Selected bacterial recovery in Trinidadian children with chronic tonsillar disease.

Pharyngotonsillitis in children is widely treated with antibiotics. AIM: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. METHODS: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. RESULTS: Tonsils (360) yielded 800 isolates of Streptococcus spp. (51.3 per cent), Staphylococcus spp. (42.3 per cent) and Gram-negative genera (6.4 per cent). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2 per cent) than cores (63.3 per cent) grew Streptococcus spp.; a-haemolytic Streptococcus prevalence was higher (p<0.001) than B-haemolytic Streptococcus on surfaces (74.4 per cent vs. 18.6 per cent) than cores (58.9 per cent vs. 13.7 per cent). Surfaces and cores were not concordant for streptococci (p<0.0004) and   haemolytic Streptococcus (p<0.007). Surface and core B-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31 per cent and 23.8 per cent vs 12.5 per cent and 8 per cent). S. pyogenes surface and core prevalence was (84.6 per cent vs 70 per cent) and (50.0 per cent vs 25.0 per cent) in older and younger children respectively. Klebsiella spp. (6.6 per cent, 2.2 per cent), Proteus (4.4 per cent, 4.4 per cent) and Pseudomonas (4.4 per cent, 1.1 per cent) grew on surfaces and cores respectively.

Evaluation of neonatal sepsis screening in a tropical area. Part I: Major risk factors of bacterial carriage at birth in Guadeloupe

This prospective study reports on screening for neonatal sepsis among 3,372 live births out of 6,060 consecutive deliveries at the University Hospital of Pointe-a-Pitre, Guadeloupe, during a 30 month period. Group B Streptococcus (GBS) was the most common pathogen, representing 46 percent (89/194) of positive blood cultures and 52 percent (335/637) of positive gastric aspirates. Although only 3,372 (55 percent) of all live births were screened, 637 (10 percent) had gastric bacterial carriage at birth; of those, 335 (5.5 percent) involved GBS. Similarly, there were 194 (3.2 percent) positive blood cultures, of which 89 (1.5 percent) involved GBS. In this report, all newborns who presented with a positive GBS blood culture had at least one of the external tests positive for GBS (gastric, ear canal, rectum and placenta). Thirty-seven per cent (14/38) of positive neonatal blood cultures occurred in newborns with foetid liquor while in deliveries with intrapartum fever 16.5 percent (32/195) of blood cultures were positive. In our clinical practice, characteristics that were evident in the delivery room (without knowledge of prenatal follow-up) such as foetid liquor, intrapartum fever, prolonged rupture of membranes, foetal tachycardia and meconium staining were associated with the great majority of neonatal sepsis.(Au)

Human T cell lymphotropic virus (HTLV-1): cutaneous manifestations

Skin manifestations are a common feature of HTLV-1 associated disorders and of HTLV-1 infection itself. These include the lymphomatous skin infiltrates in adult T-cell lymphoma/leukaemia, most commonly manifesting as persistent, generalised papules, nodules and plaques with later ulceration, acquired ichthyosis and xeroderma in HAM/TSP, infective dermatitis of children, dermatomyositis, crusted (Norwegian) scabies, psoriasiform rashes which may precede one of the more serious disease associations, and possibly also seborrhoeic dermatitis. Disorders typically associated with immunosuppression such as disseminated herpes zoster, and ulcerative non-healing herpes simplex may also be seen occasionally both in ATK as well as in other wise asymptomatic HTLV-1 infection (AU)

New nephritogenic streptococcal serotypes during epidemic post-streptococcal acute glomerulonephritis - abstract

The increased incidence of reported scabies per 100,000 population from 24.2 in 1984 to 59.5 in 1985 led to a careful monitoring in 1986 of all patients with post-streptococcal acute glomerulonephritis (PSAGN). There were 18 cases of PSAGN, 72 of whom yield 84 streptococcal isolates, 65 of which belonged to group A. All streptococcal isolates were sent to the Central Public Health Laboratory Service, Colindale, England, for serotyping. The epidemic of PSAGN was bimodal, and the first phase (March to July) saw the advent of M-type 73 strain, one previously isolated 22 years ago by one of us (DCJB, unpublished data). Since then, there had been 2 subsequent isolates in 1978 and the reappearance of this strain appears to be associated with the first wave of the PSAGN epidemic. Another new strain, M-type 48, preceded the first phase of the epidemic and was isolated from 2 PSAGN patients. Provisional type (PT) 5757 had not previously been isolated in Trinidad. Seven patients yielded this strain which occurred during the first wave of the epidemic. Thus the first wave of the bimodal epidemic involved mainly the new serotypes M73, M48 and PT 5757 while the more intense second phase was associated mainly with M-type 55, a few of which also occurred during the first phase (AU)

Bacteriology of sickle cell leg ulcers

The bacteria isolated on aerobic and anaerobic culture were compared in 80 unilateral ulcers in patients with homozygous sickle cell (SS) disease, 62 superficial skin lesions and in 30 diabetic ulcers. In SS disaese the bacterial flora was predominantly aerobic and polymicrobial with Staphylococcus aureus, Psuedomonas aeruginosa and beta haemolytic streptococci being the major isolates. Repeat sampling of 26 ulcers over a period of 23 weeks indicated the persistence of these organisms, either singly or in combination in 21 ulcers.Although a variety of Enterobacteriaceae were recovered no single genus predominated and these organisms did not normally persist on follow up. Simultaneous swabs from bilateral ulcers revealed similar if not identical flora in most cases, indicating good predictive value of a single swab in patients with multiple ulcers. Corynebacterium diphtheriae was recovered from 8 ulcers and 4 of these strains were toxigenic. By contrast the superficial skin lesions grew mainly S. aureus and beta haemolytic streptococci, and the diabetic ulcers yielded a mixed growth of streptococci, Enterobacteriaceae and anaerobes. The recovery of known skin pathogens from most sickle cell leg ulcers, the persistence of these organisms, and the presence of associated lymphadenopathy, indicates that infection may be a significant factor in the pathology of these lesions

Tropical acute rheumatic fever and associated streptococcal infections compared with concurrent acute glomerulonephritis

Ninety-three patients with acute rheumatic fever and 195 patients with acute glomerulonephritis were observed in Trinidad during an outbreak of scabies with a high incidence of secondary streptococcal infections. Clinical and laboratory manifestations of ARF were the same as those seen in temperate zones, except that antistreptolysin O titers were less markedly increased. The patients with ARF were similar to those with AGN in respect to sex, race, location of residence, and living conditions, but were older and had markedly fewer skin infections. Currently prevalent nephritogenic streptococcal strains never were isolated from patients with ARF even when M55 streptococci appeared and led to an epidemic of AGN.(AU)

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)

Relationship of acute rheumatic fever to acute glomerulonephritis in Trinidad

The incidence of acute rheumatic fever decreased during a major epidemic of acute glomerulonephritis in Trinidad in 1965. Subsequently, several minor increases in the incidence of acute rheumatic fever have been coincident with more marked increases in the incidence of acute glomerulonephritis. The relation of streptococcal infections to acute glomerulonephritis has been studied in Trinidad for the past six years. Their relation to acute rheumatic fever also has been examined during the last year of these studies. The streptococcal strains isolated from patients with acute rheumatic fever generally have differed from those found in patients with acute glomerulonephritis. Moreover, while streptococcal skin infections have been associated with acute glomerulonephritis, no such association has been apparent with rheumatic fever. However, titers of antistreptolysin O were relatively low, while titers of antihyaluronidase were makedly increased in the patients with acute rheumatic fever, much as they have been in most patients with acute glomerulonephritis in Trinidad (AU)

Epidemic scabies and acute glomerulonephritis in Trinidad

In September, 1970, an increasing number of the patients admitted with acute glomerulonephritis to San Fernado General Hospital in Trinidad were noted to have skin lesions characteristic of scabies. á-haemolytic streptococci were isolated from these lesions and also from similar scabetic lesions in members of the patients' families, in " normal" schoolchildren, and in the general population of a small village. Concomitantly, many dogs in nephritic households, as well as others running wild, were observed to have lesions compatible with scabies from which á-haemolytic streptococci also were isolated. Sarcoptes scabiei were indentified in lesions of both patients and dogs and were morphologically indentical. After the onset of this infestation with scabies, the admission-rate of patients with acute proportions which have proved, since this study, to be the beginning of the largest epidemic of acute glomerulonephritis yet recorded in Trinidad.(AU)

Changing types of nephritogenic streptococci in Trinidad

The relation of seven different M types of streptococci to acute glomerulonephritis associated with skin lesions in South Trinidad has been studied by means of type-specific antibody assays as well as by isolation and identification of the strains. The data indicate that, one after another, five of these strains have prevailed among patients with acute glomerulonephritis during the past five years. At least three of the strains (M-types 55,49,57, and/or 60) were associated with epidemic increases in nephritis cases. The appearance of five consecutively predominant types of nephritogenic streptococci during a relatively short period of time is in contrast to the continuing prevalence of M-type 12 strains among nephritogenic streptococci primarily associated with respiratory infections in temperate zones. These observations suggest that the skin sores commonly found on children in tropical Trinidad, provide a particularly suitable environment for development of nephritogenic types. It remains to be seen whether these types will recur or whether new types will continue to emerge in Trinidad. (AU)

Osteomyelitis: A study of the aetiological agents responsible for acute osteomyelitis at the University Hospital of the West Indies, 1966-1968

It is shown from a review of 50 cases of acute osteomyelitis from 1966-68 that:- 1) Infecting organism is Staph. pyogenes (coag.+ve)-86 percent of cases. 2) They claim that no toxic effects have been observed with chlorophenicol when they use it. However, this is based on no scientific study and is in conflict with most other reports. 3) They argue that less than 5 percent of the organisms involved are sensitive to penicillin. This has shown to be a gross underestimate. 4) They argue that chloramphenicol is cheap. However, pencillin is also cheap and in any case cost of treatment must be balanced against quality of treatment. 5) Finally, they argue that chloramphentic is convenient to administer. However, convenience must also be balanced against quality of treatment and in many cases it is not known wether the chlorampheticol is taken as ordered. (Summary)

Two unusual cases of mural endocarditis, with a review of the literature

Two unusual cases of mural endocarditis are described. The first was that of a 13-year-old boy with infected burns of the legs. Autopsy revealed mural vegetations in both ventricles and cytomegalic viral inclusions were demonstrated in the vegetations, heart muscle, and endothelial cells of various organs. This appears to be the first reported case of cytomegalic inclusion viral endocarditis. A review of the literature revealed only six previous reports of cytomegalic viral myocarditis, which was also present in this case. The second case was that of a 4-year-old girl with bronchiectasis. Autopsy revealed mural vegetations in the right ventricle. Group C beta-hemolytic steptococcus was isolated from th mural vegetations, as well as from the diseased lungs. Only two previous reports of endocarditis caused by this organism are found in the literature (AU)

Streptococcal skin infections and epidemic acute nephritis in Trinidad

We have presented bacteriological evidence for an association of acute glomerulonephritis with several streptococcal strains isolated from skin lesions in Trinidad: Types 52 and 55 during the first wave and type 49 during the second wave of the 1964-65 epidemic; atypical "type 2" in a sub-epidemic rise in cases during an endemic year; type 57 during a subsequent epidemic period; and type 60 most recently. Immunological confirmation of association of these strains with acute glomerulonephritis was obtained only for type 55. Low incidence of serum type specific antibodies to types 49 and "type 2" may be attributed to their poor antigenicity. However, this is not the case with type 57. Emergence of at least five and perhaps six apparently new types of nephritogenic streptococci during a relatively short period suggests that each recurrent epidemic wave of acute nephritis is the result of a newly introduced or newly developed strain of nephritogenic streptococci. Several questions might be asked: From where do these different types come? Does a skin infection represent a particularly suitable environment for development of new streptococcal antigens? (Summary)

Acute glomerulonephritis in Trinidad: serological typing of group A streptococci

The recent epidemic of acute glomerulonephritis in Trinidad had two peaks, separated by an interval of about 6 months. Evidence is presented that there were in fact two successive but overlapping epidemics, the first due to streptococci of provisional M-type 55, and second to streptococci of M-type 49. (AU)

Characteristics of beta hemolytic streptococci associated with acute glomerulonephritis in Trinidad, West Indies

Twenty-seven strains of beta hemolytic streptococci from patients with acute glomerulonephritis and 212 strains from school children were isolated in Trinidad during an epidemic of nephritis involving over 1,000 patients. Sixty-two per cent of the 27 strains from nephritic patients and 3 strains from school children belonged to an apparently new serotype referred to here as Trinidad type A. Type-specific antibodies against this type were found in 50 per cent of 56 patients 1 to 3 months after acute glomerulonephritis. Six of the 10 remaining strains from patients with nephritis and 34 strains from school children were characterized as a second new type B. This strain contained M protein of provisional type Schoenborn isolated from pyoderma in Red Lake, Minnesota. It also contained a second antigen found in some type 41 strains of streptococci. Studies of temperate bacteriophage related to these strains suggested a possible association with nephritis in a negative way. With one exception, streptococci strains from nephritic patients were not lysogenic, while antiphage activity was observed in sera from 72 per cent of 50 patients. Moreover, 33 per cent of 86 strains from school children in areas where nephritis was occurring were lysogenic, while only 3 of 46 strains from areas without nephritis contained bacteriophage.(AU)