Epidemic glomerulonephritis due to Streptococcus zooepidemicus in Nova Serrana, Brazil.
BACKGROUND
In 1998, there was a large outbreak of acute glomerulonephritis in Nova Serrana, Brazil, caused by group C Streptococcus zooepidemicus. This article reviews the characteristics of the outbreak and some aspects of the patients' follow-up.


METHODS
We describe clinical characteristics of patients with acute nephritis. Using case-control studies, we identified the source of infection. Cultures of oropharyngeal swabs from patients were performed. Of 135 patients identified in 1998, available patients were reexamined in a prospective study after 2 and 5 years.


RESULTS
Lancefield group C S. zooepidemicus was identified as the causative organism and linked to the consumption of cheese produced from unpasteurized milk. Of the original group of 134 patients, 4 died in the acute phase and 5 (3.7%) required chronic dialysis. After 2 years, of the 69 cases reevaluated, 94% were adults (mean +/- standard error age: 39 +/- 2 years); we found arterial hypertension in 42% (N= 27/64) of the patients, reduced creatinine clearance (<80 mL/min/1.73 m(2)) in 30% (N= 20/67), and increased microalbuminuria (>20 microg/min) in 34% (N= 22/65). Preliminary data at 5-year follow-up suggest that the percentage of patients with creatinine clearance lower than 60 mL/min increased from 9% to 15%.


CONCLUSIONS
This article highlights the dangers of consuming unpasteurized dairy products. Follow-up of patients with epidemic poststreptococcal glomerulonephritis due to S. zooepidemicus show that a considerable proportion present hypertension, reduced renal function, and increased microalbuminuria.
Sesso
Ricardo
R
Division of Nephrology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu 740, São Paulo, SP 04023-900, Brazil. r.sesso@nefro.epm.br
Wyton
Sergio
S
Pinto
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D004196:Disease Outbreaks; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D006439:Hemodynamics; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D018502:Streptococcus equi