Veasy L George, Tani Lloyd Y, Daly Judy A, Korgenski Kent, Miner Lonnie, Bale James, Kaplan Edward L, Musser James M, Hill Harry R
Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. george.veasy @hsc.utah.edu
Pediatrics. 2004 Mar;113(3 Pt 1):e168-72. doi: 10.1542/peds.113.3.e168.
Our objective was to confirm an observed temporal association of increased numbers of rheumatic fever cases concomitant with the appearance of an increased prevalence of mucoid strains of Streptococcus pyogenes. During the resurgence of rheumatic fever (RF) that has occurred in the Intermountain area surrounding Salt Lake City, Utah, since 1985, the largest number of cases occurred in 1985 and 1986 and 12 years later in 1997 and 1998. During the initial outbreak and the later exacerbation of the resurgence, an increased number of mucoid strains of S pyogenes were present in the community.
The referred cases of RF that fulfilled Jones criteria have been systematically reviewed by the medical staff at Primary Children's Medical Center yearly since 1985. Before the resurgence of RF, a program was initiated by the microbiology laboratory at Primary Children's Medical Center to store frozen isolates of S pyogenes. All frozen specimens were randomly selected and entered into a log; the coded entry allowed for comments regarding the origin of the isolate and whether the isolate had a mucoid appearance on the blood agar culture plate. This log was reviewed in October 2002 to determine whether the percentage of frozen mucoid isolates stored during the resurgence of RF would support the clinical and epidemiologic suspicion that mucoid isolates seemed to be present with a higher frequency during the 2 periods of high incidence of RF. The percentage of mucoid isolates was compared with the yearly number of cases of RF. A Pearson r correlation analysis was completed to determine whether there was a significant association between the percentage of mucoid isolates and the number of cases of RF.
The highest number of cases of RF was temporally associated with the highest percentage of mucoid isolates. There was statistically significant correlation between percentage of mucoid strains and the number of RF cases.
The Utah experience with the resurgence of RF in a civilian population during the last decade and a half of the 20th century confirmed the temporal association of mucoid strains of S pyogenes, primarily M-type 18, with a high incidence of RF.
我们的目的是证实观察到的风湿热病例数增加与化脓性链球菌黏液样菌株患病率上升之间的时间关联。自1985年以来，在犹他州盐湖城周边的山间地区出现风湿热（RF）复发期间，病例数最多的年份是1985年、1986年以及12年后的1997年和1998年。在最初的疫情爆发以及后来复发加剧期间，社区中化脓性链球菌黏液样菌株的数量有所增加。
自1985年以来，初级儿童医疗中心的医务人员每年都会对符合琼斯标准的转诊RF病例进行系统审查。在RF复发之前，初级儿童医疗中心的微生物实验室启动了一项计划，用于储存化脓性链球菌的冷冻分离株。所有冷冻标本均随机选取并记录在日志中；编码记录允许对分离株的来源以及该分离株在血琼脂培养平板上是否呈黏液样外观进行注释。2002年10月对该日志进行了审查，以确定在RF复发期间储存的冷冻黏液样分离株的百分比是否支持临床和流行病学方面的怀疑，即黏液样分离株在RF高发的两个时期似乎出现频率更高。将黏液样分离株的百分比与每年的RF病例数进行比较。完成了Pearson r相关性分析，以确定黏液样分离株的百分比与RF病例数之间是否存在显著关联。
RF病例数最多的时期与黏液样分离株百分比最高的时期在时间上相关。黏液样菌株百分比与RF病例数之间存在统计学上的显著相关性。
20世纪最后十五年间犹他州平民中RF复发的经历证实了化脓性链球菌黏液样菌株（主要是M18型）与RF高发之间的时间关联。
