Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

Zühlke, Liesl; Beaton, Andrea; Engel, Mark E; Hugo-Hamman, Christopher; Karthikeyan, Ganesan; Katzenellenbogen, Judith M.; Ntusi, Ntobeko; Ralph, Anna P.; Saxena, Anitá; Smeesters, Pierre; Watkins, David; Zilla, Peter; Carapetis, Jonathan R.

doi:10.1007/s11936-017-0513-y

Cited by 123 publications

(100 citation statements)

References 131 publications

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“…Finally, the subset used for the algorithm validation sub-study were selected opportunistically, which may have been open to selection bias. Despite these limitations, this study provides good baseline data for the prevalence of these common skin infections in a country where no other recent data exists and also provides valuable microbiological data on skin pathogens, which is lacking globally [1-3].…”

Section: Discussionmentioning

confidence: 99%

High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: a cross-sectional study

Armitage

Senghore

Darboe

et al. 2019

Preprint

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words)This cross-sectional study of skin infections in The Gambia revealed prevalence of scabies, pyoderma and fungal infections in children <5 years of 15.9%, 17.4% and 9.7% respectively, with increased bacterial skin infections in the rainy season.2 Abstract (max 250 words) Background: Scabies is a WHO neglected tropical disease common in children in low-and middle-income countries. Excoriation of scabies lesions can lead to secondary pyoderma infection, most commonly by Staphyloccocus aureus and Streptococcus pyogenes (group A streptococcus, GAS), with the latter linked to acute post-streptococcal glomerulonephritis (APSGN) and potentially rheumatic heart disease (RHD). There is a paucity of data on the prevalence of these skin infections and their bacterial aetiology from Africa. Materials/methods:A cross-sectional study, conducted over a four-month period that included the dry and rainy season, was conducted to determine the prevalence of common skin infections in Sukuta, a peri-urban settlement in western Gambia, in children <5 years. Swabs from pyoderma lesions were cultured for S. aureus and GAS.Results: Of 1441 children examined, 15.9% had scabies (95% CI 12.2-20.4), 17.4% had pyoderma (95% CI 10.4-27.7) and 9.7% had fungal infections (95% CI 6.6-14.0).Scabies were significantly associated with pyoderma (aOR 2.74, 95% CI 1.61-4.67).Of 250 pyoderma swabs, 80.8% were culture-positive for S. aureus, and 50.8% for GAS. Participants examined after the first rains were significantly more likely to have pyoderma than those examined before (aRR 2.42, 95% CI 1.38-4.23), whereas no difference in scabies prevalence was seen (aRR 1.08, 95% CI 0.70-1.67). Swab positivity was not affected by the season. Conclusions:High prevalence of scabies and pyoderma were observed. Pyoderma increased significantly during rainy season. Given the high prevalence of GAS

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Section: Discussionmentioning

confidence: 99%

High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: a cross-sectional study

Armitage

Senghore

Darboe

et al. 2019

Preprint

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“…RHD is a largely preventable, acquired heart disease resulting from untreated or undertreated group A streptococcal infections in the community 18. A recent publication on the outcomes of women with rheumatic mitral disease, which largely excluded low-income countries, found that heart failure complicated 23% of women entering pregnancy with moderate or severe mitral regurgitation 13.…”

Section: Discussionmentioning

confidence: 99%

Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting

Beaton

Okello

Scheel

et al. 2018

Heart

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BackgroundThe burden of pre-existing cardiovascular disease and the contribution to adverse pregnancy outcomes are not robustly quantified, particularly in low-income countries. We aimed to determine both the prevalence of maternal heart disease through active case finding and its attributable risk to adverse pregnancy outcomes.MethodsWe conducted a 24-month prospective longitudinal investigation in three Ugandan health centres, using echocardiography for active case finding during antenatal care. Women with and without heart disease were followed to 6 weeks post partum to determine pregnancy outcomes. Prevalence of heart disease was calculated. Per cent attributable risk estimates were generated for maternal, fetal and neonatal mortality.ResultsScreening echocardiography was performed in 3506 women. The prevalence of heart disease was 17 per 1000 women (95% CI 13 to 21); 15 per 1000 was rheumatic heart disease. Only 3.4% of women (2/58) had prior diagnosis. Cardiovascular complications occurred in 51% of women with heart disease, most commonly heart failure. Per cent attributable risk of heart disease on maternal mortality was 88.6% in the exposed population and 10.8% in the overall population. Population attributable risk of heart disease on fetal death was 1.1% and 6.0% for neonatal mortalityConclusionsOccult maternal heart disease may be responsible for a substantial proportion of adverse pregnancy outcomes in low-resource settings. Rheumatic heart disease is, by far, the most common condition, urging global prioritisation of this neglected cardiovascular disease.

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“…Streptococcus pyogenes is responsible for a wide range of illnesses, ranging from uncomplicated pharyngitis and impetigo to toxic shock syndrome and necrotizing fasciitis . Moreover, autoimmune sequelae such as acute rheumatic fever and rheumatic heart disease may arise after an inappropriately treated infection . Though not a severe illness, streptococcal pharyngitis is very common and associated with high costs .…”

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confidence: 99%

Protective immunity induced by an intranasal multivalent vaccine comprising 10 Lactococcus lactis strains expressing highly prevalent M‐protein antigens derived from Group A Streptococcus

Wozniak

Scioscia

García

et al. 2018

Microbiology and Immunology

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Streptococcus pyogenes (group A Streptococcus) causes diseases ranging from mild pharyngitis to severe invasive infections. The N-terminal fragment of streptococcal M protein elicits protective antibodies and is an attractive vaccine target. However, this N- terminal fragment is hypervariable: there are more than 200 different M types. In this study, an intranasal live bacterial vaccine comprising 10 strains of Lactococcus lactis, each expressing one N-terminal fragment of M protein, has been developed. Live bacterial-vectored vaccines cost less to manufacture because the processes involved are less complex than those required for production of protein subunit vaccines. Moreover, intranasal administration does not require syringes or specialized personnel. Evaluation of individual vaccine types (M1, M2, M3, M4, M6, M9, M12, M22, M28 and M77) showed that most of them protected mice against challenge with virulent S. pyogenes. All 10 strains combined in a 10-valent vaccine (M×10) induced serum and bronchoalveolar lavage IgG titers that ranged from three- to 10-fold those of unimmunized mice. After intranasal challenge with M28 streptococci, survival of M×10-immunized mice was significantly higher than that of unimmunized mice. In contrast, when mice were challenged with M75 streptococci, survival of M×10-immunized mice did not differ significantly from that of unimmunized mice. Mx-10 immunized mice had significantly less S. pyogenes in oropharyngeal washes and developed less severe disease symptoms after challenge than did unimmunized mice. Our L. lactis-based vaccine may provide an alternative solution to development of broadly protective group A streptococcal vaccines.

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Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations

Cited by 123 publications

References 131 publications

High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: a cross-sectional study

High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: a cross-sectional study

Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting

Protective immunity induced by an intranasal multivalent vaccine comprising 10 Lactococcus lactis strains expressing highly prevalent M‐protein antigens derived from Group A Streptococcus

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