Main Article Content
Objective: To assess the carriage rate of Group A beta hemolytic streptococci (Streptococcus Pyogenes/ GABHS) among school children and find out their antibiotic sensitivity.
Methodology: This cross-sectional study was carried out on 200 healthy children residing in Mardan, while samples were processed at Department of Pathology, Combined Military Hospital (CMH) Mardan from June 2019 to September 2019. Asymptomatic children with age range from 5 to 15 years were enrolled in this study. After informed consent, throat swabs were taken under aseptic conditions and sent to laboratory for culture and sensitivity. The GABHS were identified by beta-hemolysis, colony morphology, gram staining, catalase reaction and sensitivity to bacitracin. Antibiotic susceptibility of beta hemolytic streptococci were found for Penicillin G, Ceftriaxone, Erthromycin, Co-amoxiclav, Ceftriaxone, Vancomycin, Azithromycin, Tetracycline and Cephalexin by Kirby disc diffusion method. SPSS v.20.0 was used as statistical tool.
Results: Out of 200 children, there were 97 (48.5%) male. The mean age was 9.71± 2.95 years. A total of 23 (11.5%) cultures were positive for GABHS. Among these 23 carriers, 10 were males and 13 were females. All were found sensitive to Vancomycin, Penicillin G and Azithromycin. Isolates were 95.6% sensitive to Clindamycin, Ceftriaxone and Co-amoxiclav (n=22). Sensitivity to Cephalexin, Erythromycin and Tetracycline were 78.3% (n=18), 69.5% (n=16) and 65.2% (n=15), respectively.
Conclusion: GABHS carriage is common among asymptomatic school going children. GABHS cultured from these children are highly sensitive to Penicillin G, Vancomycin, Azithromycin, Co-amoxiclav, Clindamycin and Ceftriaxone.
Work published in JPMI is licensed under a
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
DeMuri GP, Wald ER. The group A Strep¬tococcal carrier state reviewed: Still an enigma. J Pediatric Infect Dis Soc.2014; 3(4):336-42. https://doi. org/10.1093/jpids/piu030
Carapetis JR, Steer AC, Mulholland EK, Weber M. the global burden of group A streptococcal diseases. Lancet Infec¬t Dis. 2005; 5(11): 685-94. https://doi. org/10.1016/S1473-3099(05)70267-X
Bisno AL. Acute pharyngitis.N Engl J Med 2001; 344: 205-11. https://doi. org/10.1056/NEJM200101183440308
Flores AR, Jewell BE, Olsen RJ, Shel¬burne SA, Fittipaldi N, Beres SB et al. As¬ymp¬tomatic carriage of group A strepto¬coccus is associated with elimination of capsule production. Infect Immun. 2010; 82(9):3958-67. https://doi.org/10.1128/ IAI.01788-14
Dietrich ML, Steele RW. Group A strep¬to¬coccus. Pediatr Rev. 2018; 39(8):379-91. https://doi.org/10.1542/pir.2017-0207
Martin JM, Green M, Barbadora KA, Wald ER. Group A streptococci among school aged children: Clinical charac¬teristics and carrier state. Pediatrics. 2004; 114(5):1212- 19. https://doi. org/10.1542/peds.2004-0133
Martin J. The Streptococcus pyogenes carrier state. Streptococcus pyogenes: Basic Biology to Clinical Manifestations. 2016 Jul 25
Hartley G, Enders JF, Mueller JH, Schoen¬bach EB. Absence of clinical disease in spite of a high incidence of carriers of group a hemolytic streptococ¬ci of a single type; failure of tyrothricin to influence the carrier rate. The J Clin Investi¬g. 1945;24(1):92-6 https://doi. org/10.1172/JCI101584
Lopardo HA, Hernandez C, Vidal P, Vazquez M, Rosaenz L, Rubinstein G et al. Erythromycin-resistant streptococcus pyogenes in Argentina. Medicina. 2004; 64(2):143-5.
Beres SB, Richter EW, Nagiec MJ, Sumby P, porcella SF, deLeo FR, et al. Molecular ge¬netics anatomy of inte and intra se¬rotype variation in the human bacterial pathogen group A streptococcus. Proc Natl acad Sci USA 2006; 103(18):7059-64. https://doi. org/10.1073/pnas.0510279103
Sepdham D, Rao S, Hitchcock K. Should you treat carrier of pharyngeal group A strept? J Pharm Pract. 2008; 57(10):673- 4.
American academy of pediatrics. Group A streptococcal infections. In: Kimberlin DW, Bradly MT, Jackson MA, Lond SS, ed. Red Book: 2015 Report of The Com¬mittee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediat-rics; 2015:32-44
Oliver J, Wadu EM, Pierce N, Moreland NJ, Williomson DA, Baker MG. Group A streptococcus pharyngitis and pharyngeal carriage: a meta-analysis. PLoS Negl Trop Dis. 2018; 12(3): e0006335. https://doi. org/10.1371/journal.pntd.0006335
Othman AM, Assayaghi RM, Al-Shami HZ, Saif-Ali R. Asymptomatic carriage of Streptococcus pyogenes among school children in Sana’a city, Yemen. BMC re¬¬search notes. 2019; 12(339):1-5. https:// doi.org/10.1186/s13104-019-4370-5
Singh AK, Kumar A, Agarwal L, Agarw¬al A, Sengupta C. Prevalence of group A strep¬tococcal pharyngitis among school chil¬dren of Barabanki district, Uttar Pradesh, India. J acad Clin Micro¬biol 2015; 17(2):110- 4. https://doi. org/10.4103/0972-1282.171893
Lioyd CA, Jacob SE, Menon T. Pharyngeal carriage of group A streptococci n school children in Chennai. Indian J Med Res 2006:124(2):195-8.
Muthusamy D, Boppe A, Suresh SP. The prevalence of group A beta hemolytic streptococcal carriers among school chil dren in Caimbatore, South India. J Clin Diag Res 2012; 6(7):1181-3.
Prajapati A, Rai S, Mukhiya R, Karki AB. Study on carrier rate of Streptococcus pyogenes among the school children and antimicrobial susceptibility pattern of iso¬lates. Nepal Med J Coll 2012; 14(3):169-71.
Anja A, Beyene G, Marium ZS, Daka D. Asymptomatic pharyngeal carrier rate of Streptococcus pyogenes and its as¬sociated factors and antibiotic suscep¬tibility pattern among school children in Hawassa Town, Southern Ethiopia. BMC Res Notes 2019; 12: 564. https://doi. org/10.1186/s13104-019-4601-9
Khas LA, Noorbakhsh S, Movahedi Z, Ashouri S. Streptococcus pyogenes and its immunological disorders in an en¬dem¬ic area. A review article in Iran. Curr Pediatr Res 2017; 21:445-51.
Nabipour F, Tayarzadeh M. Prevalence of beta-hemolytic streptococcus carrier state and its sensitivity to different an¬tibiotics among Guidance School chil¬dren in Kerman-Iran. Am J Infect Dis. 2005;1(2):128-131¬
Nayiga I, Okella E, Lwabi P, Ndeezi G.Prev¬alence of group a streptococcal pharynge¬al carriage and clinical mani-festations in school aged 5-15 years in Wakiso District, Uganda. BMC Infect Dis. 2017; 17:248. https://doi.org/10.1186/s12879-017- 2353-5
Abd El-Ghany SM, Abdelmaksoud AA, Sa¬ber SM, Abd El Hamid SH. Group a beta hemolytic streptococcal pharyngitis and carrier rate among Egyptian chil¬dren: a case-control study. Ann Saudi Med. 2015; 35(5): 377-82. https://doi. org/10.5144/0256-4947.2015.377
Belard S, Toepner N, Arnold B, Alabi AS, Berner R.Beta hemolytic streptococcal throat carrier and tonsillipharyngitis : a cross sectional prevalence study in Gabon, Central Africa. Infection. 2015:43:177-83. https://doi.org/10.1007/s15010- 014-0709-y.
Rijal KR, Dhakal N, Shah RC, Timilsina S, Mahato P, Thapa S, Ghimire P. Antibi¬otic susceptibility of group A Streptococ¬cus isolated from throat swab culture of school children in Pokhara, Nepal. Nepal Med Coll J 2009;11:238-40.