Reinfection With Streptococcus Hemolyticus in Lobar Pneumonia, Measles and Scarlet Fever and Its Prevention

A forgotten epidemic that changed medicine: measles in the US Army, 1917–18

“…The existing measles autopsy data, sparse and often of poor quality, nevertheless suggest that most postmeasles pneumonias were caused by streptococci with or without pneumococci—eg, data from Cumming and colleagues 19 on 18 measles pneumonia autopsies, which show pure streptococci in 15, and streptococci-positive pneumococci in three. 21 Other bacteria were found less often.…”

“…10,28,33,36,55 Radiology assumed an increasingly important role in pneumonia management and particularly in empyema management. 18,21–23,31,35,65…”

“…34,59,60,76 Early thoracotomy for effusion or empyema caused sudden cardiac deaths, seemingly by producing ipsilateral lung collapse that could not be immediately compensated by diseased contralateral lungs. 11,18–21,23,27–37,56,59,60 The results from clinical and radiological studies showed the natural course of S haemolyticus pleural effusions and empyemas and their optimum medical and surgical management, including cannulation, aspiration, or irrigation of empyema cavities with rubber tubes and repeated instillation of Dakin’s solution; 31,77,80,81 and non-aggressive periodic or daily tapping of early effusions as fluids gradually changed from straw-coloured or rose-coloured to frank pus, at which time safe thoracotomy was possible. 11,76 Empyema management became an important part of surgical practice during the rest of the war; recovery usually extended over many months and left soldiers weakened, emaciated, and often permanently disabled (figure 2).…”

“…17–19 Empyema, historically diagnosed in only about 2∙2% of measles-related pneumonias, 20 developed in up to 90% of all pneumonia cases. 21 The case-fatality of early epidemic empyema reached 90%. 8,17,22–35 At Camp Pike (Little Rock, AR) measles is thought to have killed more soldiers than the 1918 influenza pandemic.…”

“…During the streptococcal-carriage epidemics, incidences of scarlet fever, erysipelas, and acute tonsillitis all rose, peaking from November, 1917, to March, 1918 (figure 1). 9,21 After implementation of streptococcal control measures in early 1918, 22 pneumonia incidence and measles complications decreased (figure 1). 60 Investigators concluded that severe postmeasles pneumonia with or without empyema, primary S haemolyticus pneumonia, and scarlet fever, erysipelas, or tonsillitis, all resulted from epidemics of streptococcal acquisition or carriage related to crowding of people and mass associations during military training .…”