Incidence and clinical profile of acute rheumatic fever in Greece

BackgroundAn experimental 26-valent M protein Group A streptococcal (GAS) vaccine has entered clinical studies. Pharyngeal GAS emm type surveillances in different areas and time-periods enhance the understanding of the epidemiology of GAS pharyngitis. Moreover, these surveillances, combined with the data on GAS invasive disease, can play a significant role in the formulation of multivalent type-specific vaccines.MethodsDuring a 7-year period (1999–2005), 2408 GAS isolates were recovered from consecutive children with pharyngitis in Western Greece. The overall macrolide resistance rate was 22.8%. Along the study period we noted a tendency towards significantly decreased rates of resistance, with the lowest rates occurring in 2002 (15.3%), 2003 (15%) and 2004 (16.7%). A random sample of isolates from each year, 338 (61.7%) of the 548 macrolide-resistant and 205 (11%) of the macrolide-susceptible, underwent molecular analysis, including emm typing.ResultsThe 543 typed isolates had 28 different emm types. A statistically significant association was found between macrolide resistance and emm4, emm22 and emm77, whereas emm1, emm3, emm6, emm12, emm87 and emm89 were associated with macrolide susceptibility. A significant yearly fluctuation was observed in emm4, emm28 and emm77. The most common macrolide-resistant GAS were emm77 isolates harboring erm(A), either alone or in combination with mef(A), emm4 carrying mef(A), emm28 possessing erm(B), emm75 carrying mef(A), emm12 harboring mef(A) and emm22 carrying erm(A). We estimated that 82.8% of the isolates belonged to emm types included in the novel 26-valent M protein vaccine. The vaccine coverage rate was determined mainly by the increased frequency of nonvaccine emm4 isolates.ConclusionsA limited number of emm types dominated among macrolide-susceptible and macrolide-resistant GAS isolates. We observed seasonal fluctuations, which were significant for emm4, emm28 and emm77. This type of data can serve as baseline information if the novel 26-valent M protein GAS vaccine is introduced into practice.

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“…This decrease parallels the marked decline in incidence of acute rheumatic fever in our country [41].…”

Section: Discussionsupporting

confidence: 58%

Seven-Year Surveillance of emm Types of Pediatric Group A Streptococcal Pharyngitis Isolates in Western Greece

et al. 2013

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“…3,17,22,23 Although any layer of the heart can be affected, mitral valve insufficiency was present in more than 90% of patients who underwent echo-Doppler, as has been reported by other authors. 1,2,3,20 In this series, 19/28 (67.8%) patients with chorea had carditis as well, a figure similar to those described elsewhere. 1,13 In fact, it has been shown that screening of choreic patients with echoDoppler may further increment the detection of "silent" valvulitis.…”

Section: Discussionsupporting

confidence: 83%

“…The significantly greater overall Carditis, in the form of valvulitis, usually occurs in more than three-quarters of patients with ARF. 2,3,20 Some studies have found higher rates due to the systematic use of echo-Doppler. 2,3 In this study, patients were submitted to an echo-Doppler exam only if they presented clinical evidence of carditis, in accordance to the American Heart Association and the WHO guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Articular and cardiac manifestations have been described as the most frequent features of rheumatic fever. 1,2,3,4,19,20 Around 80% of patients on this series had joint complaints. Migratory arthritis has been said to be the typical articular manifestation of ARF, 4, 6, 19 but in our series, although arthritis occurred more frequently than arthralgia, no particular pattern of joint involvement was found to be more frequent when stratified into clinical subtypes of presentation (Table 1).…”

Section: Methodsmentioning

confidence: 97%

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Jones criteria and underdiagnosis of rheumatic fever

et al. 2007

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“…To treat the streptococcal infection, either oral or parenteral antibiotics can be administered. Penicillin is the drug of choice, but erythromycin or other macrolides, such as clarithromycin, can be used in patients allergic to penicillin (10). In addition, patients with ARF should receive secondary prophylaxis (single daily dosing) of either penicillin or erythromycin for the next 5 years, as the risk of recurrence is greatest during this time span.…”

mentioning

confidence: 98%