Académique Documents
Professionnel Documents
Culture Documents
Group a Streptococci
Group a Streptococci
Classification
I. Hemolytic classes
Group a Streptococci
Classification
Group a Streptococci
Classification
Group a Streptococci
Metabolism
Group a Streptococci
Cellular Antigens
Group a Streptococci
Extracellular Products
Case
3 year old male has had rhinorrhea, cough, and conjunctivitis for 2
days. At a Fourth of July picnic he begins to complain about a sore
throat with marked pain on swallowing. His mother looks into his mouth
and notices that his throat is bright red and his tonsils are very
enlarged. He has also begun to have some loose watery stools.
Case
Diagnosis
Would you perform a rapid strep test? Would you perform a throat
culture?
Would you perform a rapid strep test and a confirmatory throat culture
only if the rapid strep test were negative?
Sudden onset
Sore throat
Fever
Headache
Breese
At best, clinical diagnoses correlate with throat culture results 80% of the
time
Throat Culture on Bap
Accuracy
Atmosphere of incubation
Media
Duration of incubation
Recommendations
Least sensitive
Endpoints indistinct
More sensitive
Gerber 1984 LA 83 99
Roddey 1986 LA 72 98
1009 (47.7%) were positive for GABHS by THB and/or BAP in reference lab
Chicago sites
Connecticut sites
Results
Sites
Sensitivities* I 2 3 4 5 6
Case
AG is an 8 year old male, who, during the first week of March, has the
sudden onset of a severe sore throat with an oral temperature of
102EF. He has nausea, abdominal pain, and enlarged, tender anterior
cervical nodes. On examination he has marked inflammation of the
pharynx and tonsils, considerable enlargement of both tonsils with
patchy exudate, and numerous petechiae on the uvula and soft palate.
A rapid strep test is performed and is positive.
3. Reduction of morbidity
4. Prevention of spread
Group A Streptococci
Transmission
Polyarthritis Arthralgia
Chorea Fever
Erythema marginatum Laboratory findings
Prolonged PR interval
Group A Streptococci
Nonsuppurative Diseases
Treatment of GABHS
Amoxicillin
Narrow-spectrum cephalosporins
Broader-spectrum cephalosporins
New macrolides
Indirectly
Directly
1. Clinical response
2. Bacteriologic response
1. Resistance to penicillin
2. Tolerance to penicillin
1. GABHS carriers
Penicillin is ineffective
3. Noncompliance
4. Reacquisition of GABHS
Erythromycin:
Cephalosporins: no resistance
Clindamycin:
Italy: 1995- 18%
Cost
Penicillin Placebo P
(n = 59) (n = 55)
Immediate Delay P
(N = 50) (N = 63)
Streptococcal Carrier
Tonsillectomy
Group a Streptococci
2. Necrotizing fasciitis
extensive local necrosis of subcutaneous soft tissue
and skin
Group a Streptococci
Case Definition for the Streptococcal Toxic Shock Syndrome
I. Isolation of GABHS
AND
Group a Streptococci
Case Definition for the Streptococcal Toxic Shock Syndrome
Group a Streptococci
Case Definition for the Streptococcal Toxic Shock Syndrome
Group a Streptococci
Not new
No evidence of an epidemic
Group a Streptococci
Epidemiology of Severe Disease
CDC estimates:
10% TSS, 5% NF
in children 5 to 10%
Group a Streptococci
Epidemiology of Severe Disease
Antibiotic therapy
Of M-I strains isolated from patients, 91% had a common RFLP and
contained the SPE-A toxin gene: virulent clone theory
However, other serotypes also associated with severe, invasive GABHS
infections, in some areas strains have been very heterogenous
Streptococcal Pyrogenic
Exotoxins (SPEs)
85% - sporadic
Group a Streptococci
Risk Factors for Severe Disease
Not usually associated with acute pharyngitis - usually skin or soft tissue
infection
Group a Streptococci
Risk Factors for Severe Disease
Group a Streptococci
Diagnosis of Severe Disease
Blood cultures
Group a Streptococci
Management of Severe Disease
3. Antimicrobial therapy
Initial parenteral antimicrobial therapy to cover GABH and S. aureus
Group a Streptococci
Management of Severe Disease
Group a Streptococci
Prevention of Severe Disease
Group a Streptococci
Prevention of Severe Disease
Group a Streptococci
Impetigo
Group a Streptococci
Transmission
Group a Streptococci
Impetigo
Antimicrobial therapy:
minimize spread to others
Group a Streptococci
Impetigo
Microbiology
Bullous - exclusively S. aureus
Thick crusted:
Group A Streptococci
Vulvovaginitis
Boisvert 1948
Usually prepubertal
Systemic penicillin
Amren 1966
Often associated with GABHS elsewhere but not always Systemic penicillin
Recurrences common
Bibliography
Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for
recurrent throat infection in severely affected children: results of parallel
randomized and nonrandomized clinical trials. N Engl J Med 310: 674-683,
1984.
Gerber MA, Tanz RR, Kabat W, et al. Optical immunoassay test for group A
beta-hemolytic streptococcal pharyngitis: an office-based, multicenter
investigation. JAMA 277: 899-903, 1997.
Gerber MA, Randolph MF, DeMao KK, Kaplan EL. Lack of impact of early
antibiotic therapy for streptococcal pharyngitis on recurrence rates. J Pediatr
117: 853-858, 1990.
Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N
Engl J Med 334:240-245, 1996.