Group A streptococcal infection

Group A streptococcal infection Microchapters
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Overview
Classification Impetigo Strep throat Rheumatic heart disease Poststreptococcal glomerulonephritis Sinusitis Scarlet fever Tonsilitis Otitis Osteomyelitis Meningitis Brain abscess Endometritis Cellulitis Erysipelas Toxic Shock Syndrome
Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Types of infection

Infections are largely categorized by the location of infection:

• bacteremia -- bloodstream
• impetigo, cellulitis, and erysipelas -- skin and underlying tissues
• focal infections -- limited to a particular site. Bacteremia can be associated with these infections, but it is not always present. Treatment depends on the specific clinical findings. Types include:
  • pneumonia -- pulmonary alveolus
  • tonsillitis -- tonsils
  • septic arthritis -- joints
  • osteomyelitis -- bones
  • peritonitis -- peritoneum
  • meningitis -- meninges
• necrotizing fasciitis -- skin, fascia and muscle
• scarlet fever -- upper body
• sinusitis - nose.
• strep throat -- pharynx
• toxic shock syndrome -- multiple systems

(Note that some of these diseases can be caused by other infectious agents as well.)

Severe streptococcal infections

Some strains of group A streptococci (GAS) cause severe infection. Those at greatest risk include children with chickenpox; persons with suppressed immune systems; burn victims; elderly persons with cellulitis, diabetes, blood vessel disease, or cancer; and persons taking steroid treatments or chemotherapy. Intravenous drug users also are at high risk. GAS is an important cause of puerperal fever world-wide, causing serious infection and, if not promptly diagnosed and treated, death in newly delivered mothers. Severe GAS disease may also occur in healthy persons with no known risk factors.

All severe GAS infections may lead to shock, multisystem organ failure, and death. Early recognition and treatment are critical. Diagnostic tests include blood counts and urinalysis as well as cultures of blood or fluid from a wound site. The antibiotic of choice is penicillin, to which GAS is particularly susceptible and has never been found to be resistant. Erythromycin and clindamycin are other treatment options, though resistance to these antibiotics exists.

Treatment

GAS infections can be treated with many different antibiotics. Early treatment may reduce the risk of death from invasive group A streptococcal disease. However, even the best medical care does not prevent death in every case. For those with very severe illness, supportive care in an intensive care unit may be needed.

Surgery and Device Based Therapy

For persons with necrotizing fasciitis, surgery often is needed to remove damaged tissue.

Primary Prevention

The spread of all types of GAS infection can be reduced by good hand washing, especially after coughing and sneezing and before preparing foods or eating. Persons with sore throats should be seen by a doctor who can perform tests to find out whether the illness is strep throat. If the test result shows strep throat, the person should stay home from work, school, or day care until 24 hours after taking an antibiotic. All wounds should be kept clean and watched for possible signs of infection such as redness, swelling, drainage, and pain at the wound site. A person with signs of an infected wound, especially if fever occurs, should seek medical care. It is not necessary for all persons exposed to someone with an invasive group A strep infection (i.e. necrotizing fasciitis or strep toxic shock syndrome) to receive antibiotic therapy to prevent infection. However, in certain circumstances, antibiotic therapy may be appropriate. That decision should be made after consulting with a physician.

Source

• The original text of this article is taken from the NIH Fact Sheet "Group A Streptococcal Infections", dated March 1999. As a work of the U.S. Federal Government without any other copyright notice, this is assumed to be a public domain resource.

Acknowledgements

The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.

List of contributors:

Pilar Almonacid

External links

• Group A streptococcal infection at National Institutes of Health

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