Title: Burden of Group A Streptococci among Children Aged 5-15 years with Symptoms of Pharyngotonsillitis: A Study in a Tertiary Care Hospital, Bangalore

Authors: Preetha Rajan, Gayathri Devi, Sreenivasa Babu

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.202

Abstract

Background: Rheumatic fever and Rheumatic heart disease continue to be major problems in most developing countries including India where prevalence rate is 4-6/1000 children per year. Clinical presentations of streptococcal and non streptococcal pharyngitis overlap broadly, so laboratory diagnosis is required to support clinical diagnosis, minimise the potential adverse effect of inappropriate antimicrobial therapy and to prevent RF/RHD.

Objective: To isolate and determine the prevalence of Group A Streptococci in symptomatic children and detect their antibiotic sensitivity pattern.

Materials and Methods: Throat swabs from 100 symptomatic children were collected and cultured on 5% sheep blood agar. Isolated beta haemolytic colonies were identified by conventional techniques as Group A Streptococci and was confirmed by Streptex Kit. Then DNA was extracted and molecular weight confirmed with standards, thus determining the prevalence rate of 6%. Surface M Protein was extracted and molecular weight analysed using SDS PAGE showing different M Protein types. Antibiotic susceptibility was done to show the sensitivity to penicillin and to macrolides like Erythromycin.

Conclusion: Study revealed prevalence of Group A Streptococci in only 6% of symptomatic children. Protein analysis suggests the existence of more than one M type responsible for infection. None of the isolates showed Erythromycin resistance.

References

  1. Bramhadathan K N, Gladstone P, “Microbiological Diagnosis of Streptococcal Pharyngitis: Lacunae and their Implications,” Indian Journal of Medical Microbiology, 24 92-96, 2006.
  2. Brono A I, Rubin F A, Cleary P, Dale J B, “ Prospects for Group A Streptococcal Vaccine, Rationale Feasibility and Obstacles- Report of National Institute of Allergy and Infectious Disease Workshop,” Clinical Infectious Disease, 41,1150-1156,2005.
  3. Kaplan E L, “Pathogenesis of Acute Rheumatic Fever and Rheumatic Heart Disease, Evasive after half a Century of Clinical Epidemiological and Laboratory Investigation,” Heart, 91,87-88,2005.
  4. WHO Technical Series,” Rhematic Fever and Rheumatic Heart Disease,” 923-1122,2004.
  5. Padmavati S, “Rheumatic Heart Disease in India at the turn of the Century”, Indian Heart Journal,53,35-37,2001.
  6. Kumar R, Raizada A, Aggarwal A K, Ganguly N K, “A Community based Rheumatic Fever Rheumatic Heart Disease Cohort Twelve year Experience,” Indian Journal of Pediatrics,59,34-38,2004.
  7. Rajkumar S, Krishnamurthy R, “ Isolattion of Group A Beta Hemolytic Streptococci in Tonsillopharyngitis of Sschool Children in Madras City and Correlation with their Clinical Features,” Journal of Infectious Disease, 54,134-139,2001.
  8. Bisno A L, Geber M A, Gwatleny J M ,” Diagnosis and Management of Group A Streptococcal Pharyngitis: A Practice Guideline,” Clinical Infectious Disease, 25,574-583,1997.
  9. Nandi S, Kumar R, Ray P, Vohra H, Ganguly N K, “ Clinical Score Card for Diagnosis of Group A Streptococcal Sore Throat”, Indian Journal of Pediatrics, 69, 471-475, 2002.
  10. Nandi S, Kumar R, Ray P, Vohra H, Ganguly N K, “ Group A Streptococcal Sore Throat in Peri Urban Population of Northern India: A one year Prospective Study”, Bull WHO, 79, 528-533, 2001.
  11. Kumar N, Shekar C, Kumar P, Kundu A S, “Kuppuswamy’s Socioeconomic Status Scale Updating for 2007”, Indian Journal Pediatrics, 74, 1131-1133, 2008.
  12. Baron J E, Gates W J, “ Primary plate Identification of Group A Beta Hemolytic Streptococci Utilising Two Disk Technique”, Journal of Clinical Microbiology, 10, 80-84,july 1979.
  13. Sindhulina G, Geethalakshmi S, Thenmozhivilli P R, Jase J M, Bramhadathan K N ,” Bacteriological and Molecular Studies of Group A Streptococcal Pharyngitis in South Indian Hospital”, Indian journal of Medical Microbiology,26,197-198,2007.
  14. Llyod C A, Jocob E S, Menon T,” Antibiotic Resistant Beta Hemolytic Streptococci”, 74,1077-1080,2007.
  15. Fiscetti V A, Gotschilich E C, Siviglia G, Zabriski J B,” Streptococcal M Protein extracted by Nonionic Detergents”, Journal of Experimental Medicine,144,32-53,1976.
  16. Beachey E H, Campbell L Gand, Ofek I, “Peptic Digestion and Extraction of M Antigen from Group A Stretococci with Pepsin”, Infection and Immunity, 9, 891-896,1974.
  17. Russel D H, Facklam R R, “Guanidine Extraction of Streptococcal M Protein”, Infection and Immunity, 3,679-686,1975.
  18. Hafez K, Aziz M, Kholy K L, Falcklam R R,” Extraction of Group A Stretococcal M protein with Nitrous Acid,” Journal of Clinical Microbiology, 14, 530-533, 1981.
  19. Vosti K L and Williams W K, “Extraction of Streptococcal Type 12 M Protein by Cyanogen Bromide”, Infection and Immunity, 21; 2:546-555,1978.
  20. Singh A K, Kumar A, Agarwal L, Agarwal A, Sengupta C,” Prevalence of Group A Streptococcal Pharyngitis Among School Children of Barbanki District, Uttar pradesh, India”, Indian J Acad Clin Microbiol; 17; 110-114; 2015.

Corresponding Author

Dr Preetha Rajan

Assistant Professor, Dept. of Microbiology

Govt. Medical College, Thiruvananthapuram

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., +91 9020197459