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phase (March to July) saw the advent of M-type 73 strain, one previously isolated 22 years ago by one of us (DCJB, unpublished data).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)

Epidemiology of AIDS and HIV infection in the Caribbean

A review of surveillance data on AIDS and HIV infection in the 18 English-speaking Caribbean countries and Suriname suggests that the epidemiologic pattern of AIDS in the Caribbean is evolving from an epidemic that began in 1983 among homosexual and bisexual males to one in which cases are increasingly resulting from hetrosexual contact, with different countries at various stages of transition. Overall, there has been a decline in many countries-19 percent of cases in the Bahamas are among children in Trinidad and Tobago, Jamaica, Antigua, St.Vincent and the Grenadines, and other countries show high HIV sero-prevalence among homosexuals (15-40 percent), prisoners (4-10 percent), prostitutes (up to 13 percent), and cocaine users (2 percent); at present, prevalence in general population continues to be low. (AU)

The prevalence of nasal carriage of streptococcus pneumoniae and haemophilus influenzae in children from birth to three years of age attending immunization clinics - abstract

The population comprised ninety-six "well" children less than three years of age attending routine immunization clinics in four health centres in the Port-of-Spain area. The aim was to determine nasal carriage levels of pneumococcus and haemophilus influenzae amongst these children. The children were "well" and had not received antibiotics within two weeks of sampling. Swab were taken, using nasal and per-nasal seabs and innoculated immediately on growth media. They were then cultured and the organisms identified and sub typed. The population had an average age of 9.6 months: 52 percent were male. Fifty-three per cent of the children had a history of having had an upper respiratory tract infection within the 2 weeks preceding the specimen collection. Positive isolation of pneumococcus was obtained in 23 percent of the children. This result is surprisingly low and contrasts with levels ranging from 48 percent in North Carolina (Lada et al, 1974), and 53 percent in Dakar, Senegal to 100 percent in Papua, New Guinea (Gratten et al, 1984). Twenty-two per cent of the children yielded positive isolates of haemophilus influenzae. This again is a surprisingly low yield level. The accuracy of these results needs confirmation or refutation by further studies. Furthermore, the presence of other organisms, which could perhaps be the dominant organisms and which were not specifically cultured for in this study, needs to be considered (AU)

Beta-Haemolytic group G. streptococci in Trinidad

During January to March, 1982, the throats of 175 apparently healthy school children, age range 5 - 11 years, were swabbed and examined for the presence of beta-haemolytic streptococci as a prerequisite to the determination of the immune response to streptococcal antigens in normal children.j There were 68 isolates comprising 39 belonging to Group A, 1 to Group B, 4 to Group C and 24 to Group G. This high rate of Group G colonisation was surprising. Subsequent examination of past record showed that of 114 throat swabs of apparently healthy school children taken in 1967, 36 yield streptococcal isolates of which 4 belonged to Group G. Of 199 cultures from skin lesions, 166 yielded streptococcal isolates of which 4 belonged to Group G but 2 of which were of mixed culture with Group A. These observations led to a review of cases of post streptococcal sequelae, acute rheumatic fever (ARF) and acute glomerulonephrotos (AGN) which occurred at the General Hospital, San Fernando, between January 1976 and July 1980 during which time all bacitracin positive streptococcal isolates from patients with post streptococcal sequelae were sent to the Public Health Laboratory, Colindale, England for grouping and typing. Of 1,073 isolates, 958 belonged to Group A, 18 to Group B, 19 to Group C, 5 to Group D and 63 to Group G. Of the 63 Group G isolates, one was isolated from the throat of a patient with ARF and 8 from siblings of ARF patients. More interestingly, there were 7 Group G isolates from skin lesions on patients with AGN and 47 from siblings of AGN patients. Though Group G streptococci have been associated with pharyngitis, neonatal sepsis and suspected gonococcal infections, this is the first report of a possible Group G associated post streptococcal acute glomerulonephritis (AU)

Surgical wound infection in an orthopaedic patient population - abstract

A pilot prospective study of surgical wound infection was undertaken on the orthopaedic wards at the Port of Spain General Hospital. Patients enrolled in the study were admitted to hospital either for surgical intervention in traumatic orthopaedic injuries or for elective orthopaedic surgery. All surgical procedures were performed in theatre. Swabs for aerobic bacteriology were taken at the time of operation and again at least once thereafter within a period of two weeks. Laboratory methods were suitable for anaerobic organisms as well; however the swab method of culturing is relatively unsuitable and no anaerobes were recovered. Incisions were regularly inspected for signs of infection, which was defined as the presence of pus; however, swabs were taken whether or not infection supervened. Of twenty-two patients enrolled to date, seventeen had traumatic injuries and five had elective surgery. Of the patients with traumatic injuries four (23 percent) developed surgical wound infection, while one (20 percent) of the patients admitted for elective surgery developed infection. This patient had incision and drainage of an osteomyelitic abscess. Of the swabs taken in theatre, 61 percent were either sterile or showed minimal growth of saprophytic organisms while 37 percent revealed organisms which were potentially pathogenic. Culture results for the post-operative wound swabs revealed a variety of organisms including Staphylococcus aureus, E. coli and Enterobacter aerogenes. A common feature of all isolates was in vitro resistance to the antibiotics frequently used for surgical wound prophylaxis. We conclude from this preliminary study that in this population of orthopaedic patients that the organisms causing wound infection cannot be reliably detected by taking cultures at the time of operation in theatre and that organisms isolated from wounds after surgery show a high degree of antibiotic resistance whether or not infection is present (AU)

A new antibiotic resistant strain of salmonella typhimurium isolated from cases of gastroenteritis at Port of Spain General Hospital - abstract

During January - 22nd November, 1979, CAREC reported 51 isolates were recovered during the months of October and November. Sensitivity testing against 11 antibiotics showed that 88 percent of the organisms were sensitive to Polymyxin B, and that 76 percent were sensitive to Cephalothin as well. In some cases 100 percent of the organisms were resistant to antibiotics such as Sulphadiazine, Chloramphenicol, Kanamycin, and Ampicillin, and 98 percent were resistant to Streptomycin and Ampicillin. With respect to Gentamicin, of the 27 cases of Salmonella typhimurium seen 12 percent were sensitive, 40 percent were resistant, and 48 percent were classified as Intermediate to this antibiotic. In contrast, during 1978 100 percent of S. typhimurium isolates were sensitive to Gentamicin. Epidemiologically, it was thought that most of the cases occurring in October and November were nosocomially transmitted, and the results of serial specimens from patients admitted to that Ward gave supportive evidence of cross-infection. Preliminary investigations have shown the emergence of a new strain of S. typhimurium with a wide spectrum of antibiotic resistance, unlike any previous strain occurring in the community (AU)

Salmonella in wildlife from Trinidad and Grenada, W.I

Forty-four of 219 animals from Trinidad and Grenada, W.I., yielded 20 serotypes of Salmonella, 16 of which are known to have been associated with human infection in the United States in recent years. Toads (Bufo marinus) provided the greatest number of isolates. Other carriers were mammals, vultures, lizards, a treefrog and a cave cockroach.(AU)

Streptococcal pyoderma and acute nephritis in Trinidad

Following the major epidemic of acute glomeronephritis in Trinidad in 1964 and 1965, streptococcal skin infection was studied among school children. Infection was found on 1.5 percent of the children in an urban school. Simultaneous infections with more than one strain of Streptococcus pyogenes were found in some children, and also the replacement of one strain by another between weekly swabbings. Skin infection was more prevalent at a rural school (15 percent). In a year-long study the frequency of infection was found to be related to poverty, and to age and sex, diminishing with increasing age more rapidly in females than in males. The average for the school was one new streptococcal infection per child per 10 weeks. Spread was usually from skin to skin, possibly assisted by non-biting Hippelates flies; involvement of nose or throat was commonly secondary to skin infection (Summary)

Hippelates flies and streptococcal skin infection in Trinidad

An epidemic of acute glomerulonephritis in Trinidad led to an investigation into strepococcal skin infection, as most nephritis cases were asssociated with this. Hippelates in this region commonly feed on skin lesions, infected or otherwise. Some of these flies captured in the vinicity of infected children were found to be contaminated with Streptococcus pyogenes; 3 species were involved, H. peruanus, H. flavipes and H. currani. The naturally-acquired infection lasted for 28 hours or more, and the flies would return to human bait while still infectious. The Hippelates population and the streptococcal skin infection rate at one school showed similar changes. Hippelates probably contribute to the rapid spread of streptococci throughout the island, and to the frequency of infection with more than one serotype; they may also contribute to the high incidence of streptococcal skin infection, but this requires further evidence. (AU)

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)

Epidemic and endemic pattern of childhood nephritis: pathogenesis, epidemiology and clinical course of outbreaks in Trinidad

More than 800 children with acute glomerulonephritis were admitted to one hospital in Trinidad during three and one-half years. In the first 15 months the disease was epidemic. The illness affected chiefly the children of the rural poor, with the most cases attributable to streptococcal infection of the skin rather than of the respiratory tract. In signs, symptoms and clinical course, the disease in Trinidad resembles closely the acute glomerulonephritis which follows streptoccocal pharyngitis in temperate climates. (AU)