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Background. Group A beta-hemolytic streptococcus (Streptococcus pyogenes) is a widespread bacterial pathogen that can cause many clinical variants of diseases in humans and be a trigger factor for the development of various autoimmune conditions. The purpose of the study was to show the current state of infection caused by group A beta-hemolytic streptococcus in adults and children using case studies. Materials and methods. The article describes 5 cases of streptococcal infection caused by Str.pyogenes with different clinical symptoms. The streptococcal etiology was confirmed by bacteriological method, the levels of ASLO antibodies were evaluated by biochemical method, clinical and biochemical studies were performed to determine markers of organ dysfunction. Results. The paper presents cases of severe streptococcal infection, which occurred in the form of phlegmon (single or multiple), multiple fasciitis of various localizations, development of destructive pneumonia, which was complicated by pneumothorax and pyopneumothorax, streptococcal septic shock, as well as epidermolysis syndrome (“scalded skin” syndrome). Conclusions. There has been a significant increase in the incidence of diseases caused by group A beta-hemolytic streptococcus. This outbreak is characterized by a severe course of infection with the development of various clinical forms with skin and soft tissue damage, destructive pneumonia, and septicemia. All cases are caused by antibiotic-resistant strains.

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Psoriasis is the second most common skin disease after atopic dermatitis in childhood. There are factors affecting both the manifestation and aggravation of this inflammatory skin process. The leading role in the psoriasis pathogenesis is currently associated with key cytokines. However, infectious diseases could be the triggers for psoriasis.Nowadays, the approach to psoriasis management in children has been revised due to emerging of new knowledge about the clinical manifestations and the role of numerous comorbid conditions in psoriasis course. Risk factors assessment, as well as evaluation of potential comorbidities signs and symptoms, is crucial part in patient management to create a prognostic model of the disease progression and the aggravation development (with underlying associated inflammatory processes included).

Background:Tonsillitis is one of the most important diseases in the community, especially in children, but its complications can affect adults at any age. The most bacterial causative agent is group A streptococci (GAS) infections, like tonsillitis, can progress into rheumatic fever and lead to complications like heart, kidney, and joint damage, known as poststreptococcal diseases. In Iraq, rheumatism is diagnosed based on antistreptolysin O titer (ASO) antigen serological titers. Objectives:This study aimed to recognize ASO in patients who had tonsillitis in Salah Al-Din Province, Iraq, where information about the test was lacking. Materials and Methods:The cross-sectional study was conducted in Salah Al-Din Province, with 235 patients aged 5–45 years examined at the Primary Health Care Center. Blood samples were taken and examined for antistreptolysin O using turbidimetry. Results:The results showed that ASO tonsillitis often increases in early childhood and decreases in urban areas (32.5%) presenting fever, joint, and loin pain. Conclusion:In conclusion, 40% of patients with tonsillitis had elevated antistreptolysin O levels, especially in the 5–14 years age group (47.36%), in urban areas (32.5%), and associated with fever (42.1%), cough (24.2%), and loin with joint pain (33.6%). These cases may progress into rheumatic heart disease, therefore, prompt treatment is necessary. A plan to prevent GAS infection and its complications should be implemented, along with more sensitive and specific investigations.

Key Clinical Message: This pediatric case report underscores the importance of maintaining a high clinical suspicion for polyarteritis nodosa (PAN) in patients presenting with atypical features, such as migratory arthritis and subcutaneous nodules. Importantly, it highlights the focus on the potential relationship between streptococcal infection and cutaneous PAN. Early recognition and prompt, aggressive treatment is critical, as PAN can be a life‐threatening condition if left unmanaged. This case emphasizes the need for a multidisciplinary approach to effectively identify and manage this rare vasculitis disorder in the pediatric population. Polyarteritis nodosa (PAN) is a rare and life‐threatening vasculitis with diverse clinical presentations, posing a diagnostic challenge. Early recognition and prompt intervention are crucial to prevent organ damage. We present the case of an 8‐year‐old boy who exhibited atypical symptoms including migratory arthritis, myalgia, digital discoloration and ischemic changes, and subcutaneous nodules. Initial concerns for septic arthritis were ruled out. A comprehensive evaluation revealed elevated inflammatory markers and a confirmatory skin biopsy demonstrating active leukocytoclastic vasculitis, are highly suggestive of a diagnosis of PAN. Notably, elevated ASO titers suggested a possible concurrent streptococcal infection. The aggressive treatment approach with high‐dose aspirin, steroids, methotrexate, and tocilizumab is justified given the severity of the patient's symptoms and the nature of the disease process. This case underscores the importance of considering PAN in the differential diagnosis for children presenting with atypical features. Early diagnosis and prompt intervention, including addressing potential infectious triggers, are crucial for optimal outcomes in pediatric PAN. [ABSTRACT FROM AUTHOR]

Relevance. Caries of hard dental tissues is one of the most common diseases throughout the world. It affects not only the primary teeth of children, but also the permanent teeth of adults, which can lead to serious consequences for human health. In recent years, the dental community has paid special attention to the possible connection between streptococcal infection and the development of caries, and therefore this topic is extremely relevant and requires detailed consideration. Chronic rheumatoid arthritis (CRA) is one of the most common joint diseases, which is characterized by inflammation of the joint lining and destruction of cartilage. Patients with CPA are also at high risk of developing dental caries, which may be due to many factors, including changes in saliva composition and long-term use of medications.Purpose of the study: to study the effect of streptococcal infection on the occurrence of caries among patients suffering from chronic rheumatoid arthritis. To assess the incidence of caries complications caused by streptococcal infection among patients who have had COVID-19.Materials and methods of research. The authors analyzed domestic and foreign literature in order to conduct a literature review regarding the etiology of the occurrence and relationship of streptococcal infection and caries against the background of rheumatoid arthritis. The authors also analyze the incidence of caries complications caused by streptococcal infection as a consequence of COVID-19. Data from 160 patients, 100 men and 60 women, were studied.Conclusion. From the studies conducted, we can conclude that streptococcal infection is one of the factors influencing the development of caries. However, the exact mechanisms of interaction between bacteria and hard dental tissues have not yet been established. As a result of the analysis, it was revealed that the relationship between streptococcal infection and the occurrence of caries against the background of chronic rheumatoid arthritis is significant. The presence of streptococcal infections in patients with rheumatoid arthritis can lead to deterioration of oral health, which in turn contributes to the development of dental caries. Among patients who have had COVID-19, there is a fairly high percentage of caries, including those caused by streptococcal infection and a general deterioration in the health of the oral cavity and the body as a whole.

AbstractPANDAS is an acronym for ‘paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections’ and is defined as a subgroup of PANS, ‘Paediatric acute-onset neuropsychiatric syndrome’. PANDAS is considered an autoimmune disease based on a streptococcal infection with a verified immune response. The onset is often dramatic, with symptoms of OCD developing within 24-48 h. Symptoms include both psychological symptoms and physical symptoms. Treatments of PANDAS must address both physical and psychiatric symptoms. Supplemental treatments for PANDAS include tonsillectomy to prevent further streptococcal infections. We present a case of PANDAS with the aim of raising awareness of its diagnosis. PANDAS is a rare condition with an impact on the patient’s quality of life; thus, awareness is needed. A multidisciplinary team is needed for diagnosis and treatment. Otorhinolaryngologists may play an important role in the well-being of these patients when performing tonsillectomy.

Copyright of Canadian Journal of Hospital Pharmacy / Journal Canadien de la Pharmacie Hospitalière is the property of Canadian Society of Hospital Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

PANDAS is an acronym for 'paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections' and is defined as a subgroup of PANS, 'Paediatric acute-onset neuropsychiatric syndrome'. PANDAS is considered an autoimmune disease based on a streptococcal infection with a verified immune response. The onset is often dramatic, with symptoms of OCD developing within 24-48 h. Symptoms include both psychological symptoms and physical symptoms. Treatments of PANDAS must address both physical and psychiatric symptoms. Supplemental treatments for PANDAS include tonsillectomy to prevent further streptococcal infections. We present a case of PANDAS with the aim of raising awareness of its diagnosis. PANDAS is a rare condition with an impact on the patient's quality of life; thus, awareness is needed. A multidisciplinary team is needed for diagnosis and treatment. Otorhinolaryngologists may play an important role in the well-being of these patients when performing tonsillectomy. [ABSTRACT FROM AUTHOR]

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is one of the most controversial diseases in pediatric rheumatology. Despite first being described more than 25 years ago as the sudden and rapid onset of obsessive–compulsive disorder (OCD) and/or tic disorder symptoms as complications of a Group A beta-hemolytic Streptococcus (GAS) infection, precise epidemiological data are still lacking, and there are no strong recommendations for its treatment. Recent advances in the comprehension of PANDAS pathophysiology are largely attributable to animal model studies and the understanding of the roles of Ca++/calmodulin-dependent protein kinase (CaM kinase) II, disrupted dopamine release in the basal ganglia, and striatal cholinergic interneurons. The diagnosis of PANDAS should be made after an exclusion process and should include prepubescent children with a sudden onset of OCD and/or a tic disorder, with a relapsing/remitting disease course, a clear temporal association between GAS infection and onset or exacerbation of symptoms, and the association with other neurological abnormalities such as motoric hyperactivity and choreiform movements. Antibiotic medications are the primary therapeutic modality. Nonetheless, there is a paucity of randomized studies and validated data, resulting in a scarcity of solid recommendations. [ABSTRACT FROM AUTHOR]

Background and Aim: Streptococcosis is a common bacterial disease in red tilapia, in which Enterococcus faecalis infection has not been widely reported. This study aimed to evaluate the efficacy of pellets that contain chicken E. faecalis-induced immunoglobulin Y (IgY) to treat and prevent streptococcosis in red tilapia. Materials and Methods: We conducted a 28-day study for immunoprophylaxis and immunotherapy, each using four groups with two replications: Healthy control fish (KS), non-IgY pellets (PA and TA), pellets with 25% egg yolk containing E. faecalis-induced IgY (PB and TB), and pellets with 50% egg yolk containing E. faecalis-induced IgY(PC and TC). Indirect enzyme-linked immunosorbent assay was performed on prototype pellets produced with an IgY suspension at 1.63 mg/mL as the standard optical density curve. For the immunoprophylaxis study, pellets of 3% of the average body weight of the experimental fish (0.50 g per fish per day) were given daily until day 14 before the challenge test with E. faecalis (2.1 × 109 Colony-forming unit/mL peroral) on day 15. The data from the observation period on days 15–28 were analyzed. For the immunotherapy study, pellets of 3% of the average body weight (0.50 g per fish per day) were given daily for 21 days (days 8–28) 7 day spost-infection. The data from the immunotherapy study were collected during the observation period on days 8–28. Statistical analysis was performed on non-specific immune variables: Total leukocytes, monocytes, lymphocytes, neutrophils, phagocytic activity, and macrophage capacity; and the semi-quantitative distribution of melanomacrophage centers (MMCs) in the lymphoid organs, such as spleen and liver. Photomacrographic data were analyzed descriptively and qualitatively by comparing the healing process and clinical signs found between experiments in the immunotherapy study. Results: The pellet with 50% egg yolk with an IgY at 2.43 mg/g pellet, 3% of body weight once daily, was the best formula on experimental fish. The administration of this formulation can also increase non-specific immunity and the distribution of MMCs in the spleen and liver with a survival rate of 55% for 14 days of challenge period in the immunoprophylaxis study and 70% for 21 days of therapy period in the immunotherapy study. Conclusion: Immunoglobulin Y can be a prophylactic and therapeutic agent against streptococcal infections caused E. faecalis in red tilapia with an optimum dosage of 2.43 mg/g pellet.

Introduction and purpose: Erythema nodosum is a most frequent form of panniculitis and it appears as erythematous, painful rounded, nodules typically localized on the pretibial area. The purpose of our review is to present diseases that can be underlying causes of erythema nodosum and to draw attention to accompanying symptoms that can guide us to the appropriate diagnosis. Brief description of the state of knowledge: Currently, erythema nodosum is thought to be a symptom associated with hypersensitivity reactions to various antigens. Although the majority of the causes are considered idiopathic, erythema nodosum may be caused by many etiological factors. Summary: Erythema nodosum is usually an acute condition that resolves without treatment. However, it can sometimes be the first sign of a serious condition - autoimmune diseases, infections or malignancy. In such cases it is essential to observe it carefully and implement appropriate diagnostics that allow us to make a correct diagnosis.

The exact aetiology of pityriasis lichenoides chronica (PLC) remains unknown. While phototherapy is the most investigated therapeutic modality, azithromycin has been used scarcely. The aim of this study is to evaluate the therapeutic efficacy of azithromycin in the treatment of PLC compared to NB-UVB and evaluating the presence of streptococcal infection as a possible etiological factor in PLC patients. The study was designed as a randomised controlled trial. Twenty-four patients with PLC were randomly allocated into either azithromycin (n = 13, standard dose every 10 days) or NB-UVB (n = 11, thrice weekly) groups. End of study (EOS) was either complete clearance of lesions or a maximum of 8 weeks. Therapeutic efficacy was defined as percent reduction in lesions and was calculated for the rash as a whole, erythematous papules alone, and hypopigmented lesions alone and graded into complete, very-good, good, poor or no response. Anti-streptolysin O titre (ASOT), anti-deoxyribonuclease B titre (anti-DNaseB) and throat culture were evaluated at day 0. No significant difference existed between both groups as regards therapeutic efficacy. At EOS, NB-UVB achieved significantly more percent reduction in the extent of hypopigmented lesions and consequently in the rash as a whole (p = 0.001, p = 0.034, respectively). The extent of the rash as a whole was significantly less in the NB-UVB at EOS (p = 0.029, respectively). The effect of NB-UVB on hypopigmented lesions appeared early at week 4 of treatment. Only two patients, one from each group, relapsed during the 3 month follow-up. Evidence of recent streptococcal infection was present in 79% of the cases, mainly in the form of elevated ASOT (94.7%). It was significantly more encountered in young children (< 13 years) (p = 0.03) and was associated with more extent of erythematous papules and consequently with more extent of the rash as a whole (p = 0.05 and p = 0.01, respectively). It did not affect outcome of therapy at EOS. Azithromycin did not show more favorable response in patients with recent streptococcal infection. Therapeutic efficacy of azithromycin is comparable to NB-UVB in treatment of PLC; however, NB-UVB is superior in management of hypopigmented lesions. It is highly suggested that PLC could be a post streptococcal immune mediated disorder. Registration number: ClinicalTrials.gov, NCT03831269. [ABSTRACT FROM AUTHOR]

Introduction: Scarlet fever is usually a mild childhood disease caused by type A streptococci. This disease is spread by droplets, mainly through direct contact with an infected person or the objects they have used. In pediatrics, these are significant risk factors for the transmission of infectious diseases. However, it is important to remember the possibility of serious complications in the course of scarlet fever. Aim: This paper provides a discussion of two pediatric cases in order to determine the possibilities of diagnosis, differentiation, and treatment of patients with severe, non-obvious courses of scarlet fever. Methods: The case reports of two patients hospitalized in a pediatric department due to Streptococcus pyogenes infection were examined. Results: The patients were admitted to the emergency room with symptoms not directly indicative of type A streptococcal infection, which required further diagnosis. Both patients complained of weakness at the time of presentation. They had an elevated temperature, were dehydrated during the course of gastroenteritis, and passed liquid stools without pathological admixtures. Further stages of diagnosis and treatment required hospitalization in the pediatric department. Therapeutic benefit from the implemented treatment was obtained, and the patients were discharged in good general condition with further recommendations. Conclusions: Medical history, which is often very detailed, can be the key to making the final diagnosis and can supplement the data collected on the basis of laboratory tests. Scarlet fever does not always occur with a mild course, and sometimes its course can be quite non-specific and may require a thorough diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Pulmonary‐renal syndrome (PRS) is defined as a combination of diffuse alveolar haemorrhage and glomerulonephritis. An 18‐year‐old woman visited our hospital with a 2‐day history of fever, dyspnoea, and leg edema. Laboratory investigations revealed an elevated inflammatory reaction, increased serum creatinine levels, and normocytic anaemia. Additionally, the anti‐streptolysin‐O titre was positive, and complement component‐3 levels were decreased. Urinalysis revealed proteinuria and hematuria. Bronchoalveolar lavage aliquots were progressively more hemorrhagic. These findings supported a diagnosis of PRS secondary to streptococcal infection. The patient was treated with high‐dose methylprednisolone and antibiotics. After 4 days of treatment, her respiratory symptoms and serum creatinine levels improved. Steroid tapering was performed over 15 days. The findings in this case indicate that streptococcal infection is a potential cause of PRS, and that short‐term steroid therapy is an effective treatment.

Streptococcus pneumoniae (SPN) is a globally significant cause of meningitis, the pathophysiology of which involves damage to the brain by both bacterial virulence factors and the host inflammatory response. In most cases of SPN meningitis bacteria translocate from the blood into the central nervous system (CNS). The principal site of SPN translocation into the CNS is not known, with possible portals of entry proposed to be the cerebral or meningeal blood vessels or the choroid plexus. All require SPN to bind to and translocate across the vascular endothelial barrier, and subsequently the basement membrane and perivascular structures, including an additional epithelial barrier in the case of the blood-CSF barrier. The presence of SPN in the CNS is highly inflammatory resulting in marked neutrophilic infiltration. The secretion of toxic inflammatory mediators by activated neutrophils within the CNS damages pathogen and host alike, including the non-replicative neurons which drives morbidity and mortality. As with the translocation of SPN, the recruitment of neutrophils into the CNS in SPN meningitis necessitates the translocation of neutrophils from the circulation across the vascular barrier, a process that is tightly regulated under basal conditions - a feature of the 'immune specialization' of the CNS. The brain barriers are therefore central to SPN meningitis, both through a failure to exclude bacteria and maintain CNS sterility, and subsequently through the active recruitment and/or failure to exclude circulating leukocytes. The interactions of SPN with these barriers, barrier inflammatory responses, along with their therapeutic implications, are explored in this review. [ABSTRACT FROM AUTHOR]

Background and Aim: Streptococcosis is a common bacterial disease in red tilapia, in which Enterococcus faecalis infection has not been widely reported. This study aimed to evaluate the efficacy of pellets that contain chicken E. faecalisinduced immunoglobulin Y (IgY) to treat and prevent streptococcosis in red tilapia. Materials and Methods: We conducted a 28-day study for immunoprophylaxis and immunotherapy, each using four groups with two replications: Healthy control fish (KS), non-IgY pellets (PA and TA), pellets with 25% egg yolk containing E. faecalis-induced IgY (PB and TB), and pellets with 50% egg yolk containing E. faecalis-induced IgY(PC and TC). Indirect enzyme-linked immunosorbent assay was performed on prototype pellets produced with an IgY suspension at 1.63 mg/mL as the standard optical density curve. For the immunoprophylaxis study, pellets of 3% of the average body weight of the experimental fish (0.50 g per fish per day) were given daily until day 14 before the challenge test with E. faecalis (2.1 × 109 Colony-forming unit/mL peroral) on day 15. The data from the observation period on days 15-28 were analyzed. For the immunotherapy study, pellets of 3% of the average body weight (0.50 g per fish per day) were given daily for 21 days (days 8-28) 7 day spost-infection. The data from the immunotherapy study were collected during the observation period on days 8-28. Statistical analysis was performed on non-specific immune variables: Total leukocytes, monocytes, lymphocytes, neutrophils, phagocytic activity, and macrophage capacity; and the semi-quantitative distribution of melanomacrophage centers (MMCs) in the lymphoid organs, such as spleen and liver. Photomacrographic data were analyzed descriptively and qualitatively by comparing the healing process and clinical signs found between experiments in the immunotherapy study. Results: The pellet with 50% egg yolk with an IgY at 2.43 mg/g pellet, 3% of body weight once daily, was the best formula on experimental fish. The administration of this formulation can also increase non-specific immunity and the distribution of MMCs in the spleen and liver with a survival rate of 55% for 14 days of challenge period in the immunoprophylaxis study and 70% for 21 days of therapy period in the immunotherapy study. Conclusion: Immunoglobulin Y can be a prophylactic and therapeutic agent against streptococcal infections caused E. faecalis in red tilapia with an optimum dosage of 2.43 mg/g pellet. [ABSTRACT FROM AUTHOR]

Objectives The objectives of present study were to analyze the association of the streptococcal infection with childhood Henoch–Schönlein purpura (HSP) in China. Methods: We performed a case-control study over a period of five years to evaluate the epidemiology and clinical characteristics of group A β-hemolytic streptococcal (GABHS) triggered HSP. Results: 1. The frequency of GABHS-triggered HSP was 15.1%, while that of GABHS infection developing HSP in children was 4.7%. 2.The epidemiological characteristics of HSP with streptococcal infection were similar to those of HSP alone. 3. The GABHS-triggered HSP cases had a significantly higher frequency of renal involvement than the noninfectious group. 4. IgA and IgG were significantly increased in the streptococcal infection group than in the noninfectious group, while the levels of C3 and C4 decreased significantly. Conclusions: GABHS infection is the most frequent agent in HSP children, and may aggravate the immune dysfunction and prolong the course of HSP. [ABSTRACT FROM AUTHOR]

This work investigates the ability of two Croton spp. essential oils (EO) to enhance chlorhexidine (CHX) activity against oral streptococci. EO's chemical composition of Croton argyrophyllus and C. pluriglandulosus was determined by GC-MS/FID. The microbial growth kinetics and minimum inhibitory concentration (MIC) of EOs and CHX were determined, followed by their synergism against S. mutans UA159 and ATCC 25175, S. salivarius ATCC 7073 and S. sp. ATCC 15300. The microplate-based method was used to determine the EO/CHX activity against 24-h-old biofilms. The major compounds were α-pinene (54.74%) and bicyclogermacrene (16.08%) for EOAr and 1,8-cineole (17.41%), methyleugenol (16.06%) and elemicin (15.99%) for EOPg. Both EO had MIC around 16,000 µg/mL. EOs/CHX presented a synergistic effect against most strains (FICi from 0.133 to 0.375), and OE/CHX-treated biofilms showed a reduction in biomass and cell viability compared to CHX, only (p < 0.01). Thus, the EOs works as natural adjuvants for CHX. [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease (mucocutaneous lymph node syndrome), an acute febrile vasculitis of childhood that affects medium and small-sized arteries, is uncommonly reported in the West African subregion. Its diagnosis relies on the presence of a constellation of clinical signs which could mimic or coexist with infectious viral or bacterial agents, thereby requiring a high index of suspicion. Case presentation: We report a two-year, ten months-old boy who presented with prolonged high-grade fever for over 3 three weeks; non-purulent conjunctivitis, unilateral cervical lymphadenopathy, cracked lips, reddish tongue, diffuse oedema, erythema of his palms and soles; skin desquamation over the tips of his digits and left-sided facial nerve palsy. He had leukocytosis, thrombocytopenia, and elevated inflammatory markers. Throat swab yielded Streptococcus pyogenes species; however, serial echocardiography was unrevealing. He was managed with aspirin, steroids, bed rest, and antibiotics (based on culture sensitivity), but intravenous immunoglobulin (IVIG) was not readily available and therefore was not administered. His inpatient clinical course showed fever persisting into the second week of inpatient management that gradually became undulating by the third week before lysing. Conclusion: The rare complication of facial nerve palsy is highlighted, while the evidence for acute bacterial infection posed further diagnostic challenges in this child with clinical features of Kawasaki disease. The unavailability of IVIG also portends a prolonged course for the acute stages, which are largely unresponsive to antipyretics and antibiotics. The importance of longterm follow-up for potential coronary artery aneurysms in the face of risk factors is further emphasized.

Streptococcus pneumoniae (SPN) is a globally significant cause of meningitis, the pathophysiology of which involves damage to the brain by both bacterial virulence factors and the host inflammatory response. In most cases of SPN meningitis bacteria translocate from the blood into the central nervous system (CNS). The principal site of SPN translocation into the CNS is not known, with possible portals of entry proposed to be the cerebral or meningeal blood vessels or the choroid plexus. All require SPN to bind to and translocate across the vascular endothelial barrier, and subsequently the basement membrane and perivascular structures, including an additional epithelial barrier in the case of the blood-CSF barrier. The presence of SPN in the CNS is highly inflammatory resulting in marked neutrophilic infiltration. The secretion of toxic inflammatory mediators by activated neutrophils within the CNS damages pathogen and host alike, including the non-replicative neurons which drives morbidity and mortality. As with the translocation of SPN, the recruitment of neutrophils into the CNS in SPN meningitis necessitates the translocation of neutrophils from the circulation across the vascular barrier, a process that is tightly regulated under basal conditions – a feature of the ‘immune specialization’ of the CNS. The brain barriers are therefore central to SPN meningitis, both through a failure to exclude bacteria and maintain CNS sterility, and subsequently through the active recruitment and/or failure to exclude circulating leukocytes. The interactions of SPN with these barriers, barrier inflammatory responses, along with their therapeutic implications, are explored in this review.

Empyema is often caused by Streptococcus anginous species, followed by Streptococcus pneumoniae. The organism Streptococcus gordonii belongs to the Streptococcus mitis group, which rarely causes empyema. We report the case of a 59-year-old man who presented with exertional dyspnea and chest pain on the right side. The image obtained showed effusion on the right side. Streptococcus gordonii was recovered from purulent pleural effusion culture. The patient underwent video-assisted thoracoscopic surgery with decortication, pneumolysis and received antibiotics for 13 days.A total of seven cases were analyzed after combining six cases in the literature and our presented case. The majority of Streptococcus gordonii empyema patients were male (six patients, 86%) and empyema on the right side (five patients, 71%). Common risk factors included poor dental hygiene or recent dental procedure (three patients, 43%), diabetes mellitus (three patients, 43%), and smoking (three patients, 43%). Only a few cases developed empyema-related complications, including bacteremia (one patient, 14%) and spleen abscesses (one patient, 14%). Most patients underwent chest tube insertion (seven patients, 100%) and survived without recurrent empyema (six patients, 86%).

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is one of the most controversial diseases in pediatric rheumatology. Despite first being described more than 25 years ago as the sudden and rapid onset of obsessive–compulsive disorder (OCD) and/or tic disorder symptoms as complications of a Group A beta-hemolytic Streptococcus (GAS) infection, precise epidemiological data are still lacking, and there are no strong recommendations for its treatment. Recent advances in the comprehension of PANDAS pathophysiology are largely attributable to animal model studies and the understanding of the roles of Ca++/calmodulin-dependent protein kinase (CaM kinase) II, disrupted dopamine release in the basal ganglia, and striatal cholinergic interneurons. The diagnosis of PANDAS should be made after an exclusion process and should include prepubescent children with a sudden onset of OCD and/or a tic disorder, with a relapsing/remitting disease course, a clear temporal association between GAS infection and onset or exacerbation of symptoms, and the association with other neurological abnormalities such as motoric hyperactivity and choreiform movements. Antibiotic medications are the primary therapeutic modality. Nonetheless, there is a paucity of randomized studies and validated data, resulting in a scarcity of solid recommendations.

Background and Aim: Acute post-infectious glomerulonephritis (PIGN) can occur due to various etiologies. Among these, post-streptococcal glomerulonephritis is the common cause. Though the burden has drastically decreased over the years in developed nations, it remains a reason for concern in developing countries. This study aimed to document the burden, clinical presentation, etiology, and outcome of PIGN referred to a tertiary care center in a developing country. Methods: This retrospective study was conducted in a tertiary care teaching hospital in northeast India. All cases diagnosed with acute PIGN were included in the study. Cases with an alternate diagnosis and cases with incomplete records were excluded from the study. Data on relevant clinical, demographic, and laboratory variables were extracted from the case records and discharge summary. Simple descriptive statistics, such as frequency and proportion were used. Results: A total of 202 cases of PIGN were included in the study. The Mean±SD annual admission rate was 22.4±6.1 per year. The Mean±SD age at presentation was 10.0±3.9 years and the male to female ratio was 1.2 to 1. The most common clinical features at the time of presentation were hypertension in 183 patients (90.59%), edema in 168 (83.16%), history of oliguria in 146(72.27%), and hematuria in 168 patients (83.2%). Proteinuria was present in 95 cases (47.03%). Either clinical or serological evidence of preceding streptococcal infection was observed in 160 children (83.2 %). Two cases had scrub typhus and one case had hepatitis B seropositivity. Hypertensive encephalopathy and left ventricular failure were observed in 20(9.90%) and 44 children (21.78%), respectively. Admission to the pediatric intensive care unit was required in 28.21%. No mortality was observed. Conclusion: PIGN constitutes a significant burden in this part of India. The incidence of complications was high but the outcome was good with adequate acute care. [ABSTRACT FROM AUTHOR]

An 8-year-old Japanese boy with no underlying disease presented with severe intramuscular hematoma of the hip, and was admitted for a disseminated intravascular coagulation-like state with fibrinolytic dominance. Laboratory examinations revealed severe hyper-fibrinolysis with elevated markers, markedly shortened euglobulin clot lysis time, mildly decreased prothrombin, and severely decreased fibrinogen and factor XIII. Natural fibrin precipitates rapidly appeared in citrate-treated, ethylene-diamine-tetra-acetic-treated, and heparin-treated samples, but not in argatroban-treated samples, indicating that the mechanism of thrombin and fibrin formation was Ca2+-independent. The precipitates were physically similar to thrombin-triggered plasma fibrin. A global coagulation assay revealed that thrombin generation potentials were normal throughout the clinical course, whereas plasmin generation was already detected before initiation of fibrin formation in the acute phase. This phenomenon disappeared with time. Changes in coagulation abnormalities and nature of fibrinolysis paralleled those seen in specific markers for streptococcal infections. Streptokinase was possibly involved in this disease, as SDS-polyacrylamide gel electrophoresis revealed that plasmin derived from streptokinase-plasminogen complex proteolyzed the prothrombin to approximately 35-kDa α-thrombin consisting of the A-B single chain, which was identified by NH2-terminal sequence analysis. The involvement of streptokinase-plasminogen-prothrombin caused by streptococcal infection may be one mechanism that produces marked hyper-fibrinolysis associated with natural fibrin precipitates. [ABSTRACT FROM AUTHOR]

Osteomyelitis of the sternal bone is very rare and is usually secondary to trauma or surgery. Primary sternal osteomyelitis and secondary sternal osteomyelitis commonly are caused by Staphylococcus spp, and in drug addicts by Pseudomonas aerugenosa, while in sickle cell anemic children, Salmonella spp are mostly implicated. We, therefore, present an unusual causative organism, Streptococcal spp in a sickle cell anemic child.

In the presented clinical case, the combination of two pathogens (enterovirus and streptococcus) caused a severe and atypical course of the hand-foot-mouth syndrome in a child of primary school age. EVI from the first days of the disease represented by the typical localization of the primary elements of the rash and the characteristic intoxication syndrome was confirmed by the detection of enterovirus RNA in the feces. The course of the disease was undulating. In the first wave, skin rashes accompanied by soreness and itching corresponded to the classical EVI in terms of the nature of the elements, their localization and were combined with lesions of the epithelium of the oral mucosa. Starting from the 5th day of the disease, against the background of an increase in the severity of intoxication syndrome, bullous elements appeared on the skin of the extremities, an excess of the permissible values of antistreptolysin-O was found 12 times, and when sowing material from cracks in the corner of the mouth, Streptococcus pyogenes 106 KUO was isolated, which indicated a combination of the syndrome Hand-foot-mouth with streptococcal infection. Onychomadesis in the period of convalescence retrospectively testified to the dominant role of enterovirus in the presented clinical case.

Pathogenic streptococci require manganese for survival in the host. In response to invading pathogens, the host recruits nutritional immune effectors at infection sites to withhold manganese from the pathogens and control bacterial growth. The manganese scarcity impairs several streptococcal processes including oxidative stress defenses, de novo DNA synthesis, bacterial survival, and virulence. Emerging evidence suggests that pathogens also encounter manganese toxicity during infection and manganese excess impacts streptococcal virulence by manganese mismetallation of non-cognate molecular targets involved in bacterial antioxidant defenses and cell division. To counter host-imposed manganese stress, the streptococcal species employ a sophisticated sensory system that tightly coordinates manganese stress-specific molecular strategies to negate host induced manganese stress and proliferate in the host. Here we review the molecular details of host-streptococcal interactions in the battle for manganese during infection and the significance of streptococcal effectors involved to bacterial pathophysiology.

Pulmonary‐renal syndrome (PRS) is defined as a combination of diffuse alveolar haemorrhage and glomerulonephritis. An 18‐year‐old woman visited our hospital with a 2‐day history of fever, dyspnoea, and leg edema. Laboratory investigations revealed an elevated inflammatory reaction, increased serum creatinine levels, and normocytic anaemia. Additionally, the anti‐streptolysin‐O titre was positive, and complement component‐3 levels were decreased. Urinalysis revealed proteinuria and hematuria. Bronchoalveolar lavage aliquots were progressively more hemorrhagic. These findings supported a diagnosis of PRS secondary to streptococcal infection. The patient was treated with high‐dose methylprednisolone and antibiotics. After 4 days of treatment, her respiratory symptoms and serum creatinine levels improved. Steroid tapering was performed over 15 days. The findings in this case indicate that streptococcal infection is a potential cause of PRS, and that short‐term steroid therapy is an effective treatment. [ABSTRACT FROM AUTHOR]

Epidemiological situation related to the spread of streptococcal infection and post-streptococcal diseases in the world remains tense in recent decades. According to the World Health Organization, more than 616 million cases of streptococcal pharyngitis occur annually in the world. Group A Streptococcus (GAS) is the most common cause of morbidity and mortality in infectious diseases and one of the main human pathogens. The prevalence of severe cases of GAS infections amounted to 18.1 million people worldwide. At the same time, in recent years outbreaks of scarlet fever have been recorded in some countries. In 2011, scarlet fever rate was 10 times higher than the average rate of the previous decade. In the past 3 years, epidemics of scarlet fever have been registered in the UK, with an increased incidence every year. Although there are significant achievements in the fight against rheumatic fever (RF), it keeps reminding of itself in the form of new outbreaks. Currently, acute rheumatic fever (ARF) is not a mass disease, but it is a serious problem associated with heart damage. In the article, we analyzed incidence and prevalence of RF, rheumatic heart disease (RHD), chronic pharyngitis, nasopharyngitis, sinusitis and rhinitis. We present the comparative characteristic among children, adolescents and adults. We also describe high epidemiological and social significance of the problem and possible increase of RF and RHD, which cause significant social and economic damage, remaining the urgent problem of public health in Russia. It was revealed that the situation with ARF and RHD in Russia remains unstable. Between 1997 and 2016, epidemiological indicators of streptococcal infection tend to increase moderately. ARF incidence significantly increases with an average growth rate (AGR) of 2.5 %, while its prevalence has the opposite tendency to decrease. AGR was –29.2 %. RFD incidence showed a significant indicators increase with AGR of +1.1 %. At the same time, the prevalence tended to decrease and STP was –2 %. The situation makes it necessary to strengthen the epidemiological control of streptococcal infection and increase the alertness of doctors regarding the new cases of ARF and RHD.

Abstract Background Throat pain is a common complaint in the ambulatory setting. Diagnosis of group A Streptococcus is made with a culture, molecular test or a rapid antigen detection test from the tonsils or the posterior pharyngeal wall, while other areas of the oral cavity are considered unacceptable. The purpose of the study is to compare cultures from the tonsils or posterior pharyngeal wall (throat) with cultures from the oral cavity (mouth). Methods A prospective study conducted in ambulatory care. Eleven family physicians collected 2 swabs (throat and mouth) from 200 consecutive patients who complaint about throat pain. Inclusion criteria were throat pain and Centor Criteria > 2. Exclusion criteria were tonsillectomy and age ( 65 years old). Participants were later divided into two groups – pediatrics (3–18 years old) and adults (19–65 year old). Sensitivity and specificity of mouth culture were calculated, with throat culture considered the reference gold standard. Results Between November 2017 and March 2019, 200 swabs were collected (101 adults and 99 children). In the adult group sensitivity of mouth culture was 72.1% (95% Confidence Interval [CI] 59.9–82.3%) and specificity was 100% (95% CI 92.7–89.4%-100%). In the pediatric group sensitivity of mouth culture was 78.3% (95% CI 65.8–87.9%) and specificity was 100% (95% CI 92.5–100%). Conclusion Our study demonstrated higher sensitivity of mouth culture for GAS than previously published. This finding suggests that areas of the oral cavity that were considered as unacceptable sites for culture of GAS pharyngitis may be considered as acceptable swabbing sites. Trial registration Trial registration: ClinicalTrials.gov , ID NCT03137823 . Registered 3 May 2017.

Introduction: Scarlet fever is usually a mild childhood disease caused by type A streptococci. This disease is spread by droplets, mainly through direct contact with an infected person or the objects they have used. In pediatrics, these are significant risk factors for the transmission of infectious diseases. However, it is important to remember the possibility of serious complications in the course of scarlet fever. Aim: This paper provides a discussion of two pediatric cases in order to determine the possibilities of diagnosis, differentiation, and treatment of patients with severe, non-obvious courses of scarlet fever. Methods: The case reports of two patients hospitalized in a pediatric department due to Streptococcus pyogenes infection were examined. Results: The patients were admitted to the emergency room with symptoms not directly indicative of type A streptococcal infection, which required further diagnosis. Both patients complained of weakness at the time of presentation. They had an elevated temperature, were dehydrated during the course of gastroenteritis, and passed liquid stools without pathological admixtures. Further stages of diagnosis and treatment required hospitalization in the pediatric department. Therapeutic benefit from the implemented treatment was obtained, and the patients were discharged in good general condition with further recommendations. Conclusions: Medical history, which is often very detailed, can be the key to making the final diagnosis and can supplement the data collected on the basis of laboratory tests. Scarlet fever does not always occur with a mild course, and sometimes its course can be quite non-specific and may require a thorough diagnosis.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are clinical conditions characterized by the sudden onset of obsessive–compulsive disorder and/or tics, often accompanied by other behavioral symptoms in a group of children with streptococcal infection. PANDAS-related disorders, including pediatric acute-onset neuropsychiatric syndrome (PANS), childhood acute neuropsychiatric symptoms (CANS), and pediatric infection triggered autoimmune neuropsychiatric disorders (PITANDs), have also been described. Since first defined in 1998, PANDAS has been considered a controversial diagnosis. A comprehensive review of the literature was performed on PubMed and Scopus databases, searching for diagnostic criteria and diagnostic procedures of PANDAS and related disorders. We propose a test panel to support clinicians in the workout of PANDAS/PANS patients establishing an appropriate treatment. However, further studies are needed to improve our knowledge on these acute-onset neuropsychiatric conditions.

OBJECTIVE: The aim of this study was to examine the altering patterns in clinical characteristics and severity of acute post-streptococcal glomerulonephritis (APSGN) in children. PATIENTS AND METHODS: We analyzed the medical records of 119 children who were diagnosed with APSGN from 1987 to 2018, retrospectively. The patients were divided into two groups: Group I (n=72, before 1998) and Group II (n=47, after 1998). Clinical, radiologic, and laboratory findings were compared between the two groups. RESULTS: The clinical manifestations, including vomiting (20.8% vs. 4.3%, p=0.014), oliguria (40.3% vs. 19.1%, p=0.016), and generalized edema (86.1% vs. 63.8%, p=0.005), were statistically less frequent since 1998. Pulmonary edema on chest X-ray (22.7% vs. 4.4%, p=0.014) was less frequent in Group II than in Group I. The level of BUN (23.3±19.3 vs. 18.8±11.2, p=0.009) was lower in Group II than in Group I, while that of creatinine was not significantly different between the two groups. C3 level was an independent factor for predicting the development of edema (odds ratio [OR]: 1.034, 95% CI: 1.010-1.060, p=0.006) and acute nephritic symptoms (≥2) (OR: 0.974, 95% CI: 0.952-0996, p=0.020). It was also negatively correlated with an increasing number of acute nephritic symptoms, including oliguria and edema, in patients with APSGN (R=−0.182, p=0.048). CONCLUSIONS: This study demonstrated that APSGN had favorable clinical manifestations and severity over the past 30 years. The monitoring of C3 levels can be used to assess the disease severity and risk of complications, including edema and oliguria, which are decreasing in South Korean children. [ABSTRACT FROM AUTHOR]

This case report aimed to discuss the efficacy of aripiprazole for dyskinesia in patients with functional movement disorder after streptococcal infection, with its biological action of modulating dopamine hyperactivity in the basal ganglia as a dopamine partial agonist. This report has shown that the [18F] N -(3-Fluoropropyl)-2ß-carbon ethoxy-3ß-(4-iodophenyl) nortropane positron emission tomography findings of the patient revealed that the dopamine hyperactivity in the basal ganglia at baseline was normalized after aripiprazole treatment due to its balancing effect as a dopamine partial agonist. [ABSTRACT FROM AUTHOR]

Osteomyelitis of the sternal bone is very rare and is usually secondary to trauma or surgery. Primary sternal osteomyelitis and secondary sternal osteomyelitis commonly are caused by Staphylococcus spp, and in drug addicts by Pseudomonas aerugenosa, while in sickle cell anemic children, Salmonella spp are mostly implicated. We, therefore, present an unusual causative organism, Streptococcal spp in a sickle cell anemic child. [ABSTRACT FROM AUTHOR]

Acute rheumatic fever (ARF) is a sequela of streptococcal infection—typically following 2 to 3 weeks after group A streptococcal pharyngitis—that occurs most commonly in children and has rheumatologic, cardiac, and neurologic manifestations. Rheumatic heart disease (RHD) refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of ARF. Secondary prophylaxis with regular intramuscular injections of benzathine penicillin G (BPG) is a key component to prevent ARF and RHD recurrent. This study aimed to evaluate the secondary prophylaxis effectiveness based on the profile of clinical manifestations and blood laboratory findings. The data were collected by interviews, complete blood counts, the anti-streptolysin titer O (ASTO) analysis, the C-reactive protein Assay, electrocardiography, and echocardiography. Data were analyzed using SPSS 18, and the results were presented as the percentage frequency. The samples were 63 patients with ARF and RHD who get secondary prophylaxis, consisting of 32 males (50.8%) and 31 females (49.9%). The echocardiography examination showed that valve regurgitation was more common than valve stenosis, indicating longer P-R interval in 49 subjects (77.7%). Sixty subjects (92.2%) received secondary prophylaxis with BPG injection, and three subjects (4.8%) got Erythromycin oral. The main factor of secondary prophylaxis adherence is pain and injection disliking. [ABSTRACT FROM AUTHOR]

Background: Throat pain is a common complaint in the ambulatory setting. Diagnosis of group A Streptococcus is made with a culture, molecular test or a rapid antigen detection test from the tonsils or the posterior pharyngeal wall, while other areas of the oral cavity are considered unacceptable. The purpose of the study is to compare cultures from the tonsils or posterior pharyngeal wall (throat) with cultures from the oral cavity (mouth). Methods: A prospective study conducted in ambulatory care. Eleven family physicians collected 2 swabs (throat and mouth) from 200 consecutive patients who complaint about throat pain. Inclusion criteria were throat pain and Centor Criteria > 2. Exclusion criteria were tonsillectomy and age (< 3 or > 65 years old). Participants were later divided into two groups – pediatrics (3–18 years old) and adults (19–65 year old). Sensitivity and specificity of mouth culture were calculated, with throat culture considered the reference gold standard. Results: Between November 2017 and March 2019, 200 swabs were collected (101 adults and 99 children). In the adult group sensitivity of mouth culture was 72.1% (95% Confidence Interval [CI] 59.9–82.3%) and specificity was 100% (95% CI 92.7–89.4%-100%). In the pediatric group sensitivity of mouth culture was 78.3% (95% CI 65.8–87.9%) and specificity was 100% (95% CI 92.5–100%). Conclusion: Our study demonstrated higher sensitivity of mouth culture for GAS than previously published. This finding suggests that areas of the oral cavity that were considered as unacceptable sites for culture of GAS pharyngitis may be considered as acceptable swabbing sites. Trial registration: Trial registration: ClinicalTrials.gov, ID NCT03137823. Registered 3 May 2017. [ABSTRACT FROM AUTHOR]

Introduction: Streptococcal infection can be responsible for multiple complications, such as toxic, septic or allergic disorders. Toxin-mediated complications (TMC) can appear during the acute phase of disease and can involve any organ, causing carditis, arthritis, nephritis, hepatitis etc.