Streptococcus equi subspecies zooepidemicus infection is rare in humans, but a well-known cause of pyogenic disease in cows and horses. S. zooepidemicus uncommonly causes post-strep glomerulonephritis (PSGN) in humans via epidemic outbreaks. We present a sporadic case of post S. zooepidemicus glomerulonephritis in a child most probably contracted from a horse. The 14-year-old girl presented with the typical signs of PSGN, with S. equi zooepidemicus isolated from a blood culture, together with a low C3 and raised anti-DNAse B. This is the first known report of a sporadic case of PSGN in a child caused by this organism.

G roup A strep to coc cus is found around the world; its ecologi cal niche is the skin and mu cous mem branes of humans (1). There are more than 80 types of this or gan ism based on a cell wall con stitu ent known as the M-protein, which is also one of its key viru lence fac tors. Group A strepto coc cus can cause a va ri ety of ill nesses rang ing from mild con di tions such as pha ryn gi tis to less com mon, but more de struc tive in fec tions, such as ne cro tiz ing cel lu li tis (2). In the 1800s, there was a world wide pan demic of strep tococ cal in fec tions. From 1885 to the early 1980s, a gen eral decrease in the number of in fec tions oc curred, even be fore the ad vent of an ti bi ot ics. This de cline was thought to be due to cleaner and less crowded liv ing con di tions (3). Be gin ning in 1985, an in creas ing number of out breaks of acute rheu matic

A recent increase in the number of patients with severe group a streptococcal soft tissue infections and the streptococcal toxic shock like syndrome (stsls) in Edmonton sparked the interest to review eight cases that occurred between March 1991 and December 1993, including two patients after cosmetic surgery. These cases were felt to be sporadic and not linked. Four of the eight patients (age range 25 to 64 years), including one patient following upper blepharoplasties, developed invasive infection without shock. These patients presented one to seven days after the initiating event with only mild fever, but severe pain and localized erythema and swelling in the affected area which progressed quickly with the formation of bullae. Two streptococcal specimens were serotyped as M1 and contained streptococcal pyrogenic exotoxins (spe) a and B. Management included surgical debridement, penicillin, and clindamycin (interferes with M-protein and toxin production). All four patients recovered. The other four patients, including one patient following rhytidectomy, (age range 45 to 83 years) were much more ill and developed stsls. They rapidly developed septic shock within 12 to 24 h and progressed to multiorgan involvement despite surgical debridement. One streptococcal specimen was serotyped as M1 and positive for spe a and B, another specimen as M12 and positive for spe B, and another specimen as M-nontypable and positive for spe B. Two patients died within five days of presentation. The other two patients recovered following lengthy hospitalization, reconstructive surgery and rehabilitation.