Low Rates of Streptococcal Pharyngitis and High Rates of Pyoderma in Australian Aboriginal Communities Where Acute Rheumatic Fever Is Hyperendemic

Malcolm McDonald, R Towers, Ross Andrews, N Benger, Bart Currie, Jonathan Carapetis

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background. Acute rheumatic fever is a major cause of heart disease in Aboriginal Australians. The epidemiology differs from that observed in regions with temperate climates; streptococcal pharyngitis is reportedly rare, and pyoderma is highly prevalent. A link between pyoderma and acute rheumatic fever has been proposed but is yet to be proven. Group C ?-hemolytic streptococci and group G ?-hemolytic streptococci have also been also implicated in the pathogenesis. Methods. Monthly, prospective surveillance of selected households was conducted in 3 remote Aboriginal communities. People were questioned about sore throat and pyoderma; swab specimens were obtained from all throats and any pyoderma lesions. Household population density was determined. Results. From data collected during 531 household visits, the childhood incidence of sore throat was calculated to be 8 cases per 100 person-years, with no cases of symptomatic group A ?-hemolytic streptococci pharyngitis. The median point prevalence for throat carriage was 3.7% for group A ?-hemolytic streptococci, 0.7% for group C ?-hemolytic streptococci, and 5.1% for group G ?-hemolytic streptococci. Group A ?-hemolytic streptococci were recovered from the throats of 19.5% of children at some time during the study. There was no seasonal trend or correlation with overcrowding. Almost 40% of children had pyoderma at least once, and the prevalence was greatest during the dry season. In community 1, the prevalence of pyoderma correlated with household crowding. Group C and G ?-hemolytic streptococci were rarely recovered from pyoderma lesions. Conclusions. These data are consistent with the hypothesis that recurrent skin infections immunize against throat colonization and infection. High rates of acute rheumatic fever were not driven by symptomatic group A ?-hemolytic streptococci throat infection. Group G and C ?-hemolytic streptococci were found in the throat but rarely in pyoderma lesions. � 2006 by the Infectious Diseases Society of America. All rights reserved.
    Original languageEnglish
    Pages (from-to)683-689
    Number of pages7
    JournalClinical Infectious Diseases
    Volume43
    Issue number6
    Publication statusPublished - 2006

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    Pyoderma
    Rheumatic Fever
    Pharyngitis
    Streptococcus
    Pharynx
    Infection
    Crowding
    Population Density
    Climate
    Heart Diseases
    Epidemiology

    Cite this

    @article{7343d97893d04e94b9e9f7ec57f256e7,
    title = "Low Rates of Streptococcal Pharyngitis and High Rates of Pyoderma in Australian Aboriginal Communities Where Acute Rheumatic Fever Is Hyperendemic",
    abstract = "Background. Acute rheumatic fever is a major cause of heart disease in Aboriginal Australians. The epidemiology differs from that observed in regions with temperate climates; streptococcal pharyngitis is reportedly rare, and pyoderma is highly prevalent. A link between pyoderma and acute rheumatic fever has been proposed but is yet to be proven. Group C ?-hemolytic streptococci and group G ?-hemolytic streptococci have also been also implicated in the pathogenesis. Methods. Monthly, prospective surveillance of selected households was conducted in 3 remote Aboriginal communities. People were questioned about sore throat and pyoderma; swab specimens were obtained from all throats and any pyoderma lesions. Household population density was determined. Results. From data collected during 531 household visits, the childhood incidence of sore throat was calculated to be 8 cases per 100 person-years, with no cases of symptomatic group A ?-hemolytic streptococci pharyngitis. The median point prevalence for throat carriage was 3.7{\%} for group A ?-hemolytic streptococci, 0.7{\%} for group C ?-hemolytic streptococci, and 5.1{\%} for group G ?-hemolytic streptococci. Group A ?-hemolytic streptococci were recovered from the throats of 19.5{\%} of children at some time during the study. There was no seasonal trend or correlation with overcrowding. Almost 40{\%} of children had pyoderma at least once, and the prevalence was greatest during the dry season. In community 1, the prevalence of pyoderma correlated with household crowding. Group C and G ?-hemolytic streptococci were rarely recovered from pyoderma lesions. Conclusions. These data are consistent with the hypothesis that recurrent skin infections immunize against throat colonization and infection. High rates of acute rheumatic fever were not driven by symptomatic group A ?-hemolytic streptococci throat infection. Group G and C ?-hemolytic streptococci were found in the throat but rarely in pyoderma lesions. � 2006 by the Infectious Diseases Society of America. All rights reserved.",
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    author = "Malcolm McDonald and R Towers and Ross Andrews and N Benger and Bart Currie and Jonathan Carapetis",
    year = "2006",
    language = "English",
    volume = "43",
    pages = "683--689",
    journal = "Clinical Infectious Diseases",
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    }

    Low Rates of Streptococcal Pharyngitis and High Rates of Pyoderma in Australian Aboriginal Communities Where Acute Rheumatic Fever Is Hyperendemic. / McDonald, Malcolm; Towers, R; Andrews, Ross; Benger, N; Currie, Bart; Carapetis, Jonathan.

    In: Clinical Infectious Diseases, Vol. 43, No. 6, 2006, p. 683-689.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Low Rates of Streptococcal Pharyngitis and High Rates of Pyoderma in Australian Aboriginal Communities Where Acute Rheumatic Fever Is Hyperendemic

    AU - McDonald, Malcolm

    AU - Towers, R

    AU - Andrews, Ross

    AU - Benger, N

    AU - Currie, Bart

    AU - Carapetis, Jonathan

    PY - 2006

    Y1 - 2006

    N2 - Background. Acute rheumatic fever is a major cause of heart disease in Aboriginal Australians. The epidemiology differs from that observed in regions with temperate climates; streptococcal pharyngitis is reportedly rare, and pyoderma is highly prevalent. A link between pyoderma and acute rheumatic fever has been proposed but is yet to be proven. Group C ?-hemolytic streptococci and group G ?-hemolytic streptococci have also been also implicated in the pathogenesis. Methods. Monthly, prospective surveillance of selected households was conducted in 3 remote Aboriginal communities. People were questioned about sore throat and pyoderma; swab specimens were obtained from all throats and any pyoderma lesions. Household population density was determined. Results. From data collected during 531 household visits, the childhood incidence of sore throat was calculated to be 8 cases per 100 person-years, with no cases of symptomatic group A ?-hemolytic streptococci pharyngitis. The median point prevalence for throat carriage was 3.7% for group A ?-hemolytic streptococci, 0.7% for group C ?-hemolytic streptococci, and 5.1% for group G ?-hemolytic streptococci. Group A ?-hemolytic streptococci were recovered from the throats of 19.5% of children at some time during the study. There was no seasonal trend or correlation with overcrowding. Almost 40% of children had pyoderma at least once, and the prevalence was greatest during the dry season. In community 1, the prevalence of pyoderma correlated with household crowding. Group C and G ?-hemolytic streptococci were rarely recovered from pyoderma lesions. Conclusions. These data are consistent with the hypothesis that recurrent skin infections immunize against throat colonization and infection. High rates of acute rheumatic fever were not driven by symptomatic group A ?-hemolytic streptococci throat infection. Group G and C ?-hemolytic streptococci were found in the throat but rarely in pyoderma lesions. � 2006 by the Infectious Diseases Society of America. All rights reserved.

    AB - Background. Acute rheumatic fever is a major cause of heart disease in Aboriginal Australians. The epidemiology differs from that observed in regions with temperate climates; streptococcal pharyngitis is reportedly rare, and pyoderma is highly prevalent. A link between pyoderma and acute rheumatic fever has been proposed but is yet to be proven. Group C ?-hemolytic streptococci and group G ?-hemolytic streptococci have also been also implicated in the pathogenesis. Methods. Monthly, prospective surveillance of selected households was conducted in 3 remote Aboriginal communities. People were questioned about sore throat and pyoderma; swab specimens were obtained from all throats and any pyoderma lesions. Household population density was determined. Results. From data collected during 531 household visits, the childhood incidence of sore throat was calculated to be 8 cases per 100 person-years, with no cases of symptomatic group A ?-hemolytic streptococci pharyngitis. The median point prevalence for throat carriage was 3.7% for group A ?-hemolytic streptococci, 0.7% for group C ?-hemolytic streptococci, and 5.1% for group G ?-hemolytic streptococci. Group A ?-hemolytic streptococci were recovered from the throats of 19.5% of children at some time during the study. There was no seasonal trend or correlation with overcrowding. Almost 40% of children had pyoderma at least once, and the prevalence was greatest during the dry season. In community 1, the prevalence of pyoderma correlated with household crowding. Group C and G ?-hemolytic streptococci were rarely recovered from pyoderma lesions. Conclusions. These data are consistent with the hypothesis that recurrent skin infections immunize against throat colonization and infection. High rates of acute rheumatic fever were not driven by symptomatic group A ?-hemolytic streptococci throat infection. Group G and C ?-hemolytic streptococci were found in the throat but rarely in pyoderma lesions. � 2006 by the Infectious Diseases Society of America. All rights reserved.

    KW - Aborigine

    KW - adolescent

    KW - adult

    KW - article

    KW - Australia

    KW - bacterial infection

    KW - bacterium isolate

    KW - child

    KW - endemic disease

    KW - household

    KW - human

    KW - incidence

    KW - infant

    KW - infection rate

    KW - major clinical study

    KW - nonhuman

    KW - pathogenesis

    KW - pharyngitis

    KW - population density

    KW - priority journal

    KW - pyoderma

    KW - rheumatic fever

    KW - sore throat

    KW - Streptococcus group C

    KW - Streptococcus group G

    KW - Streptococcus infection

    KW - Adolescent

    KW - Adult

    KW - Carrier State

    KW - Child

    KW - Child, Preschool

    KW - Crowding

    KW - Endemic Diseases

    KW - Humans

    KW - Infant

    KW - Infant, Newborn

    KW - Oceanic Ancestry Group

    KW - Pharyngitis

    KW - Pharynx

    KW - Prospective Studies

    KW - Pyoderma

    KW - Rheumatic Fever

    KW - Risk Factors

    KW - Seasons

    KW - Streptococcal Infections

    KW - Streptococcus

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