Persistence of streptococcal group A antibody in patients with rheumatic valvular disease.

Antibody levels to streptococcal Group A and A-variant carbohydrates were determined using a radioactive immune precipitation technique on patients with rheumatic fever, with and without valvular disease, on patients with post-streptococcal acute glomerulonephritis, and on age-matched controls. During the acute phase of the above illness, the means of the antibody levels to both carbohydrate antigens were equally elevated and were significantly higher than the normal controls. When Group A antibody levels were determined on sera obtained at intervals of 5-12 months and 1-5 yr after the acute illness) it was found that the antibody levels declined within the normal range at the 5-12 month interval in patients with glomerulonephritis as well as in patients with rheumatic fever in whom no valvular involvement had complicated the disease, i.e., patients with pure Sydenham's chorea. However, in patients with rheumatic valvulitis, who had been on penicillin prophylaxis after the last acute episode, the A antibody level showed little decline from the level obtained during the acute illness. The elevated antibody level in patients with rheumatic valvulitis, including patients with Sydenham's chorea with valvulitis, persisted for periods of at least 1 yr and up to 20 yr after the last acute attack. The pattern of the decline of the antibody levels to the A-variant carbohydrate as well as of the antibody titers to the other streptococcal antigens tested, ASO and anti-DNase B, was similar in all patients studied regardless of the presence of valvular disease. These findings suggest that prolonged persistence of the Group A antibody is a phenomenon peculiar to patients with rheumatic valvular disease. Whether this persistence is involved in the pathogenesis or is an outcome of the valvular disease remains to be determined.

Temperature-dependent variation in the synthesis of group-specific carbohydrate by streptococcal variant strains. I. Immunochemical studies.

A temperature-dependent alteration in the synthesis of the group-specific polysaccharide was found to occur in two "variant" streptococcal strains, A-486-Var and C 121/46/4. These strains synthesize a polysaccharide with variant immunochemical characteristics when grown at 37 degrees C. However, when these organisms are grown at lower temperatures, 22 degrees C, an enhanced synthesis of Group A carbohydrate occurs. Other variant strains show no appreciable alteration of the cell wall carbohydrate composition when grown at lower temperatures. Studies on an intermediate strain show that this organism has a propensity for the synthesis of a polysaccharide with higher glucosamine content and enhanced Group A serological reactivity when grown at 22 degrees C. Immunochemical studies performed on the carbohydrates produced by the A-486-Var at various temperatures revealed that the appearance of Group A serological reactivity at lower temperatures is due to the additional synthesis of a polysaccharide with Group A specificity along with the continued synthesis of a variant carbohydrate. This finding contrasts with data obtained on the carbohydrate produced by the intermediate organisms that appears to consist predominently of one molecule bearing dual A and variant antigenic determinants.

Gonococcal infections in young children. Studies on the social, familial, and clinical aspects of 11 instances.

Of 43 youngsters with gonorrhea, 11 were under 10 years of age. These 11 had in common atypical clinical presentation, marital disharmony of the parents, crowded living conditions; some had been abused sexually. Management of gonorrhea in such young children may require a concerted effort by a team of medical, social, and legal personnel to meet the needs of this unique entity.

The role of normal skin in the spread of streptococcal pyoderma.

The primary body site of acquisition of group A streptococci was examined prospectively in a population with endemic streptococcal pyoderma. Weekly cultures were obtained during the skin infection season from apparently normal upper respiratory and cutaneous sites (and from skin lesions when present) in 44 children and adults living on the Red Lake Indian Reservation.During the 9-week period of the study 705 of a total of 2305 cultures were positive for group A streptococci. The percentage of positive cultures from the various sites were: throat (20%); nose (24%); wrist (32%); ankle (35%); back (22%); and skin lesions (81%). Group A streptococci were also isolated from fingernail dirt, clothing and bedding as well as from a few household pets and insects.Analysis of serial cultures obtained from the same individuals at weekly intervals suggested that the strains isolated from skin lesions first appeared on normal skin in the 2 weeks preceding the lesion. Spread to the nose and throat followed skin acquisition and/or skin lesions.The high prevalence of group A streptococci on normal skin in the absence as well as the presence of pyoderma, and their appearance on normal skin before recovery from either skin lesions or the upper respiratory tract are consistent with the view that skin acquisition was a primary predisposing factor to pyoderma. Since the literature indicates that group A streptococci are rarely part of the normal skin flora, these findings raise the possibility of unique biological properties of these and perhaps other pyoderma strains, as distinct from other group A streptococci.

Enteric immunization with live adenovirus type 21 vaccine. II. Systemic and local immune responses following immunization.

Studies of the immunologic responses following administration of a live, enteric-coated adenovirus (ADV) type 21 vaccine showed that nine of ten vaccinees and none of five controls developed neutralizing antibody. Antibody activity of serum and secretory immunoglobulins was assayed by using a (14)C-labeled ADV-21 antigen in a radioimmunodiffusion system. Increases in immunoglobulin M, A and G (IgM, IgA, IgG) activity were detected in sera from vaccinees but not in those from controls. IgA copro antibody activity was also shown in vaccinees but not in controls. Nasal secretions showed no detectable IgA antibody responses by this method. These studies show marked differences in serum and local IgA antibody activity in induced enteric ADV infection compared to previously reported responses after natural infection. The protective role of secretory IgA in adenovirus infections is obscure. However, absence of nasal IgA responses may indicate that protection against disease with enteric ADV vaccines depends primarily upon humoral antibody.

Enteric immunization with live adenovirus type 21 vaccine. I. Tests for safety, infectivity, immunogenicity, and potency in volunteers.

Studies were undertaken in volunteers to determine whether living adenovirus type 21 (ADV-21) vaccine could be safely administered orally to susceptible young adults. In the first study, ten volunteers were fed 10(6.4) tissue culture infectious dose(50) (TCID(50)) of ADV-21 vaccine virus, and five received placebo tablets. Nine of ten infected volunteers shed ADV-21 in stools (mean duration, 10.1 days; range, 4 to 17 days). No pharyngeal excretion of ADV-21 was observed in any of these volunteers. Each of the nine developed type-specific neutralizing (N) antibodies to ADV-21. No evidence for person-to-person transmission of vaccine was observed. In a second study, volunteers were immunized with ADV-21 vaccines containing 10(6.8), 10(4.6), and 10(2.4) TCID(50). ADV-21 N antibody responses were detected in nine of eleven who received the highest dose, six of twelve who received the middle dose, and two of twelve who were fed the lowest dose. None of twelve susceptible volunteers receiving the placebo capsule developed ADV-21 N antibodies postimmunization. This study established that the human infectious dose(50) for these lots of ADV-21 vaccine was approximately 10(4.6) TCID(50) and that the dose response to ADV-21 vaccine was lower than those previously reported for live ADV-4 and ADV-7 enteric vaccines.

Cephalexin and penicillin in the treatment of group A beta-hemolytic streptococcal throat infections.

OBJECTIVE: To determine whether cephalexin or penicillin is more effective in the treatment of group A beta-hemolytic streptococcal tonsillopharyngitis in children. DESIGN: Randomized, double-blind, crossover study conducted from 1981 to 1984. SETTING: Seven pediatric practices in the United States, including private offices and pediatric clinics. PARTICIPANTS: Of the 654 patients, 525 children and adolescents with clinical evidence of tonsillitis or pharyngitis and throat cultures positive for group A beta-hemolytic streptococcal infection were evaluable. Eighty percent of patients completed the study; none were withdrawn because of adverse reaction. SELECTION CRITERIA: Children and adolescents who had acute illness suggestive of group A beta-hemolytic streptococcal infection were enrolled in the study. Treatment was continued if the throat culture was positive for group A beta-hemolytic streptococcal infection. INTERVENTIONS: Four doses of cephalexin and penicillin (27 mg/kg per day) were prescribed to be taken on an empty stomach for 10 days. MEASUREMENTS/MAIN RESULTS: Symptomatic clinical failure occurred in 8% of penicillin-treated patients and in 3% of cephalexin-treated patients. Bacteriologic failure rates were 11% in the penicillin treatment group and 7% in the cephalexin treatment group. The combined treatment failure rate of clinical relapse plus asymptomatic bacteriologic failure was 19% in the penicillin treatment group and 10% in the cephalexin treatment group. Paired antistreptolysin-O titer increased significantly in 62.3% of penicillin-treated patients and in 64.2% of cephalexin-treated patients. Similarly, anti-DNase B titers rose 52.2% in penicillin-treated patients and 52.4% in cephalexin-treated patients. CONCLUSION: Cephalexin is a more effective drug than penicillin in the treatment of group A beta-hemolytic streptococcal throat infection in children.