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.

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.

Evaluation of SD Bioline Strep A for Rapid Antigen Testing in Elementary Schoolchildren / 대한임상미생물학회지

BACKGROUND: Rapid antigen tests (RAT) of group A streptococci (GAS) are easy to perform and can save two days of bacterial culture time. Performance of SD Bioline Strep A was analyzed in comparison with throat culture. METHODS: Three consecutive throat swabs were taken from 308 healthy elementary schoolchildren. The first two swabs were tested for SD Bioline Strep A and Quidel Quick Vue Dipstick Strep A rapid antigen tests, and the third one was inoculated onto blood agar plate to grow GAS. RESULTS: Sensitivity, specificity, positive predictive value and negative predictive value of SD Bioline Strep A were 79.3%, 88.9%, 72.2%, and 92.2% respectively. Those of Quidel Quick Vue Strep A were 58.5%, 93.8%, 77.4%, and 86.2% respectively. CONCLUSION: SD Bioline Strep A showed a significantly higher sensitivity and a slightly lower specificity compared to Quidel Quick Vue Strep A. SD Bioline Strep A RAT should be useful for the rapid diagnosis of bacterial pharyngitis and the optimum use of antibiotics.

Asymptomatic Infection by Streptococcus pyogenes in Schoolchildren and Diagnostic Usefulness of Antideoxyribonuclease B

This study is designed to evaluate the immune status of schoolchildren with respect to Streptococcus pyogenes, and to ascertain the usefulness of antideoxyribonuclease B (ADNase B). Antistreptolysin O (ASO) and ADNase B concentrations were measured quantitatively in 266 serum samples from healthy elementary school children in Seoul. Simultaneously, throat cultures were taken in order to isolate S. pyogenes and other beta-hemolytic streptococci (BHS). The upper limits of the normal (ULN) concentration of ASO and ADNase B were 326 IU/mL, and 362 IU/mL, respectively. The correlation between ADNase B (y) and ASO (x) was y=0.4x+173 (r= 0.46). Mean ADNase B level (392 IU/mL) was significantly higher in children with S. pyogenes than in those with non-group A BHS (236 IU/mL) or no BHS (234 IU/ mL). Some schoolchildren were proven, via ASO and ADNase B tests, to be harboring asymptomatic S. pyogenes infections. The high ULN of ASO and ADNase B in schoolchildren should be carefully considered, in order to interpret the data collected from the patients. We could add the ADNase B test to our set of diagnostic tools, which would allow us to more accurately detect and diagnose streptococcal infections, as ADNase B was more specifically related to the results of throat cultures, and there was little correlation between ASO and ADNase B.

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.

Bacteriologic characteristics and serotypings of Streptococcus pyogenes isolated from throats of school children

To determine the carrier rate of beta-hemolytic streptococci (BHS), throat cultures were taken from healthy elementary school children in four separate areas of Korea from 1992 to 1995, including Inje, Nonsan, Seoul and Chinju. The strains of Streptococcus pyogenes had been serotyped with anti-T, -OF and -M sera. The isolation rates of BHS and S. pyogenes ranged from 14.1-32.4% and 10.9-18.5% respectively. More than half of the carriers showed heavy growth of BHS. M78 (48.6%) and M28 (22.2%) were most common in Inje, M12 (23.6%) and M5 (20.3%) in Nonsan, M12 (48.8%) and M5 (14.6%) in Seoul, and M12 (26.3%) and M22 (14.5%) in Chinju, respectively. About 15% of school children were positive for S. pyogenes in throat cultures, and the distribution of serotypes varied according to geographical regions.

Serial Evaluation of Serotypes of Group A Streptococci Isolated from Throat Culture of Normal School Children / 대한임상미생물학회지

BACKGROUND: Group A streptococci (GAS) cause various infections in the school children. The change of isolation rate of GAS between time interval was observed by repeated throat cultures and acquisition rate of new strain was investigated by comparing the serotypes of GAS. METHODS: Throat cultures were taken from the school children in Chungnam and Seoul. Second throat cultures were taken from 119 children in Chungnam after 1 month and from 59 children in Seoul after 4 months, who showed GAS in the first throat culture. Serotypings such as T, M and opacity factor typing were performed and compared against 40 children in Chungnam and 26 children in Seoul who grew GAS in both throat cultures. RESULTS: GAS were isolated from 57.1% (68/119) in Chungnam and 45.8% (27/59) in Seoul in the second throat culture. Different serotypes between first and second throat culture were 5 of 40 (12.5%) in Chungnam and 4 of 26 (154%) in Seoul, respectively. CONCLUSIONS: Almost half of children contained GAS continuously until 4 months and acquisition rate of new serotypes was 14.0% during this time. When GAS is repeatedly isolated, serotyping was very useful to recognize whether the strain is same or not.

Clinical Application of a Scoring System in the Diagnosis of Group A Streptococcal Pharyngitis

PURPOSE: A scoring system could be clinically useful in determining cases in which a throat culture may be omitted or in cases whether antibiotics may be initiated or not. We propose to make a clinical guideline of antibiotics administration in patients with pharyngitis. METHODS: From Apr. 1996. to Mar. 1997, throat cultures were taken from 321 cases (72 cases from Kyung-Hee Medical Center, 249 cases from 3 local pediatric clinics). On the first day of visit, 9 clinical items on a score-card were checked and a tentative diagnosis for streptococcal or non-streptococcal infection was made. These clinical scores were compared with the results of the throat swab cultures. RESULTS: Of 321 cases with pharyngitis, 55 cases (17%) proved to have group A streptococci by throat culture. The positive culture rate of group A streptococci was 18.5% from 3 local pediatric clinics, and 12.5% from Kyung-Hee Medical Center. The positive culture rate of group A streptococci were 40% in above 31 points of score, 31.5% in 29 to 30 points, 20.5% in 27 to 28 points. The sensitivity and specificity of the scoring system using a score at least 28 above points were 71% and 67%, respectively. CONCLUSION: The clinical diagnosis of streptococcal pharyngitis indicates that patients age 5 to 10 years, findings of abnormal pharynx, high fever and no past history of antibiotics use. Further modification of the scoring system for diagnosis of streptococcal pharyngitis should be made to prevent antibiotics abuse and correct diagnosis of pharyngitis.

Distribution and Upper Limit of Normal Antistreptolysin O Concentrations of School / 감염

BACKGROUND: Antistreptolysin O (ASO) is very useful as an indicator of recent streptococcal infections and their sequelae, such as rheumatic fever and acute glomerulonephritis. To interpret single ASO level of patients, the upper limit of normal (ULN) ASO from the same age group in the area should be known. As Streptococcus pyogenes infections are quite common in elementary school, we measured ASO and analyzed them by the results of throat culture to determine upper limit of normal ASO of school children in Chinju area. METHODS: ASO concentrations were measured quantitatively by nephelometry on 436 sera of healthy elementary school children in Chinju area. Throat cultures were taken at the same time to evaluate the relationship between ASO concentrations and throat culture results, including serogroup, colony forming units (CFU), and M types. RESULTS: The mean ASO concentration was 285IU/ml and the upper limit of normal ASO was 433IU/ml. The ASO levels were even (253-285IU/ml) through whole school grades except the 5th grade (350IU/ml). Not only the carriers of group A streptococci, but also those of group C or group G streptococci had higher ASO levels. The children from whom more than 10 CFU of S. pyogenes were isolated showed higher ASO levels than those who had less than 10 CFU. The ASO levels were higher in M type 6 or 22 compared to M type 12 or 28. CONCLUSIONS: The upper limit of normal ASO of children in Chinju was 433IU/ml, that is between Seoul(326IU/ml) and Chungnam (499IU/ml). The children who had more than 10 CFU tended to have higher ASO levels, which indicate asymptomatic infections, are associated with burden of bacteria. Group C or group G streptococci may induce serum response like group A streptococci. Certain M types may be implicated as strong producer of streptolysin O.

Quantitative Analysis of Antideoxyribonuclease B Concentrations in the Carriers of Beta-hemolytic Streptococci

Although throat culture is a gold standard to diagnose group A streptococcal (GAS) pharyngitis or its sequelae, antistreptolysin O (ASO) is useful to confirm the diagnosis. In case there is no elevation of ASO, it is necessary to add one or more serologic tests, such as antideoxyribonuclease (ADNase) B test. ADNase B levels were analyzed in the carriers of beta-hemolytic streptococci (BHS) in this study. ADNase B concentrations were determined quantitatively by nephelometry (Behring Nephelometer 100 Analyzer, Germany) on 157 sera of healthy elementary school children in Chungnam who were positive of BHS in the throat culture. ASO levels were measured previously by autoanalyzer (Hitachi 747, Japan). Mean ADNase B and ASO levels were compared according to serological group of BHS and number of colonies. The carriers of GAS had significantly higher ADNase B levels (mean 453 IU/ml) than those of non-A beta-hemolytic streptococci (NGAS, 278 IU/ml), while the difference of ASO levels between GAS (482 IU/ml) and NGAS (350 IU/ml) carriers was not so high. The carriers who had more than 10 CFU of BHS had significantly higher ADNase B or ASO levels than those who had less than 10 CFU. The correlation between ADNase B (Y) and ASO (X) was Y=0.4X+229 (r2=0.13). ADNase B test could discriminate GAS from NGAS more effectively than ASO test. The carriers who have more than 10 CFU might undergo asymptomatic infection, as their ADNase B or ASO levels were significantly high. Because distribution of ADNase B showed little correlation to that of ASO, ADNase B test could be used as a supplementary test to diagnose GAS infection.

Optimal site of throat swab for the isolation of beta-hemolytic streptococci

The optimal site for the isolation of beta-hemolytic streptococci (BHS) from throat cultures was investigated in 164 healthy elementary school children. All throat cultures were streaked onto duplicate blood agar plates (BAP), one of which was taken from the tonsillar fossae and the other from the posterior pharynx. BHS were isolated in cultures from 56 (34.2%) of the children. BHS were more frequently recovered from the tonsillar fossae than from the posterior pharynx (54 vs. 47; both sites, 45; tonsillar fossae only, 9; posterior pharynx only, 2; P<0.0001). There were significantly more numerous colonies in the tonsillar fossae than in the posterior pharynx (p<0.01). To conclude, the tonsillar fossae are more optimal sites of throat cultures to isolate BHS than the posterior pharynx.