Características de pacientes con diagnóstico de patologías de ATM: una serie de casos / Characteristics of patients with diagnosis of TMJ pathologies: case series

Los tejidos que conforman la articulación temporomandibular (ATM) pueden verse afectados como cualquier otra articulación del cuerpo. Entre los factores etiológicos, podemos nombrar los traumáticos, infecciosos, autoinmunes y oclusales. El diagnóstico de las patologías de la ATM debe incluir una completa historia clínica, estudios de laboratorios y de imágenes. El objetivo del siguiente trabajo es describir características de una serie de pacientes que concurrieron a la consulta con signos y síntomas de patologías de la ATM a un consultorio particular en el sur de la provincia de Buenos Aires. Se estudió a 30 pacientes que concurrieron a la consulta con signos y síntomas de patología de la ATM; se completaron historias clínicas, se solicitaron estudios de laboratorio para la detección de anticuerpos específicos contra bacterias y resonancia nuclear magnética. La edad promedio de la población fue de 35 años, 26 eran mujeres y 25 tuvieron resultados de estudios bacteriológicos positivos. Sobre un total de 60 articulaciones, 54 presentaron alteración en la forma y de la posición del disco articular. Se verificó la importancia en la solicitud y asociación de estudios para el diagnóstico diferencial(AU)

High antistreptolysin O titer is associated with coronary artery lesions in patients with Kawasaki disease / 소아과

PURPOSE: In Kawasaki disease (KD) patients, coronary artery complications, incomplete and refractory types occur more frequently in patients with streptococcal or other bacterial/viral infections. Recently, we observed a higher incidence of coronary lesions in KD patients with high anti-streptolysin O (ASO) titer. Therefore, we hypothesized that KD patients diagnosed with concurrent streptococcal infection have poor prognoses, with respect to treatment response and development of coronary artery lesions. METHODS: A retrospective review was performed in 723 patients with KD who were admitted to 2 major hospitals between June 2010 and September 2017. RESULTS: Among 723 patients with KD, 11 initially showed an elevated ASO titer (>320 IU/mL) or elevated follow-up ASO titer after treatment. Of these patients, 5 showed no response to the first intravenous immunoglobulin treatment, 3 had abnormalities of the coronary arteries. This is a significantly higher proportion of patients with a high ASO titer (n=3, 27.3%) than those with a normal ASO titer (n=53 [7.4%], P=0.047). A severe clinical course was seen in 81.8% of patients in the high ASO group versus 14.5% of patients in the normal ASO group. CONCLUSION: It is not certain whether acute streptococcal infection may cause KD, but this study revealed that KD with high ASO titers showed higher rates of severe clinical course. It may be helpful to analyze concurrent streptococcal infection in patients with a severe clinical course.

Clinical Features and Prognosis of Henoch-Schönlein Purpura in Children and Adults: A 13-Year Retrospective Study at a Single Centre

PURPOSE: To investigate differences in clinical features, blood/urinary findings, and prognosis in different age groups of patients with Henoch-Schönlein purpura (HSP). METHODS: A total of 469 patients with HSP were analyzed retrospectively from June 2003 to February 2016. We classified patients into child or adult groups based on their age. RESULTS: The adult group had more patients with anemia (child vs. adult; 7.5% vs. 16.4%), and higher immunoglobulin A (IgA) (30.0% vs. 50.0%) levels, C-reactive protein (34.2% vs. 54.0%) and uric acid (3.1% vs. 12.1%) levels than the child group. The child group was highly positive for Mycoplasma pneumoniae immunoglobulin M (IgM) (34.4%). More patients in the child group presented with high levels of antistreptolysin O (24.7% vs. 2.9%) and high C4 (11.5% vs. 4.2%). Low C3 (1.1% vs. 10.2%) levels, and renal involvement with gross hematuria (8.6% vs. 21.5%), nonnephrotic proteinuria (1.1% vs. 11.2%), and nephrotic syndrome (1.1% vs. 6.0%) were common in the adult group. Adults also had poorer renal outcomes [persistent hematuria/proteinuria (10.5% vs. 32.8%), and chronic kidney disease (0% vs. 11.2%)] than the child group. Risk factors for renal involvement such as older age and higher level of uric acid were only found in the child group. The risk factors for poor renal outcome were nephrotic syndrome in the child group and gross hematuria in the adult group. CONCLUSION: In this study, child and adult groups presented with different clinical manifestations of HSP. We found that risk factors for renal involvement included age and high uric acid level in the child group. Moreover, nephrotic syndrome in the child group and gross hematuria in the adult group increased the risk of poor renal outcome.

Clinical Features and Prognosis of Henoch-Schönlein Purpura in Children and Adults: A 13-Year Retrospective Study at a Single Centre

PURPOSE: To investigate differences in clinical features, blood/urinary findings, and prognosis in different age groups of patients with Henoch-Schönlein purpura (HSP). METHODS: A total of 469 patients with HSP were analyzed retrospectively from June 2003 to February 2016. We classified patients into child or adult groups based on their age. RESULTS: The adult group had more patients with anemia (child vs. adult; 7.5% vs. 16.4%), and higher immunoglobulin A (IgA) (30.0% vs. 50.0%) levels, C-reactive protein (34.2% vs. 54.0%) and uric acid (3.1% vs. 12.1%) levels than the child group. The child group was highly positive for Mycoplasma pneumoniae immunoglobulin M (IgM) (34.4%). More patients in the child group presented with high levels of antistreptolysin O (24.7% vs. 2.9%) and high C4 (11.5% vs. 4.2%). Low C3 (1.1% vs. 10.2%) levels, and renal involvement with gross hematuria (8.6% vs. 21.5%), nonnephrotic proteinuria (1.1% vs. 11.2%), and nephrotic syndrome (1.1% vs. 6.0%) were common in the adult group. Adults also had poorer renal outcomes [persistent hematuria/proteinuria (10.5% vs. 32.8%), and chronic kidney disease (0% vs. 11.2%)] than the child group. Risk factors for renal involvement such as older age and higher level of uric acid were only found in the child group. The risk factors for poor renal outcome were nephrotic syndrome in the child group and gross hematuria in the adult group. CONCLUSION: In this study, child and adult groups presented with different clinical manifestations of HSP. We found that risk factors for renal involvement included age and high uric acid level in the child group. Moreover, nephrotic syndrome in the child group and gross hematuria in the adult group increased the risk of poor renal outcome.

Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression / Parâmetros indicativos de persistência de patologia valvular no diagnóstico inicial de cardite reumática aguda: o papel da albumina e da expressão de CD19

Abstract Objective: The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC). Methods: Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement. Results: During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6 ± 0.48 g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1. Conclusion: The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

Resumo Objetivo: Definir os preditores da cardite crônica em pacientes com cardite reumática aguda (CRA). Métodos: Os pacientes diagnosticados com CRA entre maio de 2010 e maio de 2011 foram incluídos no estudo. Foram feitos os testes de ecocardiografia, eletrocardiograma, uma análise do subgrupo de linfócitos, provas de fase aguda, níveis de albumina plasmática, antiestreptolisina-O (ASO) na manifestação inicial. As avaliações ecocardiográficas foram repetidas no 6º mês de acompanhamento. Os pacientes foram divididos em dois grupos de acordo com a persistência da patologia valvular no 6º mês como Grupo 1 e Grupo 2 e todos os parâmetros clínicos e laboratoriais na internação foram comparados entre dois grupos de comprometimento valvular. Resultados: Durante o período do estudo de um ano, 22 pacientes apresentaram doença valvular; 17 (77,2%) apresentaram regressão da patologia valvular. Houve desaparecimento de regurgitação moderada inicial em oito pacientes (36,3%). Entre sete (31,8%) pacientes com regurgitação moderada inicialmente, a regurgitação desapareceu em três e quatro apresentaram melhoria para regurgitação leve. Dois pacientes com regurgitação grave inicialmente apresentaram melhoria para regurgitação moderada (9,1%). Em cinco (22,8%) pacientes o grau de regurgitação (regurgitação moderada em um [4,6%] e regurgitação grave em quatro [18,2]) continuou inalterado. O nível de albumina foi significativamente menor no diagnóstico no Grupo 2 (2,6 ± 0,48 gr/dL). A análise do subgrupo de linfócitos mostrou uma redução significativa no percentual de CD8 e um aumento significativo no percentual de CD19 no Grupo 2 em comparação com o Grupo 1. Conclusão: O nível de albumina no sangue e o percentual de linfócitos CD8 e CD19 (+) no diagnóstico podem ajudar a prever risco de doença valvular crônica em pacientes com cardite reumática aguda.

Association between antistreptolysin-O serum level and chronic plaque psoriasis in Iraqi patients

Objective: Psoriasis is a disease characterised by T-cell-mediated hyperproliferation of keratinocytes initiated by antigen-presenting cells on the skin. Environmental factors including streptococcus infections and multiple genetic components may be responsible for the pathogenesis of the disease. This study was performed to assess the association between antistreptolysin-O [ASO] serum level and chronic plaque psoriasis

Methods: Serum level of ASO was measured in 45 doctor-diagnosed psoriatic patients with an age range of 10-50 years attending the dermatology outpatient clinic in Al-Hussein Medical City in Kerbala Province - Iraq during the period from March 2014 through July 2015. Psoriatic patients with chronic plaque type were selectively recruited to the study. Another 20 age- and gender-matched persons were chosen as healthy control group. Serum level of ASO was estimated in all patients and control group using enzyme-linked immunosorbent assay [ELISA]

Findings: Data revealed a significantly increased serum ASO level in the chronic plaque-type psoriatic patients compared to the healthy control group [P-value < 0.05]

Conclusion: The present study suggests that serum ASO level could be associated with the immunopathogenesis and/or susceptibility to this type of psoriasis

Valores referenciales de antiestreptolisina O y portadores asintomáticos de estreptococos β-hemolíticos en adolescentes y adultos del Municipio Francisco Linares Alcántara, Venezuela / Reference valúes antistreptolysin O and asymptomatic carriers of β-hemolytic streptococci in adolescents and adults at Municipality Francisco Linares Alcántara, Venezuela

Introduction: β-hemolytic streptococci (Streptococcus pyogenes) groups A, C or G, secretes streptolysin O, toxin which causes in the infected individual an adaptive humoral immune response with production of serum antibodies called anti-streptolysin O (ASO). Objectives: To determine the reference value of ASO in a sample of 159 individuals aged 16-72 years from municipality Francisco Linares Alcántara, Aragua state, applying indirect (passive) agglutination test. By using a throat swab sample which was sown in blood agar 5% the frequency of asymptomatic carriers of β-hemolytic streptococci was also determined. Results and Discussion: As reference value for determining ASO by agglutination method a title of up to 200 IU/mL was obtained, this reference value differs from that recommended by the commercial equipment. Asymptomatic carriers frequency was 21.2% (n = 34). The distribution of β-hemolytic streptococci isolated were: group A (17.6%), group B (32.3%), group C (20.5%), group D (2.9%), group F (8.8%), group G (14.7%) and unclusterable (2.9%). Conclusions: The new ASO reference value for teens and adults of the mentioned municipality is up to 200 IU/mL. β-hemolytic Streptococcus group B was the most frequently isolated.

Introducción: Los estreptococos β-hemolíticos del grupo A (Streptococcus pyogenes), C o G, secretan estreptolisina O, toxina que causa en el individuo infectado una respuesta inmune adaptativa humoral con producción de anticuerpos séricos denominados antiestreptolisina O (ASO). Objetivos: Determinar el valor referencial de ASO en una muestra poblacional de 159 individuos con edades comprendidas entre 16 y 72 años del municipio Francisco Linares Alcántara, estado Aragua mediante aglutinación (pasiva) indirecta. También se determinó la frecuencia de portadores asintomáticos de estreptococos β-hemolíticos utilizando una muestra de exudado faríngeo que se sembró en agar sangre de cordero al 5%. Resultados y Discusión: Como valor referencial para la determinación de ASO por el método de aglutinación se obtuvo un título de hasta 200 UI/mL, valor que difiere del recomendado por el kit comercial. La frecuencia de portadores fue 21,2% (n = 34). La distribución de los estreptococos β-hemolíticos aislados fue: grupo A (17,6%), grupo B (32,3%), grupo C (20,5%), grupo D (2,9%), grupo F (8,8%), grupo G (14,7%) y no agrupable (2,9%). Conclusiones: El nuevo valor referencial de ASO para adolescentes y adultos del municipio mencionado es hasta 200 UI/mL. Streptococcus β-hemolítico del grupo B fue el grupo más frecuentemente aislado.

Changes in Acute Poststreptococcal Glomerulonephritis: An Observation Study at a Single Korean Hospital Over Two Decades

PURPOSE: The incidence of acute poststreptococcal glomerulonephritis (APSGN) in Korea has changed. This study aimed to evaluate the epidemiological and clinical changes of APSGN observed in a single Korean institution over two decades. METHODS: We retrospectively analyzed the data of 99 children (0-15 years of age) who were admitted to our institution with APSGN between 1987 and 2013. The patients were selected based on the depression of serum complement 3 (C3, 250 IU/dL) as evidence of previous streptococcal infection. RESULTS: In the 99 patients, the mean age was 8.3 +/- 2.7 years, and the male-tofemale ratio was 2.2:1 (66:30). The annual number of cases fluctuated markedly, and most cases were observed during the late autumn and winter months. However, there have been few cases reported in the past 5 years. Clinical manifestations at presentation, including hypertension and generalized oedema, and the duration of hospitalization were higher and longer in patients admitted during the first half of the study period than during the most recent half-period, suggesting a more severe clinical course in the former group. CONCLUSIONS: APSGN has become a rare disease in Korea with a trend towards a less severe clinical course. This finding suggests that the prevalence of infection-related immune-mediated diseases could change over-time, together with environmental and possibly pathogen-host relationship changes.

[ comparative study of streptococal infection in children with PANDAS: a case-control study]

Recent evidence suggest that group A beta-hemolytic streptococcal [GABHS] infection may increase the risk of pediatric autoimmune neuropsychiatric disorders [PANDAS] composed of the clinical signs of obsessive-compulsive and attention deficit hyperactivity disorders. The objective of this study was to compare the titer of antibodies against GABHS between children with PANDS and the controls. This cross-sectional, case-control study was done in Hazrat Rasoul Hospital, in Tehran, Iran during 2008-2010. We compared serum antibodies streptolysin O, deoxyribonuclease B, and streptokinase against GABHS quantitatively in 79 cases with PANDAS and 39 age-matched controls. The area under ROC curve, sensitivity, specificity and positive predictive value [PPV] of tests were calculated. Most cases were studied in summer [57%] and spring [23%]. The three aforesaid antibodies were higher in the cases [P=0.001]. Antisterptolysin O [cut-off point 195] had a 90% sensitivity, 82% specificity and a 92% PPV, [CI=95%, 0.99-0.91]. Anti streptokinase [cut-off point 223] had an 82% sensitivity, 82% specificity and a 95% PPV, [CI=95%, 0.934-0.735]. Anti-DNase [cut-off point 140] had an 82% sensitivity, 82% specificity and a 95% PPV, [CI=95%, 0.99-0.91]. The study demonstrated a possible role for streptococcal infection in PANDAS. We found a significantly higher antibody titer against GABHS in OCD and ADHD cases in comparison with healthy children. Treatment of streptococcal infection is achievable by the use of long-acting penicillin. Use of aggressive treatment schedules like plasmaphresis, IVIG, etc needs further RCT studies

Incidencia de amígdalas hipertróficas: programa de salud escolar 2006 – 2007. Hospital León Becerra de Milagro / Incidence of hypertrophic tonsils: school health program from 2006 to 2007. León Becerra Hospital in Milagro

Se realizó un estudio prospectivo, descriptivo en el hospital “León Becerra”, del cantón Milagro durante el programa de Salud Escolar. Objetivo: determinar la frecuencia de amígdalas hipertróficas en pacientes entre 5 y 11 años, asintomáticos. Materiales y métodos: se escogió 4 escuelas donde se estudió a 1.219 niños, de los cuales 187 presentaban un crecimiento exagerado de las amígdalas, sin sintomatología. Se les realizó a cada uno de los pacientes: historia clínica y examen; biometría hemática completa (BHC), antiestreptolisina o (ASTO) y proteína C reactiva (PCR). Resultados: la frecuencia de esta patología corresponde al 15%.No depende del género. El 71% de los niños estudiados presentan algún grado de deficiencia nutricional. El 78% tiene antecedente de amigdalitis a repetición.

A prospective, descriptive study was performed at the "León Becerra" hospital in Milagro Canton during the School Health program. Objective: to determine the frequency of hypertrophic tonsils in asymptomatic patients between 5 and 11 years old. Materials and methods: we chose 4 schools where 1,219 children were studied, out of which 187 had an overgrowth of the tonsils, without symptoms. Medical history and examination, complete blood count (BHC), antistreptolysin O (ASTO) and C reactive protein (CRP) were made to each patient. Results: the prevalence of this disease is 15%. It does not depend on gender. 71% of the children studied presented some degree of nutritional deficiency. 78% have a history of recurrent tonsillitis.

Subclinical involvement of cardiovascular system in juvenile collagen diseases

Cardiovascular lesions are commonly found in children and adolescence with different collagen diseases with relevant implication in mortality and morbidity. The purpose of the study was to verify whether there is any sign of cardiovascular involvement in juvenile collagen diseases using electrocardiography [ECG] and echocardiography [ECHO]. The study was carried out on 77 patients, 52 juvenile idiopathic arthritis [JIA], 20 systemic lupus erythematosus [SLE], 3 spondylarthropathy [SPA] and 2 juvenile dermatomyositis [JDM]. They were free of any clinically evident of cardiac manifestations. Thirty six healthy children were enrolled as control group All subjects underwent complete history and physical examinations, x ray chest, ECG and two dimensional, M mode, continuous wave [CW], pulse wave [PW] and color flow Doppler examinations. The following investigations were done erythrocyte sedimentation. rate[ESR], antistreptolysin O titre [ASOT], C reactive protein[CRP], rheumatoid factor[RF], antinuclear antibodies[ANA] and anti double stranded DNA[anti ds DNA]. Minor ECG changes were detected in 3 SLE and 2 JDM. ECHO showed pericardial effusion in 2 [3.3%] JIA and 3[15%] SLE. Aortic insufficiency was detected in 5[9.6%] JIA, 4 [20%] SLE. Mitral regurge was found in 7[13.4%] JIA, 5 [25%] SLE. Mild tricuspid regurge was detected in 3[15%] SLE. Mild pulmonary hypertension was found in 4[20%] SLE. Significant systolic dysfunction was elicited in JIA in form of increased left ventricular end diastolic diameter [LVEDD], left ventricular end systolic diameter[LVESD], left ventricular end diastolic volume[LVEDV] and left ventricular end systolic volume[LVESV] and reduction of ejection fraction [EF] and fractional shortening [FS]. In SLE .there was significant reduction, of EF and FS. Significant diastolic dysfunction was manifested in JIA by decreased peak early [E], E acceleration time [Eat], E duration [Edur], Total duration [Tdur], [E/A] ratio and A acceleration time [Aat] and increased peak atrial filling velocity [A], E deceleration time [Edt], isovolumic relaxation time [IVRT] and A deceleration time [Adt] and in SLE by decreased [E] and [E/A] ratio and increased [Edt] and in JDM by decreased [E] and [E/A] ratio and increased [IVRT]. In JIA, there was a positive correlation between age and [LVEDD] and disease duration with both [LVEDD] and [LVESD] and negative correlation between disease duration and EF. Cardiovascular involvement in juvenile collagen diseases is common. Regular cardiac evaluation using [ECG] and [ECHO] is recommended for early diagnosis of cardiac involvement. Key words: Cardiovascular-juvenile-collagen diseases

Complete Atrioventricular Block in an Adolescent With Rheumatic Fever

Rheumatic fever is an acute inflammatory sequela following a group A, beta-hemolytic streptococcal infection. Rheumatic fever is characterized by polyarthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum as the major diagnostic criteria. Rarely, advanced heart block may also occur. A 13-year-old boy was admitted to the Pediatric Department for evaluation and management of complete atrioventricular block. The patient had exertional dyspnea for 1 month. Based on the findings of mitral regurgitation, fever, elevated acute phase reactants, and a high antistreptolysin O titer, the patient was diagnosed with rheumatic fever. A benzathine penicillin injection was administered, as well as salicylate therapy. On the 5th day of hospitalization, the electrocardiogram revealed a normal sinus rhythm with a 1st degree atrioventricular block. After discharge, the electrocardiogram normalized with the monthly penicillin injections. Herein we report a case of complete atrioventricular block associated with rheumatic fever. The heart block resolved without specific cardiac treatment, other than a non-steroidal anti-inflammatory medication.

Prevalencia de Streptococcus beta hemolítico en pacientes con faringoamigdalitis aguda, en un hospitalde la ciudad de Chachapoyas, Amazonas / Prevalence of beta hemolytic Streptococcus in patients with acute pharyngoamigdalitis in a Chachapoyas, Amazonas hospital

Introducción: En Chachapoyas hay numerosos pacientes con faringoamigdalitis aguda y cuadros clínicos con las complicaciones no supurativas que causa el Streptococcus pyogenes. Diseño: Estudio transversal. Lugar: Hospital I Higos Urco, EsSalud, Chachapoyas, Amazonas, e Instituto de Medicina Tropical Daniel A. Carrión, Universidad Nacional Mayor de San Marcos. Participantes: Pacientes con faringoamigdalitis aguda. Intervenciones: A 148 pacientes, seleccionados aleatoriamente, que acudieron al consultorio externo de otorrinolaringología por presentar cuadros clínicos compatibles con faringoamigdalitis aguda, se les tomó muestras de secreción faringoamigdaliana con hisopos y, usando el medio de transporte Amies con carbón (Difco), fueron enviados al Instituto de Medicina Tropical Daniel A. Carrión, en donde fueron procesados. Principales medidas de resultados: Presencia de Streptococcus beta hemolítico y otras bacterias cultivables. Resultados: Las enterobacterias fueron las más aisladas (49,1 por ciento) de los cultivos positivos. Solo 5 Streptococcus beta hemolíticos fueron aislados: un Streptococcus pyogenes, tres Streptococcus agalactiae y un Streptococcus del grupo G, los cuales fueron sensibles a los betalactámicos, macrólidos y lincosamidas. Conclusiones: Se sugiere realizar estudios complementarios con el dosaje de antiestreptolisina O.

Introduction: There are numerous Chachapoyas patients with acute pharyngoamigdalitis and clinical non suppurative complications caused by Streptococcus pyogenes. Design: Transversal study. Setting: Hospital I Higos Urco, EsSalud, Chachapoyas, Amazonas, and Instituto de Medicina Tropical Daniel A. Carrion, Universidad Nacional Mayor de San Marcos. Participants: Patients with acute pharyngoamigdalitis. Interventions: One hundred and forty-eight randomized outpatient subjects attending an ear, nose and throat office for clinical symptoms compatible with acute pharyngoamigdalitis had a sample of pharynx and tonsils taken with a cotton swab and sent in Amies with carbon medium (Difco) to the Instituto de Medicina Tropical Daniel A. Carrion to be processed. Main outcome measures: Presence of beta hemolytic Streptococcus and other bacteriae. Results: Positive cultures revealed mainly Enterobacteriae (49,1 per cent). Only 5 beta hemolytic Streptococcus were isolated: one Streptococcus pyogenes, three Streptococcus agalactiae and one group G Streptococcus, all sensitive to betalactamics, macrolides and lincosamides. Conclusions: We suggest to do complementary studies with antiestreptolysin O determination.

Acute glomerulonephritis in southern Iran

Acute post streptococcal glomerulonephritis [APSGN] is the most common type of in-patient glomerulonephritis [GN] in childhood. It has not been studied well in this region yet. Here, we report our experience with APSGN in a tertiary referral center during a five-year period. Hospital records of all 137 children who had been admitted to Nemazee hospital, between 2001 and 2006, with diagnosis of acute glomerulonephritis [AGN] were reviewed. All demographic, clinical, paraclinical data and consumed medications were obtained. Among 137 children diagnosed as AGN, 122 [89%] had APSGN. Other 15 [11%] children had membranoproliferative glomerulonephritis [n=4], mesangioproliferative glomerulonephritis [n=4], IgA nephropathy [n=2], lupus nephritis [n=2], rapidly progressive glomerulonephritis [n=2], and focal segmental glomerulosclerosis [n=1]. Mean [SD] age in children with APSGN was 8.5 [3.5] [range, 3.5-13] years, 117 [96%] children developed APSGN following a sore throat and 5 [4%] following an impetigo, with 95 [78%] during the cold seasons of the year. Periorbital edema was found in 97.5%, hypertension 75%, gross hematuria 72%, oliguria 37%, generalized edema 19%, azotemia [BUN > 20] 80%, and nephrotic-range proteinuria 24.5%. A high anti streptolysin-O [ASO] titer and a low C3 level was detected in 84% and 86%, respectively. There was dilutional anemia in 51.5%, hyponatremia in 27%, and hyperkalemia 14%. With regard to medications, 19 patients received only furosemide, 73 cases furosemide and nifidipine, and 10 patients furosemide, nifidipine, and another antihypertensive medication. Hypertensive encephalopathy occurred in 3 cases, but no mortality was reported during the study period. APSGN is the most common type of glomerulonephritis in this region. It follows sore throat in the majority of cases. It usually has an uneventful course

Changes of Clinical Findings of Acute Poststreptococcal Glomerulonephritis

PURPOSE: Several studies have reported the recent increase in the incidence of acute poststreptococcal glomerulonephritis(APSGN). The objective of this study is to see changes of clinical findings/manifwstation in children with APSGN. METHODS: Medical records of 63 children who were diagnosed with APSGN in the deparment of Pediatrics, Kyungpook National University Hospital, between January 1992 and December 2006 were reviewed retrospectively. We analyzed various clinical characteristics such as age, sex, degrees of proteinuria, degrees of hematuria, and presence or absence of histories of systemic antibiotic use in children with APSGN, and compared the children with APSGN who were diagnosed between 1992 and 2000 to those who were diagnosed between 2001 and 2006. RESULTS: Age of the patients ranged from 2-14 years(median 7.11 years) at the time of disease onset. Study patients consisted of 41 boys and 22 girls. APSGN followed infection of the throat in 87% of cases. Patient developed an acute nephritic syndrome 12 days after an antecedent streptococcal pharyngitis. Forty patients presented with gross hematuria. Fortyone patients had hypertension at the time of diagnosis. Hypertension disappeared within 7.8+/-8.2 days, gross hematuria within 11.3+/-17.2 days and microscopic hematuria within 3.5+/-3.9 months from the disease onset. Patients in 2001-2006 had significantly higher increase of antistreptolysin O(ASO) titer. However, no significant differences in clinical characteristics were observed. Age, sex, severity of proteinuria, gross or microscopic hematuria, antibiotic therapy did not affect the clinical manifestations of glomerulonephritis. In other words, hypertension, duration of hematuria, recovery of serum C3 level are not different between the two time periods. CONCLUSION: Our data indicates that patients in 2001-2006 had significantly higher level of ASO titer. However, they did not show significant clinical differences. To evaluate the causes of the resurgence of APSGN, a national epidemic is needed.

Normal antistreptolysin O titers of children by age group in the Gyeonggi-Incheon region / 소아과

PURPOSE: Measurement of antistreptolysin O (ASO) is often necessary to confirm a clinical diagnosis of recent streptococcal infection, especially in patients suspected of rheumatic fever and acute glomerulonephritis. Standard normal ranges for ASO should be established locally for each age group. We analyzed ASO to determine the upper limit of normal (ULN) ASO in children in the Gyeonggi-Incheon area. METHODS: ASO in normal individual concentrations were measured quantitatively by nephelometry on sera from 753 children (Male:381, Female:372). ULN were determined by separating the upper 20% from the lower 80% of the group (80 percentile). RESULTS: The mean ASO concentration calculated in a total cases was 149.9+/-7.2 IU/mL. The ASO concentration in neonates was 83.4+/-10.7 IU/mL, and lowest in the 1 year of age group, 26.7+/-6.6 IU/ mL, and increased to 318.0+/-33.2 IU/mL gradually in the 9 years of age group. Thereafter, ASO concentration decreased. The ULN for neonates was 122 IU/mL, for 0-3 years, 40 IU/mL; for 4-6 years, 113 IU/ mL; for 7-9 years, 489 IU/mL; for 10-19 years, 433 IU/mL; for 20-29 years, 122 IU/mL. CONCLUSION: The age-specific ULN for children in the Gyeonggi-Incheon area were determined. The distribution of ASO concentration according to age groups was different from previous reports. These results should be of clinical value to physicians to interprete the ASO results of their patients.

A Study of Clinical Manifestations of Acute Rheumatic Fever

PURPOSE: In developed countries, acute rheumatic fever appears to be a vanishing disease. In Korea, the incidence and severity of acute rheumatic fever (ARF) has significantly decreased in recent 30 years. According to this report, Korea sustained low incidence of ARF. METHODS: The medical records of 5 children diagnosed as ARF from January 2000 to September 2006 were reviewed retrospectively about clinical manifestations and laboratory findings. RESULTS: The average incidence of rheumatic fever was 0.17 per annual pediatric in-ward 1,000 patients. During study period, only 1 case had a definite history of preceding infection. Among 5 patients, the incidence of major manifestations were as follows:carditis 5 cases, chorea 1 case, arthritis 1 case and erythema marginatum 2 cases. Clinical findings of carditis were cardiac murmur, cardiomegly, congestive heart failure and pericardial effusion. Significant valvular lesions were mitral and aortic insufficiency. Minor manifestations and other clinical manifestations were fever, arthralgia, dyspnea, coughing, palpitation, weakness and chest pain. Laboratory findings were increased antistreptolysin O titer, positive C reactive protein (CRP) and increased erythrocyte sedimentation rate (ESR). CONCLUSION: The incidence of ARF has reduced but rheumatic carditis varies in severity from moderate to severe cardiac involvement. For many reasons ARF is being diagnosed inappropriately resulting from lack of awareness about the disease due to rarity and secondary prophylaxis. We should be aware of acute rheumatic fever and should pay attention to the treatment of the patients with streptococcal pharyngitis.

Clinical significance of follow-up laboratory tests, performed at 6 weeks after the onset of Kawasaki disease / 소아과

PURPOSE: Low dose aspirin is used due to its antiplatelet effect for the subacute phase of Kawasaki disease(KD). It is usually used for 6-8 weeks, then various hematologic laboratory tests and follow up echocardiography for evaluating coronary abnormalities are performed. Our review investigated the usefulness of various follow up laboratory tests performed at 6 weeks after the onset of KD. METHODS: Two hundred eighty-two children diagnosed and hospitalized with KD were identified by reviewing patient's charts. Cases which were diagnosed between January 1997 and December 2004 were included in this study. We reviewed laboratory data including leukocytes, platelet counts, antistreptolysin O(ASO), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), aspartate aminotransferase(AST), alanine aminotransferase(ALT), urinalysis, and echocardiograms performed at admission and 6 weeks after the onset of KD. Paired t-test and Fisher's exact test, as well as logistic regression tests, were used for the statistical analysis. RESULTS: At 6th week data, ESR and CRP were still elevated in 35(12.4 percent) and 12(4.3 percent) patients, respectively. Sterile pyuria were all normalized. But, 36 patients(12.8 percent) showed thrombocytosis, 22(7.8 percent) elevated AST, 15(5.3 percent) leukocytosis, and 6(2.1 percent) coronary abnormalities. Coronary abnormalities at the 6th week were only shown in patients with initial abnormalites. Younger age and initial thrombocytosis were risk factors for thrombocytosis at the 6th week. CONCLUSION: All children with initial coronary abonormalites should have an echocardiogram at 6 weeks after the onset of fever. In view of case-effectiveness, additional echocardiographic studies are justified only if abnormalities are present at admission. ESR, CRP, and urinalysis performed at the 6 weeks after onset of KD is not significant for clinical information of progression. Platelet count should be estimated at 6th week for a judgement of continuous antiplatelet therapy.

Determinação de anti-estreptolisina "O" e proteína C reativa entre escolares do município de Laranjal, PR / Determination of antistreptolysin \"O\" and C-reactive protein among school children of Laranjal, PR

Para a determinação de anti-estreptolisina "O" e proteína C reativa, no município de Laranjal-PR, foram analisados soros de 411 escolares, entre 5 a 16 anos. Para anti-estreptolisina "O", 13,6 por cento tiveram títulos elevados e 5,1 por cento foram reativos para proteína C reativa. Não foram observadas diferenças em relação ao sexo e faixa etária.