A STUDY OF THE ASSOCIATION OF GROUP A STREPTOCOCCI WITH ACUTE GLOMERULONEPHRITIS

Abstract

An initial study of 51 patients with a disease syndrome fulfilling the criteria of acute glomerulonephritis revealed either bacteriologic and/or serologic evidence of preceding streptococcal infection. All patients had had an acute respiratory illness followed by gross or microscopic hematuria, albuminuria, and elevated erythrocyte sedimentation rate. [beta]-Hemolytic streptococci were isolated from the throat cultures of 31 patients at the onset of nephritis. Among 30 Group A strains identified, 18 were type 12, 4 were type 49, one each were types 5, 18, 19, and 41 and 4 were nontypeable. Among members of 10 of 15 families studied, streptococci of the same type as that isolated from the patients were identified. Anti-streptolysin O, of more than 160 units were noted in 47 patients. Antihyaluronidase and antistrepto-kinase titers were not so consistently elevated. In 3 patients there was evidence that new streptococcal infections were followed by exacerbations of renal disease. The bacteriologic and/or immunologic evidence of an antecedent streptococcal infection in each of 51 patients supports the view that Group A streptococcal infections are nearly always associated with acute glomerulonephritis. The demonstration of a variety of Group A streptococci in the throat cultures of these patients and their familial contacts suggests that many strains are capable of producing nephritis in man. The streptococcal antibody most regularly correlated with the occurrence of glomerulonephritis was found to be antistreptolysin O. Three patients had evidence of recurrence or exacerbation of nephritis following new streptococcal infections and may justify continuous prophylactic antibiotic in this group.