Complications and treatment of streptococcal infections

the most common streptococcal infections include:
 * streptococcal tonsillopharyngitis
 * scarlet fever
 * streptococcal skin infections (erysipelas, impetigo)

Complications of tonsilopharyngitis 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:
 * migrating polyarthritis
 * carditis
 * erythema nodosum (subcutaneous nodules)
 * erythema marginatum
 * 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
Prevention of late consequences: proper treatment of streptococcal diseases.
 * Tonsilopharyngitis and scarlet fever: penicillin
 * Erysipelas: penicillin
 * Impetigo: lokální – mupirocin, framykoin, permanganate solution
 * Rheumatic fever: antirheumatics, prevention of recurrences of acute streptococcal infection