Group A streptococcal isolates temporally associated with acute rheumatic fever in Hawaii: differences from the continental United States.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Erdem
Guliz
G
Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA. guliz@hawaii.edu
Mizumoto
Carla
C
Esaki
David
D
Reddy
Venu
V
Kurahara
David
D
Yamaga
Karen
K
Abe
Lucienne
L
Johnson
Dwight
D
Yamamoto
Kara
K
Kaplan
Edward L
EL
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D006254:Hawaii; D006801:Humans; D015994:Incidence; D010406:Penicillins / Q000627:therapeutic use*; D012213:Rheumatic Fever / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D013297:Streptococcus pyogenes / Q000145:classification / Q000302:isolation & purification; D014481:United States
D000900:Anti-Bacterial Agents; D010406:Penicillins