Prevalence of Streptococcus pyogenes bacteria among children with Tonsillitis

Streptococcus pyogenes is the most common cause of bacterial tonsillopharyngitis with a sore throat in children;it can also cause weakening sicknesses such as rheumatic beart disease and other suppurative sequelae; peritonsillar abscess and lymphadenitis. The present study was conducted to determine the occurrence of Streptococcus pyogenes organism and their antibiotics susceptibility usually used to treat tonsilitis in children. From the period 2015-2016, 210 swabs were collected from children complaining of acute tonsillitis who presented to the outpatient department of Al-Karama teaching hospital, Baghdad, Iraq. The results revelated that fortuy-one isolates (19,5%) cases were positive culture for S. pyogenes. The residual results; other organisms, mixed culture and negatively cultured were excluded form the study. The incidence of treptococcus pyogenes tonsillitis was most prvalent in the age group 5-7 years 25 (23.8%) and the lowest in the age group 14-16 years 1 (10%). The isolates showed the frequency resistance percentage to: azithromycin 26 (63.4%), erythromycin 24 (58.5%), clarithromycin 19 (46.3%), 6 (14.6%) toAmoxiclillin + Clavulanic acid (Augmentin) and Clindamycin 5 (12.2%). while some isolates showed the lowest resistance percentage to Cefotaxime 3 (7.3%). S. pyogenes were frequently sensitive to Clindamycin 36 (87.8%), Cefotaxime 32 (78%) and Amoxicillin/clavulanic acid 31 (75.6%). Streptococcal infections are a considerable problem in medical and health centers. The incidence of Streptococcus pyogenes tonsillitis was the most dominant in the age group 5-7 years and antibiotics Clindamycin, Cefotaxime, and Augmentin are more effective against these bacteria in patients with recurrent tonsillitis. The early diagnosis, appropriate infection control easures, and guidelines are needed to prevent the spread of the infections ant the development of complications among patients

Vigilancia de las enfermedades invasivas por streptococcus pyogenes / Surveillance of invasive streptococcus pyogenes diseases

Situación nacional de este tipo de infecciones, del que se observa un incremento global en las últimas décadas, en Europa y Norte América, sin que la causa haya sido determinada. En Argentina, los serotipos prevalentes, en base a datos aportados por el Laboratorio Nacional de Referencia- por él identificados en infección invasiva por Streptococcus pyogenes en población general durante el período 2000- 2016- fueron M12, M1, y M. A partir del año 2017 se observa un incremento del aislamiento de serotipo M3 principalmente en población pediátrica y no se registraron resistencias antimicrobianas específicas.Se describe la situación en la Ciudad Autónoma de Buenos Aires, la normativa a cumplir para la vigilancia de estas infecciones, y se incluyen recomendaciones para el personal de salud, la comunidad, y la comunidad educativa

Tratamento intralesional de malformações linfáticas com ênfase na escleroterapia com picibanil (OK-432): revisão sistemática / Intralesional treatment of lymphatic malformations with emphasis on Picibanil (OK-432) sclerotherapy: a systematic review

INTRODUÇÃO: Conduziu-se revisão sistemática retrospectiva da literatura incluindo estudos relatando o uso de picibanil para tratar malformações linfáticas (ML). MÉTODOS: A pesquisa foi realizada com estudos publicados no PubMed de janeiro de 1990 a 14 de abril de 2013. Na estratégia de busca, usou-se os descritores "OK-432" ou "Picibanil" e "lymphatic malformation". Os seguintes elementos foram comparados aos de outras modalidades relatadas e, então, compilados: mecanismo de ação, indicações, contraindicações, eficácia, administração, efeitos colaterais, complicações, vantagens e desvantagens. RESULTADOS: Foram encontrados 44 estudos, 27 dos quais atenderam aos critérios de inclusão. O picibanil é uma preparação liofilizada de uma cepa de baixa virulência de Streptococcus pyogenes inativada pela penicilina G. Seu mecanismo de ação ainda não definido claramente, mas especula-se que provoque uma resposta inflamatória controlada com adesão das paredes dos cistos. O picibanil é indicado quase que unanimemente para o tratamento da ML macrocística, cuja resposta é mais efetiva do que em lesões microcísticas ou mistas. Em geral, o picibanil é administrado por meio de punção com visualização direta ou guiada por ultrassonografia, com o paciente sob anestesia geral. A preparação comumente utilizada consiste em 0,1 mg de picibanil em 10 ml de soro fisiológico. Os efeitos colaterais são, em geral, leves; sendo dor, inchaço e febre os mais frequentemente relatados. CONCLUSÃO: Os estudos apresentam pouca evidência científica. A revisão sistemática identificou que o picibanil é útil no tratamento da ML de qualquer tipo, mas tem resultados melhores em lesões macrocísticas. A eficácia foi comparável à de outras terapias. Não foi apresentada nenhuma contraindicação específica. Embora o mecanismo de ação ainda não tenha sido determinado, o picibanil trata-se de opção de tratamento.

INTRODUCTION: We performed a retrospective systematic review of studies reporting the use of Picibanil for treatment of lymphatic malformations (LMs). METHODS: We searched the PubMed database for available studies, including those published between January 1990 and April 14, 2013. The search strategy involved the use of the keywords "OK-432" or "Picibanil" and "lymphatic malformation." Information was compiled regarding the reported mechanism of action, indications, contraindications, efficacy, administration, side effects, complications, and advantages and disadvantages compared to those of other modalities. RESULTS: Forty-four studies were found, of which 27 fulfilled the inclusion criteria. Picibanil is a lyophilized preparation of a low-virulence strain of Streptococcus pyogenes inactivated with penicillin G. Its mechanism of action is unclear, but it has been speculated that it causes a controlled inflammatory response with adhesion of cyst walls. Picibanil is almost unanimously indicated for the treatment of macrocystic LMs, which show a greater effectiveness response compared to that shown by microcystic or mixed LMs. Picibanil is usually administered by puncturing, either with direct visualization or guided by ultrasound, with the patient under general anesthesia. The most widely used preparation comprises 0.1 mg of Picibanil in 10 mL of saline. Side effects are mostly mild, with pain, swelling, and fever being the most frequently reported. CONCLUSION: The studies had low scientific evidence. A systematic review found that Picibanil is useful against any LM, with better results in macrocystic lesions. Efficacy was comparable to that of other therapies. No specific contraindication was presented. Although the mechanism of action has not been established, the inclusion of Picibanil as a treatment option is warranted.

Regras validadas para faringite estreptocócica / Validated rules for strep throat

Duas escalas de pontuação comumente utilizadas são efetivas para determinar crianças e adultos com baixa probabilidade de ter estreptococos como causa para sua faringite aguda.1 Seu uso adequado, recomendado nos Estados Unidos pelos Centros para o Controle e Prevenção de Doenças (Centers for Disease Control and Prevention, CDC),2 pode evitar exames desnecessários.

Síndrome de choque tóxico fulminante en pediatría. presentación de casos y revisión de literatura / Fulminant toxic shock syndrome in children. presentation of cases and review of literatura

Se presentan dos casos de Síndrome de Choque Tóxico relacionados a lesiones en piel; ambos evolucionaron hacia fracaso multiorgánico precoz y muerte a pesar del tratamiento antibiótico y soporte. Destacamos su presentación fulminante y la falta de respuesta al tratamiento. Este síndrome se presenta de manera infrecuente, sin embargo su identificación es importante por su agresividad, siendo la sospecha clínica necesaria en el diagnóstico...

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.

Group A Sstreptococcus virulence factors genes in north India & their association with emm type in pharyngitis.

Background & objectives: Group A streptococcal (GAS) pharyngitis, especially among children, leads to high prevalence of rheumatic fever (RF)/rheumatic heart disease (RHD) in India, as compared to the western world where invasive diseases are common. GAS encodes numerous virulence factors that cause diseases by exhibiting extraordinary biological diversity. Hence, we studied the virulence factors genes of GAS isolated from the throat of children with pharyngitis and also asymptomatic carriers. Methods: Fifty GAS isolates cultured from throats of north Indian children aged 5-15 yr with mild pharyngitis (20), severe pharyngitis (24) and asymptomatic pharyngeal carriers (6), during 2000-2003 along with reference M1 strain were emm typed and characterized for virulence factors genes by PCR. The presence of virulence factors was also checked for their association with emm type in pharyngitis. Results: Twenty emm types, six sequence types, and one non-typeable strain were found circulating in north India. The five most prevalent types were emm 74 (12%), 11 & StI129 (8% each) and emm 68 and NS292 (6% each). The spe B gene was found to be significantly higher (P=0.0007) in opacity factor (OF) negative isolates. emm 3, 11, 77, 86, 87, 109 and StI129 showed maximum virulence factors genes. Interpretation & conclusions: GAS isolates collected from throats of children from north India possess highly virulent antigens. This study also supports concept of isolate-associated virulence rather than type relatedness.

Wound infection; frequency in clean surgical operations

The aim of the study was to evaluate the frequency of infection in clean surgical cases [General and Orthopaedic]. A descriptive study. This descriptive study was conducted at department of surgery and orthopaedic DHQ Teaching Hospital Sargodha from July 2007 to Dec, 2008. In this study 1500 clean surgical cases were included. Wounds were examined on third post operative day and then regularly after removal of stitches. Surgical wounds were examined finally on fifteenth post operative days. Description of wound condition and detailed data of patients were collected on preformed performas. Patients with wound infection developed pain at operation site and fever on third post operative day. Wounds were examined for swelling, redness, discharge; stitch abscess. Routine investigations were done as per protocol ie complete blood examination, complete urine examination, blood sugar, C-reactive proteins etc. Wounds swab was taken for microscopy and culture sensitivity. This study was carried out on fifteen hundred clean surgical cases [General and Orthopaedic]. There were 1064 males and 436 females. Male to Female ratio was 2.4:1. Infection was detected in 110 patients [7.3%] while no infection was found in 1390. Infection was maximum in patients more than 60 yrs of age [10.9%]. Wound infection was minimum in young patients [3.5%].commonest micro organism isolated from the infected wound was staphylococcus areus. Other organism isolated was streptococcus pyogenes, proteus and pseudomonas. No MRSA was detected. In our case study clean cases were found generally free of infection especially young patients. Whereas increased incidence of infection was noted in old patients. Wound infection is associated with significant morbidity in the form of delayed wound heeling, prolonged hospital stay and increased economical pressure on the patient

Curso de atualização em emergências médicas. Aula 10: faringoamigdalite e sinusites / Updating in medical emergencies course. Class 10: pharyngoamigdalitis and sinusites

As infecções das vias aéreas superiores constituem problema comum de Saúde Pública Mundial. Sua identificação adequada e o uso criterioso de antimicrobianos nestas situações evitam co-morbidades, como febre reumática e glomerunefrite, e diminuem consideravelmente o absenteísmo ao trabalho. Atualizamos "Faringoamigdalite e sinusite" na visão do clínico prático.

The infections of the upper airways constitute a common problem of the World's Public Health. Their adequate identification and the criterial usage of antimicrobial drugs in these situations avoid comorbities, such as rheumatic fever and glomerulonefritis and considerably diminishes absenteeism in the workplace. We update here "Pharyngoamigdalitis and sinusitis in the view of the general practitioner.

Meningitis neonatal por Streptococcus pyogenes y revisión de la literatura de los últimos 50 años / Neonatal meningitis caused by Streptococcus pyogenes and literature review of the last 50 years

Se describe el caso de un recién nacido fallecido a causa de meningitis bacteriana por estreptococo del grupo A. Se revisó la literatura mediante la búsqueda en distintas bases de datos y otras fuentes de los últimos 50 años. Antes de la publicación de este caso, se han documentado casos de otros 20 neonatos con meningitis bacteriana por estreptococo del grupo A y se halla la descripción clínica de ellos desde el año 1957. En otros artículos al mostrar la casuística de sepsis o meningitis neonatal, en general, reportan casos de recién nacidos con esta infección ocasionada por estreptococos del grupo A, pero no se ofrece información detallada de los casos. Según las publicaciones citadas, se demuestra que, aunque en la actualidad el estreptococo del grupo A no es ya un azote en el período neonatal, puede considerarse entre los microorganismos causales de meningitis bacteriana neonatal.

The case of a newborn infant who died of bacterial meningitis caused by streptococcus of the group A was described. The literature was reviewed by searching different databases and other sources of the last 50 years. Before publishing this case, cases of other 20 neonates with bacterial meningitis due to streptococcus of the group A have been documented and their clinical description has been made since 1957. Other articles show the casuistics of sepsis or neonatal meningitis in general by reporting cases of newborns with this infection produced by streptococcus of group A, but no detailed information of the cases is provided. According to the publications cited, it was proved that in spite of the fact that at present streptococcus is not a hazard in the neonatal period, it may be considered among the microorganisms causing neonatal bacterial meningitis.

Complicaciones respiratorias asociadas a neumonía bacteriana / Respiratory complications associated to bacterial pneumonia

En las últimas décadas ha sido reportado en varios países un aumento en el número de hospitalizaciones por neumonía bacteriana y también por complicaciones supurativas en niños. Se ha señalado al Streptococcus pneumoniae como el principal agente causal y también se ha advertido un aumento en la resistencia de éste a penicilina; sin embargo, no se ha logrado establecer una relación de causalidad. Se postula que el fenómeno de resistencia no tiene incidencia en la mayor frecuencia de complicaciones observadas y que éstas si podrían tener relación con el serotipo de S. pneumoniae (principalmente serotipos 1, 3 y 14). La neumonía necrotizante o excavada es considerada una complicación grave de la neumonía bacteriana, se asocia a fiebre prolongada, más días de hospitalización y mayor frecuencia de complicaciones (insuficiencia respiratoria, síndrome séptico). En su diagnóstico la radiografía de tórax ha demostrado ser menos sensible que la tomografía. La disminución de la impregnación del medio de contraste del parénquima pulmonar observada por hipoperfusión pueden ir posteriormente a la necrosis. El mecanismo de la necrosis está relacionado con la oclusión trombótica de los capilares alveolares. A pesar que la necrosis y la formación de cavidades pueden comprometer extensas zonas de lóbulos del pulmón, la indicación de resección quirúrgica en niños es excepcional y el seguimiento radiológico muestra resolución completa.

Induction of myocarditis in rabbits injected with group A streptococci.

BACKGROUND & OBJECTIVES: We have earlier proposed that group A streptococcal (GAS) immunoglobulin binding surface proteins (IgGBPs) might trigger anti-IgG production and immune complex formation leading to glomerulonephritis. In the present study, cardiac tissue material from rabbits injected with heat-killed GAS was investigated. METHODS: Rabbits were injected intravenously with 10(9) colony forming units of streptococci three times weekly for 8 wk. Cardiac tissue samples were obtained at different times and deposition of IgG, C3, TNF-alpha and IL-6 was studied. RESULTS: After 8 or more weeks of intravenous (iv) injections, minimal changes were seen in animals receiving an IgG non-binding GAS strain, type T27, whereas in those animals receiving either of two IgG binding GAS strains, types M1 or M22, strong inflammatory and degenerative myocardial changes accompanied by deposition of IgG and C3 were noted. Furthermore, on injecting rabbits with defined mutants of a type M22 strain, the development of myocardial tissue damage proved to be dependent on the presence streptococcal IgGBPs. INTERPRETATION & CONCLUSION: The present data supported a role of streptococcal IgGBPs in the induction of myocardial tissue injury by GAS.

Diversidad clínica de las infecciones invasivas por streptococcus pyogenes y asociación con el superantíngeno SpeA / Clinical diversity of invasive infections by streptococcus pyogenes and SpeA superantigen association

Se presenta una serie de 5 casos con infecciones invasivas por S. pyogenes observados durante 1999, con el objetivo de ilustrar la diversidad clínica de estas infecciones. Todos los pacientes presentaron bacteremia y tenían condiciones mórbidas asociadas. Tres pacientes presentaron shock, dos de ellos de tipo tóxico y el mismo número de pacientes presentó manifestaciones cutáneas. Dos pacientes tuvieron alteraciones de coagulación. Todos los casos tenían leucocitosis (valor promedio 16800 por mm3) y aumento de la proteína C reactiva (300 mg/L en promedio). Los valores de desviación a izquierda y eritrosedimentación presentaron una amplia variación en sus resultados, observando pacientes con cifras normales. Cuatro pacientes recibieron tratamiento quirúrgico y 3 pacientes gamaglobulina endovenosa. Tres pacientes fallecieron (dos de ellos a las 72 horas). Los pacientes que sobrevivieron tuvieron una hospitalización prolongada que superó el mes de duración. Todos los aislamientos bacterianos portaban el gen que codifica por el superantígeno SpeA

Meningitis bacteriana aguda por streptococcus pyogenes: caso clínico y revisión de la literatura / Acute bacterial meningitis by streptococcus pyogenes: case report and literature review

Streptococcus pyogenes (sbhga) es un microorganismo reconocido por causar una gran variedad de patologías. Durante la última década se ha observado un incremento mundial tanto en la incidencia como en la gravedad de las infecciones provocadas por esta bacteria. El presente artículo reporta el caso de un lactante menor que ingresó al área de cuidados críticos del Hospital Padre Hurtado, cursando con shock séptico y meningitis secundaria a s. pyogenes, resultando en un desenlace fatal

Faringoamigdalitis estreptocóccica / Streptococcal tonsillopharyngitis

Podemos concluir que esquemas abreviados de amoxicilina durante 6 días, cefalosporinas orales (cefadroxilo, cefuroxima, cefixima y cefpodoxima) durante 4 ó 5 días y azitromicina o superiores que el tratamiento clásico de la faringoamigdalitis estreptocóccica con fenoximetil penicilina durante 10 días, en términos de eficacia clínica y erradicación bacteriológica

Production of bacteriocin-like inhibitory substances (BLIS) by Streptococcus salivarius strains isolated from the tongue and throat of children with and without sore throat

"Streptococcus salivarius" strains, isolated from children with and without sore throat, were tested for bacteriocin production against "Streptococcus pyogenes. "S. salivarius" strains producing bacteriocin-like inhibitory substances (BLIS) against "S. pyogenes" were more frequently found in children without sore throat by the presence of BLIS-positive "S. salivarius" strains