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Community outbreak of perianal group A streptococcal infection in Denmark
Jesper P Petersen1, Margit S Kaltoft, Jens C Misfeldt
1Department of Pediatrics, Aarhus University Hospital, Denmark. jesperpadkaer@yahoo.com
Insights
A Danish kindergarten outbreak revealed a specific strain of group A streptococcal infection (PASI) in children. Clarithromycin proved effective for treatment, suggesting PASI may be more common than previously thought.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Perianal group A streptococcal infection (PASI) is primarily observed in children.
- Limited data exists on PASI incidence, transmission, and treatment.
- This study investigates a PASI cluster linked to a Danish kindergarten.
Purpose of the Study:
- To investigate a cluster of perianal group A streptococcal infections (PASI) in a Danish community.
- To determine the incidence and causative agents of PASI.
- To evaluate treatment efficacy for PASI.
Main Methods:
- Collected and analyzed group A beta-hemolytic streptococci isolates from rectal and throat swabs.
- Utilized T typing and pulsed field gel electrophoresis (PFGE) for strain characterization.
- Reviewed clinical data from general practitioners in a rural Danish community.
Main Results:
- Identified a cluster of 12 PASI cases caused by a specific T type 28 strain with identical PFGE profile.
- Six cases were linked to a single kindergarten.
- Estimated an annual PASI incidence of 2-7 per 1000 children, with clarithromycin showing effectiveness after penicillin failure.
Conclusions:
- A specific clone of T type 28 group A streptococci was identified as the cause of a significant PASI cluster.
- Clarithromycin demonstrated efficacy as a second-line treatment for PASI.
- The estimated incidence suggests PASI may be more prevalent than previously recognized.
Background:
Perianal group A streptococcal infection (PASI) occurs primarily in children. There is limited information on the incidence, transmission and treatment of PASI. We report a cluster of cases connected to a Danish kindergarten and observations of the incidence of PASI in the local population.
Setting:
A Danish rural community with 1765 children 15 years and younger registered with two general practice clinics.
Methods:
After being alerted of a possible cluster of PASI cases, all isolates of group A beta-hemolytic streptococci were collected and subjected to T typing and pulsed field gel electrophoresis (PFGE) if grown from either a rectal swab or an accompanying throat swab obtained in the offices of local general practitioners during the ensuing 4-month period. Clinical data were obtained from the files of the local general practitioners.
Results:
Twelve cases of PASI were caused by group A beta-hemolytic streptococci T type 28 with an identical PFGE profile: 6 of the cases were in children attending the same kindergarten, 4 were connected otherwise to the cluster and 2 cases seemed to be unrelated. Five cases of PASI with different T types and PFGE profiles were diagnosed during the same period giving an estimated annual incidence of 2 to 7 per 1000 children. Penicillin V was ineffective in 3 cases, and no recurrence was seen after change of the treatment to oral clarithromycin.
Conclusions:
A clone of T type 28 seemed to be the cause of the largest cluster of PASI cases described thus far. Clarithromycin was effective as second line treatment. An estimated annual baseline incidence of 2 to 7 per 1000 in the local population indicates that PASI may not be as rare as previously estimated.