Erdem Guliz, Mizumoto Carla, Esaki David, Reddy Venu, Kurahara David, Yamaga Karen, Abe Lucienne, Johnson Dwight, Yamamoto Kara, Kaplan Edward L
Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA.
Clin Infect Dis. 2007 Aug 1;45(3):e20-4. doi: 10.1086/519384. Epub 2007 Jun 19.
The annual incidence of acute rheumatic fever (ARF) in Hawaii has remained several times higher than that in the continental United States, particularly among ethnic Polynesians. The emm types of Streptococcus pyogenes that are associated with this nonsuppurative complication have, to our knowledge, not been previously reported in Hawaii.
Patients with ARF were identified through an active surveillance system at Kapiolani Medical Center (Honolulu, HI), the only pediatric tertiary care referral hospital in Hawaii. Specimens were obtained by throat culture from patients who met the Jones criteria for ARF at the time of presentation (63 patients), prior to penicillin treatment, and from consenting family contacts (10 individuals). Eight patients and 2 close family contacts with positive throat culture results were identified from February 2000 through December 2005. Group A streptococci isolates were characterized by emm sequence typing.
Unusual emm types were temporally associated with the onset of ARF. Emm types 65/69 (from 2 patients), 71, 92, 93, 98, 103, and 122 were isolated from the 8 patients with ARF, and emm types 52 and 101 were isolated from the 2 household contacts.
So-called rheumatogenic emm types and/or serotypes, which were previously associated with ARF in the continental United States, were not found in this study. Instead, emm types that are not commonly included among group A streptococci isolates in the continental United States and that are seldom, if ever, temporally associated with ARF were identified. These findings suggest that unusual group A streptococci emm types play a significant role in the epidemiology of ARF in Hawaii.
夏威夷急性风湿热（ARF）的年发病率一直比美国大陆高出数倍，尤其是在波利尼西亚族裔中。据我们所知，与这种非化脓性并发症相关的化脓性链球菌emm型此前在夏威夷尚未有报道。
通过夏威夷唯一的儿科三级护理转诊医院卡皮奥拉尼医疗中心（檀香山，夏威夷州）的主动监测系统确定ARF患者。在患者就诊时（63例患者）、青霉素治疗前，通过咽拭子培养从符合ARF琼斯标准的患者以及同意参与的家庭接触者（10人）中获取标本。从2000年2月至2005年12月，共确定了8例咽拭子培养结果呈阳性的患者和2名密切家庭接触者。A组链球菌分离株通过emm序列分型进行鉴定。
不常见的emm型与ARF的发病在时间上相关。从8例ARF患者中分离出emm型65/69（来自2例患者）、71、92、93、98、103和122，从2名家庭接触者中分离出emm型52和101。
本研究未发现此前在美国大陆与ARF相关的所谓致风湿性emm型和/或血清型。相反，发现了在美国大陆A组链球菌分离株中不常见且很少（如果有的话）在时间上与ARF相关的emm型。这些发现表明，不常见的A组链球菌emm型在夏威夷ARF的流行病学中起重要作用。
