Outbreak of acute glomerulonephritis in children: Observed association with the T1 subtype of group A streptococcal infection in Northern Kyushu, Japan

Abstract

Group A streptococcal infection is associated with the occurrence of acute glomerulonephritis (AGN) and rheumatic fever (RF). A surveillance study in the Saga area, in northern Kyushu, Japan, showed a small variation in the reported number of group A streptococcal infections in the period 1988–94. However, of the AGN cases reported in this period, more than half were observed in 1992. In order to examine whether some change had occurred in the serotype distribution of Streptococcus pyogenes during the period, patients in the Saga area diagnosed as having group A streptococcal infection and patients with AGN or RF were analyzed. Serological T‐typing of S. pyogenes was carried out for patients with group A streptococcal infections, and the association between the occurrence of AGN or RF and the distribution of each different T subtype was analyzed. M‐typing of S. pyogenes was also carried out and the correlation between T and M types was examined. From 1988 to 1994, the annual number of patients with group A streptococcal infections in the Saga area showed a small variation, range 65–100 patients/year. Of the 42 patients with AGN and three with RF observed in this period, 27 with AGN (64%) and one with RF (33.3%) were detected in 1992. Only the T1 subtype increased in 1992; the other T subtypes showed little variation in incidence. The number of patients with the T1 subtype was significantly correlated with the occurrence of AGN by regression analysis (P < 0.01). Of the 170 subjects tested for both T and M subtypes, 44 of the 45 T1‐typed subjects had the M1 protein. Our epidemiological study suggested that the T1 subtype of streptococcal infection was associated with an outbreak of AGN in 1992 in the Saga area.

Prognosis of acute poststreptococcal glomerulonephritis (APSGN) is excellent in children, when adequately diagnosed

“…1). In the study of the Saga area in Japan by Masuyama et al , the number of patients with APSGN increased in 1992, while the total number of patients with group A streptococcal infections remained almost constant 9 . They concluded that the T1 subtype was related to the outbreak of APSGN as confirmed epidemiologically.…”

An epidemic of acute postinfectious glomerulonephritis in Armenia

“…11 Outbreaks of the disease coincide with economic decline, poor hygiene, and insufficient medical care 512-14 Resurgence of APGN, although to a lesser extent, has also been noted in Japan, Western Europe, and North America 19 15 The number of patients in this epidemic in Armenia is even more impressive when taking into account the small population (three million) of the country.…”

Disease Manifestations and Pathogenic Mechanisms of Group A Streptococcus

“…Examples include the association of emm types 1, 3, and 49 with invasive disease and emm types 2, 4, 6, 12, and 44/61 with superficial disease (46,58,59). Additionally, some emm types are associated with particular GAS disease manifestations such as ARF (e.g., emm types 1, 3,5,6,11,12,14,17,18,19,24,27,29,30,32, and 41), APSGN (e.g., emm types 1, 4, 12, 49, 55, 57, and 60), and puerperal sepsis (emm type 28) (60).…”

“…Several studies had noted a reduction in GAS disease burden in industrialized countries in the mid-20th century (11)(12)(13)(14). However, in the last 50 years, there have been widespread reports of significant outbreaks of ARF (15,16), APSGN (17,18), GAS invasive disease (14,(19)(20)(21), puerperal sepsis (22)(23)(24), and scarlet fever (25,26).…”