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We report three cases of septic scarlet fever due to Streptococcus pyogenes Group A (serotype M1/T1/OF-) cellulitis in healthy young adults. Despite prompt treatment two of the patients died. Such cases of cellulitis associated with scarlet fever, severe toxaemia and septicaemia have not been reported in the post-antibiotic era.
The nitroblue tetrazolium (NBT) test was originally used to diagnose chronic granulomatous disease in childhood. Now it is applied in the diagnosis of acute bacterial infectious diseases, too. The NBT reduction of neutrophils was tested in 27 children with scarlet fever using the modified technique described by K i m et al. The tests were performed in 24 patients between the second and fourth day of illness, before starting antibiotic treatment. In accordance with the results obtained by Humbert et al. in a series of patients with various infectious diseases, 83% of the investigated children showed NBT values of between 41% and 95% (mean value 72%). The percentage of NBT-positive cells was likewise raised in cases of recurrent scarlet fever. Children with scarlet fever complications had highly elevated NBT-reduction values. The control group, consisting of children without infectious diseases, showed values of between 28% and 66% (mean value 33%).
Erythrogenic toxin type A (ETA) is assumed to play a causative role in both scarlet fever and the streptococcal toxic shock-like syndrome (TSLS). For a molecular epidemiological analysis of the gene of erythrogenic toxin type A (speA) we used altogether 497 clinical isolates of Streptococcus pyogenes belonging to three groups: a) isolates from patients with scarlet fever, b) isolates from cases with TSLS, c) isolates from patients with other streptococcal infections (like otitis media, tonsillitis, impetigo) (general group). We found that less than 50% of the scarlet fever-associated strains possessed the speA gene as compared to 25% of the general group. Only 5 to 30% of these strains secreted the toxin under experimental conditions in very low quantities. Among strains isolated from TSLS, 67% appeared to contain the speA gene. The amount of ETA secreted into the medium was also extremely low. Southern hybridization patterns proved to be the same with an speA-specific probe in all three groups of streptococcal isolates (HaeIII, HindIII). Increased occurrence of the speA gene among scarlet fever and TSLS-associated strains does not seem to be sufficient to support the hypothesis that ETA may have a causative role in both diseases since a considerable number of strains in these groups did not possess the speA gene.
Following the last epidemic in 1995 the scarlet fever incidence in Poland has been gradually decreasing. The downward trend continued in 2003, with overall incidence rate of 10.1 per 100,000. The incidence registered during 2001-2003 dropped below the lowest level noted ever sine the introduction of mandatory reporting in 1918. Regionally the incidence ranged from 3.4 per 100,000 in lódzkie voivodeship to 21.8 in opolskie voivodeship. As observed previously incidence in the urban areas (11.8) was significantly higher then in the rural areas (7.5) and the incidence in men (11.1) exceeded the incidence in women (9.2). The majority of cases occurred in children and adolescents younger then 15 years (mode--6 years; incidence 132.3). Approximately 3% of cases were hospitalized. There were no deaths due to scarlet fever reported in 2003.
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The monthly incidence of scarlet fever was studied by time-series analysis. Two types of periodic fluctuations were detected involving a bimodal short seasonal cycle and a long-term cycle whose period takes 5 years approximately. The interactions of the respiratory transmission mechanism, person to person contacts and environmental temperature would explain the seasonal cycle bimodality. The long-term cycle would be explained by asynchronic fluctuations of the fraction of population assigned to "cases" and "susceptibles".
An analysis of 135 cases of scarlet fever in Harbin Municipal infection hospital in 1987 was carried out. The patients of 0-15 years old were 75.65%, the males were higher than the females. All the patients had atypical clinical manifestation. 45.18% of them were no fever. 30.37% no angina and 40% no strawberry-like tongue. The 60 strains of beta-hemolytic Streptococcus were isolated from 129 cases (positive rate 46.51%). 49 strains of them were identified as Biotype identification was carried out in 28 strains of them. They are all Group A. 14, 6 and 6 strains as biotype 1, 4 and 8/25 respectively. The results of antibiotics resistant test showed that strains which were susceptible to ampicillin and cephalosporin were 81.58% and the strains of resistant penicillin were 21.05%. Some causes of atypical clinical manifestations were discussed.
UNLABELLED: EPIDEMIC: Following the notification of an unusual number of scarlet fever cases within the same primary school, the epidemiological and clinical features of the outbreak were investigated. Questionnaire information about the cases was collected from parents and general practitioners per telephone. Throat specimens were taken, before and after treatment, for culturing and specific typing of streptococci was performed to determine transmission. Within a period of one month, 21 schoolchildren in a class of 29 pupils, with a mean age of 5 years, presented with symptoms caused by streptococcal infection (attack rate: 72%). Eight had scarlet fever, 5 suffered from impetigo and 8 had pharyngitis. A further 6 children, outside of this class, had complaints of scarlet fever, impetigo or pharyngitis. For 90% (26/29) of the schoolchildren a throat culture was established. Twelve positive cultures of the same strain of beta-haemolytic group A streptococcus, T4M4 exotoxin C gene positive, were found. The advice given was to treat all positive children for 3 days with azithromycin to prevent complications and further spreading of the disease. After two weeks only one child, that had not taken the antibiotics, still had a positive throat culture. No further cases or complications were reported. DISCUSSION: The pattern of the outbreak was typical of a person-to-person transmission. This was confirmed by typing of the isolates. The results of this study demonstrate the importance of mandatory notification of infectious clusters by institutions, such as schools, as introduced in the new Dutch Infectious Disease Act. On the one hand, the notification gives the municipal health authority the opportunity to analyse source and transmission dynamics and on the other to prevent disease and complications.
Changes in the lymphocyte subsets of 13 patients with varicella, 5 with hand-foot-and-mouth disease, 4 with scarlet fever, 10 with measles and 20 with Kawasaki disease were examined by immunofluorescent flow cytometric analysis using monoclonal antibodies against lymphocyte cell surface antigens. The results were compared with those of age-matched normal controls. A significant increase in the percentage of Leu-2a positive (Leu-2a+) cells was shown during the early convalescence of varicella, scarlet fever and measles. A significant decrease in the percentage of Leu-3a+ cells during the acute phase was common to all the diseases examined, and a significant decrease of Leu-4+ cells was observed except in measles. As a result, a significant decrease in the Leu-3a+/Leu-2a+ ratio was common to all the diseases examined during the acute and/or early convalescent phases. Leu-M3+ cells increased significantly in varicella, scarlet fever, and Kawasaki disease. HLA-DR+ cells increased significantly in varicella and Kawasaki disease. No significant changes in the proportions of Leu-7+, Leu-10+, and 2H7+ cells were found throughout the course of all the diseases examined.
Venous blood samples were obtained from 42 children hospitalized for the recurrent episode of scarlet fever: immediately after admission and toward the end of one week's hospitalisation, after a three-week period and at a later control after four months. The 14 specific proteins were simultaneously quantitated in the serum specimens using radial immunodiffusion on antibodyagar plates. Antistreptolysin O titres were also determined and compared with the corresponding immunoglobulin levels. However, the titres showed only minor differences in various stages of illness the course of which was mild and without complications. Serum levels of prealbumin, albumin, alpha2HS-glycoproetin, transferrin and beta 2-glycoprotein I were found decreased at the acute clinical stage. Of the "negative acute phase reactants" prealbumin proved to be the most expressive one. Of a triad of "positive reactants" the largest relative increments showed haptoglobin, its increase was twofold of orosomucoid and that threefold of ceruloplasmin. C-reactive protein was increased almost in two thirds of patients on admission, but normalized in all cases about the end of the first week of penicillin therapy. No significant changes were found for alpha 2-macroglobulin. We could demonstrate significant rise and fall of IgD concentration in serum together with IgG, IgA, and IgM, all manifested the peak values already after one week's hospitalisation. In the recurrent episode of scarlet fever IgA showed significantly minor increments compared with the first illness.
Following last compensatory epidemic of scarlet fever in 1995 number of cases decreases more slowly then after earlier epidemics. In 1998 incidence for the whole country was 41.9 per 100,000 with a range of 9.2 to 72.5 for individual voivodeships. Relations between incidence and age, gender and habitation (rural vs. urban areas) did not change. In 1998 the highest incidence was noted among children 6 years old (462.4) and 7 years old (440.5). Incidence among men was slightly higher (44.5) then women (39.4). Incidence in urban areas (52.8) more than twofold surpassed incidence in rural areas (24.2). 1% of cases were hospitalized. There were not any fatalities noted.
OBJECTIVE: To demonstrate further the existence of Zeng-Ding phenomenon in disease epidemic and to explore the relationship between it and the time series in different kinds of diseases. METHODS: Incidence data of notifiable communicable diseases during 1975 to 1996 were collected. Time series of measles and scarlet fever incidence during 1975 to 1995, 1980 to 1995, 1985 to 1995 and 1990 to 1995 were established. Correlation analysis was conducted between monthly cumulative percentage and predictive ratio of increase to decrease in incidence rate at the best cut-off point. Prediction was studied based on the constructed extrapolation model. RESULTS: Correlation analysis showed that 98.3% (232/236) of the coefficients of correlation were negative (R < 0), indicating further the existence of Zeng-Ding phenomenon in disease epidemic. There was significant difference in coefficients of correlation between the four time series, which accounted for 63.8%, 54.2%, 44.1% and 35.0%, respectively; and for 73.3%, 56.7%, 36.7% and 36.7%, respectively, in measles, and for 53.6%, 51.8%, 51.7% and 33.3%, respectively, in scarlet fever. It showed that Zeng-Ding phenomenon correlated with the time series and the kinds of diseases. Prediction from extrapolation model showed that there was significant difference in predictive agreement between two time series of 1975 to 1995 (65.5%) and 1985 to 1995 (37.0%) with chi 2 of 4.54 and P < 0.05, indicating a trend that predictive agreement increased with prolonging of time series, and a trend that predictive agreement for scarlet fever increased with decreasing of coefficients of correlation. CONCLUSION: Predictive value of the incidence data can be evaluated by their source and length of time series.