Document Detail


Streptococcal infection and renal disease markers in Australian aboriginal children.
MedLine Citation:
PMID:  1565046     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To demonstrate an association between markers of streptococcal infection and markers of glomerulonephritis in Aboriginal children. DESIGN: A cross-sectional study of Aboriginal children of school age. SETTING: Three Aboriginal communities in the Northern Territory--two, coastal and one, desert. PARTICIPANTS: Sixty children, randomly selected from the school roll, were studied in each community; thus there were 180 children in total, aged 5-17 years. Midstream urine and venous blood was collected and swabs were taken from the pharynx and from impetiginous skin lesions or axillary skin in the absence of impetigo. Clinical records were examined for evidence of past glomerulonephritis. MAIN OUTCOME MEASURES: Swabs were cultured for beta-haemolytic streptococci and isolates were grouped; serum was tested for titres of antistreptolysin O (ASO) and antideoxyribonuclease B (anti-DNaseB). Protein and creatinine levels were measured in urine, and a ratio of protein to creatinine (UPC) of more than 50 mg protein per mmol creatinine was taken as a measure of significant proteinuria. Urine was examined microscopically for glomerular haematuria (greater than 10 red blood cells per microL with at least 20% dysmorphic red cells). RESULTS: Group A beta-haemolytic streptococci were isolated from the throat swabs of two children and from skin swabs of 25 (13.9%) children; 20 of these were from impetiginous lesions and five from normal axillary skin. beta-Haemolytic streptococci of group C or G were grown from the throat swabs of 13 (8.1%) children. The median titre of ASO (256 IU) was raised compared with a reference level, and the median titre of anti-DNaseB (3172 IU) was particularly high; ASO titres were significantly higher in 31 children with impetigo than in 149 children without impetigo. Significant proteinuria was present in 7 (3.9%) children and glomerular haematuria in 16 (8.9%). Glomerular haematuria was present in 2/7 (28%) children with proteinuria, 4/21 (19%) children with a past history of post-streptococcal glomerulonephritis, in 5/31 (16%) of those with impetigo and in 4/25 (16%) of those with positive skin cultures. However, none of these prevalences was significantly greater than the prevalence of glomerular haematuria among the other children. The prevalence of proteinuria differed significantly between communities and increased significantly with age. Furthermore, the differences in childhood proteinuria observed between communities in this study were parallel with community differences in the prevalence of proteinuria in a related study of adults. CONCLUSIONS: Group A streptococci are important causes of impetigo in Aboriginal children. Streptococcal skin infection may contribute to glomerular haematuria, proteinuria and persistent glomerulonephritis in Aboriginal children, and possibly to chronic glomerulonephritis in adult life. Public health programs are needed to reduce the prevalence of impetigo and group A streptococcal infections in Aboriginal communities; longitudinal studies are needed to test the relationship between streptococcal skin infection in Aboriginal children and chronic renal disease in later life.
Authors:
P G Van Buynder; J A Gaggin; D Martin; D Pugsley; J D Mathews
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Medical journal of Australia     Volume:  156     ISSN:  0025-729X     ISO Abbreviation:  Med. J. Aust.     Publication Date:  1992 Apr 
Date Detail:
Created Date:  1992-05-18     Completed Date:  1992-05-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0400714     Medline TA:  Med J Aust     Country:  AUSTRALIA    
Other Details:
Languages:  eng     Pagination:  537-40     Citation Subset:  IM    
Affiliation:
Health Department of Western Australia, South Hedland.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Antibodies, Bacterial / analysis
Antistreptolysin / analysis
Child
Chronic Disease
Glomerulonephritis / complications,  microbiology*
Hematuria / etiology
Humans
Impetigo / microbiology
Northern Territory
Oceanic Ancestry Group*
Pharynx / microbiology
Proteinuria / etiology
Skin Diseases, Infectious / microbiology
Streptococcal Infections*
Streptococcus / immunology
Streptococcus pyogenes / isolation & purification
Chemical
Reg. No./Substance:
0/Antibodies, Bacterial; 9006-92-2/Antistreptolysin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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