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The serological types of haemolytic streptococci in relation to the epidemiology of scarlet fever and its complications
- H. L. de Waal
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- Journal:
- Journal of Hygiene / Volume 40 / Issue 2 / March 1940
- Published online by Cambridge University Press:
- 15 May 2009, pp. 172-203
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1. The paper records the results of a study of the serological types of haemolytic streptococci in scarlet fever, and their clinical and epidemiological relationships, with particular reference to cross-infection.
2. Tables are given showing statistical records of scarlet-fever cases which were examined bacteriologically in an infectious diseases hospital over a period of 13 months. In all, 1831 cases were studied, including 471 with complications.
3. In 415 cases in which swab cultures were made from the throat and nose on admission, both throat and nasal swabs yielded haemolytic strepto-cocci in 115, and the nasal swab alone in nine cases (2·5 %). The total number of throat swabs giving positive results was 357. In only two cases were different types of haemolytic streptococci found in the throat and nose.
4. Only a single type of haemolytic streptococcus was found to be present in a series of twenty-eight early cases in which many colonies of the primary culture were examined serologically.
5. More than one type of haemolytic streptococcus was found in the throats of a series of twenty-five individual cases during a period of residence in hospital when swabs were plated at weekly intervals, and many colonies examined from each plate. In only six of the twenty-five cases did the original type persist throughout the period of residence in hospital. A new type appeared to replace the original strain. In one case three types of haemolytic streptococci were present in the throat at a particular time.
6. On the day a complication occurred in a scarlet-fever case only a single type of haemolytic streptococcus was found to be present in the throat or discharge. This suggests that the strain responsible for the complication is present before the complication becomes evident.
7. Many colonies from the swab cultures of seven patients, who developed complications, were serologically examined. On the day a complication occurred a single type of haemolytic streptococcus was found present in each case.
8. The swab cultures of all the patients in a ward were examined daily over a period of 45 days. Of fifty-five patients thirty-seven were infected by two or more types of haemolytic streptococci. Of these the original type persisted for an average of 9 days. Two or three days before a complication appeared the responsible type was present in the throat.
9. 455 cases with complications were studied bacteriologically. In thirty-four the complication was due to organisms other than haemolytic strepto-cocci (7·5%). 280 were due to a type of haemolytic streptococcus other than that with which the patient entered the hospital (61·5%), whereas only ninety-two were due to the same type (20·2%). In forty-nine both the original strain of haemolytic streptococcus and that associated with the complication, could not be typed (10·8%). In patients who had been 2 weeks resident in hospital 90% of complications were due to new types of streptococci.
10. Tables comparing the types of haemolytic streptococci found on admission and during the first day of a complication are appended. Reference to the types found in cases which did not develop complications is also made.
11. The types of haemolytic streptococci and the severity of the scarlet fever produced by each have been correlated in 949 cases without complications.
12. Records are included of a further series of observations made on 390 cases of scarlet fever occurring at a later date. The types of haemolytic streptococci present were compared with those of the same period in the previous year. While type 1 was the prevalent form in the earlier enquiry, type 4 was the dominant form in the later.
This work has been carried out with the assistance of the Davidson Research Fellowship in Bacteriology and certain grants from the Moray Fund. I am indebted to Dr F. Griffith for having supplied me with his thirty type strains and specific antisera. I wish to thank Prof. T. J. Mackie and Dr A. Joe for their invaluable assistance. I also wish to express my gratitude to Dr C. A. Green for his interest in the work and his guidance in the early stages of the investigation. Mr James Craig, technician in The City Fever Hospital Laboratories, deserves special mention for his technical assistance.
A study of the serological types of haemolytic streptococci in relation to the epidemiology of scarlatina and other infections due to these organisms
- H. L. de Waal, H.
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- Journal:
- Journal of Hygiene / Volume 41 / Issue 1 / January 1941
- Published online by Cambridge University Press:
- 15 May 2009, pp. 65-99
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1. The paper records the result of a study of the serological types of haemolytic streptococci in scarlatina, puerperal fever, erysipelas, ear infections, tonsillitis, erythemas, etc., and normal throats, and their epidemiological relationships.
2. Tables and charts are given showing statistical records of scarlatinal cases which occurred over a period of 16 months in Edinburgh, a city with a population of about half a million inhabitants. In all there were 2287 cases. Of these 2169 were treated in an infectious diseases hospital, and were thus readily accessible for investigation. 1364 of the cases were school children. The strains of haemolytic streptococci from 1664 of the hospital-treated cases were serologically examined.
3. During an epidemic of scarlatina certain schools practically escaped, but in these there was a proportionately greater number of cases the following year, as compared with those schools which had suffered heavily the previous season.
4. Depending on the types of haemolytic fltreptococci isolated, scarlatina patients have been divided into three main categories: (1) pupils or school children, (2) “pupil-contacts” (families of pupils), and (3) “non-pupil-contacts” (famines without children of school age). The types of haemolytic streptococci found in these three groups have been correlated. There was a similarity in the types found in pupils and “pupil-contacts”, but not in those of pupils and “non-pupil-contacts”. Those types obtained from “pupil-contacts” and “non-pupil-contacts” were related. These features have been discussed.
5. Certain types of haemolytic streptococci predominated in the pupil cases. These were for the most part the epidemic types. The non-epidemic types, sporadic in appearance, were found mostly in “non-pupil-contacts”. “Pupil-contacts” occupied an intermediate position.
6. One main epidemic type ran through the three classes of patients. It was later replaced by another type.
7. The majority of cases of scarlatina which occurred in a school at a particular time were due to one type. It tended to persist despite the sporadic occurrence of other types. On occasions two types were present concurrently, but usually the one disappeared, and afterwards the other produced most of the cases.
8. The types of haemolytic streptococci in scarlatina, erysipelas, otitis media and mastoiditis, tonsillitis, and other streptococcal infections have been compared and the findings discussed. For the most part there was a correlation of types among all these conditions, and these types appeared to be responsible for a single epidemic of streptococcal infections.
9. The major epidemic types found simultaneously in the City of Edinburgh and in a small community, 12 miles distant, differed.
10. The types of haemolytic streptococci isolated from the throats of nurses in a general hospital bore little relationship to those isolated from medical officers and nurses in an infectious diseases hospital. The common epidemic types were present in the latter.
11. Correlations were shown to exist between the types of haemolytic streptococci in scarlatina patients, and those isolated from various members of their families, in 50% of the occasions in which the organisms were found.
12. The rapid change in the types occurring in the nasopharynx and the problem of immunity have been investigated and discussed in the case of a person exposed to massive infections with haemolytic streptococci.
13. Haemolytic streptococci on the handkerchiefs of scarlatina patients were viable after 4 weeks in most cases and after 7 weeks in two cases. After 15 weeks they were all dead.
14. Haemolytic streptococci were isolated from toys and fruit taken from scarlatina patients.
Association between insulin-like growth factor-1, insulin-like growth factor-binding protein-1 and leptin levels with nutritional status in 1–3-year-old children, residing in the central region of Limpopo Province, South Africa
- R. L. Mamabolo, M. Alberts, N. S. Levitt, H. A. Delemarre-van de Waal, N. P. Steyn
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- Journal:
- British Journal of Nutrition / Volume 98 / Issue 4 / October 2007
- Published online by Cambridge University Press:
- 19 July 2007, pp. 762-769
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- October 2007
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The present study evaluated levels of growth factors and their associations with nutritional status with emphasis on stunting in children at 1 and 3 years of age. A follow-up study on a birth cohort (n 219) of children from villages in the central region of the Limpopo Province was undertaken. Of the original cohort, 156 and 162 could be traced and assessed at ages 1 and 3 years, respectively. Data collected included socio-demographic characteristics, anthropometric measurements, dietary intake and fasting blood (collected from 116 and 145 children at 1 and 3 years, respectively) for growth factor analysis (insulin-like growth factor (IGF)-1, IGF binding protein (BP)-1, IGFBP-3, leptin, glucose and insulin). At 1 year it was found that stunted children had lower leptin levels while their IGFBP-1 levels were higher than that in normal children. These differences were, however, not observed at 3 years. Furthermore at 1 year the biochemical parameters were more related to length measures whereas at 3 years the parameters were more associated with weight measures. The observed stunting in this group of children may be a result of chronic undernutrition resulting in long-term growth faltering which is already evident at 1 year. Thus the observed phenomenon might be an adaptive mechanism adopted by children's metabolic processes as they grow up in an environment with inadequate essential nutrients due to poor weaning practices and consumption of a diet of poor quality, resulting in them gaining more weight at the expense of linear growth.