Tackling Rheumatic Heart Disease: Prevalence and Antibiogram of Streptococcus pyogenes in Cases of Paediatric Pharyngitis

Abstract

Introduction: An immune mediated post-streptococcal sequelae of Streptococcus pyogenes sore throat, Rheumatic Heart Disease-associated valvulopathy and carditis are a significant cause of morbidity and mortality in developing countries around the world. In view of this, children presenting with pharyngitis were screened for Streptococcus pyogenes at the OPD level of a rural Tertiary care centre. Aim: To find out the prevalence of Streptococcus pyogenes infection in sore throat cases among children, and study isolates for antimicrobial susceptibility including macrolide resistance. Materials and Methods: Throat swabs of 200 children aged 5 to 12 years presenting to the Paediatrics OPD of Acharya Vinoba Bhave Rural Hospital, Wardha, Maharashtra, India, with complaints of sore throat, were taken over a period of two months from June 1st 2016 to July 31st 2016. Samples were cultured on Blood agar and Crystal violet blood agar to isolate β-Haemolytic, pinpoint, grayish colonies. Isolates were confirmed by gram staining, Bacitracin sensitivity and SXT (Trimethoprim 1.25 µg and sulfamethoxazole 23.75 µg) sensitivity. In vitro antibiotic susceptibility testing of isolates was carried out on Muller-Hinton agar with 5% sheep blood as per CLSI guidelines 2014. Results: A 11/200 (5.5%) of the children were found to be suffering from Streptococcal pharynigtis. An 11/11 (100%) isolates displayed sensitivity to Penicillin, Clindamycin, Ciprofloxacin and Cefotaxime but 2/11 (18.18%) isolates showed Macrolide resistance, 2/2 (100%) being MS phenotype. Conclusion: Even though the antibiogram pattern of Streptococcus pyogenes hasn’t changed significantly regarding susceptibility to Penicillin, the erythromycin resistance of two isolates obtained is a cause of concern that should be addressed urgently.

Keywords

• antibiotic resistance
• mitral stenosis
• sore throat