McDonald Malcolm I, Towers Rebecca J, Andrews Ross M, Benger Norma, Currie Bart J, Carapetis Jonathan R
Tropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
Clin Infect Dis. 2006 Sep 15;43(6):683-9. doi: 10.1086/506938. Epub 2006 Aug 9.
Acute rheumatic fever is a major cause of heart disease in Aboriginal Australians. The epidemiology differs from that observed in regions with temperate climates; streptococcal pharyngitis is reportedly rare, and pyoderma is highly prevalent. A link between pyoderma and acute rheumatic fever has been proposed but is yet to be proven. Group C beta-hemolytic streptococci and group G beta-hemolytic streptococci have also been also implicated in the pathogenesis.
Monthly, prospective surveillance of selected households was conducted in 3 remote Aboriginal communities. People were questioned about sore throat and pyoderma; swab specimens were obtained from all throats and any pyoderma lesions. Household population density was determined.
From data collected during 531 household visits, the childhood incidence of sore throat was calculated to be 8 cases per 100 person-years, with no cases of symptomatic group A beta-hemolytic streptococci pharyngitis. The median point prevalence for throat carriage was 3.7% for group A beta-hemolytic streptococci, 0.7% for group C beta-hemolytic streptococci, and 5.1% for group G beta-hemolytic streptococci. Group A beta-hemolytic streptococci were recovered from the throats of 19.5% of children at some time during the study. There was no seasonal trend or correlation with overcrowding. Almost 40% of children had pyoderma at least once, and the prevalence was greatest during the dry season. In community 1, the prevalence of pyoderma correlated with household crowding. Group C and G beta-hemolytic streptococci were rarely recovered from pyoderma lesions.
These data are consistent with the hypothesis that recurrent skin infections immunize against throat colonization and infection. High rates of acute rheumatic fever were not driven by symptomatic group A beta-hemolytic streptococci throat infection. Group G and C beta-hemolytic streptococci were found in the throat but rarely in pyoderma lesions.
急性风湿热是澳大利亚原住民心脏病的主要病因。其流行病学情况与温带气候地区不同；据报道，链球菌性咽炎罕见，而脓疱病非常普遍。有人提出脓疱病与急性风湿热之间存在联系，但尚未得到证实。C组β溶血性链球菌和G组β溶血性链球菌也被认为与发病机制有关。
对3个偏远原住民社区的选定家庭进行每月一次的前瞻性监测。询问人们有关喉咙痛和脓疱病的情况；从所有喉咙和任何脓疱病病变处采集拭子标本。确定家庭人口密度。
根据531次家访收集的数据，计算出儿童喉咙痛的发病率为每100人年8例，无症状A组β溶血性链球菌咽炎病例。A组β溶血性链球菌的咽部携带率中位数为3.7%，C组β溶血性链球菌为0.7%，G组β溶血性链球菌为5.1%。在研究期间的某个时候，19.5%的儿童喉咙中检出A组β溶血性链球菌。没有季节性趋势或与过度拥挤的相关性。近40%的儿童至少患过一次脓疱病，发病率在旱季最高。在社区1，脓疱病的发病率与家庭拥挤程度相关。脓疱病病变中很少检出C组和G组β溶血性链球菌。
这些数据与反复皮肤感染可使机体对咽部定植和感染产生免疫的假说一致。急性风湿热的高发病率并非由有症状的A组β溶血性链球菌咽部感染所致。在喉咙中发现了G组和C组β溶血性链球菌，但在脓疱病病变中很少发现。
