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1.
Am J Trop Med Hyg ; 102(2): 377-383, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31889507

RESUMEN

Pharyngitis is usually caused by a viral infection for which antibiotics are often unnecessarily prescribed, adding to the burden of antimicrobial resistance. Identifying who needs antibiotics is challenging; microbiological confirmation and clinical scores are used but have limitations. In a cross-sectional study nested within a randomized controlled trial, we estimated the prevalence and antibiotic susceptibility profiles of group A Streptococcus (GAS) in patients presenting to primary care with a sore throat and fever in northern Thailand. We then evaluated the use of C-reactive protein (CRP) and clinical scores (Centor and FeverPAIN) to identify the presence of GAS. One hundred sixty-nine patients were enrolled, of whom 35 (20.7%) had ß-hemolytic Streptococci (BHS) isolated from throat swab culture, and 11 (6.5%) had GAS. All GAS isolates were sensitive to penicillin G. The median CRP of those without BHS isolation was 10 mg/L (interquartile range [IQR] ≤ 8-18), compared with 18 mg/L (IQR 9-71, P = 0.0302) for those with GAS and 14 mg/L (IQR ≤ 8-38, P = 0.0516) for those with any BHS isolated. However, there were no significant relationships between CRP > 8 mg/L (P = 0.112), Centor ≥ 3 (P = 0.212), and FeverPAIN ≥ 4 (P = 1.000), and the diagnosis of GAS compared with no BHS isolation. Identifying who requires antibiotics for pharyngitis remains challenging and necessitates further larger studies. C-reactive protein testing alone, although imperfect, can reduce prescribing compared with routine care. Targeted CRP testing through clinical scoring may be the most cost-effective approach to ruling out GAS infection.


Asunto(s)
Proteína C-Reactiva/metabolismo , Atención Primaria de Salud , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/aislamiento & purificación , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/patología , Tailandia/epidemiología , Adulto Joven
2.
Orv Hetil ; 160(48): 1887-1893, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31760775

RESUMEN

Streptococcal toxic shock syndrome (STSS) is a hyperacute, life-threatening illness, a complication of invasive streptococcal (mostly group A, rarely groups B, G or C) infection. There is no portal of entry (skin, vagina, pharynx) in nearly half of the STSS cases. The initial signs and symptoms (fever, flu-like complaints, hypotension) are scarce and aspecific, but because of its rapid progression and poor prognosis, early high level of suspicion is necessary. Management has 3 crucial points: initiation of anti-streptococcal regimen (and intravenous immunoglobulin in some cases), aggressive intensive care support of multi-organ failure, and surgical control of the infective source. In this article, we present a case of a patient succumbing to streptococcal toxic shock syndrome which was preceded by primary S. pyogenes bacteremia, and review the key points of this potentially fatal disease for practising clinicians. Orv Hetil. 2019; 160(48): 1887-1893.


Asunto(s)
Choque Séptico/microbiología , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Choque Séptico/complicaciones , Infecciones Estreptocócicas/complicaciones
3.
An. pediatr. (2003. Ed. impr.) ; 91(5): 286-295, nov. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-186766

RESUMEN

Introducción: La enfermedad invasiva por Streptococcus del grupo A (EISGA) es una infección grave en niños, habiéndose comunicado un aumento de incidencia en los últimos años. Objetivo: Evaluar las características y evolución de la EISGA en niños y determinar cambios en la incidencia o gravedad. Material y métodos: Estudio retrospectivo de niños ≤ 16 años evaluados en un hospital terciario pediátrico de Madrid y diagnosticados de EISGA (junio 2005-julio 2013). Se analizó la epidemiología, clínica, microbiología y tratamiento, evaluándose cambios a lo largo del periodo estudiado y parámetros asociados a gravedad. Resultados: Se incluyeron 55 niños con EISGA; 33 (60%) mujeres, con una mediana de 48,5 (20,5-88,9) meses. Los síndromes clínicos más frecuentes fueron celulitis/absceso subcutáneo (21,8%), absceso ORL (20%), neumonía (16,4%), infección osteoarticular (16,4%) y mastoiditis (12,7%). La incidencia de EISGA (casos/105 urgencias/año) aumentó de 5,6 (4,2-7,2) entre junio 2005-mayo 2009 a 18,9 (15,1-26) entre junio 2009-mayo 2013; p = 0,057. El 63,6% (n = 35) y el 18,2% (n = 10) de los pacientes precisaron cirugía e ingreso en UCIP, respectivamente. Los niños en UCIP fueron más pequeños (26,5 vs. 52,6 meses; p = 0,116), presentaron proteína C reactiva más elevada (24,5 vs. 10,7 mg/dl; p < 0,001) y mayor frecuencia de neumonía (60 vs. 7%; p < 0,001). En el análisis multivariante solo la proteína C reactiva fue factor de riesgo de ingreso en UCIP (OR: 1,14 [1,004-1,286]; p = 0,04). No hubo secuelas. Conclusiones: Se objetivó un aumento de la incidencia de EISGA en niños en nuestro medio, siendo la menor edad, la presencia de neumonía y la proteína C reactiva elevada los parámetros asociados a gravedad en esta serie


Introduction: Invasive group A streptococcal disease (iGASD) is a serious infection in children. Several studies have shown an increased incidence in the past years. Objective: To evaluate the characteristics and outcome of iGASD in children, and to determine changes in incidence or severity. Material and methods: A retrospective study was conducted on children ≤ 16 years evaluated in a tertiary paediatric hospital in Madrid, and diagnosed with iGASD (June 2005-July 2013). An analysis was made of the demographics, symptomatology, microbiology, and treatment. The changes throughout the period studied were evaluated, as well as parameters associated with disease severity. Results: The study included a total of 55 children with iGASD, with 33 (60%) females, and a median age of 48.5 (20.5-88.9) months. The most frequent clinical syndromes were cellulitis/subcutaneous abscess (21.8%), ENT abscess (20%), pneumonia (16.4%), osteoarticular infection (16.4%), and mastoiditis (12.7%). The incidence of iGASD (cases/105 emergencies/year) increased from 5.6 (4.2-7.2) between June 2005-May 2009 to 18.9 (15.1-26) between June 2009-May 2013; P = .057. Surgery and admission to PICU was required by 35 (63.6%) and 10 (18.2%) patients, respectively. Children in PICU were younger (26.5 vs 52.6 months, P = .116), had a higher C-reactive protein (24.5 vs 10.7 mg/dl, P < .001) and higher frequency of pneumonia (60 vs 7%, P < .001). In the multivariate analysis, only C-reactive protein was a risk factor for admission to PICU (OR: 1.14 [1.004-1.286], P = .04). There were no sequelae. Conclusions: An increased incidence of iGASD was observed in the children in this study. Lower age, pneumonia, and higher C-reactive protein were associated with disease severity in this series


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Streptococcus pyogenes/aislamiento & purificación , Infecciones Estreptocócicas/epidemiología , Pronóstico , Infecciones Estreptocócicas/microbiología , Estudios Retrospectivos , Proteína C-Reactiva , Factores de Riesgo , Clindamicina/administración & dosificación , Macrólidos/administración & dosificación
5.
J Low Genit Tract Dis ; 23(4): 287-289, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31592977

RESUMEN

OBJECTIVES: Group A streptococcus (GAS) vulvitis is rare, mainly reported in association with vaginitis. We examined the clinical features of GAS vulvitis in adults, the presence of other infected sites, and its association with dermatological conditions. MATERIALS AND METHODS: We retrospectively analyzed the medical files and photographs of adult patients with bacteriologically confirmed GAS vulvitis seen at 3 private clinics. Coexisting infected sites, associated dermatological conditions, and bacteriological results for the husbands of 3 patients were examined. RESULTS: Nineteen patients (mean age = 52.2 [range = 23-83] years) with vulvar GAS infections were identified. The vulvar symptoms consisted of pain (11 cases), pruritus (9), burning (4), and discharge (10). The predominant physical feature was bilateral erythema, mainly located on the labia minora and the inner aspect of the labia majora. This erythema was associated with oozing (3), edema (6), or fissures (6). Seventeen patients had an associated vaginal infection, which was asymptomatic in 7 cases; anal infections were present in 9 cases. The following 10 patients had associated dermatological conditions: psoriasis (6), lichen sclerosus (2), Paget disease (1), or vitiligo (1). Two (one each from the throat and penis) of the 3 bacteriological specimens taken from the 3 husbands were GAS positive. CONCLUSIONS: In most adult women, GAS vulvitis is associated with a vaginal infection that may be asymptomatic. A bilateral, oozing, and edematous or fissured erythema involving the vulvar or anovulvar area is suggestive of GAS vulvitis. The association with psoriasis and the benefits of screening household members and sexual partners deserves further attention.


Asunto(s)
Psoriasis/complicaciones , Infecciones Estreptocócicas/patología , Streptococcus pyogenes/aislamiento & purificación , Vulvitis/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Estreptocócicas/microbiología , Vulvitis/microbiología , Adulto Joven
6.
BMC Infect Dis ; 19(1): 850, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615449

RESUMEN

BACKGROUND: To determine, from October 2010 to October 2018, the epidemiology of Deep Neck Infections (DNIs), regarding the detection, the identification and the susceptibility to antimicrobials of causative microorganisms, in Thessaly-Central Greece. METHODS: An analysis of data from a prospective database was conducted on 610 consecutive patients with DNIs treated in the Otolaryngology / Head & Neck Surgery Department of University Hospital of Larissa. Demographics, clinical features and microbiological data were analyzed. RESULTS: Among the 610 patients (1,9/1 male to female ratio, mean age: 39,24 ± 17,25) with DNIs, 579 had a single space (94,9%), while the remaining 31 had a multi-space (5,1%) DNI. The most common areas affected were the peritonsillar space (84,6%) followed by the submandibular space (6,5%). Clinical samples were obtained from 462 patients, and were tested by culture and by the application of 16S rRNA PCR. Two hundred fifty-five samples (55,2%) gave positive cultures, in which Streptococcus pyogenes and Staphylococcus aureus were predominant. The application of the 16S rRNA PCR revealed that 183 samples (39,6%) were positive for bacterial DNA; 22 of them, culture negative, were found to be positive for anaerobic (Fusobacterium necrophorum, Actinomyces israellii etc) and for fastidious microorganisms (Brucella mellitensis, Mycobacterium avium). CONCLUSION: DNIs represent a medical and surgical emergency and evidence-guided empirical treatment with intravenous infusion of antibiotics at the time of diagnosis is mandatory, highlighting the importance of epidemiological studies regarding the causative microorganisms. Although, in our study, the predominant pathogens were S. pyogenes and S. aureus, the combination of culture and molecular assay revealed that anaerobic bacteria play also a significant role in the pathogenesis of DNIs. Based on the local epidemiology, we propose as empirical therapy the intravenous use of a beta-lactam /beta-lactamase inhibitor; metronidazole or clindamycin can be added only in specific cases such as in immunocompromised patients.


Asunto(s)
Antiinfecciosos/farmacología , Bacteriemia/diagnóstico , Bacterias/efectos de los fármacos , Cuello/microbiología , Absceso/diagnóstico , Absceso/microbiología , Adulto , Bacteriemia/epidemiología , Bacteriemia/microbiología , Bacterias/aislamiento & purificación , Femenino , Grecia/epidemiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , ARN Ribosómico 16S/metabolismo , Estudios Retrospectivos , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Streptococcus pyogenes/efectos de los fármacos , Streptococcus pyogenes/genética , Streptococcus pyogenes/aislamiento & purificación
7.
Am Surg ; 85(10): 1175-1178, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657319

RESUMEN

Early surgical intervention decreases mortality in necrotizing soft tissue infections (NSTIs). Yet, a subset of patients will not have NSTIs (non-NSTIs) at the time of exploration. We hypothesized that NSTI and non-NSTI patients had similar causative organisms and that intraoperative wound cultures could help guide management. Culture results and outcomes were compared for all patients undergoing surgery for suspected NSTIs over a seven-year-period. Of 295 patients, 240 (81.4%) had NSTIs. Of the 55 non-NSTI patients (18.6%), 50 had cellulitis and 5 had abscesses. NSTI and non-NSTI patients had similar rates of bacteremia (20.4% vs 17.6%, P = 0.66), septic shock (15.9% vs 12.7%, P = 0.68), and mortality (10.4% vs 7.2%, P = 0.62). Wound cultures were collected more often in NSTI patients (229/240, 95.4%) than in non-NSTI patients (42/55, 76.4%, P < 0.01). Non-NSTI patients had positive deep wound cultures more than half of the time (23/42, 54.8%). The microbiologic profile was similar between groups, with Methicillin Resistant Staphylococcus aureus and Group A Streptococcus occurring with the same frequency. We advocate for deep wound cultures in all patients being evaluated operatively for NSTIs even if the exploration is considered negative because these patients have similar clinical characteristics and virulent microbiology, and culture results can help guide antimicrobial therapy.


Asunto(s)
Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/cirugía , Absceso/epidemiología , Absceso/microbiología , Adulto , Bacteriemia/epidemiología , Técnicas Bacteriológicas , Celulitis (Flemón)/epidemiología , Celulitis (Flemón)/microbiología , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Necrosis/microbiología , Estudios Retrospectivos , Choque Séptico/epidemiología , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/patología , Streptococcus pyogenes/aislamiento & purificación
8.
Rev. pediatr. electrón ; 16(3): 2-11, oct. 2019. tab
Artículo en Español | LILACS | ID: biblio-1046276

RESUMEN

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


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Infecciones de los Tejidos Blandos/patología , Infecciones de los Tejidos Blandos/terapia , Fascitis Necrotizante/patología , Fascitis Necrotizante/terapia , Staphylococcus aureus/aislamiento & purificación , Streptococcus pyogenes/aislamiento & purificación , Infecciones de los Tejidos Blandos/cirugía , Infecciones de los Tejidos Blandos/microbiología , Fascitis Necrotizante/cirugía , Fascitis Necrotizante/microbiología , Atención Perioperativa , Desbridamiento , Escherichia coli/aislamiento & purificación , Antibacterianos/uso terapéutico
9.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31511313

RESUMEN

BACKGROUND: Although pharyngitis is common, group A Streptococcus is an uncommon etiology, and sequelae are rare in patients <3 years old. Inappropriate testing leads to increased cost of health care and unnecessary exposure to antibiotics. Rapid streptococcal tests (RSTs) for group A Streptococcus pharyngitis are not routinely indicated in this age group. At our urban, tertiary pediatric emergency department (ED), on average, 20 RSTs were performed each month for patients <3 years of age. Our objective was to reduce RSTs in the ED in patients aged <3 years by 50% in 18 months. METHODS: We initiated this project in October 2016 at an urban, tertiary pediatric ED. We surveyed pertinent multidisciplinary stakeholders to identify factors leading to RSTs in children <3 years of age. We conducted multiple interventions and collected weekly data on the number of RSTs in children aged <3 years (outcome measure) and the number of family complaints and return visits for complications of pharyngitis (balancing measure). We used statistical process control for analysis. RESULTS: The mean number of RSTs ordered per month in patients aged <3 years declined by 52% in 10 months. The majority of tests during the study phase were ordered by nurse practitioners (62%) for patients aged 25 to 36 months (66%). There has been 1 family grievance and no patient complications attributable to the project. CONCLUSIONS: Our interventions led to a successful and sustained reduction of RSTs in patients aged <3 years. A local clinical practice guideline was developed, and the project was expanded to other acute care settings.


Asunto(s)
Servicio de Urgencia en Hospital , Pruebas de Sensibilidad Microbiana/estadística & datos numéricos , Faringitis/microbiología , Infecciones Estreptocócicas/diagnóstico , Procedimientos Innecesarios , Preescolar , Sistemas de Apoyo a Decisiones Clínicas , Registros Electrónicos de Salud , Femenino , Humanos , Capacitación en Servicio , Masculino , Missouri , Streptococcus pyogenes/aislamiento & purificación
10.
J Med Microbiol ; 68(10): 1540-1543, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31483245

RESUMEN

Four group A streptococcus (GAS) bacteraemia occurred in a small burn unit within 2 weeks. The GAS patient isolates, characterized as emm89, shared the same PFGE pulsotype with two other strains isolated 2 months later. The outbreak investigation revealed that a nurse was the most likely source of GAS transmission, as she was confirmed to carry the same outbreak strain in her throat and had direct and regular contact with the six outbreak patients in the unit. The outbreak was controlled after the nurse had undergone eradication treatment. This report highlights the emergence of the emm89 clone and its capacity to elicit invasive GAS outbreaks.


Asunto(s)
Unidades de Quemados/estadística & datos numéricos , Infección Hospitalaria/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/aislamiento & purificación , Adulto , Bacteriemia/epidemiología , Bacteriemia/microbiología , Proteínas de la Membrana Bacteriana Externa/genética , Proteínas de la Membrana Bacteriana Externa/metabolismo , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Femenino , Humanos , Persona de Mediana Edad , Epidemiología Molecular , Infecciones Estreptocócicas/epidemiología , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/genética , Túnez , Adulto Joven
11.
Int J Pediatr Otorhinolaryngol ; 127: 109666, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31491733

RESUMEN

BACKGROUND: Bacterial etiologic data for acute otitis media (AOM) otopathogens in Poland are scarce. The aim of this study was to determine the bacterial etiology and antibiotic susceptibility patterns of otopathogens in children prior to the introduction of the pneumococcal conjugated vaccine (PCV) into the national immunization program (NIP) in Poland. METHODS: Demographic and laboratory data of children < 5 years old who underwent tympanocentesis due to AOM in Nieklanska Hospital Warsaw between 2010 and 2016, were collected. All middle ear fluids (MEF) cultures were processed at the hospital according to conventional culture methods. RESULTS: Out of 940 MEF cultures, 407 (43.3%) were positive for 419 isolates. The most common etiologies of positive cultures were: S. pneumonaie, nontypeable H. infuenzae (NTHi), and S. pyogenes. Children aged 12-23 months had significantly more S. pneumoniae and NTHi positive cultures than children <12 months of age. S. pneumoniae isolates non-susceptible to penicillin, erythromycin, and clindamycin, declined over the study period (2010-2016). CONCLUSIONS: This is the largest dataset of MEF isolates from AOM patients in Poland, collected during the pre-PCV period. These data can help determine the appropriate treatment for AOM patients and can serve as a baseline for the period before the introduction of PCV to the NIP in Poland.


Asunto(s)
Haemophilus influenzae/aislamiento & purificación , Otitis Media/microbiología , Vacunas Neumococicas , Streptococcus pneumoniae/aislamiento & purificación , Streptococcus pyogenes/aislamiento & purificación , Factores de Edad , Antibacterianos/farmacología , Preescolar , Haemophilus influenzae/efectos de los fármacos , Humanos , Programas de Inmunización , Lactante , Pruebas de Sensibilidad Microbiana , Infecciones Neumocócicas/prevención & control , Polonia , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pyogenes/efectos de los fármacos , Vacunas Conjugadas
12.
Diagn Microbiol Infect Dis ; 95(3): 114866, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31473033

RESUMEN

We compared three commercially available group A Streptococcus (GAS) nucleic acid amplification tests, the Quidel Solana GAS assay, the Luminex Aries Group A Strep assay and the Focus Diagnostics Simplexa Group A Strep Direct assay, with GAS bacterial culture. A true positive result was defined as one positive by culture or positive by ≥2/3 molecular methods. Two hundred eighty-seven throat swabs (207 children, 80 adults) were collected. The sensitivity of culture was 84.8% (95% CI 77.7-90.3%) with a specificity of 100% (95% CI 97.5-100%). The Solana assay sensitivity was 94.2% (95% CI 88.9-97.5%) with a specificity of 98.7% (95% CI 95.2-99.8%). Simplexa assay sensitivity was 99.3% (95% CI 96.0-99.9%) with a specificity of 95.3% (95% CI 90.6-98.1%). Aries assay sensitivity was 96.4% (95% CI 91.8-98.8%) with a specificity of 98.0% (95% CI 94.2-99.6%). In summary, all the molecular methods evaluated showed high sensitivity and specificity and were more sensitive than culture.


Asunto(s)
Técnicas Bacteriológicas/métodos , Técnicas de Diagnóstico Molecular/métodos , Faringe/microbiología , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Adulto , Niño , Humanos , Técnicas de Amplificación de Ácido Nucleico , Sensibilidad y Especificidad , Infecciones Estreptocócicas/microbiología
13.
Clin Rev Allergy Immunol ; 57(2): 294-302, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31392657

RESUMEN

Streptococcus A infections have been associated with immune-mediated sequelae including acute glomerulonephritis, acute rheumatic fever, thrombocytopenia, hemolytic anemia, Henoch-Schönlein purpura, arthritis, uveitis, guttate psoriasis, and erythema nodosum. Available reviews do not report the occurrence of acute poststreptococcal glomerulonephritis in association with one of the mentioned conditions. We performed a systematic review of the literature on extrarenal immune-mediated disorders associated with acute poststreptococcal glomerulonephritis. The principles recommended by the Economic and Social Research Council guidance on the conduct of narrative synthesis and on the Preferred Reporting Items for Meta-Analyses and Systematic Reviews were used. We identified 41 original articles, published after 1965, which reported on 52 patients (34 males and 18 females aged from 1.7 to 57 years, median 9) affected by acute poststreptococcal glomerulonephritis associated with a further poststreptococcal disease: 29 cases with rheumatic fever (17 males and 12 females aged 3.0 to 57, median 17 years), 16 with hematologic diseases such as thrombocytopenia or hemolytic anemia (13 males and 3 females aged 1.8 to 13, median 6.0 years) and seven with Henoch-Schönlein syndrome, reactive arthritis or uveitis (4 males and 3 females aged 1.7 to 14, median 7.0 years). Patients affected by acute poststreptococcal glomerulonephritis associated with acute rheumatic fever were on the average older (P < 0.05) than patients with acute poststreptococcal glomerulonephritis associated with thrombocytopenia, hemolytic anemia, Henoch-Schönlein syndrome, reactive arthritis or uveitis. Five large case series describing 2058 patients affected by acute poststreptococcal glomerulonephritis did not mention its occurrence in association with further immune-mediated disorders. This systematic review points out that acute poststreptococcal glomerulonephritis can be associated, albeit rarely, with rheumatic fever, thrombocytopenia, hemolytic anemia, Henoch-Schönlein syndrome, reactive arthritis, or uveitis.


Asunto(s)
Anemia Hemolítica/epidemiología , Artritis Reactiva/epidemiología , Glomerulonefritis/epidemiología , Púrpura de Schoenlein-Henoch/epidemiología , Fiebre Reumática/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/aislamiento & purificación , Trombocitopenia/epidemiología , Uveítis/epidemiología , Enfermedad Aguda , Adolescente , Adulto , Niño , Preescolar , Comorbilidad , Femenino , Glomerulonefritis/microbiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven
14.
Microbiol Immunol ; 63(10): 413-426, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31403217

RESUMEN

Streptococcus pyogenes is a causative agent of streptococcal toxic shock syndrome (STSS). The complete genome sequence of a S. pyogenes strain 10-85 isolated from a STSS patient was recently announced. In this study, the genome sequence was dissected and it was found that the genomic region around 200 kbp (region A) and the genomic region around 1600 kbp (region B) were replaced by each other in strain 10-85, when compared with those in reference strains SF370 and A20. In order to address whether this replacement is unique to 10-85, we further analyzed 163 emm1-type strains. The results indicated that none of the strains isolated before 1990 had the replacement. In contrast, most of the strains isolated at least after 2000 appeared to have the 10-85-type replacement.


Asunto(s)
ADN Bacteriano/genética , Genoma Bacteriano/genética , Choque Séptico/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/genética , Secuencia de Bases , Humanos , Prevalencia , Streptococcus pyogenes/aislamiento & purificación
15.
Pediatr Emerg Care ; 35(8): e138-e140, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31373950

RESUMEN

Necrotizing soft tissue infections are a serious medical emergency that involve necrosis within the soft tissue space including the dermis, subcutaneous tissue, superficial fascia, deep fascia, and muscle. Inciting factors include recent varicella infection, omphalitis, trauma, intramuscular injections, perianal trauma, and surgery. Unlike adult cases, children presenting with necrotizing soft tissue infections are more likely to be immunocompetent and without underlying chronic illnesses. Although rare in children, familiarity with the clinical manifestations of necrotizing soft tissue infections is essential for early diagnosis and surgical debridement, as significant mortality is associated with advanced disease.


Asunto(s)
Fascitis Necrotizante/diagnóstico , Infecciones de los Tejidos Blandos/etiología , Streptococcus pyogenes/aislamiento & purificación , Antibacterianos/uso terapéutico , Desbridamiento , Diagnóstico Precoz , Servicio de Urgencia en Hospital , Fascitis Necrotizante/patología , Fascitis Necrotizante/terapia , Femenino , Humanos , Lactante , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/terapia , Resultado del Tratamiento
18.
J Hosp Infect ; 103(1): 21-26, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31283948

RESUMEN

BACKGROUND: Whole genome sequencing (WGS) of Streptococcus pyogenes linked to invasive disease has been used to identify and investigate outbreaks. The clinical application of WGS in real-time for outbreak control is seldom employed. AIMS: A fatal case of bacteraemia at a national orthopaedic hospital prompted an outbreak investigation to identify carriers and halt transmission using real-time WGS. METHODS: Retrospective surveillance was conducted to identify patients with Streptococcus pyogenes infections in the last year. Upon contact tracing, four patients and 179 staff were screened for Streptococcus pyogenes carriage. All isolates identified were emm-typed. WGS was performed in real-time on a subset of isolates. FINDINGS: Twelve isolates of Streptococcus pyogenes from the index case, two patients and eight staff were identified. Six isolates were emm 1.0, including the index case and five staff isolates. The remaining isolates belonged to distinct emm types. WGS analysis was undertaken on the six emm 1.0 isolates. Five were indistinguishable by single nucleotide polymorphism (SNP) analysis, with 0 SNP distance, and one had one SNP difference, supporting the hypothesis of recent local transmission. All screen-positive healthcare workers were offered treatment with penicillin or clindamycin. No further cases were identified. CONCLUSION: The increased molecular discrimination of WGS confirmed the clustering of these cases and the outbreak was contained. This demonstrates the clinical utility of WGS in managing outbreaks of invasive Streptococcus pyogenes in real-time and we recommend its implementation as a routine clinical service.


Asunto(s)
Bacteriemia/epidemiología , Portador Sano/epidemiología , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Infecciones Estreptocócicas/epidemiología , Streptococcus pyogenes/clasificación , Secuenciación Completa del Genoma/métodos , Bacteriemia/microbiología , Portador Sano/microbiología , Portador Sano/transmisión , Infección Hospitalaria/microbiología , Infección Hospitalaria/transmisión , Transmisión de Enfermedad Infecciosa/prevención & control , Hospitales , Humanos , Epidemiología Molecular/métodos , Tipificación Molecular/métodos , Estudios Retrospectivos , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/transmisión , Streptococcus pyogenes/genética , Streptococcus pyogenes/aislamiento & purificación
19.
BMC Infect Dis ; 19(1): 633, 2019 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-31315580

RESUMEN

BACKGROUND: Group A Streptococcal (GAS) infections cause the autoimmune disease acute rheumatic fever (ARF), which can progress to chronic rheumatic heart disease (RHD). Treating pharyngitis caused by GAS with antibiotics is important in preventing ARF. However, it is difficult to distinguish these infections from GAS carriers. There is growing evidence for GAS skin infections as a cause of ARF. This study will identify the incidence of true GAS pharyngitis and serological responses to GAS skin infections. The effectiveness of antibiotics for these conditions will be explored, and modifiable risk factors. Serum antibody titres indicating the upper limits of normal (ULN for ASO/ADB antibodies) will be established alongside carriage rates in asymptomatic children. METHODS: This is a prospective disease incidence study, with an associated case-control study. The study population includes 1000 children (5-14 years) from Auckland, New Zealand, 800 of whom have visited their healthcare professional, resulting in a throat or skin swab for GAS, and 200 who are asymptomatic. The conditions of interest are GAS throat swab positive pharyngitis (n = 200); GAS carriage (n = 200); GAS negative throat swab (n = 200); GAS skin infections (n = 200); and asymptomatic controls (n = 200). All participants, except asymptomatic controls, will have acute and convalescent serological testing for ASO/ADB titres (collected < 9 days, and 2-4 weeks following symptom onset, respectively), alongside viral PCR from throat swabs. Asymptomatic controls will have ASO/ADB titres measured in one blood specimen and a throat swab for microbial culture. Caregivers of children will be interviewed using a questionnaire and any GAS isolates identified will be emm typed. The persistence of GAS antibodies will also be investigated. DISCUSSION: Findings from this study will fill critical gaps in scientific knowledge to better understand the pathophysiology of ARF, improve clinical management of GAS infections, and design more effective ARF prevention programmes. In particular it will measure the incidence of true, serologically confirmed GAS pharyngitis; assess the immune response to GAS skin infections and its role as a cause of ARF; examine the effectiveness of oral antibiotics for treating GAS pharyngitis and carriage; and identify whether risk factors for GAS infections might provide intervention points for reducing ARF.


Asunto(s)
Faringitis/microbiología , Fiebre Reumática/microbiología , Enfermedades Cutáneas Bacterianas/microbiología , Adolescente , Antibacterianos/uso terapéutico , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Incidencia , Masculino , Nueva Zelanda/epidemiología , Faringitis/tratamiento farmacológico , Faringitis/epidemiología , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Fiebre Reumática/tratamiento farmacológico , Fiebre Reumática/epidemiología , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/epidemiología , Streptococcus pyogenes/genética , Streptococcus pyogenes/aislamiento & purificación , Streptococcus pyogenes/patogenicidad
20.
Arch Pediatr ; 26(5): 298-300, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31281034

RESUMEN

Neck abscesses after a cervical trauma rarely occur, especially in children. Cervical abscesses are more generally complications of otolaryngological infections. Progression to severe complication or death may be rapid. We describe a case of a sternocleidomastoid muscle and retropharyngeal abscess that developed after a minor cervical trauma from being struck in the neck. The patient was surgically treated and received antibiotics, but returned with a recurrence of the cervical infection. We discuss the superinfection of the hematoma, cervical abscess management, and its treatment in children.


Asunto(s)
Traumatismos del Cuello/complicaciones , Absceso Retrofaríngeo/etiología , Infecciones Estreptocócicas/etiología , Streptococcus pyogenes/aislamiento & purificación , Heridas no Penetrantes/complicaciones , Niño , Terapia Combinada , Femenino , Hematoma/diagnóstico , Hematoma/etiología , Hematoma/terapia , Humanos , Músculos del Cuello/microbiología , Músculos del Cuello/patología , Absceso Retrofaríngeo/diagnóstico , Absceso Retrofaríngeo/terapia , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/terapia
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