Epidemic acute nephritis associated with re-appearance of type 55 streptococcus - abstract

A large epidemic of acute glomerulonephritis occurred in South Trinidad in 1971, the fourth since 1952. Seven hundred and forty-three (743) cases were admitted to the San Fernando hospital during the year. After a high endemic period during the first 5 months, an epidemic broke out in June, 1971 and 598 patients were admitted with acute glomerulonephritis from June to the first week of December. This coincided with an epidemic of scabies in the island. Fifty-five per cent of the patients had scabies with secondary infection. Pyoderma was found in 441 patients (43.7 percent). Sixty-one families had more than one case of acute nephritis. Laboratory investigation included cultures of the skin and throat, grouping and typing of the streptococci, serial estimations of compliment (BIC), Antistreptolysin O titre, BUN and weekly urinalysis. Group A Beta haemolytic streptococci were isolated from 434 patients (73 percent). There were 335 positive cultures from skin sores and 278 from the throat. One hundred and seventy-nine (179) patients had Beta haemolytic streptococci in both skin sores and throat. Of the strains that were M-typed, 245 (60.6 percent) were M-typed 55. T-typing of the streptococci showed that 78.3 percent agglutinated with all the pools (T, U, W, X, Y, and Z). Type 55 streptococcus was first discovered in Trinidad in 1965 and its re-appearance with the 1971 epidemic confirms its nephritogenicity. In marked contrast, there was no increase in the number of cases of acute rheumatic fever, although these patients came from the same socio-economic group and the same areas affected by the epidemic of post-streptococcal acute glomerulonephritis (AU)

Observations on acute rheumatic fever in Trinidad during an outbreak of scabies and acute nephritis - abstract

We have been looking for differentiating aspects of the streptococcal infections associated with acute rheumatic fever (ARF) and acute alonerulonephritis (AGN) in Trinidad since November 1969. At this meeting last year, we reported our first 10 months' observation which were made during a period when AGN was endemic. Since then an outbreak of scabies accompanied by a major epidemic of AGN has occurred which afforded an excellent opportunity to study and compare the related streptococcal infections. Observations to be reported presently include the following: (1) While the number of cases of AGN increased nearly 10-fold to over 150 in both August and September, ARF increased only to less than 20 cases a month during the height of the epidemic of AGN. (2) The scabies epidemic was associated with AGN while skin lesions continued to be relatively rare in patients with ARF. (3) The streptococcal strains isolated from patients with AGN and ARF were not the same, the epidemic M-type 55 being associated with AGN but not ARF while M-type 11 strains were found in many patients with ARF and in none with AGN, (4) Antibody titres were similar in the two groups of patients as reflected by ASO and AH titres; the former continued to be low, while the latter continued to be increased. Thus, we conclude that although the antibody responses of patients with ARF and AGN are similar in Trinidad, skin infections are associated with AGN but not with ARF and the nephritogenic and rheumatogenic streptococcal strains are different (AU)