了解A组链球菌性咽炎和皮肤感染作为风湿热的原因:前瞻性疾病发病率研究的方案。

PubMed ID
发表日期 2019年Jul月

原始出处 BMC传染病
BMC infectious diseases
作者 Bennett  Julie  Moreland  Nicole J  Oliver  Jane  Crane  Julian  Williamson  Deborah A  Sika-Paotonu  Dianne  Harwood  Matire  Upton  Arlo  Smith  Susan  Carapetis  Jonathan  Baker  Michael G 

文献标题 了解A组链球菌性咽炎和皮肤感染作为风湿热的原因:前瞻性疾病发病率研究的方案。
Understanding group A streptococcal pharyngitis and skin infections as causes of rheumatic fever: protocol for a prospective disease incidence study.

文献摘要 BACKGROUND

A组链球菌(GAS)感染引起自身免疫性疾病急性风湿热(ARF),可发展为慢性风湿性心脏病(RHD)。抗生素治疗煤气性咽炎是预防ARF的重要措施。然而,很难将这些感染与气体携带者区分开来。越来越多的证据表明,气体皮肤感染是ARF的一个原因。这项研究将确定真正的气体性咽炎的发病率和气体皮肤感染的血清学反应。抗生素对这些情况的有效性,以及可改变的危险因素。血清抗体滴度显示正常上限(ASO/ADB抗体的ULN)将与无症状儿童的携带率一起确定。

METHODS

这是一个前瞻性的疾病发病率研究,与一个相关的病例对照研究。研究人群包括来自新西兰奥克兰的1000名儿童(5-14岁),其中800名儿童曾探视过他们的专业医护人员,结果导致喉咙或皮肤拭子检查气体,以及200名无症状的儿童。感兴趣的条件是:气喉拭子阳性咽炎(n = 200);气体携带(n = 200);气体阴性喉部拭子(n = 200);气体皮肤感染(n 200);无症状对照组(n = 200)。除无症状对照组外,所有受试者都将进行急性和恢复期血清ASO/ADB滴度检测(分别在症状出现后<9天和2-4周收集),并进行咽喉拭子病毒PCR检测。无症状对照组将在一个血液样本和一个用于微生物培养的咽拭子中测量ASO/ADB滴度。孩子的照顾者将接受问卷调查,并且任何确定的气体分离物都将被emm类型。气体抗体的持久性也将被研究。

DISCUSSION

这项研究的发现将填补科学知识上的重要空白,以更好地了解ARF的病理生理学,改进气体感染的临床管理,并设计更有效的ARF预防方案。特别是它将测量真实的,血清学证实的气性咽炎的发病率;评估对气性皮肤感染的免疫反应及其作为ARF病因的作用;检查口服抗生素治疗气性咽炎和气管炎的有效性;并确定气体感染的危险因素是否可以为减少ARF提供干预点。


BACKGROUND

Group A Streptococcal (GAS) infections cause the autoimmune disease acute rheumatic fever (ARF), which can progress to chronic rheumatic heart disease (RHD). Treating pharyngitis caused by GAS with antibiotics is important in preventing ARF. However, it is difficult to distinguish these infections from GAS carriers. There is growing evidence for GAS skin infections as a cause of ARF. This study will identify the incidence of true GAS pharyngitis and serological responses to GAS skin infections. The effectiveness of antibiotics for these conditions will be explored, and modifiable risk factors. Serum antibody titres indicating the upper limits of normal (ULN for ASO/ADB antibodies) will be established alongside carriage rates in asymptomatic children.

METHODS

This is a prospective disease incidence study, with an associated case-control study. The study population includes 1000 children (5-14 years) from Auckland, New Zealand, 800 of whom have visited their healthcare professional, resulting in a throat or skin swab for GAS, and 200 who are asymptomatic. The conditions of interest are GAS throat swab positive pharyngitis (n = 200); GAS carriage (n = 200); GAS negative throat swab (n = 200); GAS skin infections (n = 200); and asymptomatic controls (n = 200). All participants, except asymptomatic controls, will have acute and convalescent serological testing for ASO/ADB titres (collected < 9 days, and 2-4 weeks following symptom onset, respectively), alongside viral PCR from throat swabs. Asymptomatic controls will have ASO/ADB titres measured in one blood specimen and a throat swab for microbial culture. Caregivers of children will be interviewed using a questionnaire and any GAS isolates identified will be emm typed. The persistence of GAS antibodies will also be investigated.

DISCUSSION

Findings from this study will fill critical gaps in scientific knowledge to better understand the pathophysiology of ARF, improve clinical management of GAS infections, and design more effective ARF prevention programmes. In particular it will measure the incidence of true, serologically confirmed GAS pharyngitis; assess the immune response to GAS skin infections and its role as a cause of ARF; examine the effectiveness of oral antibiotics for treating GAS pharyngitis and carriage; and identify whether risk factors for GAS infections might provide intervention points for reducing ARF.


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