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Targeted therapy has the potential to be used in the neoadjuvant setting for odontogenic tumors, reducing the morbidities associated with major surgery. In this regard, the aim of this study was to summarize the current evidence on the different forms of targeted therapy, effectiveness, and drawbacks of this course of treatment. Four databases were searched electronically without regard to publication date or language. Grey literature searches and manual searches were also undertaken. Publications with sufficient clinical data on targeted therapy for odontogenic tumors were required to meet the criteria for eligibility. The analysis of the data was descriptive. A total of 15 papers comprising 17 cases (15 ameloblastomas and 2 ameloblastic carcinomas) were included. Numerous mutations were found, with BRAF V600E being most common. Dabrafenib was the most utilized drug in targeted therapy. Except for one case, the treatment reduced the size of the lesion (16/17 cases), showing promise. Most of the adverse events recorded were mild, such as skin issues, voice changes, abnormal hair texture, dry eyes, and systemic symptoms (e.g., fatigue, joint pain, and nausea). It is possible to reach the conclusion that targeted therapy for ameloblastoma and ameloblastic carcinoma may be a useful treatment strategy, based on the findings of the included studies.

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Introdução: A Síndrome de Aarskog-Scott (AAS) é uma rara displasia faciogenital ligada ao gene FGD1, afetando principalmente meninos. Relato de caso: Descreve-se um caso de um menino de 4 anos com AAS, destacando sua importância científica devido à raridade, escassez de descrições e morbidade associada. Ele apresentou fenda sacral, criptorquidia bilateral, atrasos no crescimento e histórico familiar semelhante. A AAS é caracterizada por estatura baixa, anomalias faciais e diversos comprometimentos. Este caso ressalta a importância do acompanhamento médico especializado. Considerações finais: A escassez de estudos comparáveis destaca a relevância dos relatos de casos para aprofundar a compreensão de condições clínicas singulares.

Introduction: Aarskog-Scott Syndrome (AAS) is a rare faciogenital dysplasia linked to the FGD1 gene, primarily affecting boys. Case report: We describe a case of a 4-year-old boy with AAS, highlighting its scientific importance due to its rarity, scarcity of descriptions, and associated morbidity. He presented with sacral cleft, bilateral cryptorchidism, growth delays, and similar family history. AAS is characterized by short stature, facial anomalies, and various impairments. Final considerations: This case underscores the importance of specialized medical care, and the scarcity of comparable studies highlights the relevance of case reports in deepening the understanding of unique clinical conditions.

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PURPOSE: In this study, we report a case of a young adult with X-linked juvenile retinoschisis (XLRS) with a rare pathogenic variant in the RS1 gene (c.522 + 2 T > A). METHODS: Ophthalmological evaluation, optical coherence tomography, full-field and multifocal electroretinograms and extensive genetic screening of genes related to visual loss were carried out in the participant. RESULTS: Clinical ophthalmological exams revealed a mild to moderate impairment of visual acuity. Retinal imaging showed bilateral foveal schisis, as well as normal a-wave, reduction in the b-wave amplitudes in dark- and light- adapted full-field electroretinograms, and abnormal oscillatory potentials. We found also diffuse amplitude reduction in multifocal electroretinogram arrays. A canonical splice variant was identified in the RS1 gene (c.522 + 2 T > A). CONCLUSION: A rare pathogenic variant of the RS1 gene was associated with diffuse retinal involvement (central and peripheral retina), probably in inner retina, and mild to moderate visual acuity impairment. The phenotypical characterization of rare mutations is relevant to provide information about the disease.

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Dowling Degos disease (DDD) is a rare autosomal dominant genodermatosis characterized by acquired, slowly progressive reticulated pigmented lesions primarily involving flexural skin areas. Mutations in KRT5, POGLUT-1 and POFUT-1 genes have been associated with DDD, and loss-of-function mutations in PSENEN, a subunit of the gamma-secretase complex, were found in patients presenting with DDD or DDD comorbid with hidradenitis suppurativa (HS). A nonsense mutation in NCSTN, another subunit of the gamma-secretase, was already described in a patient suffering from HS and DDD but whether NCSTN could be considered a novel gene for DDD is still debated. Here, we enrolled a four-generation family with HS and DDD. Through Whole Exome Sequencing (WES) we identified a novel nonsense mutation in the NCSTN gene in all the affected family members. To study the impact of this variant, we isolated outer root sheath cells from patients' hair follicles. We showed that this variant leads to a premature stop codon, activates a nonsense-mediated mRNA decay, and causes NCSTN haploinsufficiency in affected individuals. In fact, cells treated with gentamicin, a readthrough agent, had the NCSTN levels corrected. Moreover, we observed that this haploinsufficiency also affects other subunits of the gamma-secretase complex, possibly causing DDD. Our findings clearly support NCSTN as a novel DDD gene and suggest carefully investigating this co-occurrence in HS patients carrying a mutation in the NCSTN gene.

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BACKGROUND: Alpha-1 antitrypsin deficiency (AATD) is an underrecognized genetic disorder associated mainly with pulmonary emphysema and Chronic Obstructive Pulmonary Disease (COPD). All individuals with COPD regardless of age or ethnicity should be tested for AATD, but in Colombia its prevalence in unknown. MAIN OBJECTIVE: To determine the prevalence of the genetic mutations, present in AATD in adult patients with COPD in Colombia, using a genotyping test on cells from the oral mucosa. METHODS: This was a multicentre, observational, cross-sectional study which included adult patients attending seven COPD care centres in Colombia. Demographic data, medical history, including history of exposure to smoking and biomass smoke, most recent spirometry, pharmacological and non-pharmacological treatment received, serum AAT levels, and mutations detected by the genotyping test were recorded for all the recruited patients. For the comparison of variables between the groups with and without mutation, we used the X2 test for the qualitative variables and the Student's t-test or Mann-Whitney U test according to their distribution. MAIN FINDINGS: We collected a sample of 1,107 patients, the median age was 73.8 years (87.6-79.9). Mutations were documented in 144 patients (13.01%), the majority had the M/S mutation (78.50%), followed by M/Z (9.72%). One patient had a ZZ mutation and two patients had null alleles. In total, 23 patients had mutations associated with serum AAT deficiency (levels below 60 mg/dl). CONCLUSIONS: Genetic mutations were documented in 13.01% of patients with COPD in Colombia and 2.07% were AATD-related, showing that there is a significant number of underdiagnosed patients.

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Cherubism is a rare hereditary benign fibro-osseous disorder characterised by bilateral swelling of the mandible and/or maxilla with varying severity of involvement. It occurs because of dominant mutations in SH3BP2 gene on the chromosome 4p16.3. On radiography cherubic lesions appear as multilocular cystic radiolucencies in the jaw bones giving a soap bubble appearance. These lesions usually heal by themselves by the time the patient attains puberty. Treatment is necessary only in aggressive cases where there is severe facial deformity or vital functions are hampered. Surgical corrections are preferred when the lesion is in its dormant phase. The aim of the present case report is to illustrate a case of cherubism in a 9-year-old Saudi boy which is a very rare occurrence as only 1 case of cherubism has been reported so far in the Saudi Arabian population (AU)

Querubismo é uma desordem fibro-óssea hereditária rara caracterizada por aumento de volume bilateral da mandíbula e/ou maxila com graus variáveis de severidade. Ocorre devido a mutação dominante no gene SH3BP2 no cromossomo 4p16.3. Radiograficamente as lesões de querubismo aparecem como radiolucência multilocular semelhantes a bolhas de sabão nos ossos maxilares. Geralmente as lesões involuem espontaneamente quando o paciente atinge a puberdade. O tratamento se faz necessário apenas nos casos mais agressivos que demonstram deformidade facial severa ou comprometimento de funções vitais. Correções cirúrgicas são preferíveis quando a lesão está na fase dormente. O objetivo do presente relato é ilustrar um caso de querubismo em um paciente de 9 anos da Arábia Saudita, sendo este um evento raríssimo com apenas um outro caso relatado na população da Arábia Saudita (AU)

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Purpose: To perform a comprehensive and systematic critical appraisal of the genetic alterations reported to be present in adenomatoid odontogenic tumor (AOT) compared to ameloblastoma (AM), to aid in the understanding in their development and different behavior. Methods: An electronic search was conducted in PubMed, Scopus, and Web of Science during March 2021. Eligibility criteria included publications on humans which included genetic analysis of AOT or AM. Results: A total of 43 articles reporting 59 AOTs and 680 AMs were included. Different genomic techniques were used, including whole-exome sequencing, direct sequencing, targeted next-generation sequencing panels and TaqMan allele-specific qPCR. Somatic mutations affecting KRAS were identified in 75.9% of all AOTs, mainly G12V; whereas a 71% of the AMs harbored BRAF mutations, mainly V600E. Conclusions: The available genetic data reports that AOTs and AM harbor somatic mutations in well-known oncogenes, being KRAS G12V/R and BRAFV600E mutations the most common, respectively. The relatively high frequency of ameloblastoma compared to other odontogenic tumors, such as AOT, has facilitated the performance of different sequencing techniques, allowing the discovery of different mutational signatures. On the contrary, the low frequency of AOTs is an important limitation for this. The number of studies that have a assessed the genetic landscape of AOT is still very limited, not providing enough evidence to draw a conclusion regarding the relationship between the genomic alterations and its clinical behavior. Thus, the presence of other mutational signatures with clinical impact, co-occurring with background KRAS mutations or in wild-type KRAS cases, cannot be ruled out. Since BRAF and RAS are in the same MAPK pathway, it is interesting that ameloblastomas, frequently associated with BRAFV600E mutation have aggressive clinical behavior, but in contrast, AOTs, frequently associated with RAS mutations have indolent behavior. Functional studies might be required to solve this question.

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COVID-19 is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and declared by the World Health Organization a global public health emergency. Among the severe outbreaks across South America, Uruguay has become known for curtailing SARS-CoV-2 exceptionally well. To understand the SARS-CoV-2 introductions, local transmissions, and associations with genomic and clinical parameters in Uruguay, we sequenced the viral genomes of 44 outpatients and inpatients in a private healthcare system in its capital, Montevideo, from March to May 2020. We performed a phylogeographic analysis using sequences from our cohort and other studies that indicate a minimum of 23 independent introductions into Uruguay, resulting in five major transmission clusters. Our data suggest that most introductions resulting in chains of transmission originate from other South American countries, with the earliest seeding of the virus in late February 2020, weeks before the borders were closed to all non-citizens and a partial lockdown implemented. Genetic analyses suggest a dominance of S and G clades (G, GH, GR) that make up >90% of the viral strains in our study. In our cohort, lethal outcome of SARS-CoV-2 infection significantly correlated with arterial hypertension, kidney failure, and ICU admission (FDR < 0.01), but not with any mutation in a structural or non-structural protein, such as the spike D614G mutation. Our study contributes genetic, phylodynamic, and clinical correlation data about the exceptionally well-curbed SARS-CoV-2 outbreak in Uruguay, which furthers the understanding of disease patterns and regional aspects of the pandemic in Latin America.

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Paciente de 4 años de edad, con epilepsia de difícil manejo, cuya etiología se atribuye a patología autoinmune y que finalmente se diagnostica una mutación de protocadherina (PCDH19). Se discute la fisiopatología, características clínicas, exámenes y los posibles tratamientos.

Four-year-old patient with intractable epilepsy, whose etiology is attributed to autoimmune pathology and who is eventually diagnosed with a protocadherin mutation (PCDH19). Pathophysiology, clinical characteristics, examinations and possible treatments are discussed.

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Aceruloplasminemia is a rare form of brain iron overload of autosomal recessive inheritance that results from mutations in the CP gene, encoding the iron oxidase ceruloplasmin. Homozygous aceruloplasminemia causes progressive neurodegenerative disease, anemia, and diabetes, and is usually diagnosed late in life upon investigation of anemia, high ferritin, or movement disorders, but its heterozygous state is less characterized and believed to be silent. Here we report two heterozygotes for new mutations causing aceruloplasminemia from whom peripheral blood samples were collected for complete blood counts, iron studies, and genotyping by automated sequencing. We then performed a systematic review of preview reports of heterozygotes with data on genotype and clinical findings. Heterozygosity for aceruloplasminemia invariably causes reduced ceruloplasmin levels, and similarly to previews reports in the literature, our cases did not present with anemia. Mild hyperferritinemia was found only in two reports. Nevertheless, 5 out of 11 variants have been associated with significant neurological symptoms despite the presence of one wild-type alelle. This review contributes to better genetic counseling of heterozygotes for CP gene variants and supports that measuring ceruloplasmin levels may be useful when investigating patients with movement disorders or rare cases of unexplained high ferritin.

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Autosomal dominant tubulointerstitial kidney disease (ADTKD) is characterized by autosomal dominant inheritance, progressive chronic kidney disease, and a bland urinary sediment. ADTKD is most commonly caused by mutations in the UMOD gene encoding uromodulin (ADTKD-UMOD). We herein report the first confirmed case of a multi-generational Brazilian family with ADTKD-UMOD, caused by a novel heterozygous mutation (c.163G>A, GGC→AGC, p.Gly55Ser) in the UMOD gene. Of 41 family members, 22 underwent genetic analysis, with 11 individuals found to have this mutation. Three affected individuals underwent hemodialysis, one peritoneal dialysis, and one patient received a kidney transplant from a family member later found to be genetically affected. Several younger individuals affected with the mutation were also identified. Clinical characteristics included a bland urinary sediment in all tested individuals and a kidney biopsy in one individual showing tubulointerstitial fibrosis. Unlike most other reported families with ADTKD-UMOD, neither gout nor hyperuricemia was found in affected individuals. In summary, we report a novel UMOD mutation in a Brazilian family with 11 affected members, and we discuss the importance of performing genetic testing in families with inherited kidney disease of unknown cause.

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Different strains of Lactococcus lactis are capable of producing the bacteriocin nisin. However, genetic transfer mechanisms allow the natural occurrence of genes involved in nisin production in members of other bacterial genera, such as Enterococcus spp. In a previous study, nisA was identified in eight enterococci capable of producing antimicrobial substances. The aim of this study was to verify the presence of genes involved in nisin production in Enterococcus spp. strains, as well as nisin expression. The nisA genes from eight Enterococcus spp. strains were sequenced and the translated amino acid sequences were compared to nisin amino-acid sequences previously described in databases. Although containing nisin structural and maturation related genes, the enterococci strains tested in the present study did not present the immunity related genes (nisFEG and nisI). The translated sequences of nisA showed some point mutations, identical to those presented by Lactococcus strains isolated from goat milk. All enterococci were inhibited by nisin, indicating the absence of immunity and thus that nisin cannot be expressed. This study demonstrated for the first time the natural occurrence of nisin structural genes in Enterococcus strains and highlights the importance of providing evidence of a link between the presence of bacteriocin genes and their expression.

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RESUMO Objetivo: Avaliar a ocorrência de mutação em locus gênico candidato e sua relação com ceratocone em pacientes atendidos no Brasil comparados a voluntários saudáveis, através da análise de polimorfismo de nucleotídeo único no gene DOCK9. Métodos: Neste estudo clínico foram avaliados 108 indivíduos, sendo 46 pacientes com ceratocone e 62 voluntários saudáveis (controles). Amostras de DNA foram obtidas do sangue coletado de pacientes com ceratocone e controles para a realização de análise de genotipagem. O genótipo do polimorfismo de nucleotídeo único rs7995432 no gene DOCK9 foi determinado através de reação em cadeia da polimerase em tempo real (qPCR). Resultados: A frequência do alelo mutante (C) foi de 4,8% para os pacientes e 7,6% para os controles. Para o alelo selvagem (T), as frequências foram de 95,2% para os pacientes e 92,4% para os controles. O genótipo heterozigótico esteve presente em 9,5% dos pacientes e 11% dos controles, enquanto o genótipo homozigótico para o alelo selvagem (TT) foi encontrado em 90,5% e 87% para os pacientes e controles, respectivamente. Conclusão: Não foram observadas diferenças significativas na frequência e discriminação dos alelos mutante e selvagem entre os pacientes com ceratocone e os controles. Portanto, não foi possível fazer uma associação destas mutações no gene DOCK9 com a ocorrência do ceratocone para esta população.

ABSTRACT Objective: To evaluate the occurrence of a mutation in candidate genetic loci and its relation with keratoconus in patients treated in Brazil compared to healthy volunteers, through analysis of single nucleotide polymorphism in the DOCK9 gene. Methods: In this clinical study, 108 participants were evaluated, including 46 keratoconus patients and 62 healthy volunteers (controls). DNA samples were extracted from collected blood from keratoconus patients and controls. The genotyping of the single nucleotide polymorphism rs7995432 in the DOCK9 gene was determined through a real-time polymerase chain reaction (qPCR). Results: The frequency of the mutant allele (C) was 4.8% in patients and 7.6% in controls. For the wild allele (T), the frequencies were 95.2% in patients and 92.4% in controls. The heterozygous genotype was present in 9.5% of patients and 11% of controls, while the homozygous genotype for the wild allele (TT) was found in 90.5% and 87% for patients and controls, respectively. Conclusion: There were no significant differences un the frequency and discrimination of the mutant and wild alleles between patients and controls. Therefore, these results confirm no association of these mutations in the DOCK9 gene and the occurrence of keratoconus for this population.

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A osteopetrose trata-se de uma patologia osteometábolica que tem sido relatada tanto em humanos quanto em animais. As causas podem ser por distúrbios metabólicos ou mutação genética. Os sinais clínicos são relacionados à estenose do canal medular causado pela osteopetrose e são: sensibilidade dolorosa, diminuição dos movimentos e até perda do apetite. O diagnóstico pode ser feito por exames radiológicos, histopatológico e necropsia. Porém devido ao prognóstico sombrio da doença, os animais são submetidos à eutanásia. O objetivo deste trabalho é relatar um caso de osteopetrose em um porquinho-da-India, doença pouco relatada em animais silvestres.

The osteopetrosis it is a metabolic bone disease that has been reported both in humans and in animals. The causes can be from metabolic disorders or genetic mutation. The clinical signs are related to stenosis of the spinal canal caused by osteopetrosis and are: soreness, decreased movement is even loss of appetite. The diagnosis can be made by radiological examinations, necropsy and histopathology. However due to the poor prognosis of the disease, animals are euthanized. The objective of this study is to report a case of osteopetrosis in a guinea pig, under reported disease in wild animais.

La osteopetrosis es una enfermedad ósea metabólica que se ha informado tanto en humanos como en animales. Las causas pueden ser de trastornos metabólicos o mutación genética. Los signos clínicos son relacionados con la estenosis del canal espinal causada por la osteopetrosis y son: dolor, disminución del movimiento es incluso la pérdida de apetito. El diagnóstico puede hacerse mediante exámenes radiológicos, necropsia y la histopatología. Sin embargo, debido a el mal pronóstico de la enfermedad, las animales son sacrificados. El objetivo de este trabajo es presentar un caso de osteopetrosis en un conejillo-de-indias, enfermedad subregistro en los animales salvajes.

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A osteopetrose trata-se de uma patologia osteometábolica que tem sido relatada tanto em humanos quanto em animais. As causas podem ser por distúrbios metabólicos ou mutação genética. Os sinais clínicos são relacionados à estenose do canal medular causado pela osteopetrose e são: sensibilidade dolorosa, diminuição dos movimentos e até perda do apetite. O diagnóstico pode ser feito por exames radiológicos, histopatológico e necropsia. Porém devido ao prognóstico sombrio da doença, os animais são submetidos à eutanásia. O objetivo deste trabalho é relatar um caso de osteopetrose em um porquinho-da-India, doença pouco relatada em animais silvestres.(AU)

The osteopetrosis it is a metabolic bone disease that has been reported both in humans and in animals. The causes can be from metabolic disorders or genetic mutation. The clinical signs are related to stenosis of the spinal canal caused by osteopetrosis and are: soreness, decreased movement is even loss of appetite. The diagnosis can be made by radiological examinations, necropsy and histopathology. However due to the poor prognosis of the disease, animals are euthanized. The objective of this study is to report a case of osteopetrosis in a guinea pig, under reported disease in wild animais.(AU)

La osteopetrosis es una enfermedad ósea metabólica que se ha informado tanto en humanos como en animales. Las causas pueden ser de trastornos metabólicos o mutación genética. Los signos clínicos son relacionados con la estenosis del canal espinal causada por la osteopetrosis y son: dolor, disminución del movimiento es incluso la pérdida de apetito. El diagnóstico puede hacerse mediante exámenes radiológicos, necropsia y la histopatología. Sin embargo, debido a el mal pronóstico de la enfermedad, las animales son sacrificados. El objetivo de este trabajo es presentar un caso de osteopetrosis en un conejillo-de-indias, enfermedad subregistro en los animales salvajes.(AU)

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Se realizó un estudio observacional y descriptivo, de corte transversal, de 19 pacientes con fibrosis quística, atendidos en consultas externas del Hospital Pediátrico Docente Provincial "Hermanos Cordové" en Manzanillo, Granma, durante el semestre de julio-diciembre del 2012, con vistas a identificar el estado nutricional de estos a partir de una evaluación antropométrica -- para lo cual se calculó el índice de Waterlow --, y luego relacionarlo con las mutaciones genéticas. Entre los resultados de la serie sobresalió que 73,7 % de los pacientes poseía peso y talla adecuados para la edad, mientras que 31,5 % fue evaluado como desnutrido. De igual modo, existió relación entre el estado nutricional y la mutación genética, y se concluyó que la mayoría de los afectados presentaba una evaluación nutricional adecuada, como consecuencia de una correcta atención multidisciplinaria.

An observational, descriptive and cross-sectional study, of 19 patients with cystic fibrosis, assisted in the out-patient department of "Hermanos Cordové" Teaching Pediatric Hospital in Manzanillo, Granma was carried out during the semester of July-December, 2012, with the objective of identifying the nutritional state in them starting from the anthropometric evaluation -- for which the Waterlow score was calculated --, and then to relate it with the genetic mutation. Among the results of the series it was observed that 73.7% of the patients had adequate weight and size for the age, while 31.5% was evaluated as undernourished. Also, there was relation between the nutritional state and the genetic mutation, and it was concluded that most of the affected patients had an appropriate nutritional evaluation, as consequence of a correct multidisciplinary care.

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Familial Mediterranean fever (FMF) is a periodic autoinflammatory disease characterized by chronic inflammation. This study investigated the relationship between acute-phase reactants and gene mutations in attack-free periods of childhood FMF. Patients diagnosed with FMF were divided into four groups based on genetic features: no mutation, homozygous, heterozygous, and compound heterozygous. These groups were monitored for 2 years, and blood samples were collected every 6 months during attack-free periods. Erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and white blood cell count were measured. A disease severity score was determined for each patient. Mean values for erythrocyte sedimentation rate and fibrinogen were significantly different in the homozygous group. White blood cell count and C-reactive protein were similar between the groups. Disease severity score was higher in patients with the M694V mutation than in individuals without the mutation, as well as in those with other mutation groups. Periodic follow-up of patients with FMF MEFV mutations in subjects with acute-phase reactants may be useful in the prevention of morbidity.

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Se efectuó un estudio descriptivo y transversal durante el 2008 para determinar las principales características clinicoepidemiológicas de los 34 pacientes con fibrosis quística en la provincia de Santiago de Cuba, atendidos por el Grupo Provincial de esta especialidad. En la casuística primaron las siguientes variables: sexo masculino, piel amarilla, procedentes del municipio de Santiago de Cuba, bajo peso, con síntomas y diagnóstico de la enfermedad en la primera década de la vida e infección respiratoria; esta última como principal complicación. Entre los síntomas más frecuentes figuraron: tos, expectoración, dolor abdominal, apetito voraz, así como forma mixta según tipo de presentación, que fue además la causante del mayor número de ingresos; entre los resultados de otras pruebas predominaron, por citar algunos: disfunción ventilatoria obstructiva moderada, mutación genética DF 508 homocigótico, así como aislamiento de la Pseudomonas aeuruginosa en el esputo y estreptococo beta hemolítico en el exudado nasofaríngeo

A descriptive and cross-sectional study was carried out during 2008 in order to determine the main clinical-epidemiological characteristics of 34 patients with cystic fibrosis in Santiago de Cuba province assisted by the Provincial Group of this field. In the case material, the following variables: male sex, yellow skin, residents in Santiago de Cuba municipality, low weight, presenting symptoms and the diagnosis of a disease during the first decade of life and respiratory infection, the latter as main complication, were relevant. Among the symptoms, the most frequent were cough, expectoration, abdominal pain, voracious appetite, as well as the mixed form according to the occurrence type which also was the cause of the major number of admissions. Among the results of some other tests, just for quoting some examples, mild obstructive breathing malfunction, homozygotic DF 508 genetic mutation as well as isolation of the Pseudomonas aeuruginosa in the sputum and hemolytic ¦Â-streptococcus in the nasopharyngeal exudate were predominant

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