Zegeye, Nigus (2014) Throat Carriage Rate and Antibiotic Susceptibility Pattern of BetaHemolytic Streptococci and Gram Negative Oral Commensals in Children with Rheumatic Heart Disease on Secondary Antibiotic Prophylaxis in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Masters thesis, Addis Ababa University.
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Abstract
Background: Rheumatic fever and rheumatic heart disease remain significant causes of cardiovascular diseases in Ethiopian children. Objectives: This study was conducted to determine the throat carriage rate and antibiotic susceptibility pattern of beta-hemolytic Streptococci and gram negative oral commensal bacteria, such as Neisseria species in order to have a better understanding of their composition and dynamics in children having rheumatic heart disease who received on-going monthly Penicillin G prophylaxis. Methods: Throat swab from 234 children who had rheumatic heart disease and received ongoing secondary prophylaxis was collected and inoculated onto Sheep blood and Modified Thayer-Martin agar plates. The bacterial strains were analyzed by conventional methods as well as advanced mass spectrometry and molecular methods. Antimicrobial susceptibility testing of streptococci was performed by Kirby Bauer disc diffusion method. ASO titer determination was also done for infection or colonization differentiation. Results: Out of 234 participants, 38.03% were referred for possible surgical intervention but only three participants received this treatment. Throat carriage rate of beta-hemolytic streptococci was 23.93 % (56/234). Of these, 4 were S. pyogenes. Streptococcus dysgalactaie subsp. equisimilis possessing Lancefield group A, C and G were isolated. Six different emm gene types with one newly discovered subtype (stGrobn.1) were identified. The Streptococcal glycosyltransferase in strain emm 68.2 (multidrug resistant strain) had N-linked glycosylation carrying a unique HexNAc-deoxyhexose; a novel post-translational modification not previously recognized or studied which indicates it is not only M protein responsible for rheumatic fever disease. All beta- hemolytic Streptococci were susceptible to penicillin except S. agalactaie. Erythromycin and tetracycline resistant S. pyogenes were isolated. Among 234 participants, 29.49% (69) was positive to ASO. Of the positives, 66.67 % (46 / 69) showed increased ASO titers (ASO > 200 units/µL) and the rest 33.3% (23/69) was ASO =200 units/ µL. Children who received antibiotic prophylaxis within two weeks showed significantly lower beta- hemolytic streptococcal throat carriage than 4 weeks of injection (p=0. 004). The isolation rate of gram negative oropharyngeal commensals was 55.1% (129/234). Throat carrier rate of N. meningitidis, N. lactamica, M. catarrhalis, K. denitrificans and K. kingae were 4.27%, 4.27%, 19.66 %, 15.81% and 2.56 % respectively.Conclusion: Characterization of carrier strains and increased ASO titer in rheumatic heart disease is likely to elucidate the significance and mechanisms for carriage and drug resistance during on-going penicillin G monthly prophylaxis. The throat carriage rate of gram negative commensals seems affected by on-going penicillin G prophylaxis. Recommendation: The current schedule benzathine penicillin prophylaxis injection should be revised (changing schedule of benzathine penicillin G prophylaxis from four to two weeks). Treatment intervention has to be established to provide services for those who need repair or replacement of their damaged heart valves. Penicillin failure to clear pathogenic streptococci needs further investigations.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Group A streptococcus, beta-hemolytic streptococci, rheumatic heart disease, rheumatic fever, antibiotic prophylaxis, susceptibility pattern, emm type, protein profile, gram negative oral commensal, Ethiopia |
| Subjects: | Q Science > QR Microbiology Q Science > QR Microbiology > QR180 Immunology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Divisions: | Africana |
| Depositing User: | Emmanuel Ndorimana |
| Date Deposited: | 27 Nov 2018 12:30 |
| Last Modified: | 27 Nov 2018 12:30 |
| URI: | http://thesisbank.jhia.ac.ke/id/eprint/7771 |
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