Perimyocarditis following streptococcal group A infection: from clinical cases to bioinformatics analysis

BACKGROUND

Streptococcal infection is known to be associated with non-suppurative complications, including rheumatic fever. A less well recognized complication is perimyocarditis.

METHODS

We report 4 cases of myocarditis in young males associated with acute streptoccal infection. Following this clinical observation we employed bioinformatic techniques to identify common epitopes between Streptococcus group A and human muscle proteins. We used Blast to search all the proteome (1697 proteins) of the Streptococcus pyogenes M1 GAS against the human proteome of 34,180 proteins.

RESULTS

4 patients with streptococcal A related myocarditis were treated and made a complete recovery. One cardiac protein, ATP2A2 (NP_733765.1)), a cardiac Ca2+ ATPase, shared an epitope with Streptococcus group A and a high probability of being presented on a MHC Class II molecule.

CONCLUSION

Streptococcal myocarditis may be a commoner entity than previously appreciated. Bioinformatic techniques have identified a suspected common epitope between the streptococcal proteins and a cardiac Ca2+ ATPase.

Sensitivity and specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department

Acute pharyngitis in adults is primarily a viral infection; only about 10% of cases are of bacterial etiology. Most cases of bacterial pharyngitis are caused by group A beta-hemolytic streptococci (GABHS). One laboratory method for the diagnosis of GABHS is rapid antigen diagnostic testing (RADT), which can be processed during an emergency department visit and which has become a popular alternative to throat swab cultures. We conducted a study to define the sensitivity and specificity of RADT, using throat culture results as the gold standard, in 100 emergency department patients who presented with symptoms consistent with streptococcal pharyngitis. We found that RADT had a sensitivity of 68.2% (15 of 22), a specificity of 89.7% (70 of 78), a positive predictive value of 65.2% (15 of 23), and a negative predictive value of 90.9% (70 of 77). We conclude that RADT is useful in the emergency department when the clinical suspicion is GABHS, but results should be confirmed with a throat culture in patients whose RADT results are negative.

Impact of rapid antigen detection testing on antibiotic prescription in acute pharyngitis in adults. FARINGOCAT STUDY: a multicentric randomized controlled trial

BACKGROUND

Acute pharyngitis is one of the most frequent consultations to the general practitioner and in most of the cases an antibiotic is prescribed in primary care in Spain. Bacterial etiology, mainly by group A beta-hemolytic streptococcus (GABHS), accounts for 10-20% of all these infections in adults. The purpose of this study is to assess the impact of rapid antigen detection testing (RADT) to identify GABHS in acute pharyngitis on the utilization of antibiotics in primary care.

METHODS/DESIGN

Multicentric randomized controlled trial in which antibiotic prescription between two groups of patients with acute pharyngitis will be compared. The trial will include two arms, a control and an intervention group in which RADT will be performed. The primary outcome measure will be the proportion of inappropriate antibiotic prescription in each group. Two hundred seventy-six patients are required to detect a reduction in antibiotic prescription from 85% in the control group to 75% in the intervention group with a power of 90% and a level of significance of 5%. Secondary outcome measures will be specific antibiotic treatment, antibiotic resistance rates, secondary effects, days without working, medical visits during the first month and patient satisfaction.

DISCUSSION

The implementation of RADT would allow a more rational use of antibiotics and would prevent adverse effects of antibiotics, emergence of antibiotic resistance and the growth of inefficient health expenses.

Preferences for health outcomes associated with Group A Streptococcal disease and vaccination

BACKGROUND

A 26-valent Group A Streptococcus (GAS) vaccine candidate has been developed that may provide protection against pharyngitis, invasive disease and rheumatic fever. However, recommendations for the use of a new vaccine must be informed by a range of considerations, including parents' preferences for different relevant health outcomes. Our objectives were to: (1) describe parent preferences for GAS disease and vaccination using willingness-to-pay (WTP) and time trade-off (TTO) methods; and (2) understand how parents' implied WTP for a quality-adjusted life year (QALY) gained might vary depending on the particular health outcome considered (e.g. averted GAS disease vs. vaccine adverse events).

METHODS

Telephone interviews were conducted with parents of children diagnosed with GAS pharyngitis at 2 pediatric practice sites in the Boston metropolitan area. WTP and TTO (trading parental longevity for child's health) questions for 2 vaccine and 4 disease-associated health states were asked using a randomly selected opening bid, followed by a 2nd bid and a final open-ended question about the amount willing to pay or trade. Descriptive analyses included medians and interquartile ranges for WTP and TTO estimates. The Wilcoxon signed-rank test was used to assess differences in WTP/QALY values for vaccine adverse events vs. disease states.

RESULTS

Of 119 respondents, 100 (84%) and 96 (81%) provided a complete set of responses for WTP and TTO questions, respectively. The median WTP and discounted (at 3% per year) TTO values to avoid each health state were as follows: local reaction, $30, 0.12 days; systemic reaction, $50, 0.22 days; impetigo, $75, 1.25 days; strep throat, $75, 2.5 days; septic arthritis, $1,000, 6.6 days; and toxic shock syndrome, $3,000, 31.0 days. The median WTP/QALY was significantly higher for vaccine adverse events (approximately $60,000/QALY) compared to disease states ($18,000 to $36,000/QALY).

CONCLUSIONS

Parents strongly prefer to prevent GAS disease in children compared to vaccine adverse events. However, implied WTP/QALY ratios were higher for the prevention of vaccine adverse events. Regret for errors of commission vs. omission may differ and should be considered by vaccine policymakers.

Streptococcus pyogenes isolates causing severe infections in Norway in 2006 to 2007: emm types, multilocus sequence types, and superantigen profiles

To investigate the epidemiological patterns and genetic characteristics of disease caused by group A Streptococcus (GAS), all available isolates from invasive cases in Norway during 2006 to 2007 (262 isolates) were subjected to antimicrobial susceptibility testing, T serotyping, emm typing, and multilocus sequence typing and screened for known streptococcal pyrogenic exotoxin (Spe) genes, smeZ, and ssa. The average incidence rate was 3.1 cases per 100,000 individuals. The most prevalent sequence types (STs) were STs 52, 28, and 334. In association with emm types 28, 77, and 87, the serotype T-28 comprised 24.8% of the strains. emm types 28, 1, and 82 were dominating. In 2007, a sharp increase in the number of emm-6 strains was noted. All strains were sensitive to penicillin and quinupristin-dalfopristin, while 3.4% and 6.1% of the strains were resistant to macrolides and tetracycline, respectively. Furthermore, the emm-6 strains had intermediate susceptibility to ofloxacin. Isolates displayed a wide variety of gene profiles, as shown by the presence or absence of the Spe genes, smeZ, and ssa, but 48% of the isolates fell into one of three profiles. In most cases, an emm type was restricted to one gene profile. Although the incidence decreased during this study, invasive GAS disease still has a high endemic rate, with involvement of both established and emerging emm types displaying variability in virulence gene profiles as well as differences in gender and age group preferences.

[Performances of rapid antigen detection kits for group A Streptococcus]

The group A streptococcus rapid antigen detection kits used to test throat swabs are frequently used by doctors for the screening of pharyngitis caused by bacteria. The Swiss Centre for Quality Control (CSCQ) has organised External Quality Assessment Schemes (EQAS) for these kits since 1997. From 2004 to 2008, negative, positive, and moderate positive antigen containing samples were sent to the laboratories. After analysing the samples, 7749 results obtained with more than 14 different test kits were returned to the CSCQ. The correct results ranged between 84.8 and 99.8% which shows that all the test kits gave good results during the EQAS. However, in case of a negative result with clinical suspicion of a bacterial pharyngitis, the result is to be confirmed by culture.

Uveitis: an isolated complication of post-streptococcal syndrome

A child with anterior uveitis as the sole manifestation of group A streptococcal infection is described. There was a history of a 'viral' upper respiratory tract infection 2 weeks before the onset of uveitis. A post-streptococcal phenomenon was diagnosed on the basis of serial ASO titre (ASOT) monitoring. There are few reports of patients with post-streptococcal uveitis. ASOT monitoring should be included in the work-up of uveitis of undetermined aetiology.

Protein C inhibitor--a novel antimicrobial agent

Protein C inhibitor (PCI) is a heparin-binding serine proteinase inhibitor belonging to the family of serpin proteins. Here we describe that PCI exerts broad antimicrobial activity against bacterial pathogens. This ability is mediated by the interaction of PCI with lipid membranes, which subsequently leads to their permeabilization. As shown by negative staining electron microscopy, treatment of Escherichia coli or Streptococcus pyogenes bacteria with PCI triggers membrane disruption followed by the efflux of bacterial cytosolic contents and bacterial killing. The antimicrobial activity of PCI is located to the heparin-binding site of the protein and a peptide spanning this region was found to mimic the antimicrobial activity of PCI, without causing lysis or membrane destruction of eukaryotic cells. Finally, we show that platelets can assemble PCI on their surface upon activation. As platelets are recruited to the site of a bacterial infection, these results may explain our finding that PCI levels are increased in tissue biopsies from patients suffering from necrotizing fasciitis caused by S. pyogenes. Taken together, our data describe a new function for PCI in innate immunity.

The innate immune system is an integral part of our battle against an invading pathogen. Antimicrobial peptides and proteins partake in this fight due to their ability to perforate the bacterial cell wall, which eventually will cause the efflux of bacterial cytosolic content and efficient bacterial killing. Protein C inhibitor (PCI) is a multifunctional heparin-binding serpin which has been implicated in a number of pathological conditions, including severe infectious diseases. Here we show that PCI is a potent antimicrobial agent that is able to destroy the bacterial cell wall and thereby cause death of the bacteria. Our study also shows that in contrast to many other antimicrobial peptides, processing of PCI is not required since the full length protein exerts its antimicrobial activity, and we present data demonstrating that PCI is enriched at the infected site of patients suffering from severe streptococcal infection.

Streptococcal protective antigens (Spa): a new family of type-specific proteins of group A streptococci

Previous studies in our laboratory described a new group A streptococcal protective antigen (Spa) in type 18 streptococci that was distinct from the type 18 M protein. This study was undertaken to identify additional serotypes of group A streptococci that express Spa proteins. PCR techniques were used to identify and clone a new spa gene from type 36 streptococci. The 5' sequence of spa36 was highly variable compared to spa18, while the 3' sequence was conserved. Antisera against Spa36 opsonized type 36 streptococci but not type 18 streptococci, indicating that the opsonic Spa epitopes were type-specific. Antisera against the conserved carboxy-terminal half of Spa18 were used to identify Spa or Spa-like proteins expressed on the surface of 25 of 70 different serotypes of GAS. Spa proteins may represent a new family of type-specific surface antigens that function in concert with M proteins to elicit protective immune responses.

Impact of immunization against SpyCEP during invasive disease with two streptococcal species: Streptococcus pyogenes and Streptococcus equi

Currently there is no licensed vaccine against the human pathogen Streptococcus pyogenes. The highly conserved IL-8 cleaving S. pyogenes cell envelope proteinase SpyCEP is surface expressed and is a potential vaccine candidate. A recombinant N-terminal part of SpyCEP (CEP) was expressed and purified. AntiCEP antibodies were found to neutralize the IL-8 cleaving activity of SpyCEP. CEP-immunized mice had reduced bacterial dissemination from focal S. pyogenes intramuscular infection and intranasal infection. We also identified a functional SpyCEP-homolog protease SeCEP, expressed by the equine pathogen Streptococcus equi, which was able to cleave both human and equine IL-8. CEP-immunized mice also demonstrated reduced bacterial dissemination from S. equi intramuscular infection. Therefore immunization against SpyCEP may provide protection against other streptococci species with homologous proteases.

[Use of the rapid antigen detection test in group A streptococci pharyngitis diagnosis in Tunis, Tunisia]

The aims of this study were to determine the contribution of commercial rapid antigen detection test (RADT) in the rapid diagnosis of pharyngitis caused by group A streptococci. A total of 292 children with pharyngitis was included. A duplicate throat swabs was taken simultaneously from each patient. One of them was used for RADT achievement and the other for culture. When cultures were positive, a semi-quantitative evaluation was done. Throat culture and RADT were positive in 59 and 72 cases respectively. Fifty four specimens were positive simultaneously with RADT and culture and 215 specimens were negative using both methods. Eighteen specimens were positive only with RADT, 5 of them were treated by amoxicillin. Regarding to the group of patients with a negative RADT and a positive culture (5 cases), all of them had a culture evaluation at "+" or "++". Specificity and sensibility of the RADT were 92.2% and 91.5% respectively. RADT use by physicians can reduce antibiotic prescription among paediatric population. Because of the high specificity of RADT, therapeutic decisions can be made on the basis of a positive test.

[Investigation of bactericidal effect and nitric oxide responses of Caco-2 epithelial cells and THP-1 macrophage cells against Streptococcus pyogenes and Escherichia coli]

Epithelial cells and macrophages contribute to innate immune responses by cell to cell interactions and releasing proinflammatory mediators. In this study, we aimed to illuminate the underlying mechanisms of contribution of macrophages and epithelial cells in the struggle against pathogens. Therefore, Streptococcus pyogenes and Escherichia coli activated Caco-2 cells and THP-1 macrophage-like cells were investigated for their bactericidal activities and nitric oxide (NO) production when they were alone, in contact with eachother and when their contact was blocked by continuing exposure of soluble mediators. Caco-2 epithelial cells and THP-1 macrophage cells were used as effector cells and S. pyogenes or E. coli as target cells and were incubated at an effector cell/target cell ratio of 1/1 in duplication in 24-well plates. After 5 hours incubation, supernatants were collected from each well for growth inhibition assay and were inoculated onto blood agar plates for S. pyogenes and eosin methylene blue agar plates for E. coli. Following overnight incubation at 37 degrees C, bactericidal effect rate was calculated by counting the colony forming units. The supernatants were also collected after 5 and 24 hours incubation for measurement of NO production by using Griess reagent. Bactericidal effect of Caco-2 cells alone against S. pyogenes and E. coli were found 21.9% and 36.2%, when seperated from THP-1 cells via an insert was 31.8% and 30.5%, and when cell-cell contact was established with THP-1 cells was 24.4% and 55.7%, respectively. Bactericidal effect of THP-1 cells alone against S. pyogenes and E. coli was 27.7% and 63.9%, when seperated from Caco-2 cells via an insert was %27.5 and 43.6%, and when cell-cell contact was established with Caco-2 cells was 24.4% and 55.7%, respectively. As a result, we found that Caco-2 epithelial cells and THP-1 macrophage cells had an antibacterial effect against S. pyogenes and E. coli (p < 0.05), and this effect was higher in macrophage cells than epithelial cells. NO levels in epithelial and/or macrophage cell culture supernatants collected after exposure to S. pyogenes and E. coli were significantly higher for S. pyogenes at 5 hours incubation and for E. coli at 24 hours incubation (p < 0.05). Morever, it can be concluded that macrophages played a more active role than epithelial cells in bactericidal effect and NO response. Besides, epithelial cells and macrophages activated each other more when they were in contact than when they were alone or when their contact was blocked.

[Persistence of Streptococcus pyogenes]

State-of-the-art data on persistence of Streptococcus pyogenes are presented. Survival and persistence of S. pyogenes in organism of the host are considered as a result of action of widely presented virulent functions of infectious agent aimed on evasion from defense mechanisms of the host. Information on adhesins, bacteriocins, IgA-proteases, molecules with invasive function, as well as with function of protection from pahocytosis is presented. Antigenic mimicry and L-forms of S. pyogenes are briefly characterized.

The erythromycin-resistance in S. pyogenes does not limit the human polymorphonuclear cell antimicrobial activity

In order to highlight the potential erythromycin immunomodulatory properties related to different antibiotic resistance patterns in Streptococcus spp., we evaluated the influence of the macrolide on the PMNs primary functions against erythromycin-susceptible (Ery-S) and erythromycin-resistant (Ery-R) S. pyogenes strains. A total of 438 S. pyogenes were isolated over the period 2005-2007. On the basis of the triple disk testing, 345 out of 438 S. pyogenes isolates were Ery-S and 93 were Ery-R; among the resistant strains, 65 displayed the cMLSB phenotype, 23 had the M phenotype and 5 had iMLSB phenotype. Concerning antibacterial activity of PMNs, our results showed that erythromycin did not modify bacterial uptake, but significantly increased the phagocyte intracellular killing, compared with controls, for both Ery-S and Ery-R strains. Consequently, this report underlines that in immunocompetent hosts the dichotomy between the in vitro resistance and clinical trial data for antimicrobial agents should be thoroughly re-evaluated.

Mechanism of protection induced by group A Streptococcus vaccine candidate J8-DT: contribution of B and T-cells towards protection

Vaccination with J8-DT, a leading GAS vaccine candidate, results in protective immunity in mice. Analysis of immunologic correlates of protection indicated a role of J8-specific antibodies that were induced post-immunization. In the present study, several independent experimental approaches were employed to investigate the protective immunological mechanisms involved in J8-DT-mediated immunity. These approaches included the passive transfer of mouse or rabbit immune serum/antibodies in addition to selective depletion of T-cell subsets prior to bacterial challenge. Passive transfer of J8-DT antiserum/antibodies from mice and rabbits conferred significant resistance against challenge to mice. To exclude the possibility of involvement of other host immune factors, the studies were repeated in SCID mice, which highlighted the need for an ongoing immune response for long-lived protection. Depletion of CD4⁺ and CD8⁺ T-cell subsets confirmed that an active de novo immune response, involving CD4⁺ T-helper cells, is required for continued synthesis of antibodies resulting in protection against GAS infection. Taken together these results indicate an involvement of CD4⁺ T-cells in J8-DT-mediated protection possibly via an ability to maintain antibody levels. These results have considerable relevance to the development of a broad spectrum passive immunotherapy for GAS disease.

Molecular recognition of diverse ligands by T-cell receptors

T-cell receptors (TCRs) are structurally related to antibodies, and also interact with a diverse set of ligands. TCRs recognize foreign peptide antigens displayed by major histocompatibility complex (MHC) molecules and foreign lipid-based antigens presented by CD1. These interactions initiate an immune response through T-cell activation. These critical surveillance and response initiation functions of the adaptive immune system are not perfect, though, as TCR interactions with self antigens can lead to autoimmune disease. Mutated peptides can also be recognized specifically by TCRs, and may be important in tumor immunity. TCRs are also bound specifically by a family of bacterial toxins called superantigens, which over-stimulate the immune system to cause numerous human diseases.

Characteristics of Streptococcus pyogenes strains isolated from Chinese children with scarlet fever

AIM

To analyse the characteristics of Streptococcus pyogenes isolates from Chinese children with scarlet fever.

METHODS

Minimal inhibitory concentration with nine antibiotics was performed on 145 Streptococcus pyogenes isolates acquired from Beijing and Shanghai in 2007. Their macrolide-resistant genes (mefA, ermB and ermA- a subclass of ermTR), superantigens (speA and speC), and en-coding mature M protein gene (emm gene) were amplified by PCR.

RESULTS

A total of 97.9% of the isolates exhibited resistance to the macrolides, while 96.6% manifested resistance to tetracycline. All isolates were sensitive to chloramphenicol, penicillin, cefradine, and ofloxacin. Moreover, 94.5% exhibited a cMLSB phenotype, while 90.3% had the ermB gene. Five emm types (emm1.0, emm4.0, emm12.0, emm22.0 and st5240) were discovered, of which 9.7% carried the superantigen speA, 35.9% carried the speC, 42.8% carried both speA and speC and 11.7% carried neither speA nor speC. Finally, 85.5% of emm1.0 and 15.5% of emm12.0 isolates carried speA, while 79.0% of emm1.0 and 75.9% of emm12.0 isolates carried speC.

CONCLUSION

The Streptococcus pyogenes isolates had high resistance rates against macrolides and tetracycline. They mainly expressed the ermB gene type and cMLSB phenotype. Their common emm types are emm1.0 and emm12.0, which have different frequencies of speA and speC.

Incompetence of neutrophils to invasive group A streptococcus is attributed to induction of plural virulence factors by dysfunction of a regulator

Group A streptococcus (GAS) causes variety of diseases ranging from common pharyngitis to life-threatening severe invasive diseases, including necrotizing fasciitis and streptococcal toxic shock-like syndrome. The characteristic of invasive GAS infections has been thought to attribute to genetic changes in bacteria, however, no clear evidence has shown due to lack of an intriguingly study using serotype-matched isolates from clinical severe invasive GAS infections. In addition, rare outbreaks of invasive infections and their distinctive pathology in which infectious foci without neutrophil infiltration hypothesized us invasive GAS could evade host defense, especially neutrophil functions. Herein we report that a panel of serotype-matched GAS, which were clinically isolated from severe invasive but not from non-invaive infections, could abrogate functions of human polymorphnuclear neutrophils (PMN) in at least two independent ways; due to inducing necrosis to PMN by enhanced production of a pore-forming toxin streptolysin O (SLO) and due to impairment of PMN migration via digesting interleukin-8, a PMN attracting chemokine, by increased production of a serine protease ScpC. Expression of genes was upregulated by a loss of repressive function with the mutation of csrS gene in the all emm49 severe invasive GAS isolates. The csrS mutants from clinical severe invasive GAS isolates exhibited high mortality and disseminated infection with paucity of neutrophils, a characteristic pathology seen in human invasive GAS infection, in a mouse model. However, GAS which lack either SLO or ScpC exhibit much less mortality than the csrS-mutated parent invasive GAS isolate to the infected mice. These results suggest that the abilities of GAS to abrogate PMN functions can determine the onset and severity of invasive GAS infection.

Antibodies against a surface protein of Streptococcus pyogenes promote a pathological inflammatory response

Streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes is a clinical condition with a high mortality rate despite modern intensive care. A key feature of STSS is excessive plasma leakage leading to hypovolemic hypotension, disturbed microcirculation and multiorgan failure. Previous work has identified a virulence mechanism in STSS where M1 protein of S. pyogenes forms complexes with fibrinogen that activate neutrophils to release heparin-binding protein (HBP), an inducer of vascular leakage. Here, we report a marked inter-individual difference in the response to M1 protein-induced HBP release, a difference found to be related to IgG antibodies directed against the central region of the M1 protein. To elicit massive HBP release, such antibodies need to be part of the M1 protein-fibrinogen complexes. The data add a novel aspect to bacterial pathogenesis where antibodies contribute to the severity of disease by promoting a pathologic inflammatory response.

[Effectiveness of rapid antigen test with throat gargle in detecting group A beta-hemolytic streptococci]

OBJECTIVES

The most important disadvantage of rapid antigen tests (RAT) is low sensitivity for the diagnosis of group A beta-hemolytic streptococci (BHS). We determined the sensitivity, specificity, positive and negative predictive values of RAT in gargling samples.

PATIENTS AND METHODS

The study included 106 patients (53 females, 53 males, mean age 22+/-12 years; range 16-65 years) with an initial diagnosis of tonsillopharyngitis. Swab samples were taken from the posterior pharyngeal wall and tonsil surface with a sterile cotton swab. Then, gargle samples were obtained by gargling for 10 seconds with sterile 0.9% NaCl to be examined by the RAT for group A BHS. Throat cultures were processed using standard microbiologic techniques.

RESULTS

Throat cultures were positive in 12 patients (11.3%) and negative in 94 patients (88.6%). Rapid antigen test yielded five positive (4.7%) and 101 negative (95.2%) results. The sensitivity and specificity rates of RAT with throat gargling were 41.7% and 100%, with positive and negative predictive values of 100% and 93.1%, respectively.

CONCLUSION

Despite satisfactory specificity, positive and negative predictive rates of RAT with throat gargling, its low sensitivity limits its use for the diagnosis of group A BHS.

[Influence of products of bacterial origin on the expression of surface molecules in monocyte-derived and endothelial cells]

AIM

To study the influence of lypopolysaccharide (LPS) of Gram-negative bacterium (Escherichia coli O55:B5) and lysate of Gram-positive bacteria (Streptococcus pyogenes - group A, type M1, strain 40/58) on the level of expression of important surface molecules of monocyte-derived cells from continuous cell line THP-1 and endothelial cells from continuous cell line EA.hy 926.

MATERIALS AND METHODS

Expression of surface molecules HLA-DR, CD11b, CD14, CD16, CD32, and CD54 was assessed using FITC- or PE-labeled monoclonal antibodies (Beckman Coulter, USA). Intensity of fluorescence was measured by flow cytometer Epics Altra manufactured by Beckman Coulter (USA).

RESULTS

Studied components of Gram-positive and Gram-negative bacteria stimulated expression of CD14, CD16, CD32, and CD54 molecules on cells from THP-1 line; incubation of cells from EA.hy 926 line in the presence of the same bacterial components increased expression levels of CD54 and HLA-DR molecules.

CONCLUSION

Endothelial cells of EA.hy 926 line was less sensitive to LPS of E. coli and lysate of S. pyogenes compared to monocyte-derived cells of THP-1 line. Usage of THP-1 cells allowed to reveal differences between effects of components of Gram-positive and Gram-negative bacteria. The stimulating effect of LPS was more pronounced compared to effect of S. pyogenes lysate in relation to expression of HLA-DR, CD11b, and CD54 molecules, whereas lysate of S. pyogenes better stimulated expression of CD14, CD16, and CD32 molecules.

Co-occurrence of poststreptococcal reactive arthritis and acute glomerulonephritis

We report a 16-year-old patient who developed concurrent poststreptococcal reactive arthritis and acute glomerulonephritis. A high titer of antistreptolysin O antibody confirmed the preceding streptococcal infection. The patient presented with symmetric persistent tenosynovitis of hands and feet. Renal biopsy showed typical findings of acute glomerulonephritis with crescent formation. Physicians who treat patients with arthritis of acute onset, especially after throat infection, should be aware of possible urinary abnormalities or renal dysfunction.