Advertisement

Pediatric Nephrology

, Volume 23, Issue 7, pp 1101–1106 | Cite as

Changing epidemiology of acute post-streptococcal glomerulonephritis in Northeast Florida: a comparative study

  • Mohammad IlyasEmail author
  • Asad Tolaymat
Original Article

Abstract

The objective of this study was to review the epidemiological patterns of acute post-streptococcal glomerulonephritis (APSGN) in a pediatric population. We compared incidence, pathogenesis, clinical presentation and outcomes in two APSGN pediatric patient cohorts in northeastern Florida. Retrospective medical records were reviewed of children who were admitted to our institution with a diagnosis of APSGN. Patients admitted between 1999 and 2006 (recent cohort) were compared with a previously reported cohort of patients admitted between 1957 and 1973 (earlier cohort). The recent cohort comprised 45 children with APSGN of whom 87% were male and 13% were female; the median age was 7 years, and there was an average incidence of 6.4 patients per year. The earlier cohort comprised 153 children with APSGN of whom 62% were male and 38% were female; the median age 4.25 years, and there was an average incidence of 10.9 patients per year. The recent cohort was predominantly White-American (62%) and the earlier cohort predominately African American (87%). In the recent cohort, 64% of patients had antecedent pharyngitis, and in the earlier cohort, 66% of patients had antecedent pyoderma. In the recent cohort, 11% of APSGN cases occurred between August to October, and in the earlier cohort, 50% occurred during these months. In the recent cohort, symptoms of APSGN at presentation were milder and all cases recovered, but in the earlier cohort two deaths (1.3% mortality) were reported. In conclusion, there has been a decline in the incidence and severity of APSGN at our institute in recent decades. Pharyngitis has replaced impetigo as the predominant cause of APSGN. The etiological agent for impetigo has changed over the last decade, which has impacted the incidence, racial distribution, seasonal variation and severity of APSGN.

Keywords

Acute post-streptococcal glomerulonephritis Impetigo Incidence Pharyngitis 

References

  1. 1.
    Tejani A, Ingulli E (1990) Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts. Nephron 55(1):1–5Google Scholar
  2. 2.
    Pinto SW, Sesso R, Vasconcelos E, Watanabe YJ, Pansute AM (2001) Follow-up of patients with epidemic poststreptococcal glomerulonephritis. Am J Kidney Dis 38(2):249–255PubMedCrossRefGoogle Scholar
  3. 3.
    Stetson CA, Rammelkamp CH Jr, Krause RM, Kohen RJ, Perry WD (1955) Epidemic acute nephritis: Studies on etiology, natural history, and prevention. Medicine (Baltimore) 34(4):431–450CrossRefGoogle Scholar
  4. 4.
    Markowitz M (1994) Changing epidemiology of group A streptococcal infections. Pediatr Infect Dis J 13(6):557–560PubMedCrossRefGoogle Scholar
  5. 5.
    Schwartz B, Facklam RR, Breiman RF (1990) Changing epidemiology of group A streptococcal infection in the USA. Lancet 336:1167–1171PubMedCrossRefGoogle Scholar
  6. 6.
    Gordis L (1985) The virtual disappearance of rheumatic fever in the United States: lessons in the rise and fall of disease. Circulation 72(6):1155–1162PubMedGoogle Scholar
  7. 7.
    Sanjad S, Tolaymat A, Whitworth J, Levin S (1977) Acute glomerulonephritis in children: a review of 153 cases. South Med J 70(10):1202–1206PubMedGoogle Scholar
  8. 8.
    Tolaymat A, Shaefer A (2001) Management of complication of acute glomerulonephritis. In: Harwood-Nuss A (ed) The clinical practice of emergency medicine, 3rd edn. Lippincott William & Witkins, pp 1261–1267Google Scholar
  9. 9.
    Perlman LV, Herdman RC, Kleinman H, Vernier RL (1965) Poststreptococcal glomerulonephritis. A ten-year follow-up of an epidemic. JAMA 194(1):63–70PubMedCrossRefGoogle Scholar
  10. 10.
    Anthony BF, Kaplan EL, Wannamaker LW, Briese FW, Chapman SS (1969) Attack rates of acute nephritis after type 49 streptococcal infection of the skin and of the respiratory tract. J Clin Invest 48(9):1697–1704PubMedCrossRefGoogle Scholar
  11. 11.
    Yap HK, Chia KS, Murugasu B, Saw AH, Tay JS, Ikshuvanam M, Tan KW, Cheng HK, Tan CL, Lim CH (1990) Acute glomerulonephritis—changing patterns in Singapore children. Pediatr Nephrol 4(5):482–484PubMedCrossRefGoogle Scholar
  12. 12.
    Roy S 3rd, Stapleton FB (1990) Changing perspectives in children hospitalized with post streptococcal acute glomerulonephritis. Pediatr Nephrol 4(6):585–588PubMedCrossRefGoogle Scholar
  13. 13.
    Lejbkowicz F, Samet L, Belavsky L, Bitterman-Deutsch O (2005) Impetigo in soldiers after hand-to-hand combat training. Mil Med 170(11):972–974PubMedGoogle Scholar
  14. 14.
    Dajani AS, Ferrieri P, Wannamaker LW (1972) Natural history of impetigo. II. Etiologic agents and bacterial interactions. J Clin Invest 51(11):2863–2872PubMedCrossRefGoogle Scholar
  15. 15.
    Misko ML, Terracina JR, Diven DG (1995) The frequency of erythromycin-resistant Staphylococcus aureus in impetiginized dermatoses. Pediatr Dermatol 12(1):12–15PubMedCrossRefGoogle Scholar
  16. 16.
    Rørtveit S, Rortveit GI (2007) Impetigo in epidemic and non-epidemic phases: an incidence study over 4(½) years in a general population. Br J Dermatol 157(1):100–105PubMedCrossRefGoogle Scholar
  17. 17.
    Koning S, Mohammedamin RS, van der Wouden JC, van Suijlekom-Smit LW, Schellevis FG, Thomas S (2006) Impetigo: incidence and treatment in Dutch general practice in 1987 and 2001—results from two national surveys. Br J Dermatol 154(2):239–243PubMedCrossRefGoogle Scholar
  18. 18.
    Derrick CW, Dillon HC Jr (1970) Further studies on the treatment of streptococcal skin infection. J Pediatr 77(4):696–700PubMedCrossRefGoogle Scholar
  19. 19.
    Veasy LG, Wiedmeier SE, Orsmond GS, Ruttenberg HD, Boucek MM, Roth SJ, Tait VF, Thompson JA, Daly JA, Kaplan EL (1987) Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med 316(8):421–427PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2008

Authors and Affiliations

  1. 1.Pediatric NephrologyUniversity of Florida/JacksonvilleJacksonvilleUSA
  2. 2.JacksonvilleUSA

Personalised recommendations