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Asif H, Fernandes M, Gorbonos A, Khan AA, Ishak Gabra N, Palladino L. Rapidly-Developing Pleural Effusion: Explosive Pleuritis Caused by Group A Streptococcal Infection. Cureus 2022; 14:e26968. [PMID: 35989836 PMCID: PMC9381858 DOI: 10.7759/cureus.26968] [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] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
Abstract
Community-acquired pneumonia is a leading cause of death from infectious diseases globally. Parapneumonic effusion is one of the most common complications of community-acquired pneumonia. As the infection progresses within the pleural space, loculation and empyema may develop. In rare cases, the parapneumonic effusions can progress significantly within 24 hours, which has been described as explosive pleuritis and may confer additional morbidity. Group A Streptococcus is the leading causative microorganism, which in itself has higher rates of parapneumonic effusions. We describe the case of a 30-year-old-female with a past medical history of asthma who presented to the emergency department with a sore throat, cough, and runny nose and was discharged on the same day after treatment of asthma exacerbation with upper respiratory tract infection. She re-presented within 24 hours with shortness of breath and right-sided pleuritic chest pain. Chest x-ray showed a new, large right-sided pleural effusion for which pleural fluid culture grew group A Streptococcus. She ultimately had prolonged hospitalization, requiring chest tube placement, and video-assisted thoracoscopic surgery (VATS). VATS was unsuccessful and she was treated with long-term antibiotics. This case demonstrates the dramatic evolution of explosive pleuritis and highlights the typical challenges encountered in these cases.
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Khan F, Bai Z, Kelly S, Skidmore B, Dickson C, Nunn A, Rutledge-Taylor K, Wells G. Effectiveness and Safety of Antibiotic Prophylaxis for Persons Exposed to Cases of Invasive Group A Streptococcal Disease: A Systematic Review. Open Forum Infect Dis 2022; 9:ofac244. [PMID: 36046698 PMCID: PMC9424867 DOI: 10.1093/ofid/ofac244] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022] Open
Abstract
Among close contacts of patients with invasive group A streptococcal (iGAS) infection, the benefits and harms of chemoprophylaxis are uncertain. We conducted a systematic review of studies that reported on persons who, after being exposed to a case of laboratory-confirmed or probable iGAS, received any antibiotic prophylaxis for the prevention of GAS infection or carriage. Thirty-seven studies including 26 outbreak investigations and 11 case series or reports were included with predominantly descriptive information that suggested that antibiotic prophylaxis may be effective in preventing GAS infection or GAS carriage, with very few serious adverse events. However, current available evidence is scant (with limited information on contacts of iGAS cases) and largely based on studies with weak design and small sample size. Therefore, definitive conclusions on effectiveness of antibiotic prophylaxis cannot be drawn. Well designed prospective studies are required to establish the benefit-harm profile of antibiotic prophylaxis for secondary prevention of GAS disease among close contacts of iGAS cases.
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Affiliation(s)
- Faizan Khan
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Zemin Bai
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Shannon Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Ottawa Hospital Research Institute, Ottawa, Canada; Ottawa, Ontario, Canada
| | - Catherine Dickson
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, Canada
| | - Alexandra Nunn
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, Canada
| | - Katie Rutledge-Taylor
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, Canada
| | - George Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Wang J, Xia C, Sharma A, Gaba GS, Shabaz M. Chest CT Findings and Differential Diagnosis of Mycoplasma pneumoniae Pneumonia and Mycoplasma pneumoniae Combined with Streptococcal Pneumonia in Children. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8085530. [PMID: 34221302 PMCID: PMC8219438 DOI: 10.1155/2021/8085530] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this day and age, 17% of children less than 5 years of age died of pneumonia; it is the common cause of children death. It is one of the main children respiratory infectious diseases, i.e., mycoplasma pneumonia (MP). The imaging examination can be adopted to quickly observe the morphology and scope of the pulmonary lesions and know the effect of disease treatment and subsequent changes in the disease in order to provide a basis for treatment. Therefore, the most commonly applied technology for detecting pneumonia in children is imaging technology, including chest X-ray and CT. OBJECTIVES The main objective of the work is to investigate the chest computed tomography (CT) findings of children patients with Mycoplasma pneumoniae pneumonia (MPP) and MP combined with streptococcal pneumonia (SP). The mixed infection of MP and SP is very common clinically, and the diagnosis of this type of mixed pneumonia is a critical research topic faced by pediatric respiratory physicians. The comparison is done on the incidence of bronchial and pulmonary interstitial lesions, the degree of lymph node enlargement, the volume and depth of pleural effusion, and the location and morphology of the pulmonary lesions in the chest CT images of children patients from the two groups. METHODS There were comparisons on the incidence of bronchial and pulmonary interstitial lesions, the degree of lymph node enlargement, the volume and depth of pleural effusion, and the location and morphology of the pulmonary lesions in the chest CT images of children patients from the two groups. All the experiments are done in the MATLAB. RESULTS The results showed that the proportions of reticular shadow, ground glass shadow, bronchial inflation phase, tube wall thickening, and vascular bundle thickening on the CT images of children patients from the MPP group were dramatically higher than those of the MP + SP group (P < 0.05). The maximum transverse diameter of enlarged lymph node in children patients from the MPP group was obviously larger than the diameter of the MP + SP group (P < 0.05). The number of children patients with pleural effusion was 22 in the MP + SP group, which was greatly higher than the MPP group (P < 0.05). CONCLUSION In conclusion, the chest CT images of children patients from the MPP group were mainly pulmonary interstitial changes. Furthermore, the alveolar inflammation could be observed on the CT images shown when children patients were combined with SP infection. The more obvious manifestations were that the flaky shadows appeared in the lungs, the pleural effusion became thicker, and the transverse diameters of enlarged lymph nodes were bigger.
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Affiliation(s)
- Jing Wang
- 1Department of Infectious Diseases, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Chen Xia
- 1Department of Infectious Diseases, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Ashutosh Sharma
- 2Institute of Computer Technology and Information Security, Southern Federal University, Rostov-on-Don, Russia
| | - Gurjot Singh Gaba
- 3School of Electronics and Electrical Engineering, Lovely Professional University, Phagwara 144411, India
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Adverse events following mass antibiotic prophylaxis during a Group A Streptococcus outbreak in the Canadian Forces Leadership and Recruit School. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:264-271. [PMID: 33104089 DOI: 10.14745/ccdr,v46i09a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Between December 2016 and March 2018, two outbreaks of Group A Streptococcus (GAS) infection occurred at the Canadian Forces Leadership and Recruit School. A voluntary mass antibiotic prophylaxis (MAP) program was implemented in March 2018, to interrupt an ongoing GAS outbreak, and to prevent future outbreaks. Methods Instructors and recruits were offered a one-time intramuscular injection of 1.2 million units penicillin G benzathine (PGB). Individuals with a penicillin allergy were offered azithromycin; 500 mg orally once weekly for four consecutive weeks. Instructors and recruits were also asked to complete a voluntary and anonymous survey one week after receipt of MAP, to detect MAP-related adverse events. Results MAP was offered to 2,749 individuals; 2,707 of whom agreed to receive it (98.5% uptake). The majority of personnel experienced adverse events in the days following MAP; 92.3% of personnel who received PGB reported localized pain at the injection site, and 70.2% of personnel who received azithromycin reported gastrointestinal symptoms. However, only five cases of serious adverse events were reported, and less than 1% of recruits could not complete their basic military training course because of MAP-related adverse events. Conclusion The MAP program implemented in March 2018 was the first of its kind in the Canadian Armed Forces, and the largest single use of PGB in a defined group in Canada. It resulted in very few serious adverse events and with minimal impact on military recruits' successful completion of recruit training.
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Webber BJ, Kieffer JW, White BK, Hawksworth AW, Graf PCF, Yun HC. Chemoprophylaxis against group A streptococcus during military training. Prev Med 2019; 118:142-149. [PMID: 30393152 DOI: 10.1016/j.ypmed.2018.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/27/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
Chemoprophylaxis with intramuscular benzathine penicillin G has been used widely by the U.S. military to prevent epidemics of group A streptococcus infections during basic training. The recent global shortage of benzathine penicillin prompted a detailed analysis of this issue in 2017 by military preventive medicine and infectious disease authorities in San Antonio, Texas, and San Diego, California, USA. This paper explores the history of group A streptococcus and chemoprophylaxis in the U.S. military training environment, current policy and practice, and challenges associated with widespread chemoprophylaxis. In light of the history presented, preventive medicine authorities at basic training centers should be extremely cautious about discontinuing benzathine penicillin chemoprophylaxis.
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Affiliation(s)
- Bryant J Webber
- Epidemiology Consult Service, U.S. Air Force School of Aerospace Medicine, 2510 Fifth Street, Bldg 840, Rm W318.23, Wright-Patterson Air Force Base, OH 45433, USA.
| | - John W Kieffer
- 559th Medical Group, Wilford Hall Ambulatory Surgical Center, 1440 McGuire Street, Bldg 7206, Joint Base San Antonio-Lackland, TX 78235, USA.
| | - Brian K White
- 559th Medical Group, Wilford Hall Ambulatory Surgical Center, 1440 McGuire Street, Bldg 7206, Joint Base San Antonio-Lackland, TX 78235, USA.
| | - Anthony W Hawksworth
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., 6720A Rockledge Drive, Bethesda, MD 20817, USA
| | - Paul C F Graf
- Operational Infectious Diseases Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA.
| | - Heather C Yun
- Department of Infectious Diseases, San Antonio Military Medical Center, 3351 Roger Brooke Drive, MCHE-ZDM, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.
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Akuzawa N, Kurabayashi M. Bacterial Pneumonia Caused by Streptococcus pyogenes Infection: A Case Report and Review of the Literature. J Clin Med Res 2016; 8:831-835. [PMID: 27738486 PMCID: PMC5047023 DOI: 10.14740/jocmr2737w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
A 78-year-old Japanese man was admitted to our hospital because of fever lasting for 4 days. His white blood cell count and C-reactive protein level were elevated and computed tomography of the chest showed bronchopneumonia in the right upper lobe of the lung. Streptococcus pyogenes was detected from sputum and blood culture samples on admission and administration of ampicillin/sulbactam was effective. Although our patient’s clinical course was good, S. pyogenes pneumonia commonly shows a high rate of fatality and septicemia, and may affect a previously healthy population. Physicians should be aware of pernicious characteristics of S. pyogenes pneumonia.
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Affiliation(s)
- Nobuhiro Akuzawa
- Department of General Medicine, National Hospital Organization Shibukawa Medical Center, 383 Shiroi, Shibukawa, Gunma 377-0280, Japan
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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Streptococcus pyogenes Pneumonia in Adults: Clinical Presentation and Molecular Characterization of Isolates 2006-2015. PLoS One 2016; 11:e0152640. [PMID: 27027618 PMCID: PMC4814053 DOI: 10.1371/journal.pone.0152640] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/16/2016] [Indexed: 01/10/2023] Open
Abstract
Introduction In the preantibiotic era Streptococcus pyogenes was a common cause of severe pneumonia but currently, except for postinfluenza complications, it is not considered a common cause of community-acquired pneumonia in adults. Aim and Material and Methods This study aimed to identify current clinical episodes of S. pyogenes pneumonia, its relationship with influenza virus circulation and the genotypes of the involved isolates during a decade in a Southern European region (Gipuzkoa, northern Spain). Molecular analysis of isolates included emm, multilocus-sequence typing, and superantigen profile determination. Results Forty episodes were detected (annual incidence 1.1 x 100,000 inhabitants, range 0.29–2.29). Thirty-seven episodes were community-acquired, 21 involved an invasive infection and 10 developed STSS. The associated mortality rate was 20%, with half of the patients dying within 24 hours after admission. Influenza coinfection was confirmed in four patients and suspected in another. The 52.5% of episodes occurred outside the influenza seasonal epidemic. The 67.5% of affected persons were elderly individuals and adults with severe comorbidities, although 13 patients had no comorbidities, 2 of them had a fatal outcome. Eleven clones were identified, the most prevalent being emm1/ST28 (43.6%) causing the most severe cases. Conclusions S. pyogenes pneumonia had a continuous presence frequently unrelated to influenza infection, being rapidly fatal even in previously healthy individuals.
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Marchiori DM. Pulmonary Infections. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Olsen RJ, Ashraf M, Gonulal VE, Ayeras AA, Cantu C, Shea PR, Carroll RK, Humbird T, Greaver JL, Swain JL, Chang E, Ragasa W, Jenkins L, Lally KP, Blasdel T, Cagle P, Musser JM. Lower respiratory tract infection in cynomolgus macaques (Macaca fascicularis) infected with group A Streptococcus. Microb Pathog 2010; 49:336-47. [DOI: 10.1016/j.micpath.2010.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
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Abstract
In Osier’s time, bacterial pneumonia was a dreaded event, so important that he borrowed John Bunyan’s characterization of tuberculosis and anointed the pneumococcus, as the prime pathogen, “Captain of the men of death.”1 One hundred years later much has changed, but much remains the same. Pneumonia is now the sixth most common cause of death and the most common lethal infection in the United States. Hospital-acquired pneumonia is now the second most common nosocomial infection.2 It was documented as a complication in 0.6% of patients in a national surveillance study,3 and has been reported in as many as 20% of patients in critical care units.4 Furthermore, it is the leading cause of death among nosocomial infections.5 Leu and colleagues6 were able to associate one third of the mortality in patients with nosocomial pneumonia to the infection itself. The increase in hospital stay, which averaged 7 days, was statistically significant. It has been estimated that nosocomial pneumonia produces costs in excess of $500 million each year in the United States, largely related to the increased length of hospital stay.
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Al-Kaabi N, Solh Z, Pacheco S, Murray L, Gaboury I, Le Saux N. A Comparison of group A Streptococcus versus Streptococcus pneumoniae pneumonia. Pediatr Infect Dis J 2006; 25:1008-12. [PMID: 17072122 DOI: 10.1097/01.inf.0000243198.63255.c1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND St reptococcus pyogenes is an uncommon cause of community-acquired pneumonia in children. Further, its clinical course in comparison to pneumonia caused by Streptococcus pneumonia has not been previously highlighted. METHODS We reviewed medical records of children 0-18 years of age from April 1983 to April 2005, with discharge diagnoses of invasive disease caused by group A streptococcus (GAS) (Streptococcus pyogenes), or Streptococcus pneumonia (SP) or pneumonia. Data were extracted from the charts, and a comparison of clinical characteristics between the 2 etiologies was performed. Confirmed disease required blood or pleural fluid isolates. Patients with single isolates of GAS in tracheobronchial secretions or sputum were classified as having presumed disease caused by GAS. Patients with confirmed disease due to GAS and SP were compared with respect to clinical characteristics. RESULTS Of 103 patients with invasive GAS disease, 12 (11.6%) had confirmed GAS lobar pneumonia. In addition 7 patients had presumed GAS pneumonia. There were 54 patients with confirmed SP pneumonia. Most children who had GAS pneumonia were healthy and recovered completely. Compared with patients with confirmed SP pneumonia, those with confirmed GAS pneumonia had more frequent and larger effusions, more culture positive effusions, had prolonged fever, and had longer hospitalizations. There was not an increasing trend to GAS pneumonia over the 22-year period. There was not a predominant serotype responsible for the pneumonias. CONCLUSIONS Lobar GAS pneumonia represents approximately 11% of all cases of invasive disease in this institution during a 22-year period. Compared with patients with SP pneumonia, it appears to cause more effusions and morbidity. The organism is also more frequently recovered from pleural fluid.
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Affiliation(s)
- Nawal Al-Kaabi
- Chalmers Research Group, Statistical Division, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Harre B, Nashelsky M, Douvoyiannis M, Shulman ST. Fatal group A streptococcal myopericarditis during influenza A infection. Pediatr Infect Dis J 2006; 25:660-1. [PMID: 16804446 DOI: 10.1097/01.inf.0000224544.05879.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Influenza A infection can be a serious and life-threatening disease in young children. Even in those who die, however, the cause of death may not be obvious. In this illustrative report, a 7-year-old child with acute influenza A infection developed an unsuspected fatal secondary infection caused by group A streptococcus. The diagnosis of bacterial myopericarditis was made at autopsy.
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Affiliation(s)
- Barbara Harre
- Scott County Medical Examiners Office, Davenport, IA, USA
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Crum NF, Russell KL, Kaplan EL, Wallace MR, Wu J, Ashtari P, Morris DJ, Hale BR. Pneumonia outbreak associated with group a Streptococcus species at a military training facility. Clin Infect Dis 2005; 40:511-8. [PMID: 15712072 DOI: 10.1086/427502] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Accepted: 09/17/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although group A streptococci (GAS) infections are a major cause of morbidity and mortality, outbreaks of associated pneumonia are rare. We report an outbreak of GAS pneumonia that occurred at a US military training camp. METHODS Standard epidemiologic and laboratory procedures were used to characterize the outbreak and causative organism(s). A case-control study and determination of the prevalence of GAS infection among camp personnel were also performed. RESULTS A total of 162 of 4500 Marine Corps personnel were hospitalized for respiratory symptoms during the period of 1 November and 20 December 2002, and 127 (78%) had radiographically confirmed pneumonia. The attack rate was 1.6 cases per 100 person-months. Thirty-four (27%) of 127 patients with pneumonitis had definite or probable GAS pneumonia; an additional 22 (17.3%) were coinfected with GAS and another pathogen. Pathogens, in addition to GAS, included Chlamydia pneumoniae (27 patients), Mycoplasma pneumoniae (19), adenovirus (5), and Streptococcus pneumoniae (2). A survey revealed that the pharyngeal carriage rate of GAS among camp personnel was 16%. Molecular characterization of the GAS isolates found emm type 3, multilocus sequence type 15. The epidemic ended after administration of additional prophylaxis with a single dose of intramuscular benzathine penicillin (1.2 million U) or azithromycin (1 g orally). Because the number of days from the last penicillin injection was correlated with a positive throat culture result and the occurrence of pneumonia, the dosing interval of benzathine penicillin was shortened from every 28-35 days to every 21 days. CONCLUSIONS This is the largest outbreak of GAS pneumonia reported in >30 years. This outbreak emphasizes the potential for GAS to cause epidemics of severe infection and demonstrates the need for surveillance and consideration of appropriate antibiotic prophylaxis among particularly high-risk populations.
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Affiliation(s)
- Nancy F Crum
- Infectious Diseases Division, Clinical Investigation Dept., Naval Medical Center San Diego, CA 92134-1005, USA.
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Roy S, Kaplan EL, Rodriguez B, Schreiber JR, Salata RA, Palavecino E, John CC. A family cluster of five cases of group A streptococcal pneumonia. Pediatrics 2003; 112:e61-5. [PMID: 12837907 DOI: 10.1542/peds.112.1.e61] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A cluster of 5 family members, a mother and 4 children, were hospitalized for severe group A Streptococcus (GAS) pneumonia. Three family members had complications: sepsis (1), empyema (2), and a sterile parapneumonic effusion (1). Two additional family members had symptoms of upper respiratory tract infection, and 1 was hospitalized for these symptoms. GAS was isolated from the blood of 1 patient, the pleural fluid of 2 patients, and the oropharynx of 6 patients. Pulsed field gel electrophoresis testing revealed an identical deoxyribonucleic acid pattern in all 7 isolates. Genotyping revealed the speA gene and serotyping the T-1, M-1 serotype in all isolates. This family cluster of invasive GAS disease is the largest reported to date, with an attack rate of 41.7% (5 of 12 family members). This report provides further support for antibiotic prophylaxis of close contacts of individuals with invasive GAS disease.
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MESH Headings
- Anti-Bacterial Agents
- Child
- Contact Tracing
- DNA, Bacterial/analysis
- Disease Outbreaks
- Disease Transmission, Infectious/prevention & control
- Drug Therapy, Combination/therapeutic use
- Electrophoresis, Gel, Pulsed-Field
- Empyema, Pleural/drug therapy
- Empyema, Pleural/microbiology
- Empyema, Pleural/surgery
- Family Health
- Female
- Genotype
- Humans
- Male
- Middle Aged
- Pharyngitis/microbiology
- Pneumonia, Bacterial/microbiology
- Serotyping
- Shock, Septic/microbiology
- Streptococcal Infections/drug therapy
- Streptococcal Infections/microbiology
- Streptococcal Infections/prevention & control
- Streptococcal Infections/surgery
- Streptococcal Infections/transmission
- Streptococcus pyogenes/classification
- Streptococcus pyogenes/genetics
- Streptococcus pyogenes/isolation & purification
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Affiliation(s)
- Sumita Roy
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
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Neumonía asociada con bacteriemia por estreptococo del grupo A. Enferm Infecc Microbiol Clin 2003. [DOI: 10.1016/s0213-005x(03)73001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pepper PV, Owens DK. Cost-effectiveness of the pneumococcal vaccine in healthy younger adults. Med Decis Making 2002; 22:S45-57. [PMID: 12369231 DOI: 10.1177/027298902237705] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Routine vaccination for Streptococcus pneumoniae has been recommended as a cost-effective measure for elderly and immunocompromised patients, yet no analysis has been performed for healthy younger adults in America. The authors evaluated the cost-effectiveness of the pneumococcal vaccine and determined the net health benefits conferred for the healthy young adult population. METHODS The authors developed a decision model to compare the health and economic outcomes of vaccinate versus do not vaccinate for S. pneumoniae. RESULTS Vaccinating patients for S. pneumoniae generates benefits that are dependent on incidence rates and the efficacy of the vaccine. In the 22-year-old patient with a pneumonia incidence of 0.3/1000, the vaccine would need to be > 71 percent effective for the vaccination strategy to cost less than $50,000/QALY gained. At an incidence of 0.4/1000, the threshold efficacy is 53 percent, whereas at 0.5/1000 it is 43 percent. In the 35-year-old patient where the incidence of pneumococcal pneumonia is higher (0.85/1000), the vaccine would be cost-effective with an efficacy as low as 30 percent. CONCLUSIONS Use of the S. pneumoniae vaccine in young adults would provide modest reductions in pneumonia-associated morbidity and mortality. Vaccination of young adults is moderately expensive unless vaccine efficacy is above 50% to 60%. In 35-year-old adults, use of the vaccine is cost-effective even with moderate efficacy.
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Affiliation(s)
- Patricia Vold Pepper
- Department of General Internal Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Box 130, San Diego, CA 92134-5000, USA.
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Aboud FC, Verghese AC. Evarts Ambrose Graham, empyema, and the dawn of clinical understanding of negative intrapleural pressure. Clin Infect Dis 2002; 34:198-203. [PMID: 11740708 DOI: 10.1086/338148] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2001] [Indexed: 11/03/2022] Open
Abstract
The concept of negative intrapleural pressure is fairly new. Although the phenomenon had already been described, Wirz provided the first definitive analysis of its significance to the mechanics of breathing in 1923. By contrast, empyema has been known since antiquity; from the time of Hippocrates, treatment has consisted of open drainage. Open drainage was often successful and did not result in pneumothorax, because most cases of empyema were associated with adhesions and thickened visceral pleura that prevented the lung from collapsing. The epidemic of group A streptococcal pneumonia in military camps in 1917-1918 was associated with the rapid and early accumulation of empyema fluid and was the catalyst for renewed study of empyema. Use of open drainage to manage this illness resulted in a high immediate mortality rate, probably because patients developed pneumothorax. The work of Evarts Graham and the Empyema Commission married physiological understanding of pleural mechanics with rational clinical treatment and paved the way for further advances in thoracic surgery.
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Johnson JL. Pleurisy, fever, and rapidly progressive pleural effusion in a healthy, 29-year-old physician. Chest 2001; 119:1266-9. [PMID: 11296198 DOI: 10.1378/chest.119.4.1266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- J L Johnson
- Division of Infectious Diseases, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH 44106-4984, USA.
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Limbago B, McIver KS, Penumalli V, Weinrick B, Scott JR. Restoration of Mga function to a Streptococcus pyogenes strain (M Type 50) that is virulent in mice. Infect Immun 2001; 69:1215-20. [PMID: 11160026 PMCID: PMC98010 DOI: 10.1128/iai.69.2.1215-1220.2001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Mga protein in B514Sm, a Streptococcus pyogenes strain isolated as a mouse pathogen, contains amino acid substitutions at conserved sites that render the protein defective. Replacement of mga50 with the functional homolog mga4.1 restored full expression of Mga-regulated proteins. Restoration of Mga function did not affect fibrinogen binding, nor did it affect virulence in several mouse models of group A streptococcus infection.
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Affiliation(s)
- B Limbago
- Department of Microbiology and Immunology, Emory University Health Sciences Center, Atlanta, Georgia 30322, USA
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Kalima P, Riordan T, Berrisford RG, Sarsfield PT. Necrotizing pneumonia associated with group A streptococcal bacteraemia. Eur J Clin Microbiol Infect Dis 1998; 17:296-8. [PMID: 9707319 DOI: 10.1007/bf01699993] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 13-1996. A 51-year-old man with the adult respiratory distress syndrome. N Engl J Med 1996; 334:1116-23. [PMID: 8598872 DOI: 10.1056/nejm199604253341708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
It appears that many commonly recognized syndromes such as the ARDS may well be caused by agents that have only recently emerged as respiratory pathogens. HPS represents one such entity. It appears likely that the increasing pressure of antibiotic use as well as the reemergence of certain pathogens will continue to challenge the clinician. Paramount to the identification and treatment of unusual pneumonias will be the degree with which an effort is made to make an etiologic diagnosis through sputum examination, transtracheal aspirate, bronchoscopy, or lung biopsy. Although pneumococcal pneumonia is the most common community-acquired pneumonia seen by practicing physicians, in all likelihood from time to time a physician will encounter pneumonia caused by one of the unusual pathogens described in this article or else by an altogether new pathogen.
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Affiliation(s)
- L G Guerra
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso
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Hamour A, Bonnington A, Wilkins EG. Severe community acquired pneumonia associated with a desquamating rash due to group A beta-haemolytic streptococcus. J Infect 1994; 29:77-81. [PMID: 7963639 DOI: 10.1016/s0163-4453(94)95168-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In recent years frequent and severe infections due to group A beta-haemolytic streptococci have been recognised with increasing frequency. Group A streptococcal pneumonia remains a rare disease occurring sporadically in contrast to epidemics in the past. The association between group A streptococcal pneumonia and a desquamating skin rash typical of scarlet fever has rarely been reported.
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Affiliation(s)
- A Hamour
- Department of Infectious Diseases & Tropical Medicine, North Manchester General Hospital, U.K
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Carson CA, Fine MJ, Smith MA, Weissfeld LA, Huber JT, Kapoor WN. Quality of published reports of the prognosis of community-acquired pneumonia. J Gen Intern Med 1994; 9:13-9. [PMID: 8133345 DOI: 10.1007/bf02599136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To systematically assess the quality of published reports of the prognosis of community-acquired pneumonia using a formal quality assessment instrument. DESIGN Retrospective review of studies published during 1966-1991. ARTICLES: 108 articles related to the prognosis of community-acquired pneumonia retrieved by a computerized search. INTERVENTION All articles, blinded to author(s), journal title, year of publication, and study institution(s), were independently reviewed by two investigators using a ten-item quality assessment instrument designed to evaluate: 1) identification of the inception cohort (4 items), 2) description of referral patterns (1 item), 3) subject follow-up (2 items), and 4) statistical methods (3 items). Adherence to each of the ten individual quality items and an overall quality score were calculated for all articles and across three time periods. MAIN RESULTS Among all 108 articles that underwent quality assessment, 30 were published from 1966 to 1979, 61 from 1980 through 1989, and 17 from 1990 through 1991. The mean total quality score of all articles was 0.55 (range 0.22-0.90). There was a significant trend toward improvement in total quality scores over the three time periods (0.50 to 0.56 to 0.65; p < 0.001). However, several systematic errors in the study design or reporting of these studies were discovered throughout time: only 3.7% provided comparative information about nonenrolled patients, 28.7% determined whether the study institution was a referral center, 36.1% specified inclusion or exclusion criteria, and 45.5% used appropriate statistical analyses to adjust for more than one prognostic factor. CONCLUSIONS Despite improvement in overall quality of published articles, systematic errors exist in the design and reporting of studies related to the prognosis of community-acquired pneumonia. The quality assessment tool employed in this study could be used to guide the development of high-quality outcomes research in the future.
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Affiliation(s)
- C A Carson
- Department of Epidemiology, University of Pittsburgh, PA 15213
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Novotny W, Faden H, Mosovich L. Emergence of invasive group A streptococcal disease among young children. Clin Pediatr (Phila) 1992; 31:596-601. [PMID: 1395366 DOI: 10.1177/000992289203101004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990. The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient). Three cases followed chicken pox. Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance. Only four children had pharyngitis. Bacteremia was confirmed in three children and presumed in another three. All the subjects survived. Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production. These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.
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Affiliation(s)
- W Novotny
- Department of Pediatrics, State University of New York, School of Medicine, Buffalo
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Affiliation(s)
- S R Dobson
- Department of Paediatrics, John Radcliffe Hospital, Oxford
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McIntyre HD, Armstrong JG, Mitchell CA. Streptococcus pyogenes pneumonia with abscess formation. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1989; 19:248-9. [PMID: 2673177 DOI: 10.1111/j.1445-5994.1989.tb00255.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 30-year-old female with mild asthma presented with high fever, hypotension, pleuritic chest pain, vomiting and diarrhea. Chest radiograph showed consolidation of the right upper lobe, and S. pyogenes was cultured from blood and sputum. Following initial rapid recovery the patient relapsed ten days after antibiotics were ceased, with rapid development of a large abscess cavity. Clinical improvement occurred following reinstitution of treatment including intravenous penicillin. Progressive radiological resolution eventuated during outpatient follow-up. This case demonstrates that S. pyogenes pneumonia may occur without an antecedent viral infection or major predisposing condition, cause rapid cavitation despite antiobiotic therapy and resolve satisfactorily with prolonged penicillin therapy.
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Affiliation(s)
- H D McIntyre
- Princess Alexandra Hospital, Woolloongabba, Qld, Australia
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Ekenna O, Verghese A, Karnad A, Basile P, Berk SL. Isolation of beta-hemolytic streptococci from the respiratory tract: distribution and clinical significance. Am J Med Sci 1988; 295:94-101. [PMID: 3344761 DOI: 10.1097/00000441-198802000-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Isolates of beta-hemolytic streptococci obtained from respiratory tract specimens were studied for determination of their serogroup, and Patients' charts were reviewed for the clinical significance of these respiratory isolates. Fifteen of 69 patients were considered to have definite respiratory infection. Thirteen of these 15 patients had Group B beta-hemolytic streptococci. Staphylococcus aureus was isolated concomitantly with Group B streptococci (GBS) in 34% of cases, but rarely was it isolated with other beta-hemolytic streptococci. Sero-groups of beta-hemolytic streptococci were compared with respect to the patient's underlying disease, age, and clinical outcome. Patients who had GBS isolated from sputum were elderly (mean age, 68.1 years) and were older than patients with other beta-hemolytic isolates (mean age, 56 years). Patients with Group B streptococci were more likely to have cerebrovascular disease, whereas patients with Group C, G, and F were more likely to have malignancy, particularly of the head and neck.
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Affiliation(s)
- O Ekenna
- Division of Infectious Diseases, Veterans Administration Medical Center, Johnson City, TN 37684
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Affiliation(s)
- J J McMurray
- Department of Medicine, Milesmark Hospital, Dunfermline
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Abstract
Two young adults had clinical and roentgenographic evidence of explosive pleuritis that was caused by group A beta-hemolytic streptococci. Persistent high fever and intense pleuritic pain following severe pharyngitis should suggest streptococcal pleural infection and prompt careful roentgenographic investigation. These cases show that group A beta-hemolytic streptococcal infection can cause explosive pleuritis in the absence of apparent bronchopneumonia.
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McMurray J, Fraser DM. Pneumonia. Postgrad Med J 1986; 62:895. [PMID: 3543914 PMCID: PMC2422815 DOI: 10.1136/pgmj.62.731.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Overwhelming pneumonia may be caused by a large number of different organisms in both immunocompetent and compromised hosts. In this article, the most common etiologies of overwhelming pneumonia are considered from an epidemiologic and clinical point of view.
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Abstract
A classification of normal-abnormal hosts and pathogens forms the basis for discussion of the diagnosis and management of pneumonia in the critical care setting. In order to arrive at the appropriate therapy for the unusual as well as the usual causative organisms of pneumonia, individual assessment of the need for invasive procedures must be made. The critical feature, however, is to consider the wide spectrum of possibilities for each individual patient.
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Abstract
Lancefield group C streptococcal pneumonia appeared in a previously healthy young adult. The patient apparently acquired the infection while caring for her sick horse, and experienced a gradual onset of the illness. There was rapid accumulation of pleural fluid and empyema requiring open drainage. Group C pneumonia cannot be distinguished from classic group A pneumonia on clinical grounds. Beta-hemolytic streptococci isolated from sputum, transtracheal aspirates, pleural fluid, or blood of patients with pneumonia should be grouped by the precipitin method of Lancefield or one of its more rapid modifications.
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Abstract
The illnesses of 40 patients with diagnoses of septicemia, cellulitis with bacteremia, pneumonia empyema, and meningitis caused by Streptococcus pyogenes, Group A, are described. Twenty-five of 27 patients (93%) without underlying disease survived, whereas only seven of 13 children (54%) with underlying disease survived. Nine of the 25 patients who were otherwise normal and who survived these infections had prolonged, complicated illnesses. Four of these patients, and one who died, had septicemia without a focus of infection at the time of admission. Streptococcus pyogenes, Group A, although very sensitive to penicillin G and other antibiotics, can cause both severe and rapidly progressive disease in children.
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Barton LL. Letter: Pleural effusion: to tap or not to tap! J Pediatr 1975; 87:330. [PMID: 1151577 DOI: 10.1016/s0022-3476(75)80624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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