Complications and treatment of streptococcal infections

the most common streptococcal infections include:

• streptococcal tonsillopharyngitis
• scarlet fever
• streptococcal skin infections (erysipelas, impetigo)

Complications of tonsillopharyngitis and scarlet fever

• colliquative necrosis of submandibular node
• retrotonsillar, peritonsillar abscess
• otitis, mastoiditis, sinusitis
• rarely - bacteremia, metastatic foci - purulent arthritis, endocarditis, meningitis, brain abscess, osteomyelitis
• without therapy - the risk of late complications - rheumatic fever or glomerulonephritis

Complications of streptococcal skin infections

• rarely septic complications, possibly also glomerulonephritis
• rarely rheumatic fever
• therapy: penicillin, macrolides, lincosamides

Rheumatic fever

• acute immunological multisystemic inflammation
• most often after an infection caused by streptococcus of group A
• 1-4 weeks after infection (about 3% infected)
• often affects the heart (carditis) - chronic changes of the valves
• pathogenesis: hypersensitivity reactions, Ig against M-protein of streptococci cross-react with glycoproteins of the heart muscle, joints, etc.
• the course of the original infection may be inapparent
• often relapses

Diagnosis

Jones criteria:

• streptococcal infection in the anamnesis
• the presence of at least two main symptoms, or one main and two secondary:

Main symptoms:

1. migrating polyarthritis
2. carditis
3. erythema nodosum (subcutaneous nodules)
4. erythema marginatum
5. chorea minor (neurological disorder - unconscious untargeted rapid movements), or also chorea infectiosa rheumatica, Sydenham's chorea, St. Vitus Dance

Secondary symptoms:

• non-specific: fever, joint pain, increased FW and CRP, prolonged P-R interval on the ECG, increased ASLO titer (ie positive ASLO), rheumatic fever in the anamnesis

Principles of treatment of infections caused by Streptococcus pyogenes

• Tonsilopharyngitis and scarlet fever: penicillin
• Erysipelas: penicillin
• Impetigo: lokální – mupirocin, framykoin, permanganate solution
• Rheumatic fever: antirheumatics, prevention of recurrences of acute streptococcal infection

Prevention of late consequences: proper treatment of streptococcal diseases.

Links

Related articles

• Genus Streptococcus : Streptococcus pyogenes • Streptococcus agalactiae • Streptococcus pneumoniae • Streptococcus mutans • Oral streptococci
• Streptococcal infections : Group A streptococcal infections • Burns • Burn angina • Erysipelas • Impetigo • Infections caused by virulent streptococci • Complications and treatment of streptococcal infections • Rheumatic fever

Sources

• HAVLÍK, Jiří, et al. Infektologie. 2. vydání. Praha : Avicenum, 1990. 393 s. ISBN 80-201-0062-8.
• LOBOVSKÁ, Alena. Infekční nemoci. 1. vydání. Praha : Karolinum, 2001. 263 s. ISBN 80-246-0116-8.
• BENEŠ, Jiří. Studijní materiály [online]. [cit. 12.03.2010]. <http://jirben.wz.cz>.