Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence study
Abstract Background Group A Streptococcal (GAS) infections cause the autoimmune disease acute rheumatic fever (ARF), which can progress to chronic rheumatic heart disease (RHD). Treating pharyngitis caused by GAS with antibiotics is important in preventing ARF. However, it is difficult to distinguis...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-019-4126-9 |
| _version_ | 1819194684147236864 |
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| author | Julie Bennett Nicole J. Moreland Jane Oliver Julian Crane Deborah A. Williamson Dianne Sika-Paotonu Matire Harwood Arlo Upton Susan Smith Jonathan Carapetis Michael G. Baker |
| author_facet | Julie Bennett Nicole J. Moreland Jane Oliver Julian Crane Deborah A. Williamson Dianne Sika-Paotonu Matire Harwood Arlo Upton Susan Smith Jonathan Carapetis Michael G. Baker |
| author_sort | Julie Bennett |
| collection | DOAJ |
| description | Abstract Background Group A Streptococcal (GAS) infections cause the autoimmune disease acute rheumatic fever (ARF), which can progress to chronic rheumatic heart disease (RHD). Treating pharyngitis caused by GAS with antibiotics is important in preventing ARF. However, it is difficult to distinguish these infections from GAS carriers. There is growing evidence for GAS skin infections as a cause of ARF. This study will identify the incidence of true GAS pharyngitis and serological responses to GAS skin infections. The effectiveness of antibiotics for these conditions will be explored, and modifiable risk factors. Serum antibody titres indicating the upper limits of normal (ULN for ASO/ADB antibodies) will be established alongside carriage rates in asymptomatic children. Methods This is a prospective disease incidence study, with an associated case-control study. The study population includes 1000 children (5–14 years) from Auckland, New Zealand, 800 of whom have visited their healthcare professional, resulting in a throat or skin swab for GAS, and 200 who are asymptomatic. The conditions of interest are GAS throat swab positive pharyngitis (n = 200); GAS carriage (n = 200); GAS negative throat swab (n = 200); GAS skin infections (n = 200); and asymptomatic controls (n = 200). All participants, except asymptomatic controls, will have acute and convalescent serological testing for ASO/ADB titres (collected < 9 days, and 2–4 weeks following symptom onset, respectively), alongside viral PCR from throat swabs. Asymptomatic controls will have ASO/ADB titres measured in one blood specimen and a throat swab for microbial culture. Caregivers of children will be interviewed using a questionnaire and any GAS isolates identified will be emm typed. The persistence of GAS antibodies will also be investigated. Discussion Findings from this study will fill critical gaps in scientific knowledge to better understand the pathophysiology of ARF, improve clinical management of GAS infections, and design more effective ARF prevention programmes. In particular it will measure the incidence of true, serologically confirmed GAS pharyngitis; assess the immune response to GAS skin infections and its role as a cause of ARF; examine the effectiveness of oral antibiotics for treating GAS pharyngitis and carriage; and identify whether risk factors for GAS infections might provide intervention points for reducing ARF. |
| first_indexed | 2024-12-23T02:00:46Z |
| format | Article |
| id | doaj.art-3acc9848bf17497794f9d20e1a8f6c21 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-23T02:00:46Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-3acc9848bf17497794f9d20e1a8f6c212022-12-21T18:03:59ZengBMCBMC Infectious Diseases1471-23342019-07-0119111010.1186/s12879-019-4126-9Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence studyJulie Bennett0Nicole J. Moreland1Jane Oliver2Julian Crane3Deborah A. Williamson4Dianne Sika-Paotonu5Matire Harwood6Arlo Upton7Susan Smith8Jonathan Carapetis9Michael G. Baker10Department of Public Health, University of OtagoSchool of Medical Sciences, University of AucklandDoherty Institute, University of MelbourneDepartment of Medicine, University of OtagoDoherty Institute, University of MelbourneDeans Department and Department of Pathology and Molecular Medicine, University of OtagoFaculty of Medical and Health Sciences, University of AucklandSouthern Community LaboratoryLabtestsTelethon Kids Institute, University ofWestern AustraliaDepartment of Public Health, University of OtagoAbstract Background Group A Streptococcal (GAS) infections cause the autoimmune disease acute rheumatic fever (ARF), which can progress to chronic rheumatic heart disease (RHD). Treating pharyngitis caused by GAS with antibiotics is important in preventing ARF. However, it is difficult to distinguish these infections from GAS carriers. There is growing evidence for GAS skin infections as a cause of ARF. This study will identify the incidence of true GAS pharyngitis and serological responses to GAS skin infections. The effectiveness of antibiotics for these conditions will be explored, and modifiable risk factors. Serum antibody titres indicating the upper limits of normal (ULN for ASO/ADB antibodies) will be established alongside carriage rates in asymptomatic children. Methods This is a prospective disease incidence study, with an associated case-control study. The study population includes 1000 children (5–14 years) from Auckland, New Zealand, 800 of whom have visited their healthcare professional, resulting in a throat or skin swab for GAS, and 200 who are asymptomatic. The conditions of interest are GAS throat swab positive pharyngitis (n = 200); GAS carriage (n = 200); GAS negative throat swab (n = 200); GAS skin infections (n = 200); and asymptomatic controls (n = 200). All participants, except asymptomatic controls, will have acute and convalescent serological testing for ASO/ADB titres (collected < 9 days, and 2–4 weeks following symptom onset, respectively), alongside viral PCR from throat swabs. Asymptomatic controls will have ASO/ADB titres measured in one blood specimen and a throat swab for microbial culture. Caregivers of children will be interviewed using a questionnaire and any GAS isolates identified will be emm typed. The persistence of GAS antibodies will also be investigated. Discussion Findings from this study will fill critical gaps in scientific knowledge to better understand the pathophysiology of ARF, improve clinical management of GAS infections, and design more effective ARF prevention programmes. In particular it will measure the incidence of true, serologically confirmed GAS pharyngitis; assess the immune response to GAS skin infections and its role as a cause of ARF; examine the effectiveness of oral antibiotics for treating GAS pharyngitis and carriage; and identify whether risk factors for GAS infections might provide intervention points for reducing ARF.http://link.springer.com/article/10.1186/s12879-019-4126-9Group a streptococcusAcute rheumatic feverRheumatic heart diseaseSore throatSkin infectionS. pyogenes |
| spellingShingle | Julie Bennett Nicole J. Moreland Jane Oliver Julian Crane Deborah A. Williamson Dianne Sika-Paotonu Matire Harwood Arlo Upton Susan Smith Jonathan Carapetis Michael G. Baker Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence study BMC Infectious Diseases Group a streptococcus Acute rheumatic fever Rheumatic heart disease Sore throat Skin infection S. pyogenes |
| title | Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence study |
| title_full | Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence study |
| title_fullStr | Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence study |
| title_full_unstemmed | Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence study |
| title_short | Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence study |
| title_sort | understanding group a streptococcal pharyngitis and skin infections as causes of rheumatic fever protocol for a prospective disease incidence study |
| topic | Group a streptococcus Acute rheumatic fever Rheumatic heart disease Sore throat Skin infection S. pyogenes |
| url | http://link.springer.com/article/10.1186/s12879-019-4126-9 |
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