Epidemiología de la faringitis estreptocócica. Período enero de 2018 - diciembre de 2021 / Epidemiology of streptococcal pharyngitis. January 2018 - December 21

La faringoamigdalitis es uno de los motivos más frecuentes de consulta en pediatría. Aproximadamente un 70-80% de las faringoamigdalitis son de etiología viral. El 20-30% restante son de origen bacteriano. El agente causal más frecuente es Streptococcus pyogenes (estreptococo ß-hemolítico del grupo A). El rol de Streptococcus dysgalactiae subsp. equisimilis, (estreptococos ß-hemolíticos grupos C y G) fue claramente establecido como agente etiológico en la faringitis bacteriana, tanto en niños como en adultos. Se realizó un análisis descriptivo y retrospectivo entre enero 2018 y diciembre de 2021. Se evaluó la prevalencia de faringitis estreptocócica, la edad, el período estacional, los agentes etiológicos y la resistencia a macrólidos durante los períodos pre-COVID-19 (2018-2019) y COVID-19 (2020-2021). Se analizaron 11 396 muestras de exudados de fauces de pacientes con sospecha de faringitis bacteriana; las mismas se procesaron mediante el uso de técnicas microbiológicas convencionales. En el período estudiado el porcentaje de positividad de los cultivos de exudados de fauces se mantuvo constante. Al comparar los períodos pre-COVID-19 (2018-2019) y COVID-19 (2020-2021) se observó una disminución en el número de aislados de S. pyogenes con un aumento de S. dysgalactiae subsp. equisimilis, mientras que la resistencia a macrólidos encontrada fue superior en S. pyogenes y para S. dysgalactiae subsp. equisimilis se mantuvo constante. Es importante realizar el cultivo para la identificación del agente etiológico y determinar la sensibilidad antibióticapara continuar con la vigilancia epidemiológica de la resistencia a los macrólidos, porque representan una opción en pacientes alérgicos a ß-lactámicos (AU)

Pharyngotonsillitis is one of the most frequent reasons for consultation in children. Approximately 70-80% of pharyngotonsillitis are of viral etiology. The remaining 20-30% are bacterial in origin. The most frequent causative agent is Streptococcus pyogenes (group A ß-hemolytic streptococcus). Streptococcus dysgalactiae subsp. equisimilis (ß-hemolytic streptococcus groups C and G) was clearly established as an etiologic agent in bacterial pharyngitis in both children and adults. A descriptive and retrospective analysis was conducted between January 2018 and December 2021. The prevalence of streptococcal pharyngitis, age, seasonal period, etiologic agents, and macrolide resistance during the pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods were evaluated. We analyzed 11 396 specimens of swabs from patients with suspected bacterial pharyngitis. Conventional microbiological techniques were used. In the study period, the percentage of positivity of swab cultures remained constant. When comparing the preCOVID-19 (2018-2019) and COVID-19 (2020-2021) periods, a decrease in the number of S. pyogenes isolates was observed with an increase in S. dysgalactiae subsp. equisimilis, while the resistance to macrolides found was higher for S. pyogenes and remained constant for S. dysgalactiae subsp. equisimilis. The identification of the etiologic agent and determination of antibiotic sensitivity are important for epidemiological surveillance of macrolide resistance, as they are a treatment option in patients who are allergic to ß-lactams (AU)

Detección rápida de antígenos de Streptococcus pyogenes en pacientes de 0 a 14 años asistidos en dos servicios de urgencia pediátrica (14/2/2018-13/4/2018) / Rapid detection of Streptococcus pyogenes' antigens in patients of 0 to 14 years of age, assisted in two pediatric emergency wards (2/14/2018-4/13/2018) / Detecção rápida de antígenos de Streptococcus pyogenes em pacientes de 0 a 14 anos de idade assistidos por emergência pediátrica (14/2/2018-13/4/2018)

Introducción: las infecciones estreptocócicas pueden presentarse con fiebre, inflamación faringoamigdalina con o sin exudados, petequias en el paladar, adenitis cervical, exantema escarlatiniforme y / o dolor abdominal. Resulta útil en área de urgencia disponer de pruebas de detección rápida de antígenos de S. pyogenes (DRASP) de alta especificidad y sensibilidad algo menor. Objetivos: conocer la utilidad de un test de DRASP en 2 servicios de Urgencia Pediátrica, describiendo las características clínicas y epidemiológicas de los pacientes estudiados durante el período de la investigación y su correlación con el cultivo de exudado faríngeo mediante el cálculo de sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Material y métodos: estudio prospectivo, observacional, transversal en dos servicios de emergencia pediátrica. Se incluyeron niños a los que se les realizó DRASP y exudado faríngeo (EF) entre el 14 de febrero y el 13 de abril de 2018. Se registró: sexo, edad, motivo de consulta, diagnóstico, tratamiento, destino, resultado del test y de cultivo faríngeo. Se calcularon S, E, VPP y VPN. Resultados: n=241 niños. Rango 8 meses - 14 años, media 6 años. Consultaron por fiebre 103 niños (42,7%); por odinofagia 48, por erupción 11 y 47 por otros síntomas. Al 95% de los niños se le otorgó el alta. DRASP negativos 87,6% (N: 211) y positivos 12,9% (N: 31). EF negativos 80,1% (n: 193) y positivos para SßHGA en 13,7% (n: 33). La sensibilidad de la prueba fue del 52% y su especificidad del 93%. El VPP 55% y el negativo 92%. El diagnóstico más frecuente fue faringitis viral 132 (54,7%). Conclusiones: el test se aplicó fundamentalmente a escolares febriles, algunos con odinofagia. Contribuye a diferenciar en forma rápida la etiología y habilita a no usar antibióticos en caso de resultado negativo. Estos resultados avalan el uso de DRASP en la urgencia pediátrica.

Introduction: streptococcal infections can show fever, pharyngotonsillar inflammation with or without swabs, palatal petechiae, cervical adenitis, scarlatiniform rash and/or abdominal pain. Rapid detection tests for S. pyogenes antigens (DRASP) with high specificity and somewhat lower sensitivity are a useful at the Emergency Ward. Objectives: know the usefulness of a DRASP test in 2 Pediatric Emergency, describe the clinical and epidemiological characteristics of the patients studied during the research period and its correlation with the culture of pharyngeal exudates by calculating sensitivity (S) , specificity (S), positive predictive value (PPV), and negative predictive value (NPV). Material and Methods: prospective, observational, cross-sectional study carried out in two pediatric emergency wards. We included children who underwent DRASP and pharyngeal swab (PS) between February 14 and April 13, 2018. The following data were recorded: sex, age, reason for consultation, diagnosis, treatment, destination, test results and throat cultures. S, S, PPV and NPV were calculated. Results: n=241 children. Range 8 months - 14 years, average 6 years. 103 children (42.7%) consulted due to fever; 48 due to sore throat, 11 due to rash and 47 due to other symptoms. 95% of children were discharged. DRASP negative 87.6% (N: 211) and positive 12.9% (N: 31). Negative EP 80.1% (n: 193) and positive for SßHGA in 13.7% (n: 33). The test sensitivity was 52% and specificity 93%. The PPV 55% and the negative 92%. The most frequent diagnosis was viral pharyngitis 132 (54.7%). Conclusions: the test was applied mainly to febrile schoolchildren, some with odynophagia. A quick etiology differentiation is helpful, since it prevents antibiotics from being used in the event of a negative result. These results support the use of DRASP in pediatric emergency wards.

Introdução: as infecções estreptocócicas manifestam-se com febre, inflamação faringotonsilar com ou sem exsudado, petéquias palatinas, adenite cervical, erupção cutânea escarlatiniforme e/ou dor abdominal. Nos serviços de emergência é útil realizar testes de detecção rápida para antígenos de S. pyogenes (DRASP) com alta especificidade e sensibilidade um pouco mais baixa Objetivos: conhecer a utilidade do teste DRASP em 2 Emergências Pediátricas, descrever as características clínicas e epidemiológicas dos pacientes estudados durante o período da pesquisa e sua correlação com a cultura de exsudatos faríngeos por meio do cálculo de sensibilidade (S) , especificidade (S), positivo valor preditivo (VPP) e valor preditivo negativo (VPN). Material e métodos: estudo prospectivo, observacional, transversal, realizado em duas unidades de emergência pediátrica. Foram incluídas crianças que realizaram DRASP e swab faríngeo (PS) entre 14 de fevereiro e 13 de abril de 2018. Foram registrados os seguintes dados: sexo, idade, motivo da consulta, diagnóstico, tratamento, destino, resultados de exames e culturas de garganta. S, S, VPP e VPN foram calculados. Resultados: n=241 crianças. Faixa 8 meses - 14 anos, média 6 anos. 103 crianças (42,7%) consultadas por febre; 48 por dor de garganta, 11 por erupção cutânea e 47 por outros sintomas. 95% das crianças receberam alta. DRASP negativo 87,6% (N: 211) e positivo 12,9% (N: 31). EP negativo 80,1% (n: 193) e positivo para SßHGA em 13,7% (n: 33). A sensibilidade do teste foi de 52% e a especificidade de 93%. O PPV 55% e o negativo 92%. O diagnóstico mais frequente foi faringite viral 132 (54,7%). Conclusões: o teste foi aplicado principalmente em escolares febris, alguns com odinofagia. A rápida diferenciação etiológica é útil, pois evita o uso de antibióticos em caso de resultado negativo. Esses resultados apoiam o uso do DRASP em enfermarias de emergência pediátrica.

Enfermedad invasiva por Streptococcus pyogenes con celulitis de manos bilateral: A propósito de un caso / Invasive Streptococcus pyogenes disease with bilateral cellulitis of the hands: A case report

El Streptococcus pyogenes o estreptococo B hemolítico Grupo A (EßHGA) suele ser una causa poco habitual de enfermedad invasiva en pediatría, la cual ha presentado un aumento en su incidencia en los últimos años. Se define como cualquier infección asociada al aislamiento de dicha bacteria de un sitio normalmente estéril y cuya presentación más frecuente es la bacteriemia. Los pacientes con EßHGA habitualmente se presentan con un sindrome febril asociado a manifestaciones clínicas relacionadas con el sitio primario de infección. Se presenta el caso de una paciente de 10 años, sin comorbilidades, que desarrolló enfermedad invasiva por EßHGA con bacteriemia e impacto secundario de piel y partes blandas resultando en una celulitis de manos bilateral

Streptococcus pyogenes or Group A Streptococcus (GAS) is an infrequent cause of invasive disease in pediatrics. Its incidence has increased in the last few years. It is defined as any infection associated with the isolation of GAS in a normally sterile site and its most frequent presentation is bacteremia. Patients with GAS bacteremia usually present with a febrile syndrome associated with clinical manifestations related to the primary site of infection. We present the case of a previously healthy, 10-year-old patient, who developed an invasive disease due to GAS with bacteremia and secondary impact of skin and soft tissues that developed in bilateral cellulitis of the hands

Diagnóstico e tratamento da síndrome do choque tóxico estreptocócico em unidade de terapia intensiva pediátrica: relato de caso / Diagnosis and treatment of streptococcal toxic shock syndrome in the pediatric intensive care unit: a case report

RESUMO Dentre as infecções causadas por Streptococcus β hemolyticus do grupo A de Lancefield, talvez a síndrome do choque tóxico seja a mais grave, com alto índice de mortalidade. A semelhança clínica com outras formas de choque, principalmente séptico, pode, muitas vezes, confundir o avaliador e interferir na escolha da terapêutica mais adequada. Esse relato tem o objetivo de auxiliar seus leitores quanto à necessidade de adicionar tal síndrome como diagnóstico diferencial, frente a quadros de choque, principalmente aqueles que não apresentam manifestações clínicas bem definidas. Para isso, apresentamos o quadro de um lactente com sintomas gripais comuns, que evoluiu rapidamente com exantema, rebaixamento do nível de consciência, sinais clínicos e laboratoriais de choque, com necessidade de suporte intensivo. Além de culturas indicando o agente etiológico, o aparecimento de exantema e fasciíte necrosante levou ao diagnóstico, mas, em menos de 50% dos casos temos sinais clínicos clássicos dessa entidade. As penicilinas em terapia combinada com aminoglicosídeos ainda são a terapia de escolha e possuem alto nível de evidência. Apesar da gravidade a evolução foi satisfatória.

ABSTRACT Among the infections caused by Streptococcus β hemolyticus from the Lancefield serogroup A, toxic shock syndrome is perhaps the most severe, and its mortality rate is high. Its clinical similarity to other forms of shock, especially septic shock, can often confuse the evaluator and interfere with the selection of the most appropriate therapy. This report aims to inform readers of the need to add this syndrome as a differential diagnosis in cases of shock, especially those with no well-defined clinical manifestations. For this purpose, we present the case of an infant with common flu-like symptoms who progressed rapidly with a rash, a reduced level of consciousness and clinical and laboratory signs of shock that required intensive support. In addition to cultures indicating the etiological agent, the appearance of exanthema and necrotizing fasciitis led to the diagnosis. However, less than 50% of cases present classic clinical signs of this entity. Penicillins combined with aminoglycosides are still the therapy of choice and are supported by a high level of evidence. Despite the severity of this patient's presentation, the progression was satisfactory.

Infección necrotizante de tejidos blandos: experiencia durante 15 años en un hospital pediátrico / Necrotizing soft tissue infections: experience over 15 years in a pediatric hospital

INTRODUCCIÓN: La Infección Necrotizante de tejidos blandos (INTB) tiene una elevada morbimortalidad. El objetivo de este trabajo es describir del manejo perioperatorio de menores de 15 años que cursaron con INTB durante 15 años en un Hospital pediátrico. MATERIAL Y MÉTODOS: serie de pacientes identificados INTB entre 2000 y 2015 en el Hospital Roberto del Río. Se describen variables demográficas, clínicas, vacuna, tratamiento, cirugías, complicaciones, microorganismos, seguimiento, y fallecimientos. RESULTADOS: 22 pacientes, con mediana de 2 años y 9 meses de edad. 50% estaban cursando con una varicela. Dos fallecieron. Ninguno era previamente vacunado contra el virus varicela zoster. La localización fue tronco (14), extremidades (7), cuello (1). Los pacientes conscientes presentaron hiperestesia cutánea. Se realizó aseo quirúrgico con una mediana de 6,8 horas desde el inicio de la hiperestesia y 2 horas desde la sospecha diagnóstica. Los microorganismos fueron: S. pyogenes (38%) y E. coli (31%). Los antibióticos más frecuentes fueron penicilina más clindamicina. La herida se manejó con cierre primario, injertos y/o colgajos. Cinco evolucionaron con secuelas que necesitaron tratamiento. CONCLUSIÓN: Se identificó que la INTB puede presentarse con varicela. Debe sospecharse en lesiones cutáneas e hiperestesia desproporcionada. Resección amplia y precoz son fundamentales para el tratamiento.

INTRODUCTION: Necrotizing soft tissue infection (NSTI) has a high morbidity and mortality. The objective of this study is to describe the perioperative management of children under 15 years of age who have had this condition for 15 years in a pediatric hospital. MATERIAL AND METHODS: cases series of patients identified by Pathological Anatomy with NSTI during 2000 and 2015 at the Dr. Roberto del Río Hospital. Demographic variables, treatment, antecedents of vaccination, surgeries, complications, microorganisms, follow-up, and deaths are described. RESULTS: 22 patients were identified, with a median of 2 years 9 months of age (interquartile range: 13 months to 5 years y 10 months). 50% of the cases were associated to chickenpox. Two died. No patient was previously vaccinated against varicella zoster virus. The location was trunk (14), extremities (7) and neck (1). All conscious patients presented cutaneous hyperesthesia. Surgical debridement was performed with a median of 6.8 hours from the onset of hyperesthesia and 2 hours from diagnostic suspicion. The most frequent microorganisms were: Streptococcus pyogenes (38%) and Escherichia coli (31%). The most frequent antibiotics used were penicillin plus clindamycin. The wound was handled with primary closure, grafts and / or flaps. Five patients evolved with sequelae that needed treatment. CONCLUSION: It was identified that STNI in children is associated with chickenpox. It should be suspected in cutaneous lesions and disproportionate hyperesthesia. Aggressive resection is essential for treatment

Sensibilidad a trimetoprima-sulfametoxazol de Streptococcus pyogenes aislados de infecciones invasivas / Susceptibility of Streptococcus pyogenes isolated from invasive infections to trimethoprim-sulfamethoxazole

Se cree erróneamente que los estreptococos del grupo A (EGA) son universalmente resistentes a trimetoprima-sulfametoxazol (TMS). Esto se debe a que la timidina presente en los medios habitualmente usados para determinar sensibilidad in vitro a antibióticos antagoniza el efecto antibiótico de TMS. El objetivo de este trabajo fue determinar la sensibilidad de EGA a TMS, en presencia y ausencia de timidina. A tal fin, fueron analizados 95 aislamientos clínicos obtenidos de tejidos normalmente estériles con infección invasiva por EGA. La pruebas de sensibilidad por difusión con discos de TMS fueron realizadas en agar Mueller Hinton adicionado ya sea con 5% de sangre de carnero (MH-SC) o con 5% de sangre equina lisada (MH-SEL). La sangre equina lisada contiene timidina fosforilasa, que degrada este nucleósido. Como método de referencia se utilizó la epsilometría (Etest). El control de calidad con la cepa Enterococcus faecalis ATCC 29212 fue satisfactorio para ambos medios. La sensibilidad a TMS por difusión fue 100% en MH-SEL; en agar MH-SC 6 (6.3%) aislamientos resultaron resistentes; por Etest todos fueron sensibles, excepto uno de esos seis que presentó sensibilidad intermedia (CIM = 1.5/28.5 μg/ml). En este aislamiento no se encontraron las mutaciones genéticas de EGA más frecuentemente asociadas a resistencia a TMS. Probablemente, si se establecieran mejores puntos de corte para difusión, específicos para EGA, podría optimizarse la correlación con métodos de dilución o con Etest, aun empleando MH-SC.

It is erroneously believed that group A streptococci (GAS) are universally resistant to trimethoprim-sulfamethoxazole (TMS). This is mainly because media commonly used for in vitro determination of susceptibility to antibiotics contain thymidine, a nucleoside that antagonizes the antibiotic effect of TMS. The objective of this work was to determine EGA sensitivity to TMS in the presence and absence of thymidine. To this aim, 95 GAS isolates obtained from clinical tissues with i nvasive infections were analyzed. Susceptibility tests were performed by diffusion with TMS discs in Mueller Hinton agar supplemented either with 5% sheep blood or with 5% lysed equine blood (MH-LEB). Lysed equine blood contains thymidine phosphorylase, which degrades this nucleoside. Epsilometry (Etest) was used as gold standard. Quality controls with Enterococcus faecalis strain ATCC 29212 were satisfactory with both media. A 100% sensitivity to TMS was found in MH-SEL whereas 6 isolates (6.3%) resulted resistant in MH-SC; only one of them was found to have intermediate susceptibility by Etest (MIC > 1.5/28 μg/ml). The genetic determinants most frequently associated to TMS resistant EGA were not found in this isolate. Probably, if more accurate GAS-specific cut-off points were established for diffusion, the correlation with dilution methods or with the Etest could be improved, even employing MH-SB.

Celulitis orbitaria complicada por absceso subperióstico debido a infección por Streptococcus pyogenes / Orbital cellulitis complicated by subperiosteal abscess due to Streptococcus pyogenes infection

Resumen: Introducción: La celulitis orbitaria es una enfermedad infecciosa muy frecuente en la edad pediátrica que puede provocar el desarrollo de severas complicaciones. Los principales microorganismos involucrados son Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis, que juntos corresponden al 95% de los casos. También se pueden presentar Streptococcus beta hemolíticos y microorganismos anaerobios, que corresponden a menos del 5% de los casos. Se presenta un caso poco frecuente de celulitis orbitaria complicada por absceso subperióstico ocasionado por Streptococcus pyogenes (estreptococo beta hemolítico del grupo A). Caso clínico: Paciente masculino de 9 años de edad con antecedente de trastorno por déficit de atención e hiperactividad desde los 5 años de edad. Inició su padecimiento actual por presentar eritema en canto externo del ojo derecho; posteriormente, aumento de volumen periorbicular con limitación de apertura palpebral, progresión a proptosis, dolor a los movimientos oculares y secreción conjuntival purulenta. Los estudios de imagen subperióstico reportaron absceso y preseptal derecho con celulitis extraocular. Se inició manejo empírico con antibióticos, drenaje quirúrgico y cultivo del material purulento. De este, se aisló Streptococcus pyogenes. Conclusiones: Debido a la implementación de los esquemas de vacunación desde la década de los 90 contra H. influenza y S. pneumoniae, los casos por estos patógenos han disminuido, provocando que nuevas bacterias tomen su lugar como causantes de la infección. La importancia de considerar a S. pyogenes como etiología de celulitis orbitaria radica en la rápida progresión para la formación de abscesos, así como los pocos casos descritos en la literatura.

Abstract: Background: Orbital cellulitis is an infectious disease that is very common in pediatric patients, in which severe complications may develop. Etiological agents related to this disease are Haemophilus influenzae B, Staphylococcus aureus, Streptococcus pneumoniae and Moraxella catarrhalis, which correspond to 95% of cases. Moreover, Streptococcus beta hemolytic and anaerobic microorganisms may also be present corresponding to < 5% of the cases. We present an uncommon case of cellulitis complicated by sub-periosteal abscess caused by Streptococcus pyogenes (Group A beta hemolytic streptococcus). Case report: A 9-year-old male patient with a history of deficit disorder and hyperactivity since 5 years of age. His current condition started with erythema in the external edge of the right eye, increase in peri-orbicular volume with limitation of eyelid opening, progression to proptosis, pain with eye movements and conjunctival purulent discharge. Image studies reported subperiosteal abscess and preseptal right with extraocular cellulitis. The patient started with empirical antibiotic treatment, surgical drainage and culture of purulent material from which Streptococcus pyogenes was isolated. Conclusions: Due to the implementation of vaccination schemes against H. influenza and S. pneumoniae since the 90s, the cases by these pathogens have decreased, causing new bacteria to take place as the cause of the infection. The importance of considering S. pyogenes as an etiology of orbital cellulitis is the rapid progression to abscess formation, and the few cases described in the literature.

Enfermedad invasora por Streptococcus pyogenes como coinfección en un paciente con influenza A H1N1 / Invasive disease due to Streptococcus pyogenes in a patient with A H1N1 influenza infection. Report of one case

Bacterial superinfection is a known complication among patients affected by viral respiratory tract infections. Streptococcus pyogenes, a major bacterial agent involved in acute tonsillopharyngitis, skin and soft tissue infections, was reported as a co-infecting microorganism during the 2009 A H1N1 influenza pandemic. We report a 65-year-old male patient who evolved with multifocal pneumonia and multiple organ failure with a fatal outcome. Influenza A H1N1 was detected by a polymerase chain reaction-based technique from a tracheal aspirate sample. S. pyogenes was identified by a rapid test from a nasopharyngeal sample and isolated afterwards from a positive blood culture.

Infecciones invasivas por estreptococos de los grupos A, C y G en la Argentina / Invasive infectios due to group A, C and G streptococci in Argentina

Streptococcus pyogenes (estreptococo beta-hemolítico del grupo A) (SGA) y Streptococcus dysgalactiae subsp. equisimilis, (estreptococos beta-hemolíticos grupos C y G) (SDSE) son capaces de provocar enfermedades graves como la fascitis necrotizante y el síndrome de shock tóxico estreptocócico (SSTE) y de causar complicaciones posinfecciosas. El objetivo de este trabajo fue presentar resultados de un estudio multicéntrico y compararlo con diferentes estudios descriptivos previos sobre infecciones invasivas por estreptococos beta-hemolíticos de los grupos A, C y G, también realizados en la Argentina. Se incluyeron 54 pacientes de 0 a 15 años con infecciones invasivas por SGA (N=50) o SDSE (N=4) en forma prospectiva entre julio de 2011 y junio de 2012 en 28 centros de 17 ciudades argentinas. Se aisló S. pyogenes en 28 pacientes que presentaron bacteriemia, 6 de ellas sin foco. Cuatro pacientes (7,4%) presentaron SSTE, en todos los casos por S. pyogenes. La mortalidad fue del 2,0% para SGA. La evolución de los pacientes fue peor en los tres estudios anteriores respecto del actual: mayor porcentaje de casos de SSTE (diferencias no significativas) y mayor mortalidad (diferencia significativa respecto de dos estudios previos). Es probable que la morbimortalidad haya decrecido en esta última década en la Argentina posiblemente debido al uso temprano de clindamicina en las infecciones invasivas por S. pyogenes y SDSE, aunque no se puede descartar la diferente circulación de cepas virulentas. Esta apreciación además está sesgada por la inclusión de pacientes de distintos centros con diferentes formas de presentación inicial (AU)

Streptococcus pyogenes (group A ß-hemolytic streptococcus (GAS)) and Streptococcus dysgalactiae subsp. equisimilis (group C and G ß-hemolytic streptococcus (GCGS)) may cause severe diseases such as necrotizing fasciitis and streptococcal toxic shock syndrome (STSS) as well as postinfectious complications. The aim of this report was to present the results of a multicenter study and compare them with the results of different previous descriptive studies on invasive infections due to beta-hemolytic streptococcus groups A, C, and G that were also conducted in Argentina. Forty-five patients between 0 and 15 years of age with invasive infections due to GAS (N=50) or GCGS (N=4) were prospectively included in the study between July 2011 and June 2012 from 28 centers in 17 Argentine cities. S. pyogenes was isolated in 28 patients who presented with bacteremia, without a focus in six. Four patients (7.4%) had STSS, due to S. pyogenes in all of them. In patients with GAS, mortality rate was 2.0%. Outcome of the patients was worse in previous studies than in the present one: Percentages of cases with STSS (no significant difference) and mortality (significant difference) were higher. It is probable that over the last decade morbidity and mortality have decreased in Argentina, possibly due to the early use of clindamycin in invasive infections due to S. pyogenes and GCGS, although a different circulation of virulent strains cannot be ruled out. Additionally, this observation is biased by the inclusion of patients from different centers with different presentations at onset (AU)

Repeated Serum Alkaline Phosphatase Measurements in the Treatment of Childhood Acute Bone and Joint Infections with High Doses of Antibiotics

No abstract available.

Prevalência de Streptococcus β-hemolítico em crianças portadoras de necessidades especiais / Prevalence of β-hemolytic Streptococcus in children with special health care needs

Faringotonsilite causada por Streptococcus β-hemolítico afeta principalmente crianças e imunocomprometidos, sendo Streptococcus pyogenes (Grupo A) o agente mais comum em faringotonsilites bacterianas. OBJETIVO: Este trabalho objetivou a busca por Streptococcus β-hemolítico do Grupo A (SBHGA) e Não A (SBHGNA) na orofaringe de indivíduos com necessidades especiais da APAE (Maceió-AL). MÉTODO:Estudo prospectivo com amostras da orofaringe de pacientes com síndrome de Down e outras desordens mentais (teste) e estudantes de escola privada (controle) de 5-15 anos. Culturas em ágar sangue (5%) foram identificadas através dos testes de Gram/catalase e o método de disco difusão com bacitracina/sulfametoxazol-trimetoprim, aplicando-se o teste Chi-quadrado em análises estatísticas. RESULTADOS: Um total de 222 colônias bacterianas foram isoladas em 74 indivíduos da APAE e 65 no grupo controle. No grupo teste, episódios prévios de faringotonsilites foram relatados por 36,49% (27/74) e 9,46% (7/74) foram diagnosticados com sintomas e/ou sinais sugestivos de infecção orofaríngea. Nenhuma amostra de S. pyogenes foi confirmada na APAE, sendo todas identificadas como SBHGNA, com cinco SBHGA no grupo controle. CONCLUSÃO:A identificação precoce de Streptococcus β-hemolítico é importante para o tratamento rápido de faringotonsilites e a ausência de S. pyogenes evita futuras sequelas supurativas ou não supurativas no grupo da APAE.

Pharyngotonsillitis by β-hemolytic Streptococcus mostly affects children and imunocompromissed, being Streptococcuspyogenes (Group A) the most common agent in bacterial pharyngotonsillitis. AIM:This work targeted the research of β-hemolytic Streptococcus Group-A (SBHGA) and No-A (SBHGNA) in the oropharynx of individuals with special health needs from the APAE (Maceió-AL). METHOD: A prospective study with oropharynx samples from patients with Down syndrome and other mental disorders (test) and students from a private school (control) aged 5-15 years. Cultures in blood agar (5%) were identified through Gram/catalase tests and bacitracin/trimethoprim-sulfamethoxazole disk diffusion method, applying the chi-squared statistical analysis. RESULTS: A total of 222 bacterial colonies were isolated in 74 individuals from APAE and 65 in the control group. In the test group, previous episodes of pharyngotonsillitis were reported by 36.49% (27/74) and 9.46% (7/74) were diagnosed with symptoms and/or signs suggestive of oropharynx infection. No positive sample of S. pyogenes was confirmed at APAE, being all samples classified as SBHGNA, with 5 SBHGA in the control group. CONCLUSION: The early identification of β-hemolytic Steptococcus is important for the fast treatment of pharyngotonsillitis and the absence of S. pyogenes avoid future suppurative or not-suppurative sequels in the group from APAE.

Experimentally induced anachoresis in the periapical region after root canal filling / Anacoresis inducida experimentalmente en la región periapical después de obturación del conducto radicular

Anachoresis is the phenomenon through which blood-borne bacteria, dyes, pigments and other materials are attracted and fixed to circumscribed areas of inflammation. This study evaluated the occurrence of anachoresis in the periapical region of dogs submitted to root canal fillings. One hundred and four roots from four dogs were endodontically treated and root canals were filled with zinc-oxide-eugenol cement. Fifty percent were filled up to the dentinocemental junction and the others were overfilled. At 120 days after root canal treatment, experimental bacteremia was induced by intravenous inoculation of 105 CFU Streptococcus pyogenes. The dogs were sacrificed 48 hours and 30 days after the bacteremia. Culture and DNA amplification by PCR revealed the presence of the inoculated bacteria just in periapical tissues of dogs sacrificed 48 hours after bacteremia and not in animals sacrificed after 30 days. AP-PCR fingerprints of recovered colonies of S. pyogenes and the presence of genetic markers of resistance to antimicrobials were similar to the inoculated strain. Endodontically treated periapices seemed to be prone to the occurrence of anachoresis and there was no relationship between the phenomenon and the level of root canal filling.

Anacoresis es el fenómeno por el cual las bacterias transmitidas por la sangre, colorantes, pigmentos y otros materiales se atraen y se fija a zonas circunscritas de la inflamación. Este estudio evaluó la incidencia de anacoresis en la región periapical de los perros presentados a raíz de los rellenos del canal. Un total de ciento cuatro raíces de cuatro perros fueron tratados con endodoncia y tratamientos de conducto se rellena con cemento de óxido de zinc-eugenol. El cincuenta por ciento estaban llenos hasta el cruce dentinocemental y los otros se llene en exceso. A los 120 días después del tratamiento de conducto radicular, bacteriemia experimental fue inducida por la inoculación intravenosa de 105 UFC por Streptococcus pyogenes. Los perros fueron sacrificados 48 horas y 30 días después de la bacteriemia. La cultura y la amplificación del ADN por PCR reveló la presencia de las bacterias inoculadas sólo en los tejidos periapicales de los perros sacrificados 48 horas después de la bacteriemia y no en los animales sacrificados después de 30 días. AP-PCR huellas dactilares de las colonias recuperadas de S. pyogenes y la presencia de marcadores genéticos de resistencia a los antimicrobianos fueron similares a la cepa inoculada. Periápices endodonciados parecía ser propensos a la ocurrencia de anacoresis y no había ninguna relación entre el fenómeno y el nivel de llenado del conducto radicular.

Unusual Primary Peritonitis due to Streptococcus pyogenes in a Young Healthy Woman

We describe the first case of primary peritonitis in Korea of a healthy person due to Streptococcus pyogenes. In the absence of comorbid conditions, such as liver cirrhosis, immunosuppression, or nephrotic syndrome, primary peritonitis is uncommon in a young healthy woman. Abdomen computed tomography revealed ascites in the lower abdomen and peritoneal enhancement suggesting peritonitis. In diagnostic laparoscopy, purulent ascites was found in the pelvic cavity but both ovaries and fallopian tubes were intact. There were no intra-abdominal abnormalities such as bowel perforation, appendicitis, or necrosis. The reports of blood culture, ascites culture, and cervical swab culture confirmed S. pyogenes. After use of antibiotics, the patient was cured and discharged without sequelae.

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.

Bacteriemia por Streptococcus pyogenes: Presentación de un caso clínico con aparición tardía de neumonía / Pneumonia caused by Streptococcus pyogenes: Report of one case

We report a 58-year-old female presenting with fever and vomiting. The initial laboratory examination disclosed two blood cultures that were positive for Streptococcus Pyogenes. An abdominal CAT scan showed a right basal pneumonia. The patient was treated with antimicrobials and discharged with oral cefadroxil for 21 days. One month after discharge she was asymptomatic and with a normal C reactive protein. Pneumonia is an important differential diagnosis in unknown origin bacteremia caused by Streptococcus Pyogenes. It may have a fulminant evolution and may complicate with abscess and empyema.

Fascitis necrosante palpebral y shock tóxico por Streptococcus pyogenes / Necrotizing fasciitis of the eyelids and toxic shock syndrome due to Streptococcus pyogenes

Necrotizing fasciitis (NF) is a serious infection that compromises subcutaneous tissue, fascia, and adipose tissue, with high mortality rate and sequelae. Extremities, trunk and pelvis are the most common body sites affected. Periorbital celullitis with necrotizing fasciitis of the eyelid is rare. We report the case of a three years old child with bilateral NF of the eyelids and toxic shock syndrome secondary to Streptococcus pyogenes infection ocurring after a minor skin trauma. Early recognition leading to intensive care treatment and prompt surgical debridement were critical in the favourable outcome of the child.

La fascitis necrosante (FN) es una infección grave de los tejidos subcutáneos, localizada más frecuentemente en extremidades, tronco y pelvis. El compromiso de la cara y la región palpebral es inusual. Reportamos el curso clínico de un niño de tres años, previamente sano, que presentó una FN palpebral bilateral asociado a shock tóxico por Streptococcus pyogenes, secundaria a un trauma localizado. El paciente requirió tratamiento en cuidado intensivo con resucitación enérgica, antimicrobianos, inmunoglobulina intravenosa y desbridamiento quirúrgico precoz, lo que permitió su evolución favorable.

Choque séptico puerperal por Streptococcus β-hemolítico e síndrome de Waterhouse-Friderichsen / Puerperal septic shock due to β-hemolytic Streptococcus and Waterhouse-Friderichsen syndrome

É relatado caso excepcional de puérpera de 15 anos com choque séptico pelo Streptococcus beta-hemolítico do grupo A e síndrome de Waterhouse-Friderichsen, observado à necropsia. São revistos aspectos do diagnóstico, patogênese e evolução da infecção (sepse) puerperal associada à hemorragia e insuficiência das supra-renais.

An exceptional case of a 15-year-old puerpera with septic shock caused by Group A β-hemolytic Streptococcus and Waterhouse-Friderichsen syndrome is reported. The findings were observed at the necropsy. The characteristics of the diagnosis, pathogenesis and evolution of this puerperal infection (sepsis), associated with adrenal hemorrhage and insufficiency are reviewed in this paper.

evaluation of relationship between group A streptococcal infection with tic disorders in children

To evaluate the relationship between group A beta hemolytic streptococcus infection [GABHS] and tic disorders in children. This is a case-control study that was conducted in Child and Adolescent Psychiatric Clinic, Isfahan, Iran, between May 2008 and February 2009. Thirty-six children [aged 5-15] with tic and 36 children without tic and obsessive-compulsive disorder [OCD] were investigated for clinical and laboratory signs of GABHS. The tools utilized in this research were clinical interview according to the DSM IV-TR and laboratory tests [throat culture, rapid antigen detection test [RADT], anti streptolysin O [ASO] and yale global tics severity scale [YGTSS]]. The control group was of the same gender and age as the tic group who had come to the clinic for other illnesses and was in need of blood test. None of the subjects in the case and control groups had a clinical history of GABHS infection. The relationship between tic disorder and GABHS infection [if any of these laboratory tests takes place: throat culture, RADT, ASO >/= 250] in the tic group was 16 [44.4%] and in the control group was 9 [25%], there were significant differences [p<0.05]. No significant correlation was found between ASO titer and YGTSS scores. The specificity of RADT was 100%. The result showed correlation between GABHS infection and tic disorder, but it does not mean that GABHS infection caused tic disorder