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)

The families of patients with acute rheumatic fever or glomerulonephritis in Trinidad

The families of 21 patients with acute rheumatic fever (ARF) and 44 patients with acute glomerulonephritis (AGN) in Trinidad were examined in their homes. The ARF and AGN families were equally large and crowded and they lived in the same largely rural areas. However, only 22 percent of the ARF family members had skin infections in contrast to 61 percent of the AGN family members. Sixty-eight per cent of skin infections in ARF families and 69 percent of skin infection in AGN families yielded group A streptococci. Throat cultures were positive in 19 percent of ARF family members and 25 percent of AGN family members. Thirty-two per cent of 51 group A strains isolated from ARF family members (29 from throat, 22 from skin) were M11 of "M41" strains which were associated with ARF during the study, while only 8 percent were M1, T4 (MNT or 60) or M55 strains which were associated with AGN. In contrast, 49 percent of 171 group A strains isolated from AGN family members (64 from throat, 107 from skin) were M1, T4 (MNT or 60) of M55 while only 10 percent were M11 of "M41." Serum antibody titres were similar in both groups: antistreptolysin-0 titres were not markedly increased in either while anti-hyaluronidase and/or antideoxyribonuclease-B titres were increased in both. Evidence of subclinical AGN was found equally often in both groups: 6 percent of each had abnormal urine and 4 percent of each had decreased serum complement while 2 percent of the ARF and 3 percent of the AGN family members had both abnormal urine and decreased serum complement.(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)

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)

Scabies and acute post streptococcal glomerulonephritis - abstract

During the months of December, 1970 and January, 1971, a large number of patients admitted to the San Fernando General Hospital with acute glomerulonephritis presented with skin lesions characteristic of scabies. During this period there was also an increase in the number of admissions for acute glomerulonephritis as compared with the same months in the inter-epidemic years. This has been associated with an outbreak of scabies maninly in South Trinidad. Beta hemolytic streptococci were isolated from scabies lesions in patients with acute glomerulonephritis, in nephritic families, in school children and in the residents of an affected village. The main types of beta hemolytic streptococci are described with special reference to their significance. Concomitantly it was observed that an increasing number of dogs in nephritic households had skin lesions ("mange") suggestive of scabies. The beta hemolytic streptococci isolated from the dogs are also described. The authors call attention to the fact that patients with rheumatic fever admitted to hospital during the same period were remarkably free from both scabies and skin sores and that there has been no previous published report of an outbreak of acute glomerulonephritis associated with scabies (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)