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β-HEMOLYTIC STREPTOCOCCUS GROUP A CARRIER IN CHILDREN: THE PROBLEM OF DIFFERENTIAL DIAGNOSIS

https://doi.org/10.22627/2072-8107-2018-17-2-52-57

Abstract

Streptococcal infection is characterized by a variety of manifestations from asymptomatic carriage of the pathogen to manifest forms. Recently, in addition to the bacteriological method for confirming streptococcal etiology, the rapid test for β-hemolytic streptococcus group A is increasingly being used. Isolation of streptococci does not always indicate their involvement in pathology, quite often a person is a healthy carrier of the pathogen. The share of carrier is 10—28% of cases. However, in the practical activities of a physician, positive tests for β -hemolytic streptococcus group A (rapid test or bacteriological culture) are often treated as acute streptococcal infection even in children without any clinical manifestations of acute tonsillopharyngitis and, as a result, antibiotic therapy is prescribed.

For differential diagnosis, a correct evaluation of epidemiological and clinical data with a mandatory serological test — the determination of ASO in paired sera with an interval of 7—10 days is required. Absence of an increase in antibodies indicates carrier.

b-hemolytic streptococcus group A carriers in most cases do not need antibiotic therapy. However, if there is a history or risk of developing rheumatic fever, acute poststreptococcal glomerulonephritis, antibiotic therapy is necessary.

The authors proposed an algorithm for managing patients with the release of b-hemolytic streptococcus group A from the oropharynx.

About the Authors

E. V. Novosad
Pirogov Russian National Research Medical University
Russian Federation

Ekaterina Novosad, Ph.D., Associate Professor of the Department of Infectious Diseases in Children 

Moscow



S. L. Bevza
Pirogov Russian National Research Medical University
Russian Federation

Svetlana Bevza, PhD, main laboratory assistant of the Department of Infectious Diseases in Children 

Moscow



N. M. Obolskaya
Treatment and Rehabilitation Center of the Ministry of Economic Development of Russia
Russian Federation

Natalia Obolskaya, PhD, deputy сhief medical officer 

Moscow



O. V. Shamsheva
Pirogov Russian National Research Medical University
Russian Federation

Olga Shamsheva, MD, Professor, Head of the Department of Infectious Diseases in Children 

Moscow



V. V. Belimenko
Pirogov Russian National Research Medical University
Russian Federation

Vladislav Belimenko, Ph.D., leading research assistant of the laboratory of protozoology 

Moscow



References

1. Johnson R., Kurlan R., Leckman J., Kaplan L. The Human Immune Response to Streptococcal Extracellular Antigens: Clinical, Diagnostic, and Potential Pathogenetic Implications. Clin Infect Dis. 2010; 50 (4): 481—490.

2. Miller J., Stancer S., Massell B. F. A controlled study of beta hemolytic streptococcal infection in rheumatic families: I. Streptococcal disease among healthy siblings. Am J Med. 1958; 25 : 825—844.

3. Heart Foundation of New Zealand. Group A Streptococcal Sore Throat Management Guideline. New Zealand, Auckland. 2014 Update.

4. Belyakov V., Hodyrev A., Totolyan A. Streptococcal infection. M.: Medicina, 1978:296. (In Russ.)

5. Zacharioudaki M., Galanakis E. Management of children with persistent group A streptococcal carriage. Expert Rev Anti Infect Ther. 2017; 15(8): 787—795.

6. Tanz R.R., Shulman S.T. Chronic Pharyngeal Carriage of Group A Streptococci. Pediatric Infectious Disease Journal. 2007; 26(2): 175—176.

7. Kaplan E. The group A streptococcal upper respiratory tract carrier state: An enigma. J Pediatr. 1980; 97: 337—345.

8. Martin J., Green M., Barbadora K., Wald E. Group A streptococci among school-aged children: clinical characteristics and the carrier state. Pediatrics. 2004; 114(5): 1212—9.

9. Österlund A., Popa R., Nikkilä T., Scheynius A. et al. Intracellular Reservoir of Streptococcus pyogenes In Vivo: A Possible Explanation for Recurrent Pharyngotonsillitis. Laryngoscope. 1997; 107(5): 640—647.

10. Passàli D., Lauriello M., Passàli G., Passàli F. et al. Group A Streptococcus and its antibiotic resistance. Acta Otorhinolaryngol Ita. 2007; 27: 27—32.

11. Neeman R., Keller N., Barzilai A., Korenman Z. et al. Prevalence of internalisation-associated gene, prtF1, among persisting group-A streptococcus strains isolated from asymptomatic carriers. Lancet. 1998; 352(9145):1974—1978.

12. Medina E., Goldmann O., Toppel A., Chhatwal G. Survival of Streptococcus pyogenes within Host Phagocytic Cells: A Pathogenic Mechanism for Persistence and Systemic Invasion. J Infect Dis. 2003; 187(4): 597—603.

13. Lei B., DeLeo F.R., Hoe N.P., Graham M.R. et al. Evasion of human innate and acquired immunity by a bacterial homolog of CD11b that inhibits opsonophagocytosis. Nature Medicine. 2001; 7(12): 1298—305.

14. Epidemiological surveillance and prevention of streptococcal (group A) infection. Methodical instructions. 3.1.1885-04; 04.03.2004. (In Russ.)

15. Spinaci C., Magi G., Zampaloni C., Vitali L. A. et al. Genetic diversity of cell-invasive erythromycin-resistant and -susceptible group A streptococci determined by analysis of the RD2 region of the prtF1 gene. J. Clin. Microbiol. 2004; 42: 639—644.

16. DeMuri G., Wald E. The Group A Streptococcal Carrier State Reviewed: Still an Enigma. Journal of the Pediatric Infectious Diseases Society. 2014; 3(4): 336—342.

17. Pichichero M. Treatment and prevention of streptococcal tonsillopharyngitis (updated: Feb 16, 2017) / [Электронный ресурс] / URL: https://ru.scribd.com/document/343345831/Treatmentand-Prevention-of-Streptococcal-Tonsillopharyngitis-UpToDate.

18. Davies D.H, McGeer A., Schwartz B. и et. al. Invasive group A streptococcal infections in Ontario, Canada. N Engl J Med. 1996; 335: 547.

19. Prevention of streptococcal (group A) infection. Sanitary-epidemiological rules. 3.1.2.3149-13; 18.12. 2013. (In Russ.)

20. Shulman S.T., Bisno A.L., Clegg H.W., Gerber M.A., et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2012; 55(10): e86-e102. https://doi.org/10.1093/cid/cis629

21. Pickering L., Baker, Kimberlin D., Long S. Red Book: 2012 Report of the Committee on Infectious Diseases — American Academy of Pediatrics (AAP), 2012:1058.

22. Gerber M., Tanz R., Kabat W., Bell G.L., et al. Potential mechanisms for failure to eradicate group A streptococci from the pharynx. Pediatrics. 1999; 104: 911.

23. Kaplan E., Gastanaduy A., Huwe B. The role of the carrier in treatment failures after antibiotic for group A streptococci in the upper respiratory tract. J Lab Clin Med. 1981; 98: 326.

24. Shulman S., Gerber M., Tanz R., Markowitz M. Streptococcal pharyngitis: the case for penicillin therapy. Pediatr Infect Dis J.1994; 13(1):1—7.


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For citations:


Novosad E.V., Bevza S.L., Obolskaya N.M., Shamsheva O.V., Belimenko V.V. β-HEMOLYTIC STREPTOCOCCUS GROUP A CARRIER IN CHILDREN: THE PROBLEM OF DIFFERENTIAL DIAGNOSIS. CHILDREN INFECTIONS. 2018;17(2):52-57. (In Russ.) https://doi.org/10.22627/2072-8107-2018-17-2-52-57

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