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Folia Medica 2011; 46 No 1:1-8Figure 1. Representation of certain M typesAmong patients who had the streptococciisolated M typing in relation to sex andage there are no statistically significant differencesin M - types of streptococci.Also was done the testing blood samplesfor the presence of anti-streptolysin Oantibody (ASO) titer in 19 or 27.1% of respondents.The results which derived fromASO tests indicate that it is positive in 9 or47.4% of respondents, and that its value of200 were found in 3 or 33.3% of total positivetests, and the titer of 400 at 6 or 66.7%of total ASO positive tests. Most patientswith positive findings ASO 200 have theM-6 type, and most patients with ASO valueof 400 is M-3 type. ASO value 400 is foundwith M-1 and M-6 type.DiscussionThis study of severe forms of streptococcaldisease came to the conclusion that it occurin cycles that are caused by certain prevalenttypes of streptococci. European studies haveshown that the distribution of ß-streptococcusgroup A haemolyticus is representeddifferently in different countries. In severalEuropean countries, the types of M-1, M-3and M-28 predominates, but there is a tendencyof increase of new invasive types (M-77, M-81, M-82, M-89) (17-19). It is knowthat in certain regions of the United States,during the twentieth century, was found alarge number of patients with acute rheumaticfever, of which had as a previous illness,infection with Streptococcus pyogenes,type M-1, M-3 and M 18 (20). Reducementin the incidence of rheumatic fever in theUnited States explains the changing representationof virulent strains of streptococcus-reducednumber rheumatic types(significantly reduce the number of isolatedtype M-3, M-5 and M-6 streptococci, from49.7% to 10.6%) (21). Tests in the Republicof Croatia indicate that the occurrence ofsevere forms of diseases caused by streptococciand the occurrence of complicationsare associated with the isolation and identificationof highly virulent strains of mucousM-serotypes of Streptococcus pyogenes(22). Testing (during the six year period) inpatients treated for streptococcal disease atthe Clinic for Infectious Diseases (Dr “FranMihaljević”) in Zagreb, Republic of Croatia,has shown that patients with severe streptococcaltoxic and invasive infections in 45.5%of cases have isolated invasive M-1 and M-3type, with documented types of M-6, M-28also M-76 M-4, M-12 and M-60, but in asmaller percentage (23).In the Microbiological laboratory of theDepartment of Public Health of SarajevoCanton, was isolated by standard methodsand typed Streptococcus pyogenes, which6
Aida Koso et al.: Serotyping Streptococcus Pyogenes of Preschool and Primary School Childrenis governed by the microbiology laboratoryof the National Reference Laboratoryin Prague, Czech Republic. Of the 72 typedstrains of streptococcus, in 70 or 97.2% ofthe samples type was confirmed by isolationof Streptococcus pyogenes, which indicatesthe high quality and validity of routine microbiologicaldiagnostics in bacteria that isperformed in the microbiological laboratoryof the Department of Public Health ofthe Canton Sarajevo. Serotyping of streptococciin our country does not exist, and thesamples were serotyped in Prague, invasivetypes of M 1 and M 3 were isolated in 35.7%of samples. Considering the total number ofM type sorts, 75.7% of samples were M-1,M-3, M-6, M-12. Other types which areisolated was M-28, M-4, M-5, M-27G, M-50.62, M-75, M-77, M-87 and M-89.Epidemiological data on streptococcalinfections in developing countries are ofcrucial importance, although it turned outthat they are very scarce. Consequently isdeveloped the Strep-EURO project, whichaims to improve our knowledge of streptococcusgroup A. In order to prevent streptococcaldisease it is necessary continuouslycollect information and knowledge aboutthe cause of the diseases that are its consequence.It is necessary to continually monitorthe presence of particular antigenic types(10.24).ConclusionStudies in the world have pointed out theimportance of isolation, identification andserotyping of streptococcus, the importanceof identifying the occurrence of mucoustypes greater incidence of acute rheumaticfever and the importance of introducing anactive control over the movement of certainM-types of streptococci, as a risk factorin the possible development of rheumaticheart disease, or acute glomerulonephritis.In the future in our country it is necessary tocreate a program similar to the Strep-EUROprogram for identification and serotypingStreptococcus pyogenes in order to establisha permanent expert network of referenceand other relevant centers. Role of referencecenters would be to develop and applymodern methods in the field of molecularbiology, genetics, microbiology and otherbranches of medicine, with the aim of theresearch of streptococci and streptococcalinfections. The results should be evaluatedand coordinated with other European centersin order to take appropriate measures toprevent streptococcal infection.References:1. Kalenić S, Mlinarić–Missoni E. Medicinska bakteriologijai mikologija. Merkur A.B.D. Zagreb,2005; 142-160.2. Bisno AL, Brito MO, Collins CM. Molecular basisof group A streptococcal virulence. Lancet InfectDis 2003; 3(4): 191-2003. Kriz P, Mottova J. Analysis of active survellenceand passive notification of streptococcal diseasesin The Czech Republic. Adv Exp Med Biol 1997;418: 217-19.4. Veasy LG, Tany LY, Daly JA, Korgenski K, et all.Temporal association of the appearance of mucoidstrains of Streptococcus pyogenes with a continuinghigh incidence of rheumatic fever in Utah. PubMed Pediatrics 2004; 113(3 ): 168-72.5. Martin JM, Green M, Barbadora KA, Wald ER.Group A Streptococci among school-aged children:clinical characteristics and the carrier state.Pub Med Pediatrics 2004; 114(5): 1212-9.6. Stephenson KN. Acute and chronic pharyngitisacross lifespan. Pub Med Lippincots Prim CarePract 2000; 4 (5) : 471-89.7. Bisno AL, Brito MO, Collins CM. Molecular basisof group A streptococcal virulence. Lancet InfectDis 2003; 3(4): 191-200.8. Facklam R, Beall B, Efstratiou A, Fischetti V, et all.Emm typing and validation of provisional M typesfor group A streptococci. Emerg Infect Dis 1999;5(2): 247-53.9. Stollerman GH. Rheumatic fever as we enter the21 century. Boston University. Archived Reports,20007
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