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As part of a clinical-epidemiological follow-up carried out between 1975 and 1979 in Iaşi, the evolution of the clinical and functional recuperatory process in a series of 269 patients with articular rheumatismal manifestations, out of which 67.6% caused by pharyngo-amigdalytis infections, was studied. The investigations on ASLO, fibrinogen, VSH, urinary sediment, ECG and presence of some germs, having etiological significance, in the nasopharyngeal exudate have brought data pleading for the infectious-allergic etiopathogenesis of an important number of the chronic articular rheumatism cases. The drug treatment and balneophysiotherapy had full recuperatory effects in 18.2% and partial ones in 57.6% of the cases. The cost of the recuperatory intervention is about 4-4,500 lei/year/patient.

Pharyngolaryngeal reflux (PLR) refers to backflow of stomach contents into the throat and larynx. Its diagnosis is difficult because of a variety of atypical symptoms, low sensitivity of traditional tests of gastrointestinal tract, and no consensus on the diagnostic algorithm. The aim of this study was to provide an algorithm for the diagnosis and treatment of PLR. There were no pathognomonic symptoms or findings, but the characteristic symptoms validate the Reflux Symptom Index and Reflux Findings Score as tools in the initial diagnosis. The first approach is empirical medical treatment for 3 month, based on endoscopic findings at laryngofiberscopy; then objective demonstration of reflux events using multichannel intraluminal impedance and pH monitoring. Proton pump inhibitors represent the mainstay of therapy for the patients with PLR, but they require a more aggressive and prolonged treatment than the patients with gastroesophageal symptoms.

To establish the validity and the role of a clinical sore throat score in clinical management of streptococcal angina on a first visit to a primary care provider.This study included 168 patients. The sore throat score had 5 criteria: age, fever, absence of cough, tender anterior cervical nodes, tonsillar swelling or exudate. The score range is -1 to 5.Of the 168 patients, 53 (31.5%) had a positive culture result for beta hemolytic streptococci. Compared with throat culture a score = 3 has a sensitivity of 62.,26% (95%CI: 47.9%-75.2%), a specificity of 78.26% (95%CI: 69.6%-85.4%). Efficiency of this score is 73.21%.The clinical sore throat score may assist the primary care providers in estimating that a patient has streptococcal angina without replacing rapid antigenic testing or culture.

The infections caused by group A betahemolytic streptococcus represent a major problem of community health, worldwide and in Romania, too. Between 1990-2000, in the Galati County, scarlet fever registered values of morbidity with a yearly variability between 8.2 and 54.1 cases/100,000 inhabitants. Angina, although underrated, reached values of 30-80%ooo, followed by erysipelas with an incidence of 80-100%ooo. The socio-economical impact was partially highlighted by assessing the dynamics of hospitalizations which registered values from 363.86 to 527.14%ooo inhabitants. To the previous, the costs of bacteriological investigations were added. For example, 60-80% of cases of angina were positive.

A. haemolyticum is involved in acute pharingotonsillitis in present, reaching a maximal incidence between 10 and 30 years of age. The authors examined 7402 throats swabs obtained from children between March 1995 and February 1996. The swabs were plated on a selective culture medium: 5% sheep blood agar added with 3.5% NaCl; the plates were incubated for 48 h in aerobic conditions. The colonies of A. haemolyticum have been suspected on the basis of a) the growing time interval (48 h); reduced size (diameter less than 1 mm); c) the presence of a narrow zone of incomplete beta-haemolysis and d) the typical pitting of the culture medium beneath the colony. The definitive identification was realised on the basis of the microscopical appearance (diphtheroid gram-positive bacilli), negative catalase test and inverse CAMP test (narrowing of the haemolytic zone produced by staphylococcal beta-lysine). The frequency of A. haemolyticum in the throat swabs investigated was 0.07% (5 cases), comparing with S. pyogenes which was found in 8.21% of cases.

Arcanobacterium haemolyticum (A.h.) was recovered from 0.43% of throat cultures of 3715 patients with sore throat, scarlatina and various skin rash. In a 57.90% patients A.h. was the only bacterial pathogen isolated, while in the remainder beta-haemolytic streptococci, Haemophilus and S. aureus were also detected. beta-haemolytic streptococci were much more frequent than A.h. in the throat cultures (26.83%). All A.h. strains were of the smooth type based on colony morphology and the ability to ferment sucrose. The strains were susceptible to penicillins, cephalosporins, erytromycin and resistant to trimethoprim-sulphamethoxazole. Pharyngeal injection in 89.47% and exanthem in 78.90% were the most common signs present to the patients.

Starting with the year 1974 a total 11 pilot units have been organized, in as many counties in which a complex program of surveillance of streptococcal infections was applied, that had the following objectives: 1. Prevention and fight against acute streptococcal infection ; 2. Prevention of severe complications of acute rheumatic fever of rheumatic carditis and acute glomerulonephritis ; 3. Prevention of relapses of acute rheumatic fever. The establishment and verification of methods for clinical and laboratory diagnosis was followed, as well as of therapeutic techniques and dispensarization. The analysis of results obtained after the application for a period of 3 years of the program in high-risk collectivities, and in the conditions of an intensive circulation of some epidemic strains of streptococcus has shown the decrease each year of the incidence of scarlet fever, the increased efficiency of detection of acute non-eruptive (non-rash) streptococcal infections, as well as a significant decrease in the number of cases that developed a first attack of acute rheumatic fever and acute glomerulonephritis. A significant decrease was also obtained in the number of relapses and of severe evolution of rheumatic carditis, due to active detection, continuous evidence, prophylaxis and periodic control of cases with acute rheumatic fever.

Starting from the particularities of the streptococcal infections, and the possibilities for fighting acute forms and the immediate and late complications, multiple aspects are discussed that should be implied by the prophylaxis of this infection in the present stage. Aspects of primary prophylaxis are treated separately, that are related to the limiting of the circulation of the etiologic agent, especially in view of preventing the epidemic forms of the disease. Also aspects of secondary prophylaxis are discussed, aimed at preventing streptococcal re-infections in subjects in whom complications such as rheumatic fever or acute glomerulonephritis have occured. "Primary prophylaxis" represents the key to the limitation of the streptococcal infection on the one hand, and of the transformation of acute articular rheumatic fever, of rheumatic carditis and of acute glomerulonephritis in "rarely encountered" diseases, on the other.

In 1975, clinical and epidemiological investigations were carried out on streptococcal infections, affecting 261 persons in a children's community. Rapid laboratory tests were used, employing commercial sodium amyl polyethylen microtablets. Of the total persons investigated 24.5% (64) presented primary streptococcal infections and 0.3% (1) complications. Environmental complications was 5% greater in the communities with scarlet fever foci than in the intact communities. The absence of late manifestations in the 1--4 year-old children attests to the effectiveness of the preventive measures taken.