A clinocostatistical observation was made on 191 cases of inpatients & 42 cases of out-patients, who had beem admitted or controlled but to streptococcal infections & its related diseases at the Department of pediatrics, N.M.C. from Jan. 1971 to Dec. 1977. The results were obtained as follows: 1) The streptococcal infections occupied 3.6% of all the inpatients(5,317) during the period. Among 233 cases, 137 cases(58.8%) were male. The annual incidence was between 1.9% and 4.2%. 2) The related disease entities were acute glomerulonephritis (70.8%), rheumatic fever (18.4%), Henoch-Sh?lein purpura (3.9%), acute tonsillitis (1.7%), scarlet fever (1.3%) and others in order. 3) The peak age incidence was between 7 to 9 year and the seasonal incidence showed prevalance in cold months from October to February. 4) The URI was the most common preceding event both in acrte glomerulonephritis (53.9%) & rheumatic fever (39.5%). 5) The mean interrval between the onset of streptococcal infections and its related diseases of acute glomerulonephritis & rheumatic fever were 6 to 10 days & 11 to 15 days, respectively. 6) The main symptoms of over all streptococcal infections were fever, edema, proteinuria, hematuria & throat injection. 7) Lab. Data showed elevated E.S.R. in 59.7%, leucocytosis in 41.6%, increased ASO titer in 96.6% & positive CRP in 79.4% of the cases. Positive culture from throat swab, CSF or pus were obtained in 18.1% of the cases.
Edema ; Fever ; Glomerulonephritis ; Hematuria ; Humans ; Incidence ; Inpatients ; Male ; Outpatients ; Palatine Tonsil ; Pediatrics ; Pharynx ; Proteinuria ; Purpura ; Rheumatic Fever ; Scarlet Fever ; Seasons ; Streptococcal Infections* ; Suppuration ; Tonsillitis

With introduction of penicillin and improvement of socioeconomic status, severe group A streptococcal (GAS) infections and their sequelae declined dramatically since 1970s. However, there have been worldwide reports on the increase in invasive GAS infections and the resurgence of rheumatic fever since mid-1980s. Necrotizing fasciitis and streptococcal toxic shock syndrome produce marked hypotension and fatal outcome with multiorgan failure. Mortality rate is over 30% in spite of intensive antibiotic treatment and surgical debridement of necrotic tissue. Scarlet fever is not uncommon, but toxic or septic scarlet fever is rare. In Korea poststreptococcal glomerulonephritis (PSGN) is increasing in Chinju city since 1994, while M12, a nephritogenic strain, was more common in Chinju (26.3%) and Seoul (48.8%). Because GAS is very common, highly contagious and cause fatal infections, bacteriological and epidemiologic studies on GAS infections should be continued. With resurgence of rheumatic fever in developed countries, the increasing incidence of PSGN in Chinju area may indicate the need of national surveillance program.
Debridement ; Developed Countries ; Epidemiologic Studies ; Fasciitis, Necrotizing ; Fatal Outcome ; Glomerulonephritis ; Gyeongsangnam-do ; Hypotension ; Incidence ; Korea* ; Mortality ; Penicillins ; Rheumatic Fever ; Scarlet Fever ; Seoul ; Shock, Septic ; Social Class ; Streptococcal Infections*

It is well known that both acute glomerulonephritis and rheumatic fever are a common sequelae of group A streptococcal infection. However, their simultaneous occurrence is uncommon. Only a few cases have been reported because they are different in epidemiologic, clinical, serologic and immunopathogenic characteristics. We experienced a 10-year-old boy who presented the manifestation of acute rheumatic fever and acute poststreptococcal glomerulonephritis. We report this case with brief review of literature.
Child ; Glomerulonephritis* ; Humans ; Male ; Rheumatic Fever* ; Streptococcal Infections

BACKGROUND: Streptococcus pyogenes causes most often pharyngitis or tonsillitis but may also be responsible for severe diseases including bacteremia and pneumonia. Recent publications from several geographic areas showed high rates of resistance to erythromycin and newer macrolides, often used in patients allergic to penicillin, in clinical isolates of S. pyogenes. METHODS: Minimum inhibitory concentration of 31 strains of S. pyogenes, isolated at the Seoul National University Children's Hospital from October 1991 through April 1998, were determined for penicillin, ceftriaxone, vancomycin, clindamycin, erythromycin, roxythromycin, and clarithromycin by agar dilution method or E-test. In addition, clinical features of the patients from whom the organisms were isolated were reviewed retrospectively. RESULTS: Of the 28 patients whose medical records were reviewed, the most common clinical presentations were soft-tissue infection (8 cases) and pharyngitis (5 cases). Other presentations included bacteremia without focus, pneumonia, vaginitis, lymphadenitis, omphalitis (two of each); primary peritonitis, rheumatic fever with carditis, scarlet fever, acute otitis media, and disseminated disease (one of each). All of the isolates were susceptible to penicillin, ceftriaxone, and vancomycin. However, 5 isolates (16%) were resistant to erythromycin, and all of the erythromycin-resistant strains were resistant to roxythromycin and clarithromycin as well. Three of these erythromycin-resistant strains were also resistant to clindamycin. CONCLUSION: S. pyogenes may cause serious infections in children. Emergence of resistance in clinical isolates of S. pyogenes to macrolides and clindamycin should be considered in empirical antimicrobial therapy of suspected group A streptococcal infections and in establishment of antibiotic policy in Korea.
Agar ; Bacteremia ; Ceftriaxone ; Child* ; Clarithromycin ; Clindamycin ; Erythromycin ; Humans ; Korea ; Lymphadenitis ; Macrolides ; Medical Records ; Microbial Sensitivity Tests ; Myocarditis ; Otitis Media ; Palatine Tonsil ; Penicillins ; Peritonitis ; Pharyngitis ; Pneumonia ; Retrospective Studies ; Rheumatic Fever ; Scarlet Fever ; Seoul ; Streptococcal Infections ; Streptococcus pyogenes* ; Streptococcus* ; Tonsillitis ; Vaginitis ; Vancomycin

PURPOSE: The annual incidence of acute rheumatic fever in Korea was not changing during 1980 to 1989 from Nationwide survey in 1991 in spite of talking about scanty outbreak among doctors in recent year.The proportion of patients with acute rheumatic fever among the entire pediatirc inpatients each year was approximately 0.3% and did not change significantly throughout the survey period. But rheumatic heart disease is still major heart problem in the adults in our country. Otherwise, the trend of streptococcal infection seems to be occuring virulent strains which developed fetal toxic shock like syndrome resurgence of acute rheumatic fever in North America since mid-1980. We would like to know the number of outbreak and the changing of clinical patterns of this disease between 101 cases of acute rheumatic fever during 1973 to 1985 and 41 cases during 1986 to 1992 METHODS: Subject were 41 cases of children with acute rheumatic fever and/or acute rheumatic carditis diagnosed by rivised Jones criteria who were admitted to the Department of Pediatris, Kyunghee University Hospital from Jan. 1986 to Dec. 1992 RESULTS: 1) The average incidence of rheumatic fever and rheumatic carditis for 20 years period was 0.5 per 1,000 annual pediatric inward patients. The annual changes of rheumatic fever increased between 1981 and 1986 and decreased after then. 2) The seasonal peak incidence was observed in December and the group of peak the incidence was 11-15 years. 3) The preceding infection history was observed in 43.9% 4) The incidence of major manifestation was as follows : carditis(7.0%), polyarthritis(63.4%), chorea(22.0%), erythematous marginatum(12.2%) and subcutaneous nodule(4.9%). 5) Doppler echocardiographic valvualr lesions were mitral insufficiency(65.9%), aortic insufficiency(24.4%) and mitral insuffiency combined with aaortic insuffiency(17.1%). 6) The EKG findings were PR interval prolongation(41.5%), left ventricular hypertrophy(34.1%), and prolonged P wave duration(34.1%). 7) Sites of joint involvement were knee joint(56.1%), ankle joint(26.6%), hip joint(14.6%), and elbow joint(14.6%) 8) Minor and other manifestation were fever(56.1%), arthralgia(56.1%), cough(24.4%), dyspnea(22.0), and generalized weakness(22.0%). 9) Laboratory findings were increaed ASO titer(>200 Todd units, 78.0%), posotive CRP(73.2%), and increased ESR(>30 min/hr, 65.9%). 10) The initial choice of treatment was aspirin(96.7%) and corticosteroid was used in one case because of severe congestive heart failure. CONCLUSIONS: The incidence of acute rheumatic fever in Korea was gradually decreased. On the other hand, the incidence of rheumatic carditis was increasing patterns. Especially, development of diagnositic tools in cardiology such as Doppler echocardiography contributed to make accurate diagnosis of silent carditis, valvular lesions which were passed without mentioning early study period.
Adult ; Ankle ; Cardiology ; Child ; Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Elbow ; Electrocardiography ; Hand ; Heart ; Heart Failure ; Hip ; Humans ; Incidence ; Inpatients ; Joints ; Knee ; Korea ; Myocarditis ; North America ; Rheumatic Fever* ; Rheumatic Heart Disease ; Seasons ; Shock, Septic ; Streptococcal Infections

PURPOSE: The annual incidence of acute rheumatic fever in Korea was not changing during 1980 to 1989 from Nationwide survey in 1991 in spite of talking about scanty outbreak among doctors in recent year.The proportion of patients with acute rheumatic fever among the entire pediatirc inpatients each year was approximately 0.3% and did not change significantly throughout the survey period. But rheumatic heart disease is still major heart problem in the adults in our country. Otherwise, the trend of streptococcal infection seems to be occuring virulent strains which developed fetal toxic shock like syndrome resurgence of acute rheumatic fever in North America since mid-1980. We would like to know the number of outbreak and the changing of clinical patterns of this disease between 101 cases of acute rheumatic fever during 1973 to 1985 and 41 cases during 1986 to 1992 METHODS: Subject were 41 cases of children with acute rheumatic fever and/or acute rheumatic carditis diagnosed by rivised Jones criteria who were admitted to the Department of Pediatris, Kyunghee University Hospital from Jan. 1986 to Dec. 1992 RESULTS: 1) The average incidence of rheumatic fever and rheumatic carditis for 20 years period was 0.5 per 1,000 annual pediatric inward patients. The annual changes of rheumatic fever increased between 1981 and 1986 and decreased after then. 2) The seasonal peak incidence was observed in December and the group of peak the incidence was 11-15 years. 3) The preceding infection history was observed in 43.9% 4) The incidence of major manifestation was as follows : carditis(7.0%), polyarthritis(63.4%), chorea(22.0%), erythematous marginatum(12.2%) and subcutaneous nodule(4.9%). 5) Doppler echocardiographic valvualr lesions were mitral insufficiency(65.9%), aortic insufficiency(24.4%) and mitral insuffiency combined with aaortic insuffiency(17.1%). 6) The EKG findings were PR interval prolongation(41.5%), left ventricular hypertrophy(34.1%), and prolonged P wave duration(34.1%). 7) Sites of joint involvement were knee joint(56.1%), ankle joint(26.6%), hip joint(14.6%), and elbow joint(14.6%) 8) Minor and other manifestation were fever(56.1%), arthralgia(56.1%), cough(24.4%), dyspnea(22.0), and generalized weakness(22.0%). 9) Laboratory findings were increaed ASO titer(>200 Todd units, 78.0%), posotive CRP(73.2%), and increased ESR(>30 min/hr, 65.9%). 10) The initial choice of treatment was aspirin(96.7%) and corticosteroid was used in one case because of severe congestive heart failure. CONCLUSIONS: The incidence of acute rheumatic fever in Korea was gradually decreased. On the other hand, the incidence of rheumatic carditis was increasing patterns. Especially, development of diagnositic tools in cardiology such as Doppler echocardiography contributed to make accurate diagnosis of silent carditis, valvular lesions which were passed without mentioning early study period.
Adult ; Ankle ; Cardiology ; Child ; Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Elbow ; Electrocardiography ; Hand ; Heart ; Heart Failure ; Hip ; Humans ; Incidence ; Inpatients ; Joints ; Knee ; Korea ; Myocarditis ; North America ; Rheumatic Fever* ; Rheumatic Heart Disease ; Seasons ; Shock, Septic ; Streptococcal Infections

At the end of 2022, the World Health Organization reported an increase in group A Streptococcus (GAS) infections, such as scarlet fever, in multiple countries. The outbreak primarily affected children under 10 years old, and the number of deaths was higher than anticipated, causing international concern. This paper reviews the current state of the GAS disease outbreak, its causes, and response measures. The authors aim to draw attention from clinical workers in China and increase their awareness and vigilance regarding this epidemic. Healthcare workers should be aware of the potential epidemiological changes in infectious diseases that may arise after the optimization of control measures for coronavirus disease 2019 to ensure children's health.
Child ; Humans ; Streptococcus pyogenes ; COVID-19/epidemiology* ; Streptococcal Infections/epidemiology* ; Scarlet Fever/epidemiology* ; Epidemics ; Disease Outbreaks

PURPOSE: Measurement of antistreptolysin O (ASO) is often necessary to confirm a clinical diagnosis of recent streptococcal infection, especially in patients suspected of rheumatic fever and acute glomerulonephritis. Standard normal ranges for ASO should be established locally for each age group. We analyzed ASO to determine the upper limit of normal (ULN) ASO in children in the Gyeonggi-Incheon area. METHODS: ASO in normal individual concentrations were measured quantitatively by nephelometry on sera from 753 children (Male:381, Female:372). ULN were determined by separating the upper 20% from the lower 80% of the group (80 percentile). RESULTS: The mean ASO concentration calculated in a total cases was 149.9+/-7.2 IU/mL. The ASO concentration in neonates was 83.4+/-10.7 IU/mL, and lowest in the 1 year of age group, 26.7+/-6.6 IU/ mL, and increased to 318.0+/-33.2 IU/mL gradually in the 9 years of age group. Thereafter, ASO concentration decreased. The ULN for neonates was 122 IU/mL, for 0-3 years, 40 IU/mL; for 4-6 years, 113 IU/ mL; for 7-9 years, 489 IU/mL; for 10-19 years, 433 IU/mL; for 20-29 years, 122 IU/mL. CONCLUSION: The age-specific ULN for children in the Gyeonggi-Incheon area were determined. The distribution of ASO concentration according to age groups was different from previous reports. These results should be of clinical value to physicians to interprete the ASO results of their patients.
Antistreptolysin* ; Child* ; Diagnosis ; Glomerulonephritis ; Humans ; Infant, Newborn ; Nephelometry and Turbidimetry ; Pediatrics ; Reference Values ; Rheumatic Fever ; Streptococcal Infections

Humans ; Pharyngitis ; complications ; microbiology ; Rheumatic Fever ; etiology ; Streptococcal Infections ; complications ; Streptococcus pyogenes

BACKGROUND: Antistreptolysin O (ASO) is very useful as an indicator of recent streptococcal infection and its sequelae, such as rheumatic fever and acute glomerulonephritis. Because the upper limit of normal (ULN) value of ASO varies according to age, the ULN value of ASO in an area should be evaluated to accurately interpret single ASO levels of patients. METHODS: The ULN value and distribution of ASO concentrations were investigated in three age groups of preschool children (N=162), elementary school children (N=436), and adults (N=231) in Chinju. ASO concentra-tions were measured quantitatively by autoanalyzer or nephelometer from sera of healthy population in Chinju who had no symptoms or signs of streptococcal infec-tions. RESULTS: The mean(+/-SD) ASO concentrations were 71(+/-107) IU/mL, 285(+/-246) IU/mL, and 80(+/-64) IU/mL and the UNL value of ASO concentrations were 131 IU/mL, 433 IU/mL, and 136 IU/mL in each group of preschool children, elementary school children, and adults, respectively. CONCLUSION: The distribution and ULN value of ASO concentrations varied according to age group. The ULN value of ASO concentrations should be set differ-ently according to the patient' s age. Group A strepto-coccal infections might be quite common in elementary school children, while very rare in preschool children or adults.
Adult ; Antistreptolysin* ; Child ; Child, Preschool ; Glomerulonephritis ; Gyeongsangnam-do ; Humans ; Rheumatic Fever ; Streptococcal Infections