A community outbreak of suspected acute post-streptococcal glomerulonephritis with adult predominance in rural Ethiopia: A mixed-Methods epidemiological investigation

Abstract Background Acute post-streptococcal glomerulonephritis (APSGN) typically affects children aged 5–12 years in low-resource settings. Outbreak data from sub-Saharan Africa are sparse, and changing demographic patterns remain poorly characterized. We initiated prospective surveillance following the observation of increment in acute nephritic syndrome cases at our hospital. Methods We utilized a dual-component design. First, a retrospective hospital logbook review was conducted spanning August 2023 through July 2026 (late 2015 to late 2018 E.C.) to assess baseline disease trends and quantify the magnitude of the case increase. Second, active prospective surveillance was initiated over a 60-day period (December 15, 2025–February 13, 2026) at Enat General Hospital, the sentinel hospital for three Ethiopian districts (catchment population 371,381). Patients meeting predefined clinical and laboratory criteria for acute nephritic syndrome were consecutively enrolled. Throat cultures were performed universally. Three-month clinical outcomes were assessed. Results Nineteen patients were enrolled (median age 27 years, IQR 15–49; 53% female). Farming was the predominant occupation (58%), and 79% reported direct animal contact. Generalized or peripheral edema (95%), hematuria (100%), and hypertension (79%) were the most common presentations. Throat culture was positive for Group A Streptococcus in 4 patients (21%); all patients tested negative for HIV, hepatitis B, and hepatitis C. At 3 months, 16 of 17 evaluable patients (94%) achieved complete clinical recovery, defined as resolution of edema, normotensive without requiring continued antihypertensive therapy, and normalization of serum creatinine. One patient (5.3%) died from flash pulmonary edema secondary to acute kidney injury. Conclusion This community outbreak of APSGN in rural Ethiopia demonstrated an unusual adult predominance among young, previously healthy individuals, contrasting with the classic pediatric pattern. While most patients recovered with supportive care, the single fatality underscores the potential severity in resource-limited settings.