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Vasilev V, Savvina M, Argunova A, Danilova A. A Case of Adult-Onset Still's Disease With Positive Antinuclear Antibodies and Positive Antineutrophil Cytoplasmic Antibodies. Cureus 2024; 16:e61399. [PMID: 38953085 PMCID: PMC11215933 DOI: 10.7759/cureus.61399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
Adult-onset Still's disease (AOSD) is a rare autoinflammatory disease characterized by nonspecific symptoms such as fever, maculopapular rash, and arthralgias. The exact etiology and pathogenesis remain unclear despite advancements in medical science. Diagnosis is typically established using the Yamaguchi criteria, which include a negative antinuclear antibody (ANA) test as one of the minor criteria. However, some patients with AOSD exhibit positive ANA and even positive antineutrophil cytoplasmic antibodies (ANCA), complicating the diagnostic process. We present the case of a 19-year-old Asian woman of Yakut ethnicity who initially presented with symptoms resembling an upper respiratory tract infection. Laboratory tests revealed the presence of both ANA and ANCA. The diagnosis of AOSD was confirmed based on clinical presentation and the Yamaguchi criteria. Subsequent pulse therapy with prednisolone resulted in significant clinical improvement and a one-year remission. A review of the literature revealed that simultaneous ANCA and ANA positivity in AOSD has not been previously reported. Follow-up over 12 months showed no evidence of other autoimmune or autoinflammatory diseases, suggesting that the positive ANA and ANCA results may be either false positives or atypical laboratory manifestations in AOSD, which should be considered in the diagnosis.
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Affiliation(s)
- Valentin Vasilev
- Department of General Medicine, Medical Institute of the Federal State Autonomous Educational Institution of Higher Education, M.K. Ammosov North-Eastern Federal University, Yakutsk, RUS
| | - Maria Savvina
- Department of Internal Medicine, State Budgetary Institution of the Republic of Sakha (Yakutia) Yakutsk Republican Clinical Hospital, Yakutsk, RUS
| | - Agrafena Argunova
- Department of Hospital Therapy, Occupational Diseases, and Clinical Pharmacology, Medical Institute of the Federal State Autonomous Educational Institution of Higher Education, M.K. Ammosov North-Eastern Federal University, Yakutsk, RUS
| | - Aitalina Danilova
- Department of Administration, Clinic No. 1, State Autonomous Institution of the Republic of Sakha (Yakutia), Yakutsk, RUS
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Gorczyca D, Iwańczyk P, Staś K, Postępski J. Knee pain as a reason for referral to a paediatric rheumatologist: A retrospective study. J Paediatr Child Health 2023; 59:439-444. [PMID: 36627832 DOI: 10.1111/jpc.16309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023]
Abstract
AIM Knee pain is the most frequently reported type of lower extremity pain among children and adolescents. The objective of this study was to establish the features distinguishing inflammatory knee pain from non-inflammatory knee pain and to determine the specific variables to consider in suspected juvenile idiopathic arthritis (JIA). METHODS A retrospective chart review was performed among children with knee pain evaluated through paediatric rheumatology consultations at a single centre between 2012 and 2019. RESULTS Among the 262 children, 32 patients (12.2%) were diagnosed with JIA, 46 patients (17.6%) presented with inflammatory knee pain (IP) of an origin different than JIA, and 57 patients (21.7%) with non-inflammatory knee pain (NIP). In 127 cases (48.5%), no musculoskeletal disorder was diagnosed (NDD). The presence of limping, joint swelling, decreased passive range of motion and decreased active range of motion of the knee joint were registered more frequently in the JIA group compared to the other three groups. Multivariate analysis showed that a family history of autoimmune diseases and pain in other joints were associated with inflammatory pain. Increased pain after physical activity, pain only in the knee joint and absence of limping were predictors of NIP. The risk factors of JIA were limping and an erythrocyte sedimentation range of ≥10 mm after an hour. In the NDD group, the risk factors included no increase in pain after physical activity, serum C-reactive protein level < 5 mg/L and normal musculoskeletal ultrasound image. CONCLUSIONS The majority of children with knee pain referred to a paediatric rheumatologist do not have arthritis. Knee pain alone, as a chief complaint, rarely leads to a final JIA diagnosis. Further studies are necessary in order to design the appropriate diagnostic and therapeutic algorithms.
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Affiliation(s)
- Daiva Gorczyca
- Center for Chronically Sick Children Berlin, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Patrycja Iwańczyk
- Neonatology Department, The Institute of Mother and Child, Warsaw, Poland
| | - Karolina Staś
- Paediatric Department, Public Autonomous Health Care Hospital, Sulechów, Poland
| | - Jacek Postępski
- Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, Lublin, Poland
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Mehta T, Malinovsky Y, Abnet CC, Albert PS. Using group testing in a two-phase epidemiologic design to identify the effects of a large number of antibody reactions on disease risk. BMC Med Res Methodol 2022; 22:324. [PMID: 36526967 PMCID: PMC9756457 DOI: 10.1186/s12874-022-01798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of immunological responses to exposed bacteria on disease incidence is increasingly under investigation. With many bacterial species, and many potential antibody reactions to a particular species, the large number of assays required for this type of discovery can make it prohibitively expensive. We propose a two-phase group testing design to more efficiently screen numerous antibody effects in a case-control setting. METHODS Phase 1 uses group testing to select antibodies that are differentially expressed between cases and controls. The selected antibodies go on to Phase 2 individual testing. RESULTS We evaluate the two-phase group testing design through simulations and example data and find that it substantially reduces the number of assays required relative to standard case-control and group testing designs, while maintaining similar statistical properties. CONCLUSION The proposed two-phase group testing design can dramatically reduce the number of assays required, while providing comparable results to a case-control design.
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Affiliation(s)
- Tanvi Mehta
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room SG/7E146, Rockville, MD, 20850, USA
| | - Yaakov Malinovsky
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room SG/7E146, Rockville, MD, 20850, USA
| | - Paul S Albert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room SG/7E146, Rockville, MD, 20850, USA.
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Caseiro Alves ME, Cordeiro AI, Carvalho R, João A. Atypical presentation of erythema multiforme. BMJ Case Rep 2022; 15:e251076. [PMID: 35793857 PMCID: PMC9260799 DOI: 10.1136/bcr-2022-251076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- M Eduarda Caseiro Alves
- Pediatric Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rodrigo Carvalho
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Alexandre João
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Whitcombe AL, McGregor R, Bennett J, Gurney JK, Williamson DA, Baker MG, Moreland NJ. OUP accepted manuscript. J Infect Dis 2022; 226:167-176. [PMID: 35134931 PMCID: PMC9373162 DOI: 10.1093/infdis/jiac043] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Group A Streptococcus (GAS) causes superficial pharyngitis and skin infections as well as serious autoimmune sequelae such as acute rheumatic fever (ARF) and subsequent rheumatic heart disease. ARF pathogenesis remains poorly understood. Immune priming by repeated GAS infections is thought to trigger ARF, and there is growing evidence for the role of skin infections in this process. Methods We utilized our recently developed 8-plex immunoassay, comprising antigens used in clinical serology for diagnosis of ARF (SLO, DNase B, SpnA), and 5 conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD, Group A carbohydrate), to characterize antibody responses in sera from New Zealand children with a range of clinically diagnosed GAS disease: ARF (n = 79), GAS-positive pharyngitis (n = 94), GAS-positive skin infection (n = 51), and matched healthy controls (n = 90). Results The magnitude and breadth of antibodies in ARF was very high, giving rise to a distinct serological profile. An average of 6.5 antigen-specific reactivities per individual was observed in ARF, compared to 4.2 in skin infections and 3.3 in pharyngitis. Conclusions ARF patients have a unique serological profile, which may be the result of repeated precursor pharyngitis and skin infections that progressively boost antibody breadth and magnitude.
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Affiliation(s)
- Alana L Whitcombe
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Reuben McGregor
- School of Medical Sciences and Maurice Wilkins Centre, University of Auckland, Auckland, New Zealand
| | - Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah A Williamson
- University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicole J Moreland
- Correspondence: Nicole J. Moreland, BSc, PhD, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand ()
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Whitcombe AL, Han F, McAlister SM, Kirkham LAS, Young PG, Ritchie SR, Atatoa Carr P, Proft T, Moreland NJ. An eight-plex immunoassay for Group A streptococcus serology and vaccine development. J Immunol Methods 2021; 500:113194. [PMID: 34801540 DOI: 10.1016/j.jim.2021.113194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
Group A Streptococcus (GAS) is a major human pathogen responsible for superficial infections through to life-threatening invasive disease and the autoimmune sequelae acute rheumatic fever (ARF). Despite a significant global economic and health burden, there is no licensed vaccine available to prevent GAS disease. Several pre-clinical vaccines that target conserved GAS antigens are in development. Assays that measure antigen-specific antibodies are essential for vaccine research. The aim of this study was to develop a multiplex beadbased immunoassay that can detect and quantify antibody responses to multiple GAS antigen targets in small volume blood samples. This builds on our existing triplex assay comprised of antigens used in clinical serology for the diagnosis of ARF (SLO, DNase B and SpnA). Five additional conserved putative GAS vaccine antigens (Spy0843, SCPA, SpyCEP, SpyAD and the Group A carbohydrate), were coupled to spectrally unique beads to form an 8-plex antigen panel. After optimisation of the assay protocol, standard curves were generated, and assessments of assay specificity, precision and reproducibility were conducted. A broad range of antibody (IgG) titres were able to be quickly and accurately quantified from a single serum dilution. Assay utility was assessed using a panel of 62 clinical samples including serum from adults with GAS bacteraemia and children with ARF. Circulating IgG to all eight antigens was elevated in patients with GAS disease (n = 23) compared to age-matched controls (n = 39) (P < 0.05). The feasibility of using dried blood samples to quantify antigen-specific IgG was also demonstrated. In summary, a robust and reproducible 8-plex assay has been developed that simultaneously quantifies IgG antibodies to GAS vaccine and diagnostic antigens.
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Affiliation(s)
- Alana L Whitcombe
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand
| | - Franklin Han
- School of Medical Sciences, The University of Auckland, New Zealand
| | - Sonia M McAlister
- Wesfarmers Centre of Vaccines & Infectious Disease, Telethon Kids Institute, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines & Infectious Disease, Telethon Kids Institute, Perth, Western Australia, Australia; Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Paul G Young
- School of Biological Sciences, The University of Auckland, New Zealand
| | | | | | - Thomas Proft
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand
| | - Nicole J Moreland
- School of Medical Sciences, The University of Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, The University of Auckland, New Zealand.
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Bennett J, Rentta NN, Leung W, Atkinson J, Wilson N, Webb R, Baker MG. Early diagnosis of acute rheumatic fever and rheumatic heart disease as part of a secondary prevention strategy: Narrative review. J Paediatr Child Health 2021; 57:1385-1390. [PMID: 34296804 DOI: 10.1111/jpc.15664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 01/07/2023]
Abstract
Acute rheumatic fever (ARF) and its sequela rheumatic heart disease (RHD) remain significant causes of morbidity and mortality. In New Zealand, ARF almost exclusively affects Indigenous Māori and Pacific children. This narrative review aims to present secondary interventions to improve early and accurate diagnosis of ARF and RHD, in order to minimise disease progression in New Zealand. Medline, EMBASE and Scopus databases were searched as well as other electronic publications. Included were 56 publications from 1980 onwards. Diagnosing ARF and RHD as early as possible is central to reducing disease progression. Recent identification of specific ARF biomarkers offer the opportunity to aid initial diagnosis and portable echocardiography has the potential to detect undiagnosed RHD in high-risk areas. However, further research into the benefits and risks to children with subclinical RHD is necessary, as well as an economic evaluation.
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Affiliation(s)
- Julie Bennett
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Neilenuo N Rentta
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - William Leung
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - June Atkinson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Rachel Webb
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand.,KidzFirst Children's Hospital, Counties Manukau District Health Board, Auckland, New Zealand.,Department of Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
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Osowicki J, Azzopardi KI, Fabri L, Frost HR, Rivera-Hernandez T, Neeland MR, Whitcombe AL, Grobler A, Gutman SJ, Baker C, Wong JMF, Lickliter JD, Waddington CS, Pandey M, Schuster T, Cheng AC, Pollard AJ, McCarthy JS, Good MF, Dale JB, Batzloff M, Moreland NJ, Walker MJ, Carapetis JR, Smeesters PR, Steer AC. A controlled human infection model of Streptococcus pyogenes pharyngitis (CHIVAS-M75): an observational, dose-finding study. THE LANCET MICROBE 2021; 2:e291-e299. [PMID: 35544165 DOI: 10.1016/s2666-5247(20)30240-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Streptococcus pyogenes is a leading cause of infection-related morbidity and mortality. A reinvigorated vaccine development effort calls for new clinically relevant human S pyogenes experimental infection models to support proof of concept evaluation of candidate vaccines. We describe the initial Controlled Human Infection for Vaccination Against S pyogenes (CHIVAS-M75) study, in which we aimed to identify a dose of emm75 S pyogenes that causes acute pharyngitis in at least 60% of volunteers when applied to the pharynx by swab. METHODS This observational, dose-finding study was done in a clinical trials facility in Melbourne (VIC, Australia). Groups of healthy volunteers aged 18-40 years, at low risk of complicated S pyogenes disease, and without high type-specific anti-emm75 IgG antibodies against the challenge strain were challenged and closely monitored as inpatients for up to 6 days, and then as outpatients for 6 months. Antibiotics were started upon diagnosis (clinical signs and symptoms of pharyngitis and a positive rapid molecular test) or after 5 days in those without pharyngitis. Rapid test results were confirmed by standard bacterial culture. After a sentinel participant, cohorts of five and then ten participants were challenged, with protocol-directed dose-escalation or de-escalation for subsequent cohorts. The primary outcome was the proportion of participants at each dose level with pharyngitis by day 5 after challenge. The study is registered with ClinicalTrials.gov, NCT03361163. FINDINGS Between July 10, 2018, and Sept 23, 2019, 25 healthy adults were challenged with emm75 S pyogenes and included in analyses. Pharyngitis was diagnosed in 17 (85%; 95% CI 62-97) of 20 participants at the starting dose level (1-3 × 105 colony-forming units [CFU]/mL). This high proportion prompted dose de-escalation. At the lower dose level (1-3 × 104 CFU/mL), pharyngitis was diagnosed in one of five participants. Immunological, biochemical, and microbiological results supported the clinical picture, with acute symptomatic pharyngitis characterised by pharyngeal colonisation by S pyogenes accompanied by significantly elevated C-reactive protein and inflammatory cytokines (eg, interferon-γ and interleukin-6), and modest serological responses to streptolysin O and deoxyribonuclease B. There were no severe (grade 3) or serious adverse events related to challenge. INTERPRETATION We have established a reliable pharyngitis human infection model with reassuring early safety findings to accelerate development of vaccines and other interventions to control disease due to S pyogenes. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Joshua Osowicki
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.
| | - Kristy I Azzopardi
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Loraine Fabri
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Hannah R Frost
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Tania Rivera-Hernandez
- Unidad de Investigación Médica en Inmunoquímica, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Melanie R Neeland
- Epigenetics Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Alana L Whitcombe
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anneke Grobler
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah J Gutman
- Department of Cardiology, The Alfred Hospital, Melbourne, VIC, Australia; Imaging Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Ciara Baker
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | | | - Claire S Waddington
- Department of Medicine, University of Cambridge, Cambridge, UK; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Manisha Pandey
- The Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, UK
| | - James S McCarthy
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Michael F Good
- The Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - James B Dale
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael Batzloff
- The Institute for Glycomics, Griffith University, Gold Coast, QLD, Australia
| | - Nicole J Moreland
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Mark J Walker
- School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
| | - Pierre R Smeesters
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
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Streptococcal infection in childhood Henoch-Schönlein purpura: a 5-year retrospective study from a single tertiary medical center in China, 2015-2019. Pediatr Rheumatol Online J 2021; 19:79. [PMID: 34078391 PMCID: PMC8173722 DOI: 10.1186/s12969-021-00569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The present study focuses on the associations of streptococcal infection with the clinical phenotypes, relapse/recurrence and renal involvement in Henoch-Schönlein purpura (HSP) children. METHODS Two thousand seventy-four Chinese children with HSP were recruited from January 2015 to December 2019. Patients' histories associated with HSP onset were obtained by interviews and questionnaires. Laboratory data of urine tests, blood sample and infectious agents were collected. Renal biopsy was performed by the percutaneous technique. RESULTS (1) Streptococcal infection was identified in 393 (18.9%) HSP patients, and served as the most frequent infectious trigger. (2) Among the 393 cases with streptococcal infection, 43.0% of them had arthritis/arthralgia, 32.1% had abdominal pain and 29.3% had renal involvement. (3) 26.1% of HSP patients relapsed or recurred more than 1 time within a 5-year observational period, and the relapse/recurrence rate in streptococcal infectious group was subjected to a 0.4-fold decrease as compared with the non-infectious group. (4) No significant differences in renal pathological damage were identified among the streptococcal infectious group, the other infectious group and the non-infectious group. CONCLUSIONS Streptococcal infection is the most frequent trigger for childhood HSP and does not aggravate renal pathological damage; the possible elimination of streptococcal infection helps relieve the relapse/recurrence of HSP.
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An unusual case of IgA-dominant membranoproliferative glomerulonephritis associated with psoriasis vulgaris. Int Urol Nephrol 2021; 53:1951-1952. [PMID: 33387230 DOI: 10.1007/s11255-020-02741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
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Monemo P, Demba N, Touré FS, Traoré A, Avi C, N’Guessan MA, Tadet JO, Gobey AR, Anoh AE, Diarrassouba A, Tuo MN, Cissé A, Saric J, Utzinger J, Tia H, Kouassi-N’Djeundo J, Becker SL, Akoua-Koffi C. Pharyngeal Carriage of Beta-Haemolytic Streptococcus Species and Seroprevalence of Anti-Streptococcal Antibodies in Children in Bouaké, Côte d’Ivoire. Trop Med Infect Dis 2020; 5:tropicalmed5040177. [PMID: 33261048 PMCID: PMC7709589 DOI: 10.3390/tropicalmed5040177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/17/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022] Open
Abstract
The pharynx of the child may serve as a reservoir of pathogenic bacteria, including beta-haemolytic group A streptococci (GAS), which can give rise to upper airway infections and post-streptococcal diseases. The objective of this study was to determine the prevalence of beta-haemolytic Streptococcus spp. in pharyngeal samples stemming from children aged 3–14 years in Bouaké, central Côte d’Ivoire. Oropharyngeal throat swabs for microbiological culture and venous blood samples to determine the seroprevalence of antistreptolysin O antibodies (ASO) were obtained from 400 children in March 2017. Identification was carried out using conventional bacteriological methods. Serogrouping was performed with a latex agglutination test, while an immunological agglutination assay was employed for ASO titres. The mean age of participating children was 9 years (standard deviation 2.5 years). In total, we detected 190 bacteria in culture, with 109 beta-haemolytic Streptococcus isolates, resulting in an oropharyngeal carriage rate of 27.2%. Group C streptococci accounted for 82.6% of all isolates, whereas GAS were rarely found (4.6%). The ASO seroprevalence was 17.3%. There was no correlation between serology and prevalence of streptococci (p = 0.722). In conclusion, there is a high pharyngeal carriage rate of non-GAS strains in children from Bouaké, warranting further investigation.
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Affiliation(s)
- Pacôme Monemo
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
- Unité de Formation et Recherche des Sciences Médicales, Université Alassane Ouattara, Bouaké, Cote d’Ivoire; (A.R.G.); (J.K.-N.)
- Correspondence: (P.M.), (S.L.B.)
| | - Nadia Demba
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
| | - Fidèle S. Touré
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
| | - Adjartou Traoré
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
| | - Christelle Avi
- Service de Pédiatrie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire;
| | - Micheline A. N’Guessan
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
| | - Juste O. Tadet
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
| | - Arthur R. Gobey
- Unité de Formation et Recherche des Sciences Médicales, Université Alassane Ouattara, Bouaké, Cote d’Ivoire; (A.R.G.); (J.K.-N.)
- Laboratoire d’Immunologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire
| | - Augustin E. Anoh
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
| | - Abdoulaye Diarrassouba
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
- Unité de Formation et Recherche des Sciences Médicales, Université Alassane Ouattara, Bouaké, Cote d’Ivoire; (A.R.G.); (J.K.-N.)
| | - Marie N. Tuo
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
| | - Amadou Cissé
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
| | - Jasmina Saric
- Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland; (J.S.); (J.U.)
- University of Basel, CH-4003 Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland; (J.S.); (J.U.)
- University of Basel, CH-4003 Basel, Switzerland
| | - Honoré Tia
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
- Unité de Formation et Recherche des Sciences Médicales, Université Alassane Ouattara, Bouaké, Cote d’Ivoire; (A.R.G.); (J.K.-N.)
| | - Judith Kouassi-N’Djeundo
- Unité de Formation et Recherche des Sciences Médicales, Université Alassane Ouattara, Bouaké, Cote d’Ivoire; (A.R.G.); (J.K.-N.)
- Service d’Oto-Rhino-Laryngologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire
| | - Sören L. Becker
- Swiss Tropical and Public Health Institute, CH-4002 Basel, Switzerland; (J.S.); (J.U.)
- University of Basel, CH-4003 Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421 Homburg/Saar, Germany
- Correspondence: (P.M.), (S.L.B.)
| | - Chantal Akoua-Koffi
- Laboratoire de Bactériologie-Virologie, Centre Hospitalier Universitaire de Bouaké, Bouaké, Cote d’Ivoire; (N.D.); (F.S.T.); (A.T.); (M.A.N.); (J.O.T.); (A.E.A.); (A.D.); (M.N.T.); (A.C.); (H.T.); (C.A.-K.)
- Unité de Formation et Recherche des Sciences Médicales, Université Alassane Ouattara, Bouaké, Cote d’Ivoire; (A.R.G.); (J.K.-N.)
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Okello E, Murali M, Rwebembera J, Atala J, Bowen AC, Harik N, Kaudha G, Kitooleko S, Longenecker C, Ndagire E, Omara IO, Oyella LM, Parks T, Pulle J, Sable C, Sarnacki R, Stein E, Zimmerman M, de Klerk N, Carapetis J, Beaton A. Cross-sectional study of population-specific streptococcal antibody titres in Uganda. Arch Dis Child 2020; 105:825-829. [PMID: 32601082 PMCID: PMC11149943 DOI: 10.1136/archdischild-2020-318859] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/09/2020] [Accepted: 05/30/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Despite substantial variation of streptococcal antibody titres among global populations, there is no data on normal values in sub-Saharan Africa. The objective of this study was to establish normal values for antistreptolysin O (ASO) and antideoxyribonuclease B (ADB) antibodies in Uganda. DESIGN This was an observational cross-sectional study. SETTING This study was conducted at Mulago National Referral Hospital, which is located in the capital city, Kampala, and includes the Uganda Heart Institute. PATIENTS Participants (aged 0-50 years) were recruited. Of 428 participants, 22 were excluded from analysis, and 183 (44.4%) of the remaining were children aged 5-15 years. MAIN OUTCOME MEASURES ASO was measured in-country by nephelometric technique. ADB samples were sent to Australia (PathWest) for analysis by enzyme inhibition assay: 80% upper limit values were established. RESULTS The median ASO titre in this age group was 220 IU/mL, with the 80th percentile value of 389 IU/mL. The median ADB titre in this age group was 375 IU/mL, with the 80th percentile value of 568 IU/mL. CONCLUSIONS The estimated Ugandan paediatric population standardised 80% upper-limit-of-normal ASO and ADB titres is higher than many global populations. Appropriateness of using population-specific antibody cutoffs is yet to be determined and has important implications for the sensitivity and specificity of rheumatic fever diagnosis.
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Affiliation(s)
| | - Meghna Murali
- Children's National Health System, Washington, District of Columbia, USA
| | | | | | - Asha C Bowen
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- University of Western Australia, Crawley, Western Australia, Australia
| | - Nada Harik
- Children's National Health System, Washington, District of Columbia, USA
| | | | | | - Chris Longenecker
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | | | | | | | - Tom Parks
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Craig Sable
- Children's National Health System, Washington, District of Columbia, USA
| | - Rachel Sarnacki
- Children's National Health System, Washington, District of Columbia, USA
| | - Elizabeth Stein
- University of Washington School of Medicine, Seattle, Washington, United States
| | - Meghan Zimmerman
- Dartmouth-Hitchcock School of Medicine, Dartmouth, New Hampshire, United States
| | - Nicholas de Klerk
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati School of Medicine, Cincinnati, Ohio, United States
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Development and Evaluation of a New Triplex Immunoassay That Detects Group A Streptococcus Antibodies for the Diagnosis of Rheumatic Fever. J Clin Microbiol 2020; 58:JCM.00300-20. [PMID: 32461283 DOI: 10.1128/jcm.00300-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/20/2020] [Indexed: 02/04/2023] Open
Abstract
Streptococcal serology is a cornerstone in the diagnosis of acute rheumatic fever (ARF), a postinfectious sequela associated with group A Streptococcus infection. Current tests that measure anti-streptolysin O (ASO) and anti-DNaseB (ADB) titers require parallel processing, with their predictive value limited by the low rate of decay in antibody response. Accordingly, our objective was to develop and assess the diagnostic potential of a triplex bead-based assay, which simultaneously quantifies ASO and ADB together with titers for a third antigen, SpnA. Our previous cytometric bead assay was transferred to the clinically appropriate Luminex platform by coupling streptolysin O, DNaseB, and SpnA to spectrally unique magnetic beads. Sera from more than 350 subjects, including 97 ARF patients, were used to validate the assay and explore immunokinetics. Operating parameters demonstrate that the triplex assay produces accurate and reproducible antibody titers which, for ASO and ADB, are highly correlative with existing assay methodology. When ARF patients were stratified by time (days following hospital admission), there was no difference in ASO and ADB between <28 and 28+ day groups. However, for anti-SpnA, there was a significant decrease (P < 0.05) in the 28+ day group, indicative of faster anti-SpnA antibody decay. Anti-SpnA immunokinetics support very recent group A Streptococcus infection and may assist in diagnostic classification of ARF. Further, bead-based assays enable streptococcal serology to be performed efficiently in a high-throughput manner.
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The use of benzathine penicillin in streptococcal erythema nodosum: May it reduce recurrence? Presse Med 2019; 48:1180-1182. [DOI: 10.1016/j.lpm.2018.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/17/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022] Open
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Epidemiology, pathogenesis, treatment and outcomes of infection-associated glomerulonephritis. Nat Rev Nephrol 2019; 16:32-50. [PMID: 31399725 DOI: 10.1038/s41581-019-0178-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 12/31/2022]
Abstract
For over a century, acute 'post-streptococcal glomerulonephritis' (APSGN) was the prototypical form of bacterial infection-associated glomerulonephritis, typically occurring after resolution of infection and a distinct infection-free latent period. Other less common forms of infection-associated glomerulonephritides resulted from persistent bacteraemia in association with subacute bacterial endocarditis and shunt nephritis. However, a major paradigm shift in the epidemiology and bacteriology of infection-associated glomerulonephritides has occurred over the past few decades. The incidence of APSGN has sharply declined in the Western world, whereas the number of Staphylococcus infection-associated glomerulonephritis (SAGN) cases increased owing to a surge in drug-resistant Staphylococcus aureus infections, both in the hospital and community settings. These Staphylococcus infections range from superficial skin infections to deep-seated invasive infections such as endocarditis, which is on the rise among young adults owing to the ongoing intravenous drug use epidemic. SAGN is markedly different from APSGN in terms of its demographic profile, temporal association with active infection and disease outcomes. The diagnosis and management of SAGN is challenging because of the lack of unique histological features, the frequently occult nature of the underlying infection and the older age and co-morbidities in the affected patients. The emergence of multi-drug-resistant bacterial strains further complicates patient treatment.
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Tziortzioti C, Gartzonika C, Gaitanis G, Bassukas ID. Increased antistreptolysin O serum levels in cellulitis recurrences and head and neck disease localization. Int J Dermatol 2019; 58:e98-e99. [DOI: 10.1111/ijd.14383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chrysanthi Tziortzioti
- Department of Dermatology and Venereology General University Hospital of Ioannina Ioannina Greece
| | - Constantina Gartzonika
- Department of Microbiology Faculty of Medicine School of Health Sciences University of Ioannina and Laboratory of Microbiology General University Hospital of Ioannina Ioannina Greece
| | - Georgios Gaitanis
- Department of Dermatology and Venereology General University Hospital of Ioannina Ioannina Greece
- Department of Skin and Venereal Diseases Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece
| | - Ioannis D. Bassukas
- Department of Dermatology and Venereology General University Hospital of Ioannina Ioannina Greece
- Department of Skin and Venereal Diseases Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece
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Ushimaru S, Ichikawa D, Yazawa M, Suzuki T, Okada E, Koike J, Shibagaki Y. Tubulointerstitial Nephritis Associated with Enteritis and Sacroiliitis. Intern Med 2019; 58:79-84. [PMID: 30146576 PMCID: PMC6367097 DOI: 10.2169/internalmedicine.1255-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The association between sacroiliitis and tubulointerstitial nephritis has not been reported. A 28-year-old man with a history of clinically diagnosed ulcerative colitis (4 years earlier) and sacroiliitis (6 months earlier) developed renal dysfunction 9 months ago, which progressed thereafter. We diagnosed him with tubulointerstitial nephritis by a renal biopsy, for which we started steroid therapy. Subsequently, his renal dysfunction, sacroiliitis, and enteritis partially improved. A pathological analysis of the kidney and intestine revealed lymphocyte infiltration and non-caseating granuloma in both organs. The similarities in the pathological findings and treatment response suggested a pathogenetic association between tubulointerstitial nephritis, enteritis, and sacroiliitis.
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Affiliation(s)
- Shu Ushimaru
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Masahiko Yazawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Tomo Suzuki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Eri Okada
- Department of Nephrology, National Hospital Organization Chiba-East-Hospital, Japan
| | - Junki Koike
- Department of Pathology, Kawasaki Municipal Tama Hospital, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
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Abstract
A wide variety of microorganisms are potential respiratory pathogens, and the spectrum of known pathogens for each respiratory infection syndrome has not changed markers over recent years. Detection of likely etiologic agents of respiratory infections can help direct management and can also play an important role in disease surveillance. For this purpose, we are still reliant on many traditional diagnostic tools that have been used for decades in order to determine the microbial etiology of respiratory infections. However, these tools have been increasingly supplemented by newer methods, particular molecular diagnostic techniques, which have enabled the more rapid detection of many pathogens that were previously difficult to detect. These advances have particularly lead to improvements in the ability to detect respiratory viruses and also other microorganisms that do not normally colonize the respiratory tract. Recognition of the existence of the lung microbiome has challenged the traditional views of pneumonia pathogenesis and may provide the opportunity for new diagnostic tools that are focused on more than just detection of specific known pathogens. Continued liaison between clinicians and laboratory staff is vital in order to facilitate the most cost-effective use of laboratory diagnostics.
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Oliver J, Malliya Wadu E, Pierse N, Moreland NJ, Williamson DA, Baker MG. Group A Streptococcus pharyngitis and pharyngeal carriage: A meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006335. [PMID: 29554121 PMCID: PMC5875889 DOI: 10.1371/journal.pntd.0006335] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/29/2018] [Accepted: 02/21/2018] [Indexed: 01/22/2023] Open
Abstract
Objective Antibiotic treatment of Group A Streptococcus (GAS) pharyngitis is important in acute rheumatic fever (ARF) prevention, however clinical guidelines for prescription vary. GAS carriers with acute viral infections may receive antibiotics unnecessarily. This review assessed the prevalence of GAS pharyngitis and carriage in different settings. Methods A random-effects meta-analysis was performed. Prevalence estimates for GAS+ve pharyngitis, serologically-confirmed GAS pharyngitis and asymptomatic pharyngeal carriage were generated. Findings were stratified by age group, recruitment method and country income level. Medline and EMBASE databases were searched for relevant literature published between 1 January 1946 and 7 April 2017. Studies reporting prevalence data on GAS+ve or serologically-confirmed GAS pharyngitis that stated participants exhibited symptoms of pharyngitis or upper respiratory tract infection (URTI) were included. Included studies reporting the prevalence of asymptomatic GAS carriage needed to state participants were asymptomatic. Results 285 eligible studies were identified. The prevalence of GAS+ve pharyngitis was 24.1% (95% CI: 22.6–25.6%) in clinical settings (which used ‘passive recruitment’ methods), but less in sore throat management programmes (which used ‘active recruitment’, 10.0%, 8.1–12.4%). GAS+ve pharyngitis was more prevalent in high-income countries (24.3%, 22.6–26.1%) compared with low/middle-income countries (17.6%, 14.9–20.7%). In clinical settings, approximately 10% of children swabbed with a sore throat have serologically-confirmed GAS pharyngitis, but this increases to around 50–60% when the child is GAS culture-positive. The prevalence of serologically-confirmed GAS pharyngitis was 10.3% (6.6–15.7%) in children from high-income countries and their asymptomatic GAS carriage prevalence was 10.5% (8.4–12.9%). A lower carriage prevalence was detected in children from low/middle income countries (5.9%, 4.3–8.1%). Conclusions In active sore throat management programmes, if the prevalence of GAS detection approaches the asymptomatic carriage rate (around 6–11%), there may be little benefit from antibiotic treatment as the majority of culture-positive patients are likely carriers. Treating sore throats caused by Group A Streptococcus infections (GAS pharyngitis) with antibiotics is important for preventing acute rheumatic fever (ARF). It is impossible to distinguish patients with true GAS pharyngitis infections from GAS carriers with pharyngitis caused by viral infections when throat swab culturing alone is used to diagnose GAS pharyngitis. Carriers are not likely to benefit from antibiotic treatment, but may receive treatment unnecessarily. Reported rates of GAS pharyngitis and carriage vary considerably depending on the setting. Thus it is difficult to ascertain which groups are likely to benefit significantly from active sore throat management programmes which treat GAS pharyngitis in order to prevent ARF. We performed a meta-analysis to estimate the prevalence of GAS pharyngitis and asymptomatic carriage in different settings. Approximately 10% of all children swabbed for a sore throat in clinical settings have true GAS pharyngitis, but this increases to around 55% if the children have GAS detected in their throat using swab cultures. In active sore throat management programmes, the prevalence of GAS detection is lower than in clinical settings and if it declines towards 8% (the asymptomatic carriage level), there may be little benefit in treating GAS culture-positive patients with antibiotics.
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Affiliation(s)
- Jane Oliver
- University of Otago Wellington, Newtown, Wellington, New Zealand
| | | | - Nevil Pierse
- University of Otago Wellington, Newtown, Wellington, New Zealand
| | - Nicole J. Moreland
- Maurice Wilkins Centre and School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Deborah A. Williamson
- University of Otago Wellington, Newtown, Wellington, New Zealand
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Michael G. Baker
- University of Otago Wellington, Newtown, Wellington, New Zealand
- * E-mail:
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Hanson-Manful P, Whitcombe AL, Young PG, Atatoa Carr PE, Bell A, Didsbury A, Mitchell EA, Dunbar PR, Proft T, Moreland NJ. The novel Group A Streptococcus antigen SpnA combined with bead-based immunoassay technology improves streptococcal serology for the diagnosis of acute rheumatic fever. J Infect 2017; 76:361-368. [PMID: 29269013 DOI: 10.1016/j.jinf.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/27/2017] [Accepted: 12/12/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Streptococcal serology provides evidence of prior Group A Streptococcus (GAS) exposure, crucial to the diagnosis of acute rheumatic fever (ARF) and post-streptococcal glomerulonephritis. However, current tests, which measure anti-streptolysin-O and anti-DNaseB antibodies, are limited by false positives in GAS endemic settings, and incompatible methodology requiring the two tests to be run in parallel. The objective was to improve streptococcal serology by combining the novel GAS antigen, SpnA, with streptolysin-O and DNaseB in a contemporary, bead-based immunoassay. METHODS Recombinant streptolysin-O, DNAseB and SpnA were conjugated to polystyrene beads with unique fluorescence positions so antibody binding to all three antigens could be detected simultaneously by cytometric bead array. Multiplex assays were run on sera collected in three groups: ARF; ethnically matched healthy children; and healthy adults. RESULTS The ability of the antigens to detect a previous GAS exposure in ARF was assessed using the 80th centile of the healthy children group as cut-off (upper limit of normal). SpnA had the highest sensitivity at 88%, compared with 75% for streptolysin-O and 56% for DNaseB. CONCLUSIONS SpnA has favorable immunokinetics for streptococcal serology, and can be combined with anti-streptolysin-O and anti-DNaseB in a multiplex format to improve efficiency and accuracy.
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Affiliation(s)
- Paulina Hanson-Manful
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand
| | - Alana L Whitcombe
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul G Young
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Polly E Atatoa Carr
- Waikato District Health Board, Hamilton, New Zealand; National Institute of Demographic and Economic Analysis, University of Waikato, Waikato, New Zealand
| | - Anita Bell
- Waikato District Health Board, Hamilton, New Zealand
| | - Alicia Didsbury
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Edwin A Mitchell
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - P Rod Dunbar
- Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Thomas Proft
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand.
| | - Nicole J Moreland
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand.
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