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Arnold B, Bélard S, Alabi A, Hufnagel M, Berner R, Toepfner N. High Diversity of emm Types and Marked Tetracycline Resistance of Group A Streptococci and Other ß-Hemolytic Streptococci in Gabon, Central Africa. Pediatr Infect Dis J 2022; 41:405-410. [PMID: 35213863 DOI: 10.1097/inf.0000000000003483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Group A ß-hemolytic streptococcus (GABHS) is a leading pathogen worldwide and post-streptococcal sequelae is a major cause of morbidity and mortality in resource-limited countries. The M protein (coded by the emm gene) is a key virulence factor and a component of GABHS vaccine candidates. As data on BHS in Central Africa are scarce, antibiotic resistance, emm diversity and potential vaccine coverage were investigated. METHODS In a prospective cross-sectional study, 1014 Gabonese were screened for streptococcal throat carriage, tonsillopharyngitis and pyoderma by throat and skin smear tests. All BHS were isolated, species were identified and analysis of antibiotic resistance, emm types and emm clusters was performed. RESULTS One hundred sixty-five BHS were detected, comprising 76 GABHS, 36 group C ß-hemolytic streptococcus (GCBHS) and 53 group G ß-hemolytic streptococcus (GGBHS) in 140 carrier, 9 tonsillopharyngitis and 16 pyoderma isolates. Eighty percentage of GABHS, 78% of GCBHS and 79% of GGBHS were tetracycline resistant. Forty-six emm types were identified. GABHS emm58, emm65 and emm81 were most prevalent (26%). Emm diversity of GABHS was the highest, GCBHS and GGBHS were less divers. Every second GABHS, every third GCBHS and every tenth GGBHS carrier was colonized with emm types detected in tonsillopharyngitis or pyoderma isolates. CONCLUSIONS Tetracycline resistance and emm type diversity was high among BHS carriers in Gabon with a potential coverage of 58% by the 30-valent GABHS vaccine. A relevant overlap of carrier emm types with emm types found in tonsillopharyngitis and pyoderma characterizes a shared pool of circulating BHS strains.
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Affiliation(s)
- Benjamin Arnold
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
- Department of Infectious Disease/Tropical Medicine, Nephrology and Rheumatology, St. Georg Hospital, Leipzig, Germany
| | - Sabine Bélard
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin, Berlin
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
- Berlin Institute of Health, Berlin, Germany
| | - Abraham Alabi
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital, Lambaréné, Gabon
| | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Reinhard Berner
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Chang AY, Scheel A, Dewyer A, Hovis IW, Sarnacki R, Aliku T, Okello E, Bwanga F, Sable C, Maurer TA, Beaton AZ. Prevalence, Clinical Features and Antibiotic Susceptibility of Group A Streptococcal Skin Infections in School Children in Urban Western and Northern Uganda. Pediatr Infect Dis J 2019; 38:1183-1188. [PMID: 31568247 PMCID: PMC10495073 DOI: 10.1097/inf.0000000000002467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Group A Streptococcus (GAS) skin infections can lead to invasive sepsis, poststreptococcal glomerulonephritis, and potentially rheumatic heart disease (RHD). Within a study to identify predisposing factors of RHD in Ugandan schoolchildren, we determined the prevalence of skin infections and assessed the clinical features and antibiotic susceptibility of GAS skin infection. METHODS Cross-sectional study conducted at 3 urban primary schools in Western and Northern Uganda in March 2017. A dermatologist rendered clinical diagnoses and obtained a skin swab specimen from lesions with signs of bacterial infection. Beta-hemolytic colonies underwent Lancefield grouping, species identification by polymerase chain reaction and antimicrobial susceptibility testing. RESULTS From 3265 schoolchildren, we observed 32% with ≥1 fungal, 1.8% with ≥1 bacterial, 0.9% with ≥1 viral, and 0.2% with ≥1 ectoparasitic infection. Of 79, 25 (32%) specimens were GAS-positive, of which one-third demonstrated tetracycline resistance. Of 17 impetigo cases, 13 (76%) were located on the leg/foot and 3 (18%) on the head/neck. Prevalence of GAS skin infection was 0.8% (25 of 3265). In Northern Uganda, where subclinical definite RHD prevalence is 1.1%, GAS skin infection prevalence was 1.2% (4 of 343) and 0.9% (3 of 352). CONCLUSION This study identifies tetracycline-resistant GAS in Ugandan communities, suggests modified skin examination of exposed anatomic locations may be appropriate for population-based GAS skin infection studies, and underscores need for clear case definitions of GAS skin infection. Future studies are needed to evaluate the role of GAS skin infection in development of RHD in Ugandan communities.
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Affiliation(s)
- Aileen Y. Chang
- University of California, San Francisco, Department of Dermatology, San Francisco, USA
| | - Amy Scheel
- Emory University, School of Medicine, Atlanta, GA, USA
| | - Alyssa Dewyer
- Children’s National Health System, Division of Cardiology, Washington, D.C., USA
| | - Ian W. Hovis
- Children’s National Health System, Division of Cardiology, Washington, D.C., USA
| | - Rachel Sarnacki
- Children’s National Health System, Division of Cardiology, Washington, D.C., USA
| | - Twalib Aliku
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Emmy Okello
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Freddie Bwanga
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Craig Sable
- Children’s National Health System, Division of Cardiology, Washington, D.C., USA
| | - Toby A. Maurer
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, USA
| | - Andrea Z. Beaton
- Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
- University of Cincinnati College of Medicine, Cincinnati, USA
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Anja A, Beyene G, S/Mariam Z, Daka D. Asymptomatic pharyngeal carriage rate of Streptococcus pyogenes, its associated factors and antibiotic susceptibility pattern among school children in Hawassa town, southern Ethiopia. BMC Res Notes 2019; 12:564. [PMID: 31500654 PMCID: PMC6734480 DOI: 10.1186/s13104-019-4601-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives The aim of this study was to determine the asymptomatic pharyngeal carriage rate of S. pyogenes, antimicrobial pattern and related risk factors among school children in Hawassa, southern Ethiopia. Results Out of 287 school children’s screened, 35 (12.2%) were colonized with S. pyogenes. The carriage rate was significantly associated with factors such as sex (female p = 0.013) occupational status of mother (p = 0.002), lower income source (500–900 ETB, 1000–1500 ETB) (p = 0.001, and p = 0.042), history of hospitalization (p = 0.00) and residence of the children (p = 0.002). High level resistant to tetracycline and low level to vancomycin were observed, while penicillin, amoxicillin, erythromycin, chloramphenicol, and ceftriaxone were found to be effective.
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Affiliation(s)
- Asrat Anja
- Dilla University College of Medicine, Dilla, Ethiopia
| | - Getenet Beyene
- Jimma University Institute of Health Sciences, Jimma, Ethiopia
| | | | - Deresse Daka
- Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia.
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Moloi AH, Mall S, Engel ME, Stafford R, Zhu ZW, Zühlke LJ, Watkins DA. The Health Systems Barriers and Facilitators for RHD Prevalence: An Epidemiological Meta-Analysis From Uganda and Tanzania. Glob Heart 2017; 12:5-15.e3. [PMID: 28302546 DOI: 10.1016/j.gheart.2016.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/30/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is an important and preventable cause of cardiovascular disease. OBJECTIVES As part of a recent RHD initiative in Uganda and Tanzania, we systematically reviewed group A streptococcal disease (GAS), acute rheumatic fever (ARF), and RHD in these countries. METHODS Using a systematic review and meta-analysis/meta-synthesis, we searched PubMed, Embase, and grey literature for quantitative and qualitative studies conducted in Uganda and Tanzania that included individuals affected by GAS, ARF, and RHD. We pre-specified 3 sets of outcomes: 1) disease epidemiology; 2) barriers and facilitators to health care; and 3) stakeholder identification and engagement. Study descriptors, outcomes, and interest, and quality assessments were recorded. For the first objective, we conducted random-effects meta-analyses. For the second objective, we produced a narrative synthesis of themes. No studies contained data on the third objective. RESULTS Of 293 records identified, 12 met our inclusion criteria (9 for objective 1 and 3 for objective 2). Most quantitative studies were at moderate or high risk of bias, and only 1 of 2 qualitative studies was high quality. We estimated the prevalence of RHD to be 17.9 (95% confidence interval [CI]: 4.0 to 41.2) per 1,000 individuals. The most frequent nonfatal sequelae were heart failure, pulmonary hypertension, and atrial fibrillation. Case-fatality rates in medical and surgical wards were 17% (95% CI: 13% to 21%) and 27% (95% CI: 18% to 36%), respectively. Barriers and facilitators to GAS and RHD care were identified in the domains of individual knowledge, family support, provider communication and knowledge, and system design. CONCLUSIONS RHD remains endemic in Tanzania and Uganda, and symptomatic RHD is associated with high rates of morbidity and mortality. We have identified critical data gaps in the areas of GAS and ARF epidemiology as well as health care utilization patterns and their determinants.
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Affiliation(s)
- Annesinah H Moloi
- Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sumaya Mall
- Centre for Evidence Based Health Care, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa; Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark E Engel
- Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Zhang Wan Zhu
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Liesl J Zühlke
- Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - David A Watkins
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
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Bélard S, Toepfner N, Arnold B, Alabi AS, Berner R. β-Hemolytic streptococcal throat carriage and tonsillopharyngitis: a cross-sectional prevalence study in Gabon, Central Africa. Infection 2014; 43:177-83. [PMID: 25429792 DOI: 10.1007/s15010-014-0709-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Group A streptococcus (GAS) and possibly other β-hemolytic streptococci (BHS) account for a considerable morbidity and mortality burden in African populations; however, disproportionately little is known about the epidemiology of BHS in sub-Saharan Africa. This study assessed the prevalence of GAS, group G streptococcus (GGS) and group C streptococcus (GCS) carriage and tonsillopharyngitis in a Central African population. METHODS A prospective cross-sectional study was performed to assess the prevalence of and risk factors for BHS carrier status and tonsillopharyngitis in children and adults in Gabon. RESULTS The overall BHS carrier prevalence was 135/1,005 (13.4%); carrier prevalence of GAS, GGS, and GCS was 58/1,005 (5.8%), 50/1,005 (5.0%), and 32/1,005 (3.2%), respectively. Streptococcal carriage was associated with school and pre-school age (adjusted OR 2.65, 95% CI 1.62-4.36, p = 0.0001 and 1.90, 95% CI 1.14-3.17, p = 0.0141, respectively). Participants residing in urban areas were less likely carriers (OR 0.52, p = 0.0001). The point-prevalence of BHS-positive tonsillopharyngitis was 1.0% (9/1,014) and 15.0% (6/40) in school children with sore throat. CONCLUSIONS Non-GAS exceeded GAS throat carriage and tonsillopharyngitis suggesting a yet underestimated role of non-GAS streptococci in BHS diseases.
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Affiliation(s)
- Sabine Bélard
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
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Chang H, Shen X, Fu Z, Liu L, Shen Y, Liu X, Yu S, Yao K, Zhao C, Yang Y. Antibiotic resistance and molecular analysis of Streptococcus pyogenes isolated from healthy schoolchildren in China. ACTA ACUST UNITED AC 2010; 42:84-9. [PMID: 19883153 DOI: 10.3109/00365540903321598] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Streptococcus pyogenes are highly prevalent bacterial pathogens, especially in school-aged children. However, the characteristics of asymptomatic carriers vary geographically in different countries. We aimed to investigate S. pyogenes isolated from healthy schoolchildren in China. From 2007 to 2008, a total of 94 S. pyogenes isolates were obtained from healthy schoolchildren in Beijing and Chongqing, China. Antimicrobial susceptibility testing, determination of macrolide resistance genes (ermB, ermA and mefA), emm genotyping, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) were performed. The resistance rate to macrolides was 96.8% and to tetracycline was 92.6%. All macrolide-resistant isolates exhibited constitutive resistance; 77 isolates (84.6%) had the ermB gene, while 14 isolates (15.4%) had the ermA gene. Among the macrolide-resistant isolates, the most frequent emm type was emm12 (51.6%), followed by emm22 (14.3%) and ST1815 (8.8%). PFGE analysis revealed 12 different patterns, with a given pattern having the same sequence type (ST) by MLST and the same emm type. In conclusion, the rate of macrolide resistance to S. pyogenes is currently very high in China. This is due primarily to the dissemination of a limited number of clones.
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Affiliation(s)
- Hesheng Chang
- Beijing Children's Hospital, Capital Medical University, 56 Nan Lishi Road, Beijing, China
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Pereira LMP, Juman S, Bekele I, Seepersadsingh N, Adesiyun AA. Selected bacterial recovery in Trinidadian children with chronic tonsillar disease. Braz J Otorhinolaryngol 2009; 74:903-911. [PMID: 19582348 PMCID: PMC9448947 DOI: 10.1016/s1808-8694(15)30152-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 06/11/2007] [Indexed: 12/04/2022] Open
Abstract
Pharyngotonsillitis in children is widely treated with antibiotics. Aim: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. Methods: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. Results: Tonsils (360) yielded 800 isolates of Streptococcus spp. (51.3%), Staphylococcus spp. (42.3%) and Gram-negative genera (6.4%). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2%) than cores (63.3%) grew Streptococcus spp.; α-haemolytic Streptococcus prevalence was higher (p<0.001) than ß-haemolytic Streptococcus on surfaces (74.4% vs. 18.6%) than cores (58.9% vs. 13.7%). Surfaces and cores were not concordant for streptococci (p<0.0004) and α-haemolytic Streptococcus (p<0.007). Surface and core ß-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31% and 23.8% vs 12.5% and 8%). S. pyogenes surface and core prevalence was (84.6% vs 70%) and (50.0% vs 25.0%) in older and younger children respectively. Klebsiella spp. (6.6 %, 2.2%), Proteus (4.4%, 4.4%) and Pseudomonas (4.4 %, 1.1%) grew on surfaces and cores respectively.
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Affiliation(s)
| | | | - Isaac Bekele
- Dr (Senior Lecturer, Biometrics and Head, Department of Food Production)
| | | | - Abiodun A Adesiyun
- Dr (Professor of Veterinary Public Health and Director, School of Veterinary Medicine)
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Abstract
BACKGROUND Acute rheumatic fever and rheumatic heart disease cause a high burden of disease in Fiji and surrounding Pacific Island countries, but little is known about the epidemiology of group A streptococcal (GAS) pharyngitis in the region. We designed a study to estimate the prevalence of carriage of beta-hemolytic streptococci (BHS) and the incidence of BHS culture-positive sore throat in school aged children in Fiji. METHODS We conducted twice-weekly prospective surveillance of school children aged 5 to 14 years in 4 schools in Fiji during a 9-month period in 2006, after an initial phase of pharyngeal swabbing to determine the prevalence of BHS carriage. RESULTS We enrolled 685 children. The prevalence of GAS carriage was 6.0%, while the prevalence of group C streptococcal (GCS) and group G streptococcal (GGS) carriage was 6.9% and 12%, respectively. There were 61 episodes of GAS culture-positive sore throat during the study period equating to an incidence of 14.7 cases per 100 child-years (95% CI, 11.2-18.8). The incidence of GCS/GGS culture-positive sore throat was 28.8 cases per 100 child-years (95% CI, 23.9-34.5). The clinical nature of GAS culture-positive sore throat was more severe than culture-negative sore throat, but overall was mild compared with that found in previous studies. Of the 101 GAS isolates that emm sequence typed there were 45 emm types with no dominant types. There were very few emm types commonly encountered in industrialized nations and only 9 of the 45 emm types found in this study are emm types included in the 26-valent GAS vaccine undergoing clinical trials. CONCLUSIONS GAS culture-positive sore throat was more common than expected. Group C and group G streptococci were frequently isolated in throat cultures, although their contribution to pharyngeal infection is not clear. The molecular epidemiology of pharyngeal GAS in our study differed greatly from that in industrialized nations and this has implications for GAS vaccine clinical research in Fiji and other tropical developing countries.
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