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An epidemic of acute post-streptococcal glomerulonephritis among aboriginal children
C L Streeton1, J N Hanna, R D Messer
1National Centre for Epidemiology and Population Health, Australian National University, Canberra.
Insights
An epidemic of acute post-streptococcal glomerulonephritis (APSGN) in Aboriginal children was linked to group A streptococci (GAS) skin infections. Mass penicillin treatment appeared to reduce GAS transmission and APSGN cases.
Area of Science:
- Infectious Disease Epidemiology
- Pediatric Nephrology
- Public Health
Background:
- Acute post-streptococcal glomerulonephritis (APSGN) is a significant kidney disease in children.
- Skin infections caused by group A streptococci (GAS) are a known trigger for APSGN.
- Remote Aboriginal communities face unique challenges in healthcare access and disease management.
Purpose of the Study:
- To investigate an outbreak of APSGN in Far North Queensland Aboriginal communities.
- To identify the prevalence of APSGN and associated risk factors.
- To evaluate the impact of a public health intervention.
Main Methods:
- Screening of children aged 2-14 years for APSGN in three remote communities.
- Collection of urine samples and skin swabs for analysis.
- Mass administration of parenteral penicillin to screened children.
Main Results:
- APSGN was diagnosed in 10% of 583 screened children; 24% had microscopic haematuria.
- Group A streptococci (GAS) were isolated from 71% of skin swabs, with higher prevalence in APSGN cases.
- A significant decrease in APSGN cases was observed following mass penicillin administration.
Conclusions:
- The APSGN epidemic was strongly associated with GAS skin infections.
- Mass penicillin treatment may have curtailed the transmission of nephritogenic GAS strains.
- Microscopic haematuria was common, warranting further investigation into its long-term significance.
Objective:
To describe an epidemic of acute post-streptococcal glomerulonephritis (APSGN) that occurred in Aboriginal children in three remote Aboriginal communities in Far North Queensland between July and October, 1993.
Methodology:
Children at the communities aged between 2 and 14 years were screened so as to identify all cases of APSGN. Parenteral penicillin was administered to all 583 children who presented for the screening procedure.
Results:
APSGN was diagnosed in 58 (10%) of the 583 children. A further 142 (24%) children had microscopic haematuria. Children aged 5-8 years had the highest APSGN attack rate, and the highest prevalence of microscopic haematuria. Of all 583 children, 34% had skin sores, and group A streptococci (GAS) were isolated from 71% of the skin swabs. The prevalence of both skin sores and GAS were greater in the children with APSGN, and in those with microscopic haematuria, than in children with normal urine. A marked decline in the number of cases of APSGN occurred after the mass administration of penicillin.
Conclusions:
The epidemic of APSGN was associated with GAS skin infections. The mass use of penicillin may have had an effect in reducing the transmission of the nephritogenic strain of GAS. Microscopic haematuria was a significant finding in many of the children, and further prospective studies are required to understand the significance of this finding.
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