YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==STREPTOCOCCUS, BETA-HEMOLYTIC== 2 AUTHOR Brundage JF AUTHOR Gunzenhauser JD AUTHOR Longfield JN AUTHOR Rubertone MV AUTHOR Ludwig SL AUTHOR Rubin FA AUTHOR Kaplan EL TITLE Epidemiology and control of acute respiratory diseases with emphasis on group A beta-hemolytic streptococcus: a decade of U.S. Army experience. SOURCE Pediatrics; VOL 97, ISS 6 Pt 2, 1996, P964-70 ABSTRACT OBJECTIVE. To summarize the experiences of the U.S. Army regarding prevention and control, and frequencies, rates, trends, and determinants of febrile acute respiratory diseases (ARDs), particularly Group A beta-hemolytic streptococcus (GABHS). METHODOLOGY. Since 1966, the U.S. Army has conducted routine surveillance of ARDs among basic trainees. Since 1985, all trainees with fever and respiratory tract symptoms have been cultured for GABHS. Field investigations were conducted when outbreaks of acute respiratory or GABHS-associated illnesses were detected. Mass plus tandem benzathine penicillin prophylaxis were used to interdict and control training center GABHS outbreaks. RESULTS. During the period 1985 to 1994, there were 65,184 hospitalizations for acute febrile respiratory illnesses among Army trainees. The crude hospitalization rate was 0.45 per 100 trainees per week. The rate consistently declined over the period. Incremental declines were temporally associated with increased use of adenovirus immunizations and broader use of benzathine penicillin prophylaxis. During the period, 10,789 of 59,818 (18%) pharyngeal cultures were positive for GABHS. GABHS outbreaks were associated with diverse clinical manifestations including streptococcal toxic shock, acute rheumatic fever, and pneumonia. The emergence of mucoid colony morphology in clinical isolates was a consistent indicator of circulating virulent strains with epidemic potential. Outbreak-associated M types were M1, M3, M5, and M18. In response to six GABHS outbreaks, mass plus tandem benzathine penicillin chemoprophylaxis produced rapid and sustained GABHS control. ARD and GABHS recovery rates were lowest when benzathine penicillin prophylaxis was widely used. CONCLUSIONS. ARD rates among Army trainees have consistently declined to unprecedented levels. GABHS has reemerged as an important threat to military trainees. Benzathine penicillin chemoprophylaxis is safe and effective for interdicting and preventing GABHS outbreaks in closed, healthy young adult populations. 5 AUTHOR Troillet N AUTHOR Leuenberger A AUTHOR de Werra P AUTHOR Praz G TITLE [Invasive Streptococcus pyogenes infection (beta-hemolytic Streptococcus of group A)] SOURCE Schweiz Med Wochenschr; VOL 124, ISS 24, 1994, P1064-9 ABSTRACT Group A streptococcal infections are frequent and most often benign. Severe invasive infections due to this microorganism have nevertheless been reported with increasing frequency in various countries for several years. Moreover, a toxic shock-like syndrome has recently been recognized and characterized in such infections. Two cases of invasive group A streptococcal infections (one primary peritonitis and one toxic shock syndrome) are reported to increase a better understanding of this disease in the light of a review of the pertinent literature. This is hoped to contribute to better management of what is a growing problem for many physicians who are nowadays no longer familiar with the broad spectrum of group A streptococcal infections. 7 AUTHOR Bercion R AUTHOR Carrere C AUTHOR Demaille H AUTHOR Buisson Y TITLE [Clinical and biological aspects of a collective alimentary toxi- infection by group A streptococcus in a military unit stationed in Djibouti] SOURCE Bull Soc Pathol Exot; VOL 86, ISS 1, 1993, P29-34 ABSTRACT An outbreak of streptococcal pharyngitis due to a group A beta-hemolytic streptococcus has occurred in a French Army unit based in Djibouti during the month of september 1991. Out of 304 sick soldiers, 73% were seen by a physician in the initial 48 hours of the outbreak. All the patients showed a sore throat, associated with myalgia and rachialgia (85%), headache (26%) and digestive signs (24%). They were given a systematic antibiotic therapy by a penicillin or a macrolide, so no post-streptococcal complication was observed. From 23 throat swabs, 10 Streptococcus pyogenes strains were recovered with identical chimiotype, antibiotype and serotype (T:11, M non typable). Five serological assays were performed on 33 paired (early and 15 days later) samples of serum: ASLO (latex agglutination and microtitration), ASH, ASD and ASK. ASLO microtitration with ASD appear to be the most profitable association. The cost of such an outbreak is very heavy. More, the operational capacity of this unit was seriously compromised as long as 6 days. Measures to be applied are those used for the prevention of foodborne diseases, including medical surveillance of the cooking staff and strict observance of cool conservation of cooked meals and foods. 16 AUTHOR Fujikawa J AUTHOR Struewing JP AUTHOR Hyams KC AUTHOR Kaplan EL AUTHOR Tupponce AK AUTHOR Gray GC TITLE Oral erythromycin prophylaxis against Streptococcus pyogenes infection in penicillin-allergic military recruits: a randomized clinical trial. SOURCE J Infect Dis; VOL 166, ISS 1, 1992, P162-5 ABSTRACT Historically, military recruits have required benzathine penicillin G to prevent epidemics of Streptococcus pyogenes. In this randomized clinical trial, low-dose oral erythromycin was evaluated as an alternative for prophylaxis against group A beta-hemolytic streptococci in penicillin-allergic recruits. US Marine Corps recruits (186) reporting penicillin allergy were randomly given either oral erythromycin (250 mg twice a day) or a vitamin (one tablet daily) for 60 days. Evidence of infection was defined as a two-dilution rise in anti-streptolysin O titer. The erythromycin group had a significantly lower risk of S. pyogenes infection than did the vitamin group (relative risk 0.44; 95% confidence interval, 0.22-0.89). There was no significant difference among the treatment groups in isolation of group A beta-hemolytic streptococci from throat cultures. Low-dose oral erythromycin appears as effective as benzanthine penicillin G in preventing S. pyogenes infection.