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Acute post-streptococcal glomerulonephritis in the Northern Territory

Marshall, Catherine Susan (2009). Acute post-streptococcal glomerulonephritis in the Northern Territory. Master Thesis, Charles Darwin University.

Document type: Thesis
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Author Marshall, Catherine Susan
Title Acute post-streptococcal glomerulonephritis in the Northern Territory
Institution Charles Darwin University
Publication Date 2009
Thesis Type Master
Subjects 1117 - Public Health and Health Services
Abstract Background
In the past twenty years industrialised countries have reported a decline in the incidence of acute post-streptococcal glomerulonephritis (APSGN), especially related to skin infection. The disease remains common however in many developing countries and in central and tropical northern Australia

Methods
Retrospectively collected data from the Northern Territory APSGN notification database in Australia was reviewed. Streptococcal isolates from confirmed cases were emm sequence typed to identify the strains of Streptococcus pyogenes responsible.

Results
From 1991-July 2008 there were 415 confirmed cases and 23 probable cases of APSGN notified. 414 (94.7%) of these were Aboriginal Australians and 428 (97.7%) were people living in remote or very remote locations. The overall annual incidence of confirmed cases was 12.5 per 100,000 person years with an annual incidence in children under the age of 15 of 41.4 cases per 100,000 persons and an overall rate ratio of cases in Indigenous Australians to non-Indigenous Australians of 53.6 (95% CI 32.6-94.8). The annual incidence in Indigenous Australian children younger than 15 years was 94.3 cases per 100,000 persons. The median age of cases was 7 years (range 0-54). Outbreaks of disease across multiple communities occurred in 1995 (n=68), 2000 (n=55) and 2005 (n=87). Various strains of S. pyogenes were isolated from cases of APSGN including a number not previously recognised to be nephritogenic. Strain emm55 was responsible for a widespread outbreak in 2005.

Conclusions
APSGN continues to occur in remote Indigenous communities in Australia at rates comparable to or higher than those estimated in developing countries. Improvements in preventative and outbreak control strategies are needed.


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