Assessment of Efficacy of BLIS-Producing Probiotic K12 for the Prevention of Group A Streptococcus Pharyngitis: a Short Communication

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Abstract

The neutral outcome of the recently reported school-based trial of probiotic K12 (The effect of the oral probiotic Streptococcus salivarius K12 on group A streptococcus pharyngitis: a pragmatic trial in schools) can be attributed at least partially to several readily identifiable confounding factors. Mainly, the execution and outcome were negatively impacted by (a) the suboptimal efficacy and frequency of K12 administration, (b) the failure both clinically and microbiologically to adequately diagnose and distinguish active group A streptococci (GAS) pharyngitis from harmless GAS carriage, and (c) the exceptionally low occurrence of GAS in this population at the time of the probiotic intervention due to recent high-intensity antibiotic exposure.

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Most cited references 14

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Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing of children who present with symptoms of pharyngitis. We conducted a meta-analysis to determine the (1) prevalence of streptococcal infection among children who presented with sore throat and (2) prevalence of streptococcal carriage among asymptomatic children. We searched Medline for articles on pediatric streptococcal pharyngitis. We included articles in our review when they contained data on the prevalence of group A Streptococcus (GAS) from pharyngeal specimens in children who were younger than 18 years. Two evaluators independently reviewed, rated, and abstracted data from each article. Prevalence estimates were pooled in a meta-analysis and stratified according to age group. Of the 266 articles retrieved, 29 met all inclusion criteria. Among children of all ages who present with sore throat, the pooled prevalence of GAS was 37% (95% confidence interval [CI]: 32%-43%). Children who were younger than 5 years had a lower prevalence of GAS (24% [95% CI: 21%-26%]). The prevalence of GAS carriage among well children with no signs or symptoms of pharyngitis was 12% (95% CI: 9%-14%). Prevalence rates of GAS disease and carriage varied by age; children who were younger than 5 years had lower rates of throat cultures that were positive for GAS.

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Developing oral probiotics from Streptococcus salivarius.

Philip Wescombe, John Hale, N Heng … (2012)

Considerable human illness can be linked to the development of oral microbiota disequilibria. The predominant oral cavity commensal, Streptococcus salivarius has emerged as an important source of safe and efficacious probiotics, capable of fostering more balanced, health-associated oral microbiota. Strain K12, the prototype S. salivarius probiotic, originally introduced to counter Streptococcus pyogenes infections, now has an expanded repertoire of health-promoting applications. K12 and several more recently proposed S. salivarius probiotics are now being applied to control diverse bacterial consortia infections including otitis media, halitosis and dental caries. Other potential applications include upregulation of immunological defenses against respiratory viral infections and treatment of oral candidosis. An overview of the key steps required for probiotic development is also presented.

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Roger Kurlan, Paul Johnson, James Leckman … (2010)

Determination of an immune response to group A Streptococcus (GAS) antigens, frequently anti-streptolysin O and anti-DNase B, is crucial for documentation of bona fide GAS infection. Although the importance of immunologic confirmation of infection is widely accepted, the immediate and long-term immunokinetics of the human antibody response are incompletely documented and poorly understood. Pediatric study participants (n = 160) were followed during a 2-year study with monthly throat cultures (n = 3491) and blood samples (n = 1679) obtained every 13 weeks. Recovered GAS were characterized; serum anti-streptolysin O and anti-DNase B antibody titers were determined. Antibody titers and GAS culture results were temporally correlated and analyzed. The analyses clearly document, in some instances for the first time, that an increase in antibody titer more accurately defines infection than does an absolute titer (eg, "upper limit of normal"), that antibody titers can remain elevated for many months even without GAS, and that some individuals may harbor GAS continuously for months or years without symptoms of infection and without an associated immune response. Measuring 2 different antibodies is more accurate in defining infection. Single time-point cultures and single antibody titers are often misleading. Sequential samples more accurately define infection, allowing correlation of titer increases with temporal confirmation of GAS acquisition. Understanding kinetics of the immune response(s) to GAS infection is necessary in formulating accurate clinical diagnostic conclusions, to appropriate design of clinical and epidemiological studies examining the association of GAS with subsequent sequelae, and to providing insight into pathogenetic mechanisms associated with this important human pathogen.

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Author and article information

Contributors

Francesco Di Pierro:

ORCID: http://orcid.org/0000-0001-6654-8675

393495527663 , f.dipierro@vellejaresearch.com

Journal

Journal ID (nlm-ta): Probiotics Antimicrob Proteins

Journal ID (iso-abbrev): Probiotics Antimicrob Proteins

Title: Probiotics and Antimicrobial Proteins

Publisher: Springer US (New York )

ISSN (Print): 1867-1306

ISSN (Electronic): 1867-1314

Publication date (Electronic): 20 February 2018

Publication date PMC-release: 20 February 2018

Publication date (Print): 2019

Volume: 11

Issue: 1

Pages: 332-334

Affiliations

Velleja Research, Viale Lunigiana 23, 20125 Milan, Italy

Author information

Francesco Di Pierro http://orcid.org/0000-0001-6654-8675

Article

Publisher ID: 9398

DOI: 10.1007/s12602-018-9398-7

PMC ID: 6449295

PubMed ID: 29464500

SO-VID: 5f065cc6-6982-473f-82c3-6c59b1b849ee

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.