[The significance of antistreptolysin O characteristics for the determination of indications for tonsillectomy in the children]. / Znachenie pokazatelei antistreptolizina O pri opredelenii pokazanii k tonzilléktomii u detei.

The objective of the present work was to evaluate the diagnostic significance of the measurement of the antistreptolysin O (ASLO) titers in the children presenting with chronic tonsillitis for determining the indications for tonsillectomy. The study included 54 patients at the age varying from 4 to 17 years who had undergone bilateral tonsillectomy for the treatment of chronic tonsillitis. The diagnosis was confirmed by the results of the histological study of the removed amygdalae. Prior to surgery, all the patients had been subjected to the bacteriological investigation of the smears taken from the surface of the palatal tonsils. The titers of antistreptolysin O in the serum were determined with the use of the kinetic nephelometric technique before, 6 and 12 months after the surgical intervention. The results of the measurements were treated using the Statzilla software package (version 3.2, R Foundation for Statistical Computing, Vienna, Austria). Streptococcus pyogenes (group A) was identified only in 7 (13%) patients. The initially enhanced content of ASLO ranging from 273 to 1880 IU/ml was documented in 42 (77.7%) of the 54 patients. Twelve patients had the ASLO titers within the normal limits (from 13 to 124 IU/ml). The removal of palatal tonsils resulted in a significant decrease of the ASLO titers in the patients who had presented with the initially enhanced content of antistreptolysin O (p < 0.05); nevertheless, their ASLO titers remained higher than the normal values in 69% and 82% of the patients examined within 6 and 12 months after the surgical intervention, respectively. The patients who had exhibited the high levels of antistreptolysin O during the preoperative period did not experience normalization of this parameter after surgery. It is concluded, taking into account the absence of correlation between the enhancement of serum antistreptolysin O titers and the presence of group A beta-chemolytic Streptococci (BCSA), that the result of the measurement of ASLO titers can not be considered as a valid indication for tonsillectomy in the children.

Clinical value of antistreptolysin O levels in adult patients with tonsillitis: report I.

To assess the clinical value of antistreptolysin O (ASO) level in adult patients with acute tonsillitis of group A beta-hemolytic streptococcus (GABHS) etiology and its interaction with the Centor score and throat cultures data. ASO antibody titers and throat cultures were obtained from 260 adult patients with acute tonsillitis of GABHS etiology initially proven by the Centor score. The results were compared with the group of 100 adult patients with recurrent tonsillitis who underwent tonsillectomy and with the group of 100 healthy adults. Throat cultures revealed GABHS-positive results in 69 acute cases (26.5%) and in 24 recurrent cases (24%), i.e., with no significant differences between the groups (p = 0.845). There was no significant difference between cases with GABHS-positive and with GABHS-negative throat culture in ASO titers results (mean 250 and 280, respectively, p = 0.44) but these titers were significantly higher than established normative data (p < 0.01). For the group of recurrent tonsillitis cases, the mean ASO titer was 363 being significantly higher in comparison with acute cases (p = 0.015). The ASO antibody titers are significantly higher than normative ranges in cases of acute tonsillitis in adults. The detection of the elevated titers may lead to early antibiotherapy to tonsillitis. The Centor score is supported by the ASO data and less supported by throat cultures data. Further research should reveal if these titers might have predictive value for possible further recurrence or serve as an indicator for tonsillectomy in cases of recurrent tonsillitis.

Neutrophilic figurate erythema of infancy.

We report here a new case of neutrophilic figurate erythema of infancy in a 1-year and 9-month-old white boy. Neutrophilic figurate erythema of infancy is a rare inflammatory dermatosis which is part of the figurate inflammatory dermatoses of infancy and is considered a variant of annular erythema of infancy. The disease is clinically characterized by annular erythematous lesions, sometimes with a polycyclic configuration, and histologically by a dermal neutrophilic infiltration with leukocytoclasia. Differential diagnosis mainly includes clear-cut severe diseases with a well-known etiology, such as neonatal lupus erythematosus and its variant erythema gyratum atrophicans transiens neonatale, erythema chronicum migrans and erythema marginatum rheumaticum, and diseases of unknown origin and with less clear limits, such as erythema annulare centrifugum and its variant familial annular erythema. Anamnesis, laboratory findings, clinical features, and histology allow the correct diagnosis and therefore, having excluded severe diseases, parents should be reassured as neutrophilic figurate erythema of infancy, as the annular erythema of infancy, is a benign disease, in most cases unassociated with other conditions and usually self-limiting over a few months, even though a chronic course may rarely occur. Our case was characterized by a chronic persistent course and by a complete resolution of the lesions only during febrile episodes.

Occurrence of subclinical post-streptococcal glomerulonephritis in family contacts.

OBJECTIVE: There are few data in the published literature on the occurrence of subclinical post-streptococcal glomerulonephritis. In order to estimate the incidence of subclinical disease, 75 families of index cases with sporadic clinical post-streptococcal glomerulonephritis were screened for the presence of subclinical disease. METHODS: Three hundred and seventeen family contacts were investigated 1-7 days after the admission of the index cases. The diagnosis of subclinical disease was based on the presence of abnormal urinalysis, transitory hypocomplementaemia and increased antistreptolysin O titre. RESULTS: No cases of clinical/subclinical disease were detected among 147 parents. Abnormal urinalyses were found in 22.3% of sibling contacts. The incidence of nephritis among 170 siblings was 9.4% and the calculated ratio subclinical/clinical disease was 0.11. There were 16 siblings (9.4%) whose abnormal urinalyses could not be explained by appropriate tests; 11 of them had dysmorphic microhaematuria and significantly elevated antistreptolysin O titre. CONCLUSIONS: Sibling contacts have increased risk for the development of clinical/subclinical post-streptococcal glomerulonephritis compared with their parents. Sibling contacts with unexplained urinary abnormalities might have subclinical nephritis in evolution; their complement levels normalized before occurrence of nephritis in index cases.

Elevated IgG titer against the C region of streptococcal M protein and its immunodeterminants in patients with poststreptococcal acute glomerulonephritis.

OBJECTIVE: To determine the immune responses to the streptococcal M protein in patients with poststreptococcal acute glomerulonephritis (PSAGN). STUDY DESIGN: The gene coding type 12 M protein of group A streptococcus (M12), a known PSAGN-associated serotype, was cloned and expressed in Escherichia coli to investigate the specific immune responses to the M12 protein in patients with PSAGN. Recombinant M proteins for the variable N-terminal half (AB region) and conserved C-terminal half (C region) were produced separately. IgG titers against each region were measured by enzyme-linked immunosorbent assay in patients with PSAGN (n = 51), uncomplicated streptococcal pharyngitis (n = 26), chronic glomerulonephritis (n = 10), and in healthy control subjects (n = 51). Immunodominant domains within the M protein in PSAGN were further investigated by use of overlapping synthetic peptides. RESULTS: IgG titers against the C region, but not the AB region, were markedly higher in the PSAGN group than in other groups (p < 0.01), and these titers were maintained for at least several months after antistreptolysin O or antistreptokinase levels had returned to normal. Studies with overlapping synthetic peptides demonstrated that increased IgG reactivity was observed against the C repeat blocks. CONCLUSION: IgG titers against the C region are significantly elevated in patients with PSAGN, and it may be a diagnostic marker for PSAGN.

Claritromicina versus penicilina en el tratamiento de las faringoamigdalitis por estreptococo beta hemolítico grupo A en niños / Clarithromycin versus penicillin in the treatment of group A streptococcal pharyngitis in children

La penicilina ha sido considerada el antibiótico de elección para tratar las faringoamigdalitis por EBHA. En el último tiempo se han desarrollado drogas alternativas para aquellos pacientes alérgicos a penicilina, que tengan eficacia y erradiquen el agente infeccioso. Con el objeto de probar la eficacia y la erradicación del EBHA en faringoamigdalitis aguda en niños entre 2 y 15 años, se realiza un ensayo clínico randomizado controlado en 43 niños consultantes, con diagnóstico acreditado, ingresados al servicio de urgencia del Hospital Sótero del Río. Se compara el uso de claritromicina 15 mg/K/día en dosis diarias por vía oral con penicilina 250 mg tres veces al día por vía oral. Exito clínico se encontró en 86,4 por ciento de los casos tratados con claritromicina y 85,7 por ciento en los tratados con penicilina cuya diferencia no es significativa. Tampoco se encontró diferencias entre ambas terapias respecto a erradicación bacteriológica con 86,4 por ciento en el caso de los tratados con claritromicina versus un 85,7 por ciento en los tratados con penicilina. No se observaron efectos adversos serios en ambos grupos, Este estudio sugiere que la claritromicina es igualmente efectiva y bien tolerada que penicilina para el tratamiento de faringoamigdalitis aguda por EBHA, pudiendo considerarse un antibiótico de alternativa

Recurrent juvenile dermatomyositis and cutaneous necrotizing arteritis with molecular mimicry between streptococcal type 5 M protein and human skeletal myosin.

An adult patient had a syndrome associating the features of juvenile dermatomyositis and cutaneous polyarteritis nodosa that followed a cyclic course from childhood; recurrences were always associated with a rise of serum antistreptococcal antibodies. Regions of homology between streptococcal type 5 M protein and skeletal myosin were found. These findings suggest that streptococcal infection, possibly through a molecular mimicry mechanism, played a role in the pathogenesis of the disease in our patient.

[Common cold: diagnostic steps? Antibiotics?]. / Common cold: Diagnostische Schritte? Antibiotika?

The common cold is caused by more than 100 virus types. However, the clinical manifestation is always similar with rhinorrhea, stuffiness, sneezing, pharyngitis, laryngitis and cough. The local inflammatory reactions are not due to the presence of virus but caused by locally produced inflammatory mediators. Bacterial superinfections may cause otitis or sinusitis. Bacterial nasopharyngitis has been described in children. This entity possibly exists also in adults. Traditional viral cultures are rarely positive and are not recommended in the daily routine. In children, antigen detection for adenovirus, respiratory syncytial virus, parainfluenza and influenza virus are recommended to confirm the viral etiology or for epidemiological surveillance. The presence of group-A streptococci must be proven by culture or antigen detection before treatment with penicillin. Antiviral treatment is limited to interferon or ribavirin. New antiviral substances are in development. Today, treatment of common cold is limited to symptomatic measures, and antibiotic treatment is not justified.

Verificacao dos niveis sericos de Antiestreptolisina "O" em individuos normais da grande Florianopolis / Determining titers of Antiestreptolysin \"O\" in healthy individuals in the Florianopolis area

Com o objetivo de verificar os valores de referencia para a determinacao dos niveis sericos de Antiestreptolisina "O" na regiao da Grande Florianopolis foram analisados 100 amostras de soro provenientes de individuos sadios e em bom estado nutricional. As amostras foram classificadas de acordo com a procedencia em relacao a idade e sexo, enquadrando em duas faixas etarias (15-34) e (35-50) anos. Os resultados foram processados por metodos estastisticos para a verificacao do efeito do sexo e da idade em uma das variaveis (50 unidades Todd) que comportou o maior numero de soros, nao sendo notificado alteracao em relacao a estes parametros. Na grande maioria das dosagens, 98 poe cento, os niveis sericos da Antiestreptolisina "O" determinados foram inferiores a 250 unidades Todd.

Anticuerpos antiestreptocócicos en población general: estudio comparativo en dos períodos en un servicio de salud / Streptococcal antibodies in a general population: comparative study in 2 periods in a health service

Se registraron los títulos de anticuerpos antiestreptocócios, mediante pruebas de antiestreptolisina O y antiDNAsa B en ambos sexos, por grupos de edad, en una muestra de 135 personas de la población general del servicio de salud metropolitano suroriente de la región metropolitana, Santiago, Chile. Se calculó de las muestras la media geométrica de los títulos. En el conjunto de las muestras la media geométrica de antiestreptolisina O fue 110 UT y 194 U para anti-DNAsa B. Los valores por grupos etarios para antiestreptolisina O fueron: 62 UT de 5 a 9 años; 127 UT de 10 a 14 años y 114 UT de 15 años y más. Los valores para antiDNAsa B fueron: 158 U, 240 U y 198 U en los mismos grupos, repectivamente. Los resultados obtenidos fueron comparados con un estudio similar realizado entre 1978 y 1980 en el mismo servicio, sin encontrar diferencias significativas entre ambos período, a excepción de los títulos de antiDNAsa B en el grupo de 5 a 9 años de edad que resultaron significativamente menores en el más reciente de los rastreos

Immunological abnormalities in children with acute rheumatic carditis and acute post-streptococcal glomerulonephritis.

Immunological functions were investigated in 10 children with acute rheumatic fever and 11 children with acute nephritis to try and elucidate the cause of heart damage in acute rheumatic fever. Children with acute rheumatic fever and carditis showed an increase in serum IgG, IgA and antistreptococcal antibodies during the acute stage. Lymphocyte transformation responses to phytohaemagglutinin and streptococcal antigens were reduced but this was due to a serum suppressor effect. After recovering from acute rheumatic fever a lymphocytosis and an increased lymphocyte blastogenic response to streptococcal antigen were found. T-cells, T-helper cells and T-suppressor cells showed some changes in acute rheumatic fever but these were not statistically significant in our study. None of the changes in immunological responses that were seen in acute rheumatic fever were found in acute nephritis. These results support the hypothesis that an abnormal immune response to streptococcal products is involved in the development of carditis and the other phenomena observed in acute rheumatic fever.

Títulos médios de antiestreptolisina O ALSO, em Paiçandú, Paraná, Brasil / Media O antistreptolysin titres (ALSO), in Paiçandú, Paraná, Brazil

Foi determinado o título de antiestreptolisina O no soro de 450 pacientes da cidade de Paiçandú, Estado do Paraná. Foi obtido título médio de 263 U.I./ml (média aritmética). Os maiores valores de título médio foram nas faixas etárias dos cinco aos nove e dos dez aos quatorze anos. Näo houve diferença significativa entre títulos médios de pacientes do sexo masculino e feminino. A bimodalidade (picos em 125 e 333 U.I./ml) na distribuiçäo da freqüência de títulos deverá ser objeto de novos estudos

Estimation of antistreptococcal esterase in rheumatic fever and rheumatic heart disease.

In hemolytic streptococcal infection, a high ASE value in the absence of a rise in ASO has shown to occasionally occur. The relationship between ASO and ASE titers in rheumatic fever and rheumatic heart disease and the significance of these values was therefore studied. ASE values were measured by ASE Kit "Marupi" in 8 patients during the acute stage of rheumatic fever and in 9 patients with rheumatic heart disease, and then compared with the corresponding ASO values. Among the patients with rheumatic fever, a rise of ASO only was seen in 1 patient and a rise of ASE only was seen in another. In the remaining 6 patients, both ASE and ASO were elevated. Only in 1 patient with rheumatic heart disease was ASE found to be elevated.

Clinical significance of anti-streptococcal esterase (ASE) determination in rheumatic fever and other streptococcal diseases.

Streptococcal esterase is known as one of the extracellular products of Group A streptococci. In this paper, an antibody of streptococcal esterase titers in patients with rheumatic fever, acute glomerulonephritis and other streptococcal infections were determined. In cases with acute rheumatic fever and acute glomerulonephritis, ASE titers showed almost the same changes as ASO, ASK and ADN-B. The characteristics of the ASE determination, however, is that small changes in the titers could be detected because the final definition of this titer was determined by photometer.

Study on serum antistreptococcal esterase among school children.

Antistreptococcal esterase (an antibody to extracellular esterase produced by Group A streptococci: ASE) was evaluated according to Hayano's method by using an assay kit on sera of children from two schools, one (F-school) in a non-epidemic state and the other (I-school) in an epidemic state of Group A streptococcal infection. Out of 104 children of F-school, 51 with negative throat cultures for Group A streptococci showed a mean serum ASE titer of 191 +/- 144 unit, and 53 with positive throat cultures for Group A streptococci showed a mean serum ASE titer of 360 +/- 147 unit. Follow-up determinations on serum antibodies to four Group A streptococcal antigens were performed on the children from I-school during a period of 13 months after an epidemic infection of Group A streptococci. The initially elevated serum ASE titer showed a decreasing trend on subsequent bleedings during the study period as well as antistreptolysin O (ASO) and antideoxyribonuclease B (ADN-B) titers. However, the changing pattern of the antistreptococcal polysaccharide (ASP) titer was different from that of the other three antibodies. A positive correlation was observed statistically between ASE and ASO titers, and also between ASE and ADN-B titers. The ASE tests appear to be useful for serological evidence of a streptococcal infection.

Antistreptococcal esterase distribution in healthy individuals.

The distribution of serum antistreptococcal esterase titers in healthy school children, aged 10 to 12, and in healthy adults was determined by the method used by Hayano and Tanaka. The upper limit of its normal titer value was 600 ASE units in the children and 500 ASE units in the adults, and its diagnostic levels were over 600 ASE units in children and over 500 ASE units in adults. There was no close correlation between ASE and ASO or ADN-B.