Le streptocoque du groupe A. Un pathogène majeur pour la prochaine décennie ?

[Use of group A streptococcal rapid diagnostic test in extra-pharyngeal infections]

The purpose of this study was to assess the performances of the group A streptococcus (GAS) rapid antigen diagnostic tests (RADTs) in extra-pharyngeal infections. Between October 2009 and June 2014, 368 patients (median age: 48 months) were enrolled. The pathologies involved were : 160 perineal infections (44 %), 69 blistering distal dactylitis (19 %), 55 cervical lymphadenitis (15 %), 31 crusty or bleeding rhinitis (8 %), and 53 other diseases (14 %). The sensitivity of GAS-RADT used was 96 % (95 % CI: 92-99 %), the specificity 81 % (95 % CI: 75- 86 %), the negative predictive value 97 % (CI 95 %: 93-99 %), and the positive predictive value 79 % (95 % CI: 73-85 %). Finally, positive and negative likelihood ratio were 5 (95 % CI: 4-7) and 0.05 (95 % CI: 0.02-0.11) respectively. The GAS-RADTs developed for pharyngitis have comparable performances in these settings and therefore can be used.

[Multifocal inflammatory syndrome after invasive infection due to an M1 strain of Streptococcus pyogenes]

We report on a case of Streptococcus pyogenes invasive disease with toxic shock syndrome due to an M1 strain producing SpeA and SmeZ superantigenic toxins. Post-streptococcal sequelae included several episodes of reactive arthritis and orchitis whose outcome was favorable with corticosteroid therapy. Invasive streptococcal infections are increasingly reported and may associate septic, toxinic, and immunological diseases. High-grade systemic inflammation may induce nonsuppurative complications and autoimmune diseases by molecular mimicry. Among them, reactive arthritis has been recognized as a separate entity from acute rheumatic fever and post-streptococcal orchitis has not been described before. Treatment should be quickly started and should be effective on the etiologic agent but also on its toxins due to the severity of the invasive infections associated with the spread of highly virulent bacterial clones and the potential development of multifocal nonsuppurative sequelae.

[Place of Streptococcus pyogenes in the throat infection in Morocco and overview of its susceptibility to antibiotics]

OBJECTIVE

In this study we report the prevalence of the throat infections to Streptococcus pyogenes in child and adult in Morocco, and the current antimicrobial susceptibility of the aminopenicillins and erythromycin.

PATIENTS AND METHODS

A prospective surveillance study was made from March 2006 to February 2007 in four primary health care in Rabat and Sale cities. Six hundred and ninety-seven patients (494 children and 203 adults) were the object of samplings by throat cotton swab probe, for researching the group A Streptococcus (GAS). The patients were those proposed by their doctors for the treatment of throat infections. The antimicrobial susceptibility was realized by two methods: the disc-diffusion method on Mueller-Hinton agar plates and MICs were determined by E-test. The antibiotics tested were the penicillin G, the amoxicillin and the erythromycin.

RESULTS

S. pyogenes was identified in 65 cases (9.3%): 45 strains in children (9.1%) and 20 strains in adults (9.9%). Two peaks of throat infections to S. pyogenes were recorded in children aged 12 to 15 years and in adults between 36 and 39 years old. All strains were susceptible to penicillin G and amoxicillin. One strain was resistant to erythromycin with a MIC greater than 256 microg/mL.

Paediatric varicella hospitalisations in France: a nationwide survey

Paediatric patients hospitalised with varicella (n = 1575) were reported to a French national network between March 2003 and July 2005. Superinfection was identified in 50.3% of cases, principally of skin and soft-tissue (36.5%). The risk of superinfection increased with fever relapse, use of non-steroidal anti-inflammatory drugs, prolonged fever, an age of 1-5 years, and contamination at the childminder's home. Neurological complications were observed in 7.8% of cases, while pulmonary complications were less frequent (3.1%). Forty-nine patients had sequelae and eight patients died. Surveillance should continue in France with a view to the future implementation of a universal vaccination programme.