An epidemic of acute post-streptococcal glomerulonephritis among Aboriginal children

Objective: To describe an epidemic of acute post-streptococcal glomerulonephritis (APSGN) that occurred in Aboriginal children in three remote Aboriginal communities in Far North Queensland between July and October, 1993.
Methodology: Children at the communities aged between 2 and 14 years were screened so as to identify all cases of APSGN. Parenteral penicillin was administered to all 583 children who presented for the screening procedure.
Results: APSGN was diagnosed in 58 (10%) of the 583 children. A further 142 (24%) children had microscopic haematuria. Children aged 5-8 years had the highest APSGN attack rate, and the highest prevalence of microscopic haematuria. Of all 583 children, 34% had skin sores, and group A streptococci (GAS) were isolated from 71% of the skin swabs. The prevalence of both skin sores and GAS were greater in the children with APSGN, and in those with microscopic haematuria, than in children with normal urine. A marked decline in the number of cases of APSGN occurred after the mass administration of penicillin.
Conclusions: The epidemic of APSGN was associated with GAS skin infections. The mass use of penicillin may have had an effect in reducing the transmission of the nephritogenic strain of GAS. Microscopic haematuria was a significant finding in many of the children, and further prospective studies are required to understand the significance of this finding.