note

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Streptococcal infections

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• Streptococcal infections are any type of infection caused
by the streptococcus ("strep") group of bacteria.
• There are many different types of Streptococci bacteria,
and infections vary in severity from mild throat infections
to life-threatening infections of the blood or organs.
• Most streptococcal infections can be treated with
antibiotics.

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• Streptococci are divided into two key groups:
1. alpha- haemolytic – made up of two groups,
including Streptococcus pneumoniae
2. beta- haemolytic – made up of several groups,
including Group A and Group B streptococci

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• Streptococcal (strep) infections are communicable diseases that
develop when bacteria normally found on the skin or in the
intestines, mouth, nose, reproductive tract, or urinary tract
invade other parts of the body and contaminate blood or tissue.
• Some strep infections don't produce symptoms. Some are fatal.
• Many species of streptococci live harmlessly in and on the body.
Some species that can cause infection are also present in some
healthy people but cause no symptoms. These people are called
carriers.

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• Most people have some form of strep bacteria in
their body at some time.
• A person who hosts bacteria without showing signs
of infection is considered a carrier.
• So, Streptococcal infections are caused by any one of
several species of Streptococcus.

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Types of infection
• Primary strep infections invade healthy tissue,
and most often affect the throat.
• Secondary strep infections invade tissue
already weakened by injury or illness.
• They frequently affect the bones, ears, eyes,
joints, or intestines.

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• Both primary and secondary strep infections can
travel from affected tissues to lymph glands, enter
the bloodstream, and spread throughout the body.
• Numerous strains (damage) of strep bacteria have
been identified.
• Types A, B, C, D, and G are most likely to make
people sick.

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Modes of transmission
• Different groups of these bacteria are spread in different ways-for example
through:-
– Coughing or sneezing,
– Through contact with infected wounds or sores, or
– During vaginal delivery (from mother to child).
• These infections affect various areas of the body, including the:-
– Throat,
– Middle ear,
– Sinuses,
– Lungs,
– Skin,
– Tissue under the skin,
– Heart valves, and
– Bloodstream.

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• Group A streptococci, as well as Streptococcus pneumoniae, are spread through inhalation
of droplets of secretions from the nose or throat, dispersed when an infected person
coughs or sneezes, or through contact with infected wounds or sores on the skin.
• Usually, the bacteria are not spread through casual contact, but they may spread in
crowded environments such as dormitories, schools, and military barracks.
• After 24 hours of antibiotic treatment, people no longer can spread the bacteria to others.
• Group B streptococci can be spread to newborns through vaginal secretions during
vaginal delivery.
• Viridans streptococci inhabit the mouth of healthy people but can invade the
bloodstream, especially in people with periodontal inflammation, and infect heart valves
(causing endocarditis).

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Clinical features
• Symptoms may include red and painful swollen tissues,
scabby sores, sore (strep) throat, and a rash, depending
on the area affected.
• Symptoms vary, depending on where the infection is:
• Cellulitis: The infected skin becomes red, and the tissue
under it swells, causing pain.
• Impetigo: Usually, scabby, yellow-crusted sores form.

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• Necrotizing fasciitis: The connective tissue that
covers muscle (fascia) is infected.
• People have sudden chills, fever, and severe pain and
tenderness in the affected area.
• The skin may appear normal until infection is severe.

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• Strep throat (pharyngitis): This infection usually occurs in
children 5 to 15 years old.
• Children under 3 years old seldom get strep throat.
• Symptoms often appear suddenly.
• The throat becomes sore.
• Children may also have chills, fever, headache, nausea,
vomiting, and a general feeling of illness (malaise).

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• The throat is beefy(heavy) red, and the tonsils are swollen, with or
without patches of pus.
• Lymph nodes in the neck are usually enlarged and tender.
• However, children under 3 years old may not have these symptoms.
• They may have only a runny nose.
• If people with a sore throat have a cough, red eyes, hoarseness,
diarrhea, or a stuffy nose, the cause is probably a viral infection, not
a streptococcal infection.

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Diagnosis
• Doctors may be able to diagnose the infection based
on symptoms and can confirm the diagnosis by
identifying the bacteria in a sample of infected tissue,
sometimes supplemented with imaging tests.
• Culture test.

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• Doctors suspect strep throat based on the
following:
1. Fever
2. Enlarged and tender lymph nodes in the neck
3. Pus in or on the tonsils
4. Absence of cough

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• The main reason for diagnosing strep throat is to reduce the chance of
developing complications, such as infection of the sinuses, middle ear, or
mastoid bone or rheumatic fever, by using antibiotics.
• However, because symptoms of group A strep throat are often similar to
those of throat infection due to a virus, testing with a throat culture or
another test is necessary to confirm the diagnosis.
• Several diagnostic tests (called rapid tests) can be completed in minutes. For
these tests, a swab is used to take a sample from the throat.
• If these results indicate infection (positive results), the diagnosis of strep
throat is confirmed, and a throat culture, which takes longer to process, is not
needed.

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• However, results of rapid tests sometimes indicate no
infection when infection is present (called false-negative
results).
• If results are negative in children and adolescents, culture is
needed.
• In adults, negative results do not require confirmation by
culture because the incidence of streptococcal infection and
risk of rheumatic fever in adults is so low.

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• If group A streptococci are identified, they may be tested to see
which antibiotics are effective (a process called susceptibility
testing).
• Cellulitis and impetigo can often be diagnosed based on
symptoms, although culture of a sample taken from impetigo
sores can often help doctors identify other microorganisms that
may be the cause, such as Staphylococcus aureus.
• To diagnose necrotizing fasciitis, doctors frequently use x-rays,
computed tomography (CT), or magnetic resonance imaging (MRI)
and culture

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Treatment
• Antibiotics are given by mouth or, for serious
infections, intravenously.

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• Strep throat usually resolves within 1 to 2 weeks, even without
treatment.
• Antibiotics reduce the severity of symptoms but shorten their
duration by only about 1 day.
• Nevertheless, antibiotics are given to help prevent the spread of
the infection to the middle ear, sinuses, and mastoid bone, as well
as to prevent spread to other people.
• Antibiotic therapy also helps prevent rheumatic fever, although it
may not prevent kidney inflammation (glomerulonephritis).

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• Usually, antibiotics need not be started immediately.
• Waiting up to 9 days for culture results before starting
antibiotics does not increase the risk of rheumatic fever.
• An exception is when a family member has or has had
rheumatic fever.
• Then, every streptococcal infection in any family member
should be treated as soon as possible.

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• Usually, penicillin or amoxicillin is given by mouth for 10 days.
• One injection of a long-lasting penicillin (benzathine) can be
given instead.
• People who cannot take penicillin can be given erythromycin,
clarithromycin, or clindamycin by mouth for 10 days or
azithromycin for 5 days.
• Usually, the bacteria that cause strep throat are not resistant to
penicillin.

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Complications
• Streptococcus pyogenes
• toxic shock syndrome
• scarlet fever
• Rheumatic fever
• Post-streptococcal glomerulonephritis
• PANDAS

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Prevention
1. Hand Washing
2. Cover your mouth
3. Don’t share personnel item
4. Treat early by clinician from prevent
rheumatic heart disease
5. Maintain personnel hygiene