Acute nephritis and streptococcal sore throat: a prospective study in general practice.

Abstract

The evidence linking acute nephritis and infection of the throat or skin with certain types of group A beta-haemolytic streptococci is of three kinds: (1) studies of streptococcal disease when acute nephritis was more prevalent than usual, (2) cultures from the throats of established cases of acute nephritis, and (3) serological studies of such cases for type-specific antibodies.Examples of the first are the reports of Manser and Wilson (1952), Reed (1953), Kleinman (1954), Seigel et al. (1955), Stetson et al. (1955), and George et al. (1958. Studies of established cases of acute nephritis have been reported by Rammelkamp and Weaver (1953), Wertheim et al. (1953), Wilmers et al. (1954, Hardin et al. (1956), andBernstein andStillerman (1960). Two investigations on the production of type-specific antibodies are noteworthy-those of Cullhed et at. (1959) and of Earle and Jennings (1959 (Ravenswaay, 1944, Rantz et al., 1945. In assessing the significance of such isolations it is essential to know the prevalence of different types in the community from which the cases are drawn. There are, however, few reports on the relative incidence of different types in acute pharyngitis in normal populations; what evidence there is suggests that type 12 is widely prevalent (Siegel et al., 1961 ; Mitchell, 1962Valkenburg et al., 1963.Moreover, the literature abounds in anomalies. Acute nephritis is said to be twice as common in males (Seegal et al., 1935 ;Earle and Seegal, 1957) has since appeared.We report here a prospective study in a normal community: in a small town and the neighbouring countryside, virtually the whole population of which is under our care. In 1959 this population numbered approximately 14,000 persons; the study began on 28 January of that year and continued for 12 months. * General Practitioners, Rugeley, Staffs.The objects were: (1) to determine the prevalence of different types of streptococci found in association with acute sore throat, (2) to uncover cases developing acute nephritis or urinary abnormalities after streptococcal pharyngitis, and (3) to relate them to the type of Streptococcus pyogenes isolated at the patient's first attendance. MethodAll patients with symptoms or signs of sore throat were admitted to the study. The throat was swabbed when the patient was first seen, and specimens of urine were tested. After three months it became necessary to reduce the number of urine specimens tested, and patients were asked thereafter to send in one specimen when first seen, and a second three weeks later. For the first nine months information (including details of temperature and treatment) was recorded on special cards; recording was then simplified and such details were omitted.Urines were tested by heat and acetic acid; if protein was found the urine was centrifuged and the deposit examined microscopically.Throat swabs were sent by post to the Public Health Laboratory 10 miles (16 km.) away (usually arriving within 24 hours) and were sown on to horse-blood agar plates, which were incubated aerobic...

Sore Throat in Children: Its Causation and Incidence

“…Laboratories which gave comparable results were London (95-7%'), Prague (97-90o), Copenhagen (97.30°), Jerusalem (99-8o0), Atlanta (97.00o), and Moscow (98-00%). Similar figures were also produced by Zanen et al (1959), Mitchell (1962, and Higgins et al (1965).…”

“…In the study of Higgins et al (1965), in which there were similarities to the present one in technique and in the population studied, the isolation rate for viruses was 2480°', which was higher than that of the present study. Respiratory syncytial virus was isolated in their study but not in the present one and this accounts for part of the difference.…”

Streptococcal pharyngitis in general practice. 1. Some unusual features of the epidemiology

“…For a period of 12 months up to mid-December 1965 all patients of mine with acute infections of the upper respiratory tract were recruited into a study of transient urinary abnormalities following acute sore throat [1]. This paper reports the epidemiological findings, supplemented by data recorded in 1963 and 1964 and the results of a study of acute sore throat in all patients of the practice in 1959 [2].…”

Streptococcal pharyngitis in general practice. 2. A note on dual infection and transient urinary abnormalities

“…Studies in that practice in 1958 and 1959 suggested that either 'nephritogenicity', if it existed, was not a sufficient cause of nephritis [6,7] or that only a very small proportion of patients yielding nephritogenic streptococci had streptococcal infection. In 1963 an unusual cluster of post streptococcal conditions occurred amongst my patients at a time when both streptococcal infections and infectious mononucleosis-like illnesses were prevalent [8] and at the end of that year a patient developed acute nephritis following a sore throat due to group A streptococci and a primary infection with herpes simplex virus [9].…”

“…The full picture of acute nephritis is not often encountered in general practice but urinary abnormalities without other signs of nephritis after acute streptococcal sore throat are relatively common [7,10,11]. Such abnormalities may be found in contacts of patients with acute nephritis [12][13][14].…”