Streptococcal infection - Symptoms, Diagnosis, Treatments, Cure & Causes

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Group A streptococcal infection - From Wikipedia, the free encyclopedia

Streptococcus, group A, as the cause of diseases classified to other chapters

Classification & external resources ICD-10 B95.0

The group A streptococcus bacterium (Streptococcus pyogenes, or GAS) is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. Other types (B, C, D, and G) may also cause infection. Several virulence factors contribute to the pathogenesis of GAS, such as M protein, hemolysins, and extracellular enzymes. For further explanation of these virulence factors, see the main article on Streptococcus pyogenes.

Contents

1 Severe streptococcal infections

2 Relation with OCD

3 Types of infection

4 Complications

5 References

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. 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.

Relation with OCD

In recent years, children with obsessive compulsive disorder (OCD) thought to be caused by an autoimmune response to group A beta-hemolytic streptococcal infection (P.A.N.D.A.S.) have been identified, although the hypothesis remains contentious. [1]

Types of infection

Infections are largely categorized by the location of infection:

strep throat -- pharynx

scarlet fever -- upper body

impetigo, cellulitis, and erysipelas -- skin and underlying tissues

bacteremia -- bloodstream

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

toxic shock syndrome -- multiple systems

necrotizing fasciitis -- skin, fascia and muscle

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

Complications

Acute rheumatic fever (ARF) is a complication of a strep throat caused by particular strains of GAS. Although common in developing countries, ARF is rare in the United States, with small isolated outbreaks reported only occasionally. It is most common among children between 5-15 years of age. A family history of ARF may predispose an individual to the disease. Symptoms typically occur 18 days after an untreated strep throat. An acute attack lasts approximately 3 months. The most common clinical finding is a migratory arthritis involving multiple joints. The most serious complication is carditis, or heart inflammation (rheumatic heart disease), as this may lead to chronic heart disease and disability or death years after an attack. Less common findings include bumps or nodules under the skin (usually over the spine or other bony areas) and a red expanding rash on the trunk and extremities that recurs over weeks to months. Because of the different ways ARF presents itself, the disease may be difficult to diagnose. A neurological disorder, chorea, can occur months after an initial attack, causing jerky involuntary movements, muscle weakness, slurred speech, and personality changes. Initial episodes of ARF as well as recurrences can be prevented by treatment with appropriate antibiotics.

Post streptococcal glomerulonephritis (PSGN) is an uncommon complication of either a strep throat or a streptococcal skin infection. Symptoms of PSGN develop within 10 days following a strep throat or 3 weeks following a GAS skin infection. PSGN involves inflammation of the kidney. Symptoms include pale skin, lethargy, loss of appetite, headache and dull back pain. Clinical findings may include dark-colored urine, swelling of different parts of the body (edema), and high blood pressure. Treatment of PSGN consists of supportive care.

References

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.

History of Treatment of OCD. Stanford School of Medicine. Retrieved on 2007-04-12

Streptococcus - From Wikipedia, the free encyclopedia

Streptococcus

Scientific classification

Kingdom: Eubacteria

Phylum: Firmicutes

Class: Bacilli

Order: Lactobacillales

Family: Streptococcaceae

Genus: Streptococcus

Rosenbach, 1884

Streptococcus is a genus of spherical, Gram-positive bacteria, and a member of the phylum Firmicutes. Streptococci are lactic acid bacteria.

Cellular division occurs along a single axis in these bacteria, and thus they grow in chains or pairs, thus the name — from Greek streptos, meaning easily bent or twisted, like a chain. Contrast this with staphylococci which divide along multiple axes and generate grape-like clusters of cells.

Contents

1 Pathogenesis

1.1 Alpha-Hemolytic Streptococci

1.1.1 Pneumococci

1.1.2 Viridans and Others

1.2 Beta-Hemolytic Streptococci

1.2.1 Group A

1.2.2 Group B

1.2.3 Group C

1.2.4 Group D (Enterococci)

1.3 Non-Hemolytic Streptococci

2 References

Pathogenesis

In addition to strep throat, Streptococcus species are responsible for many cases of meningitis, bacterial pneumonia, endocarditis, erysipelas and necrotizing fasciitis (the 'flesh-eating' bacterial infections). It should be noted, however, that many streptococcal species are non-pathogenic. Streptococci are also part of the normal commensal flora of the mouth, skin, intestine and upper respiratory tract of humans.

Clinically, individual species of Streptococcus are classified primarily based on their hemolytic properties (breakdown of red blood cells in a laboratory). Alpha hemolysis is caused by a reduction of iron in hemoglobin giving it a greenish color on blood agar. Beta only hemolysis is complete rupture of red blood cells giving distinct, wide, clear areas around bacterial colonies on blood agar. Other streptococci are labeled as gamma haemolytic, actually a misnomer as no hemolysis takes place.

Beta-hemolytic streptococci are further characterised via the Lancefield serotyping - based on specific carbohydrates in the bacterial cell wall. These are named Lancefield groups A to T, although some species, such as S. pneumoniae, do not express Lancefield antigens. See the related article on Rebecca Lancefield. Medically the most important groups are the alpha-hemolytic streptococci, S. pneumoniae and Streptococcus Viridans-group, and the beta-hemolytic streptococci of Lancefield groups A and B (also known as “Group A Strep” and “Group B Strep”)

Alpha-Hemolytic Streptococci

Pneumococci

S. pneumoniae, a leading cause of bacterial pneumonia, otitis media and meningitis.

Viridans and Others

S. mutans, a contributor to dental caries.

S. viridans, a cause of endocarditis and dental abscesses.

S. thermophilus is used in the manufacture of some cheeses and yogurts.

Beta-Hemolytic Streptococci

Group A

S. pyogenes (also known as GAS) is the causative agent in Group A streptococcal infections, (GAS) including strep throat, acute rheumatic fever, scarlet fever, acute glomerulonephritis and necrotizing fasciitis. If strep throat is not treated, it can develop into rheumatic fever, a disease that affects the joints and heart valves. Other Streptococcus species may also possess the Group A antigen, but human infections by non-S. pyogenes GAS strains (some S. dysgalactiae subsp. equisimilis and S. anginosus Group strains) appear to be uncommon.

Group B

S. agalactiae, or GBS, causes meningitis in neonates and the elderly, with occasional systemic bacteremia. They can also colonize the female reproductive tract, increasing the risk for premature rupture of membranes and transmission to the infant. The American College of Obstetricians and Gynecologists, American Academy of Pediatrics and the Centers for Disease Control recommend all pregnant women, who are between 35-37 weeks gestation, should be tested for GBS. Those who test positive should be given prophylactic antibiotics during labor which can prevent transmission to the infant. In the UK, clinicians have been slow to implement the same standards as the US, Australia and Canada. Only 1% of maternity units test for the presence of Group B Strep.[5] As a result over 75 infants in the UK die each year of GBS related disease.

Group C

Includes S. equi which causes strangles in horses, and S. zooepidemicus which causes infections in several species of mammals including cattle and horses.

Group D (Enterococci)

Many former Group D streptococci have been reclassified and placed in the genus Enterococcus (includes S. faecalis, S. faciem, S. durans, and S. avium).[8] For example, Streptococcus faecalis is now Enterococcus faecalis.

The remaining non-enterococcal Group D strains include S. bovis and S. suis.

Non-Hemolytic Streptococci

Non-hemolytic streptococci rarely cause disease. However weakly hemolytic group D beta-hemolytic streptococci and Listeria monocytogenes should not be confused with non-hemolytic streptococci.

References

^ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill. ISBN 0-8385-8529-9.

^ Patterson MJ (1996). Streptococcus. In: Baron's Medical Microbiology (Baron S et al, eds.), 4th ed., Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.

^ Facklam R (2002). "What happened to the streptococci: overview of taxonomic and nomenclature changes". Clin Microbiol Rev 15 (4): 613-30. PubMed.

^ Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A (2002). "Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC". MMWR Recomm Rep 51 (RR-11): 1-22. PMID 12211284.

^ Hughes, RG, et al.. "Prevention of Early Onset Neonatal Group B Streptococcal Disease" (HTML). Royal College of Obstetricians and Gynaecologists.

^ Group B Strep Support Home Page (HTML). Group B Strep Support (2007-01-09).

^ Harrington D, Sutcliffe I, Chanter N (2002). "The molecular basis of Streptococcus equi infection and disease". Microbes Infect 4 (4): 501-10. PMID 11932201.

^ Ruoff KL (1990). "Recent taxonomic changes in the genus Enterococcus". Eur J Clin Microbiol Infect Dis 9 (2): 75-9. PMID 2108030.

Retrieved from "http://en.wikipedia.org/wiki/Streptococcus"

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