Streptococcal pharyngitis in slum versus non-slum communities in Salvador Brazil

巴西萨尔瓦多贫民窟与非贫民窟社区的链球菌咽炎

• 批准号: 7406586
• 负责人: Sara Tartof
• 金额: $ 3.78万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2009-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7406586
• 关键词: Streptococcal; pharyngitis; slum; versus; non

DESCRIPTION (provided by applicant): Streptococcal pharyngitis is the acute disease that precedes the chronic disease process of rheumatic heart disease (RHD). Recent studies have revealed that the microbiologic and epidemiologic features of RHD in tropical environments are distinct from those described in the literature, which are based mostly on studies from temperate zone communities. Whether these differences are due to temperate versus tropical environment, or the nature of community structures in the so-called tropical areas slum versus non- slum remains unknown. In Brazil, RHD appears to occur predominantly in populations that reside in urban slums (favelas). RHD epidemiology in slums may be very distinct from what is described in the literature. This may be due to structural, social or other aspects of slums. Effective prevention strategies depend on understanding the disease dynamics in a population. Therefore, this project seeks to study the early events that are known to be associated with the eventual outcome of RHD in these communities. Specifically, this project will compare the epidemiology and microbiology of streptococcal pharyngitis in contrasting populations- -slum versus non-slum--in the same urban center. Specific Aims: One aim of the CDC Health Protection Goal of Healthy People in a Healthy World is to prevent infectious diseases and their consequences. This study will help achieve this objective with the following studies: 1.) An assessment of the diversity and clonal composition of Group A Streptococcus isolates from pharyngitis (symptomatic) cases from favela and non-favela populations in the same urban setting in a developing country (Salvador, Brazil), and a comparison of these isolates with the population structure of GAS from an unrelated geographic setting in a developed country (Oakland, CA, USA); and 2.) An evaluation of the relative prevalence, proportion, and clonal composition of Group G Streptococcus (GGS) and Group C Streptococcus (GCS) from pharyngitis (symptomatic) cases in three populations: favela and non-favela populations in Salvador, Brazil; and a pediatric population in Oakland, CA, USA. Research Design and Methods: Streptococcal isolates will be collected from children aged 5-14 who present with pharyngitis to two clinics in Salvador, Brazil. One clinic serves a population with high socioeconomic status, and the other clinic serves a favela population. Isolates will be genotyped and analyzed for clonal diversity and serogroup with emm-typing, as well as multilocus sequence typing (MLST). Conclusion: By addressing these aims, this study will determine whether streptococcal pharyngitis in a slum population has patterns distinct from that described in the medical literature; and also from communities in the same city but which are not considered slums. Past literature has demonstrated that strain type (based on M surface protein) has important implications for development of RHD. It is important that we assess this known risk factor in a slum community at high risk for RHD.

描述(申请人提供)：链球菌性咽炎是风湿性心脏病(RHD)慢性疾病进程之前的一种急性疾病。最近的研究表明，热带环境中风湿性心脏病的微生物学和流行病学特征与文献中描述的不同，文献中的描述大多基于温带社区的研究。无论这些差异是由于温带和热带环境，还是所谓的热带地区贫民窟和非贫民窟的社区结构的性质，目前尚不清楚。在巴西，风湿病似乎主要发生在居住在城市贫民窟(贫民窟)的人口中。贫民窟的风湿性心脏病流行病学可能与文献中所描述的截然不同。这可能是由于贫民窟的结构、社会或其他方面造成的。有效的预防策略取决于对人群中疾病动态的了解。因此，该项目试图研究已知与这些社区风湿性心脏病最终结果相关的早期事件。具体地说，该项目将在同一城市中心的不同人群--贫民窟和非贫民窟--中比较链球菌咽炎的流行病学和微生物学。具体目标：CDC《健康世界中的健康人健康保护目标》的一个目标是预防传染病及其后果。这项研究将通过以下研究帮助实现这一目标：1)评估来自发展中国家(巴西萨尔瓦多)同一城市环境中的贫民窟和非贫民区人群的咽炎(有症状)病例的A组链球菌分离株的多样性和克隆组成，并将这些分离物与发达国家(美国奥克兰，加利福尼亚州奥克兰)无关地理环境中的GAS的种群结构进行比较；对三个人群(巴西萨尔瓦多的贫民窟和非贫民窟人群；以及美国加利福尼亚州奥克兰的儿科人群)咽炎(有症状)病例中G群链球菌(GGS)和C群链球菌(GCS)的相对流行率、比例和克隆构成进行了评估。研究设计和方法：链球菌分离株将从5-14岁患有咽炎的儿童身上收集到巴西萨尔瓦多的两家诊所。一家诊所服务于社会经济地位较高的人群，另一家诊所服务于贫民窟人群。将对分离株进行基因分型和克隆多样性分析，并使用emm分型和多位点序列分型(MLST)进行血清组分析。结论：通过解决这些目标，这项研究将确定贫民窟人群中的链球菌性咽炎是否具有与医学文献中描述的不同的模式；也将确定同一城市中不被视为贫民窟的社区的模式。过去的文献表明，菌株类型(基于M表面蛋白)对风湿性心脏病的发展具有重要意义。重要的是，我们在风湿性心脏病高危的贫民窟社区评估这一已知的风险因素。