group A beta-hemolytic streptococcus
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Etiology
- disorders associated with infection
Epidemiology
- pharyngeal carriage rate 8-16% children, 2% adults[5]
Pathology
- virulence factors:
- M proteins (80 different types)
- hematogenous spread
- may localize to muscle or fascia without antecedent trauma
Laboratory
- rapid screen for group A streptococcus[7]
- negative rapid Strep antigen test followed up by culture for beta-hemolytic streptococcus (gold standard)[6]
- anti-streptolysin O titer[11]
- see ARUP consult[8]
Complications
Differential diagnosis
- formation of skin abscesses, such as furuncles or carbuncles, suggests S aureus
Management
- penicillin
- prevents non-suppurative sequelae if started within 48 hours
- 10 days of therapy recommended
- no resistant organisms[2]
- erythromycin in penicillin-allergic patients
- some resistance
- strains resistant to erythromycin are resistant to other macrolides as well (i.e. azithromycin, clarithromycin)
- cephalosporins may have superior cure rates to pencillin[4]
- evidence supporting reduced incidence of complications is lacking
- beta-lactam antibiotic + clindamycin may reduce mortality in hospitalized patients relatice to beta-lactam antibiotic alone []
- contact precautions for invasive disease
More general terms
More specific terms
Additional terms
References
- ↑ Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1140
- ↑ Jump up to: 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
- ↑ Prescriber's Letter 9(5):25 2002
- ↑ Jump up to: 4.0 4.1 Journal Watch 24(9):73, 2004 Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics. 2004 Apr;113(4):866-82. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15060239
- ↑ Jump up to: 5.0 5.1 5.2 Danchin MH et al, Burden of acute sore throat and group A streptococcal pharyngitis in school-aged children and their families in Australia. Pediatrics 2007, 120:950 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17974731
- ↑ Jump up to: 6.0 6.1 Journal Watch 23(14):115, 2003 Gieseker KE et al Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing. Pediatrics 111:e666, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12777583
- ↑ Jump up to: 7.0 7.1 Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings. Arch Intern Med. 2006 Mar 27;166(6):640-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16567603
- ↑ Jump up to: 8.0 8.1 ARUP Consult: Group A Streptococcal Disease The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/streptococcal-disease-group
- ↑ Siegel JD, Rhinehart E, Jackson M et al 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007 Dec;35(10 Suppl 2):S65-164 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18068815
- ↑ Babiker A, Li X, Lai YL et al. Effectiveness of adjunctive clindamycin in beta-actam antibiotic-treated patients with invasive beta-haemolytic streptococcal infections in US hospitals: A retrospective multicentre cohort study. Lancet Infect Dis 2020 Dec 14; PMID: https://www.ncbi.nlm.nih.gov/pubmed/33333013 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30523-5/fulltext
- ↑ Jump up to: 11.0 11.1 11.2 NEJM Knowledge+ Dermatology
- ↑ Group A Streptococcal Infections https://www.niaid.nih.gov/diseases-conditions/group-streptococcal-infections