Acute post-streptococcal glomerulonephritis in the Northern Territory of Australia: A review of 16 years data and comparison with the literature

Acute post-streptococcal glomerulonephritis in the Northern Territory of Australia: A review of 16 years data and comparison with the literature Journal Article

The American Society of Tropical Medicine and Hygiene

• Author(s): Marshall, Catherine S., Cheng, Allen C., Markey, Peter G., Towers, Rebecca J., Richardson, Leisha J., Fagan, Peter K., Scott, Lesley, Krause, Vicki L., Currie, Bart J.
• Published: 2011
• Publisher: The American Society of Tropical Medicine and Hygiene
• Volume: 85

Link to resource Report broken link

Abstract: The epidemiology of acute post-streptococcal glomerulonephritis (APSGN) has changed substantially over the past 50 years. Before the 1980s APGSN was relatively common worldwide with multiple large and recurrent epidemics reported, especially in the Native Americans in the United States and in Central and South America.1 Many of these epidemics were thought to be related to streptococcal skin rather than throat infection, often associated with preceding scabies.2,3 Over the past 20 years there has been a substantial decline in the reported incidence of APSGN in many industrialized countries. Despite this declining incidence of APSGN in many developed countries, there is still a significant global burden of disease. It has been estimated that there are more than 470,000 cases of APSGN worldwide annually with ~5,000 deaths, with 97% occurring in less developed countries. It is likely that APSGN is underreported in many developing countries and these figures are likely to be an underestimate of the true burden of this condition. As in most developed countries, the southern temperate regions of Australia have sporadic cases of APSGN, mostly related to pharyngitis. In contrast, in tropical northern Australia APSGN is far more common and outbreaks have previously been reported in Aboriginal communities. In the Northern Territory (NT), which comprises a semi-arid central Australian region and a tropical northern region, sporadic cases occur each year but also larger outbreaks in the northern region are documented by public health authorities around every 5–7 years. The majority of these cases are related to pyoderma caused by infection with Streptococcus pyogenes (Group A Streptococcus [GAS]), often with underlying scabies. The overall incidence and patterns of disease in this population have not been characterized. It has long been recognized that certain GAS M protein types, as now determined by the emm genotype (emm sequence type), are associated with nephritis and these are mostly different from the emm types that cause acute rheumatic fever. Previous studies of the molecular epidemiology of GAS in Aboriginal communities of the NT have shown that there is a wide diversity of emm types present. The GAS carriage is dynamic with high acquisition rates within households. We reviewed the epidemiology of APSGN within the NT over a 16-year period with the aim of determining the current incidence, patterns of disease, and diversity of emm sequence types of GAS responsible for APSGN in the region. We document that despite declining rates of APSGN in other industrialized countries, rates remain very high for children living in remote Indigenous Australian communities.

• Urls: https://www.ajtmh.org/view/journals/tpmd/85/4/article-p703.xml
• Publisher Location: Arlington VA, USA