.0% in 2002) rather than restriction of macrolide use.

Microbiological Characteristics of Throat Cultures from School Children in Jinju, 2006 / 대한임상미생물학회지

BACKGROUND: Group A streptococci (GAS) are the most common cause of pharyngitis in children. The streptococci in throat cultures from healthy elementary school children in Jinju were compared with previous results. METHODS: Throat cultures were taken from 1,402 healthy school children in 2006. beta-hemolytic streptococci (BHS) were identified with a bacitracin disk (0.04 U) and latex agglutination test (Seroiden Strepto Kit, Eiken, Tokyo, Japan). RESULTS: Two-hundred sixteen (15.4%) and 149 (10.6%) cultures grew BHS and GAS, respectively. The isolation rate of GAS was significantly lower than in 2004 (16.0%) or 2002 (16.9%) (P<0.05). Among BHS, the prevalence of group A strains (69.0%) decreased significantly compared with 2004 (84.9%) and 2002 (83.8%) (P<0.05). None of the 1st-grade children yielded BHS or GAS. CONCLUSION: The isolation rates of BHS and GAS from healthy school children were lower in 2006 than in previous years. Natural immunization against the common serotypes or improvement in individual hygiene might have played roles in the reduction of isolations of GAS.

Association of T Antigens with emm Genotypes of Group A Streptococci / 대한임상미생물학회지

BACKGROUND: T typing has been used as a screening test for epidemiologic studies of group A streptococci (GAS) infections or carriers, and M typing has been performed for virulence studies. However, M typing is difficult to perform in routine laboratories. Recently, genotyping of the emm gene, which encodes the M protein, has become available. We investigated which T antigen is closely associated with a certain emmgenotype. METHODS: GAS were collected from the children in Jinju who were asymptomatic carriers (N=349) or had acute pharyngitis (N=122) during the 3 year-period from 2002 through 2004. T typing was performed by a slide aggulutination, and emmgenotyping by PCR and DNA sequencing. RESULTS: More than 90% of T1, T3, T6, T12, T25, and T5/27/44 antigens were associated with emm1, emm3, emm6, emm12 and 22, emm75, and emm44/61 genotypes, respectively; however, other T antigens, such as T2, T4, T7, T11, and B3264, were not associated with any particular emm genotypes. CONCLUSION: Several T antigens are so closely associated with particular emm genotypes that one could predict emmgenotypes based on the result of T typing.

Genetic Diversity and Exotoxin A Production of Group A Streptococci Causing Sepsis

The M protein and streptococcus pyrogenic exotoxin (SPE A) are important virulence factors in group A streptococci (GAS) infections. The emm types of GAS strains isolated from patients with sepsis were determined by sequencing the 5' N-terminus of the emm gene, encoding the M protein, and clonality analysis using pulsed-field gel electrophoresis. The presence of speA and production of SPE A were also examined. There were no predominant GAS clones. The emm genotypes were variable, and the most common genotype was emm13 (17.9%). The production prevalence of SPE A was 21.4%. The low mortality rate (7.1%) of GAS sepsis might be attributable to the low incidence of virulent strains such as emm1 (10.7%) and emm3 (7.1%), as well as to low production rate of SPE A.

Distribution of Beta-Hemolytic Streptococci of Throat Culture of Elementary School Children in Jinju Area, 2004 / 대한임상미생물학회지

BACKGROUND: The carrier study of group A streptococci (GAS), the most common cause of bacterial pharyngitis, is important to understand the epidemiology of GAS in the region. The authors performed throat cultures from the children of four elementary schools in Jinju area to investigate current microbiological characteristics in this area. METHODS: Throat cultures were taken from 2,351 healthy elementary school children (male 1,311 and female 1,040) from October through December, 2004. Two schools are located in rural areas, while the other two schools are in Jinju city. Beta-hemolytic streptococci (BHS) were identified with bacitracin disk (0.04 U) and latex agglutination test (Seroiden Strepto Kit, Eiken). RESULTS: Four-hundred forty-three (18.8%) yielded BHS from 2,351 school children. Serogrouping revealed 84.9% of group A, 5.9% of group C, 4.7% of group B, 3.6% of group G, and 0.9% of non-group A, B, C, G in a decreasing order. Isolation rate of GAS was similar between girls and boys. Children of elementary schools in rural areas showed significantly higher isolation rates (18.6-21.7%) compared to those (12.5-12.7%) in urban areas. CONCLUSION: The isolation rate of BHS was 18.8% in Jinju area, 2004. Group A was 84.9% and group C was next common. Although the isolation rate of GAS was similar by age or sex, it showed a significant difference by the location of the schools.

Molecular Genetic Characterization of Clinical Isolates of Streptococcus pyogenes / 대한진단검사의학회지

BACKGROUND: Group A streptococcus (Streptococcus pyogenes) is the most common cause of bacterial pharyngitis and an important cause of a variety of suppurative and nonsuppurative diseases. The molecular genetic analysis of group A streptococci in clinical isolates is rarely reported in Korea. In this study, molecular genetic analysis using serotyping and emm sequence analysis, testing the presence of the SpeA and SpeB gene, and the determination of an antimicrobial resistance pattern were investigated. METHODS: Sixty nine strains of S. pyogenes from clinical isolates in Korea during 1999-2002 were examined by T agglutination, serum opacity reaction, and emm sequence analysis. Also investigated were antimicrobial susceptibility and the frequency of SpeA and SpeB genes. RESULTS: The antibiotic resistance rates for S. pyogenes isolates were shown at 28.9% of erythromycin, 14.2% of ampicillin, 9.5% of chloramphenicol, and 6.3% of levofloxacin. However, all strains were susceptible to penicillin, vancomycin, and teicoplanin. By T agglutination typing, forty-one (59.4%) among sixty-nine isolates were identified as T28 (13%), T6 (13%), T1 (10%), T12 (8.7%), T4 (4%), T5/27/44 (4%), T3/B3264 (2.9%), T11/12 (1.4%), and TB3264 (1.4%). Thirty-five (50.7%) among sixty nine isolates were positive in serum opacity reaction. The SpeB gene showed positive in all strains but the SpeA gene in eleven (15.9%) strains. By emm gene sequence analysis, forty-seven (68.1%) CONCLUSIONS: Our data showed that antimicrobial resistance of clinical isolates to erythromycin were higher than those reported from the United States and Europe, and emm genotyping could be used for a reliable and efficient typing method.

Clonality Analysis Using Pulsed-Field Gel Electrophoresis of Erythromycin Resistant Group A Streptococci / 대한임상미생물학회지

BACKGROUND: Antibiotic resistance of group A streptococci (GAS) is increasing nationwide. Pulsed-field gel electrophoresis (PFGE) is useful for investigating genetic relationship among outbreaks of bacterial infection. Erythromycin (EM) resistance is mediated by either ermB, ermTR, or mefA gene.The emm gene encodes M protein which is the most important virulence factor of GAS. METHODS: The clonal relationship among 56 EM resistant GAS isolated from the children with acute pharyngitis in Jinju was investigated by analysis of chromosomal DNA restriction pattern with SmaI enzyme. The ermB and mefA genes were amplified and emm genotype was identified with PCR and sequencing. Their relationship with PFGE pattern was investigated. RESULTS: The emm genotyes were identified as 2, 3, 12, 18, and 75. Mostly emm12 had ermB gene, while emm 3, 18 and 75 had mefA resistance gene. All strains with mefA gene were not restricted with SmaI. The emm12 strains showed 5 different PFGE patterns. CONCLUSIONS: The emm genotypes were closely related with resistance genes. Analysis of macrorestriction fragment patterns by PFGE showed that EM resistant GAS were polyclonal at least in Jinju. GAS strains with mefA gene were not restricted with SmaI suggesting mefA gene might inhibit chromosomal digestion with SmaI.

Clinical Characterization of Group A Streptococcal Bacteremia and Restriction-Fragment Length Polymorphism of emm Gene and Pulsed-field Gel Electrophoresis / 대한진단검사의학회지

BACKGROUND: M protein is the major virulence factor of group A streptococci (GAS). As the emm gene, which encodes the M protein, has a variable sequence at 5'-terminus by each M type, it can be classified into several restriction-fragment length polymorphisms (RFLP) by restriction enzymes. Pulsed-field gel electrophoresis (PFGE) is useful for investigating clonal outbreaks or bacterial transmission. Molecular epidemiological analysis using emm-RFLP and PFGE was performed on GAS isolated from bacteremia. METHODS: Twenty-eight strains of GAS isolated from patients with bacteremia were included. Medical records of 27 cases were reviewed retrospectively to see the prognosis of GAS bacteremia. The restriction patterns of emm gene digested with HaeIII enzyme were compared by each emm genotype. Macrorestriction patterns were produced by PFGE after digestion of chromosomal DNA with SmaI and ApaI enzymes. RESULTS: All but 2 cases with toxic streptococcal syndrome survived. The DNA fragments of emm-HaeIII restriction showed 3 to 4 bands. Each emm genotype showed a different emm-HaeIII restriction pattern, except emm49 and SP2346, of which the restriction pattern was similar to that of emm1. Thirteen different PFGE patterns were observed by SmaI, and emm6, emm12, and emm75 were not cut with SmaI. All 28 strains were cut with ApaI, which yielded 17 different PFGE patterns. All but emm13 showed a high concordance between the PFGE patterns and the emm genotypes. CONCLUSIONS: The patients with GAS bacteremia showed a relatively good prognosis. We found that the restriction enzyme analysis of emm gene was rapid, simple and inexpensive to perform, and that PFGE was useful for classifying GAS strains because it generally discriminated well between each emm genotype. Although the number of strains studied was small, GAS bacteremia was not due to a single clone.

Analysis of Phenotypic and Genotypic Distribution of Erythromycin and Clindamycin Resistance of Group A Streptococci Isolated from Acute Pharyngitis / 대한진단검사의학회지

BACKGROUND: Erythromycin (EM) or other macrolides have been used commonly for the treatment of bacterial pharyngitis. Recently, however, EM-resistant group A streptococci (GAS) are being reported with increasing frequency. The phenotypic expression of macrolide resistance is classified as constitutive, inducible, and M. EM resistance is mediated by ermB, ermTR, or mefA genes. The emm gene encoding M protein has variable sequences at 5'end terminus. METHODS: GAS was isolated from patients with acute pharyngitis at a local clinic in Jinju from November 2001 to May 2002. Antimicrobial susceptibility testing was performed using the disk diffusion method. The phenotypes of EM and clindamycin (CC) resistance were evaluated, and the frequency of ermB and mefA genes was determined by PCR. The emm genotype was identified with PCR and sequencing. RESULTS: A total of 125 strains of group A streptococci was isolated. The resistance rate to EM and CC was 44.8% and 19.2%, respectively. Constitutive resistance was observed in 42.1%, M phenotype in 57.9%, but inducible resistance was not seen. The ermB and mefA genes were positive in 39.3% and 58.9%, respectively. Most emm12 strains showed constitutive resistance, while emm18 and emm75 showed M phenotype. CONCLUSIONS: The EM and CC resistance rates of group A streptococci isolated from acute pharyngitis were remarkably high compared to the previous reports. M phenotype was more common than constitutive resistance in acute pharyngitis. The resistance pattern was variable according to the emm types, suggesting an association between the emm gene and resistant genes.

Antibiotic Resistance and Its Mechanism of Group A Streptococci in School Children of Jinju / 대한임상미생물학회지

BACKGROUND: Group A streptococci (GAS) is the most common cause of bacterial pharyngitis. Recently, a high frequency of resistance to erythromycin (EM), the drug of choice for penicillin-allergic patients, has been reported, especially in countries where antibiotics are overused. Resistance is classified as constitutive, inducible, or M according to the sensitivity results with EM and clindamycin (CC). These EM resistance phenotype is attributable to the erm , ermTR, and mefA genes, respectively. Although EM resistance of GAS is a serious problem in our country, there are very few reports regarding to its mechanism. METHODS: GAS were isolated from elementary school children of Jinju in 2002. Antibiotic sensitivity testing by disk diffusion was performed against tetracycline (TC), ofloxacin, EM and CC, and the results were compared to the previous one in 1995 at the same area. The phenotypes of EM resistance were evaluated, and the frequency of ermB and mefA genes was determined by PCR. The resistance pattern was analyzed by each emm genotype. RESULTS: The resistance rate to EM and CC was 51% and 34%, respectively, which is significantly higher than the rate of 25% and 9% recorded in 1995. Constitutive resistance was seen in 64% of the EM-resistant strains, the M phenotype in 34%, and inducible resistance in only 2%, compared to 38% of constitutive resistance and 62% of M phenotype in 1995. The ermB and mefA genes were present in 64% and 34% of strains, respectively. Most (88%) of the emm12 strains showed constitutive resistance, while emm18 and emm75 showed M phenotype. The organisms with most of the other emm genotypes were susceptible to EM. CONCLUSION: The EM and CC resistance rate had increased more than twofold. Constitutive resistance was twice as common as the M phenotype, whereas the mefA gene was more common in 1995. The resistance pattern was variable according to emm type, which suggests an association between the emm and resistance genes. Continuous microbiologic and epidemiological surveillance should be conducted and the seriousness of antibiotic resistance should be underscored in our community.

Serological Analysis and Epidemiologic Characteristics of Group A Streptococci in Seoul(1998-2000)

PURPOSE: Group A streptococci have a cell wall which consists of M protein and T protein. T protein is known to be helpful in the understanding of the epidemiology of group A streptococci. To study the epidemiologic characteristics, we serotyped T protein of group A streptococci obtained from patients admitted to hospitals, or who visited OPD in five districts of Seoul the during last three years. METHODS: Group A streptococci were obtained in five districts in north, northeast, central, northwest and south Seoul from 1998 through 2000. All isolated group A streptococci were serotyped with T protein antisera(Institute of Sera and Vaccine, Prague, Czech Republic). RESULTS: In 1998, analysis of obtained total number of 92 strains revealed that T12, T4, and NT acounted for 72.2%. Among seven cases of scarlet fever, T12 was isolated in four cases and T4 was found in three cases. Two cases of tonsilar abscess produced T8 and NT. One case of cervical lymphadenitis showed T12. In 1999, 41 cases were studied showing that T12, T4, and T1 contributed 68%. Among five cases of scarlet fever, T12 and T4 make up three case. There were two cases of pneumonia(T4 and T1) and one case of cervical lymphadenitis(T8/25). In 2000, the study was performed in four districts except the central area. Among 83 isolates, T12, T4 and T1 accounted for 63.9%. There were three cases of scarlet fever(T12, T4, T5), one case of tonsillar abscess(T12), one case of pneumonia(NT) and one case of sepsis(T1). CONCLUSION: Serological analysis of T protein of group A streptococci shows no endemic specificity. The yearly pattern reveals that T12 had been decreasing but T1 had shown the opposite trend.