Streptococcal group A, C and G pharyngitis in school children: a prospective cohort study in Southern India.

Diagnosing streptococcal pharyngitis in children on the basis of clinical appearance and throat culture is complicated by high colonisation rates and by the ability of other pathogens to cause clinically similar disease. To characterise the epidemiology of Lancefield Group A, C and G ß-haemolytic streptococcus (GAS, GCS and GGS, respectively) in children, we conducted a 2-year prospective study of 307 school children between 7 and 11 years old. GGS and GAS were commonly identified organisms both for silent streptococcal colonisation and symptomatic sore throat, while GCS was uncommonly found. Streptococcal culture positivity at the time of clinical pharyngitis was estimated to reflect true streptococcal pharyngitis in only 26% of instances, with the frequency varying from 54% for children rarely colonised to 1% for children frequently colonised. Numerous GAS emm types were identified, including several types previously associated with severe pharyngitis (e.g. emm types 1, 3 and 28). No severe complications were seen in any child. These data suggest that the clinical diagnosis of streptococcal pharyngitis is likely to remain difficult and that treatment decisions will remain clouded by uncertainty. There remains a need for organism-specific rapid point-of-care streptococcal diagnostic tests and tests that can distinguish between streptococcal colonisation and disease.

Clinical and microbiologic characteristics of invasive Streptococcus pyogenes infections in north and south India.

The lack of epidemiologic data on invasive Streptococcus pyogenes infections in many developing countries is concerning, as S. pyogenes infections are commonly endemic in these areas. Here we present the results of the first prospective surveillance study of invasive Streptococcus pyogenes infections in India. Fifty-four patients with invasive S. pyogenes infections were prospectively enrolled at two study sites, one in the north and one in the south of India. Sterile-site isolates were collected, and clinical information was documented using a standardized questionnaire. Available acute-phase sera were tested for their ability to inhibit superantigens produced by the patient's own isolate using a cell-based neutralizing assay. The most common clinical presentations were bacteremia without focus (30%), pneumonia (28%), and cellulitis (17%). Only two cases of streptococcal toxic shock syndrome and no cases of necrotizing fasciitis were identified. Characterization of the isolates revealed great heterogeneity, with 32 different emm subtypes and 29 different superantigen gene profiles being represented among the 49 sterile-site isolates. Analyses of acute-phase sera showed that only 20% of the cases in the north cohort had superantigen-neutralizing activity in their sera, whereas 50% of the cases from the south site had neutralizing activity. The results demonstrate that there are important differences in both clinical presentation and strain characteristics between invasive S. pyogenes infections in India and invasive S. pyogenes infections in Western countries. The findings underscore the importance of epidemiologic studies on streptococcal infections in India and have direct implications for current vaccine developments.

Comparison of instability resistance training, traditional resistance training and plyometric training on athletic performance parameters.

OBJECTIVES: The objective of the study was to compare traditional resistance, instability resistance, and plyometric training methods on measures of athletic performance in healthy subjects. METHODS: Sixty five healthy, physically active male students were randomly assigned to the following groups: traditional resistance training (RT, n=22), instability training (IT, n=22), and plyometric training (PLY, n=21).Athletic performance parameters were assessed pre- and post-training using chair squat test, standing stork test, shuttle run test, t-test, and vertical jump test. RESULTS: General linear univariate model with baseline as covariate (ANCOVA) was used for analyzing the change in outcome from baseline to post-treatment. Statistically significant improvement was observed in all the athletic performance parameters in all three groups after seven weeks of training (p-value<0.05). The highest change in chair squat test was reported for RT compared to IT (p-value<0.001) and PLY (p-value<0.001). The change in standing stork test among the IT group was substantially higher than that among RT (p-value=0.007) but did not significantly differ from that among the PLY (p-value=0.27). No statistically significant difference was observed in post-test values of vertical jump test among three groups. The highest change in t-test and shuttle run test was reported for PLY compared to IT (p-value<0.001) and RT (p-value<0.001). CONCLUSIONS: Based on the findings of this study, it is suggested that IT and PLY can be included with traditional RT to improve various aspects of athletic performance in healthy physically active individuals. The current study will give an insight to athletes, coaches, and trainers regarding utilization of appropriate training methods in enhancing athletic performance. However, further research is required to establish the effectiveness.

Genetic diversity and allelic variation in south Indian isolates of Group A streptococci causing invasive disease.

BACKGROUND: Reported literature on invasive group A streptococcal isolates in India is very scanty. This study was undertaken to determine the molecular heterogeneity of such isolates as seen in a tertiary care center. MATERIALS AND METHODS: Thirty two blood culture isolates and 18 from other sterile body fluids were characterized by emm gene sequencing and multilocus sequence typing. RESULTS: Forty two emm types were identified including 25 from 32 blood isolates and 17 from 18 other body fluid isolates. Types 110, 74, 63, 85, 102, 105, 124 and st854.1 were common to both groups and accounted for 40% of the isolates. Two types namely, stKNB6 and stKNB9 were newly identified types. MLST identified forty eight sequence types (MLST - ST) of which 31 were from 32 blood isolates and 17 from 18 body fluid isolates; thirty three of them were hitherto unrecognized at the time of identification. Two blood isolates of emm 85 had the same MLST - ST 484 while three blood isolates of emm 110 had three different STs namely, ST 493, 494 and 497. Two types, ST 493 and ST497 had single locus variation while ST 497 had a double locus variation. CONCLUSIONS: Our study shows that subtle allelic variations in the house keeping genes results in the development of new strains in a given emm type and contribute significantly to the existing high diversity of strains circulating in the community.