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)

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)

Epidemiology of acute rheumatic fever in South Trinidad - abstract

Streptococcal infections have been studied in South Trinidad during and for five years following a major epidemic of acute glomerulonephritiis (AGN). Many of these infections have been in the skin, especially in children in the rural areas. The relation of these infections to acute rheumatic fever (ARF) also has been examined with the following conclusions: During the mafor epidemic of AGN in 1964 and 1965, the incidence, of ARF decreased. This is in accordance with the current hypothesis that rheumatogenic streptococcal strains rarely are nephritgenic and vice versa. Since 1966, however, three increases in incidence of AGN have been accompanied by modest increases in the incidence of ARF. The streptococcal strains isolated from patients with ARF usually were not of the types concurrently isolated from patients with AGN. Moreover the lack of skin infections in the patients with ARF is striking in comparison with "normal" school children as well as with patients with AGN. Antristreptolysin O (ASO) titres in patients with ARF, as with AGN, increased only slightly or not at all while antithyaluroindase titres increased to similar high values in patients with both AGN and ARF. The lack of increased ASO titres in patients with ARF is in control to observations in other geographic areas where they consistently have been high. The lack of increased ASO titres in patients with AGN in Trinidad, as in other areas where AGN is associated with skin infections, has been attributed to the site of infections. However, no cases of ARF have been definitely related to skin infections in Trinidad or elsewhere (AU)

Recurrent epidemic nephritis in South Trinidad

An unusually large epidemic of acute glomerulonephritis occurred in Trinidad, the third outbreak on that island in fifteen years. Clinical and laboratory observations on 681 cases in South Trinidad are presented in this report. These data indicated that the majority of cases were poststreptococcal acute glomerulonephritis, associated with impetiginous sores, which are common among children in Trinidad. (AU)

Epidemic acute nephritis in South Trinidad

Two hundred and ninety-seven patients were admitted to the San Fernando General Hospital with acute glomerulonephritis from September 1964 to February 1965. Only a small number of the patients gave a history of sore throat and many patients had septic skin lesions one to four weeks before the onset of oedema, the presenting symptom in all the cases. Children between the ages of 3 and 9 years were most commonly affected. There were 46 children under the age of 3 years. 57 percent of the patients were male. The concentration of cases occurred in the rural areas within a radius of 10 miles from San Fernando, and 76 percent of the patients were Indians. Group A beta Haemolytic streptococci were isolated from the skin and throat of a representative sample of nephritic patients. A pilot streptococcal survey was also conducted among normal school-children in both "nephritic" and "non-nephritic" districts. 66 percent of 50 normal children selected at random from the three schools in Dede (nephritic district) had Group A beta haemolytic streptococci either in the throat or skin. 44 percent of 50 normal school-children from the two school in Tortuga (non-nephritic) had Group A beta haemolytic streptococci. The epidemic is on the wane. The present epidemic was compared with the 1958-1959 epidemic of acute nephritis in South Trinidad (AU)