title: Group A streptococcal isolates temporally associated with acute rheumatic fever in Hawaii: differences from the continental United States.
abstract: 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.
authors.affiliation: Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA. guliz@hawaii.edu
authors.forename: Guliz
authors.initials: G
authors.lastname: Erdem
authors.forename: Carla
authors.initials: C
authors.lastname: Mizumoto
authors.forename: David
authors.initials: D
authors.lastname: Esaki
authors.forename: Venu
authors.initials: V
authors.lastname: Reddy
authors.forename: David
authors.initials: D
authors.lastname: Kurahara
authors.forename: Karen
authors.initials: K
authors.lastname: Yamaga
authors.forename: Lucienne
authors.initials: L
authors.lastname: Abe
authors.forename: Dwight
authors.initials: D
authors.lastname: Johnson
authors.forename: Kara
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Edward L
authors.initials: EL
authors.lastname: Kaplan
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins