Post-streptococcal acute glomerulonephritis in Chile?20�years of experience

Abstract

In order to characterize the epidemiological and clinical picture of post-streptococcal acute glomerulonephritis (PSAGN), a prospective study was designed to investigate all admissions to a general hospital of a local health service in Chile. The protocol included the investigation of previous streptococcal infections (SI), clinical symptoms and signs, socioeconomic situation (SES), throat and skin swabs for the isolation of group A beta-hemolytic streptococci, sequential determination of serum antistreptolysin O (ASO) titer, anti-DNAase B antibodies, and C3. During the 20 years studied, 926 cases were admitted (56% males). Incidence showed an endemic period (EP) 1980-1983, an epidemic outbreak (EO) 1984-1989, and a late period (LP) 1990-1999, with a rate per 100,000 inhabitants of 6.2, 13.2, and 1.7, respectively. The clinical picture was similar in the three periods. SES was homogeneous, with 80% of the population in low and middle-low categories. The average size of the family was 6.9 compared with 4.8 in the general population. Pyoderma was more frequent than pharyngeal infection, and more so during the EO. The isolation rate of group A beta-hemolytic streptococci from the pharynx was 20% compared with 60% from skin swabs. During EP, the most prevalent serotypes were T14-M0 and T1-M1 from the pharynx and TImp19-M0 from the skin. During EO, T14-M0 was more prevalent (30%). M or T classification was possible in EP and EO in 80%-85% of all strains isolated from the two locations. Significant titers for ASO and anti-DNAase B were found on admission: 55% and 75%, respectively. Both tests allowed identification of 100% of previous SI. In conclusion, the incidence of PSAGN had an uneven trend during the observed period. EO was mainly due to skin infection and a predominance of one serotype, T14-MO, was observed. After the EO, the yearly rate gradually decreased from 13.2 in 1988 to 0.0 in 1999, a rate similar to that of industrialized nations.

Acute Post-Streptococcal Glomerulonephritis in the Northern Territory of Australia: A Review of 16 Years Data and Comparison with the Literature

“…1 Many of these epidemics were thought to be related to streptococcal skin rather than throat infection, often associated with preceding scabies. 2,3 Over the past 20 years there has been a substantial decline in the reported incidence of APSGN in many industrialized countries. 1,[3][4][5][6] Despite this declining incidence of APSGN in many developed countries, there is still a significant global burden of disease.…”

“…2,3 Over the past 20 years there has been a substantial decline in the reported incidence of APSGN in many industrialized countries. 1,[3][4][5][6] Despite this declining incidence of APSGN in many developed countries, there is still a significant global burden of disease. It has been estimated that there are more than 470,000 cases of APSGN worldwide annually with ~5,000 deaths, with 97% occurring in less developed countries.…”

The Current State of Poststreptococcal Glomerulonephritis

“…Table 1 lists epidemics with Ͼ100 cases 10,[15][16][17][18][19][20][21][22][23][24] and Table 2 the epidemics with Ͻ100 cases or clusters in families or communities. 9,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Figure 1 shows that in the past 30 yr, large epidemics have been reported in countries in the middle range of the Human Development Index (HDI; between the 48th and the 87th rank place out of 177) and clusters of cases in countries in the upper 10% of the HDI. 43 The countries where PSGN has not been reported in the past 30 yr are in the socalled "low" range of the HDI (0.449 to 0.336), 43 and overwhelming social and health problems in combination with poor documentation resources ( Figure 1A) are likely reasons for the apparent absence of PSGN.…”

“…Acute postinfectious glomerulonephritis is frequently the cause of severe acute renal failure (requiring dialysis and/or admission to pediatric intensive care units) in underdeveloped countries. The proportion of cases of acute renal failure that correspond to acute postinfectious glomerulonephritis of demonstrated or assumed poststreptococcal etiology is 13% in New Delhi, 44 30% in Istanbul, 45 51.6% in Casablanca, 46 4.6% in Lagos, 47 27% in Bombay, 48 19.2% in Lucknow, 49 33% in Asunció n, 50 17.4% in Chandrigarth, 51 5.2% in Lima, 52 9.3% in Varanasi, 53 and 25% in Osun State, Nigeria. 54 …”

Acute Post-Streptococcal Glomerulonephritis in Children

“…Однако у некоторых пациентов заболе-вание может сопровождаться образованием полулуний (экстракапиллярная пролиферация) и приобретать чер-ты быстропрогрессирующего гломерулонефрита. В этих случаях после купирования острого эпизода возможно развитие прогрессирующей хронической болезни почек вследствие необратимого повреждения значительного числа клубочков [4]. ЭПИДЕМИОЛОГИЯ ОПСГН вместе с острой ревматической лихорадкой относится к негнойным осложнениям стрептококковой инфекции, однако существенные эпидемиологические и клинические отличия этих двух заболеваний привели к формированию концепции о существовании различных ревмато-и нефритогенных штаммов стрептококка [5].…”