Egészségügy | Infektológia » Maródi László - Infections by Group A Streptococci

Infections by Group A Streptococci László Maródi Re-emerging GAS infections • Reappearance of acute rheumatic fever • Increase in invasive GAS infections – necrotizing fasciitis – TSS Clinical diagnosis of GAS tonsillo-pharyngitis • 5-12 years of age • acute onset of fever and sore throat • absent of viral type symptoms • abdominal pain • winter and spring time • lymphadenitis • exsudate+palatal petechia Laboratory diagnosis of GAS tonsillo-pharyngitis • Throat culture (90% accurate) • Requires 24-48 hrs • Antigen detection tests – Latex agglutination – EIA – Optical IE Diagnosis of URT viral illness • Rhinitis • Rhinorrhoea • Horsenes • Cough • <3 years of age Treatment of GAS tonsillopharyngitis • Rational – Prevention of acute rheumatic fever – Prevention of spread – Relieve symptoms Treatment of GAS tonsillopharyngitis • Oral penicillin – 10 day course – 2-3x a day • Benzathine penicillin G

– Single i.m dose • Alternatives to penicillin (penicillin allergy) – Erythromycin, 10 day course – Clindamycin, 10 day course – 5 day Azithromycin (FDA) • Treatment of carriers Role of cephalosporins • Slightly higher rate of eradication of GAS • Shorter time (3-5 days ?) • Broader antimicrobial spectrum • Not a choice in penicillin allergy 6-year-old girl • No fever • Healing varicella lesions • Rapidly enlarging skin lesion – 3x4 cm area – erythema – tenderness – Gram+ cocci in clusters (Gram stain) • Other lesions are scabbed and dry The best choice of treatment in invasive GAS infection • penicillin G + Clindamycin • ampicillin • nafcillin • amoxicillin • vancomycin Prevention of rheumatic fever • Primary prevention – treatment of the acute infection • 66% of patients with ARF has no symptomatic sore throat • Secondary prevention – to prevent group A strep infection in patients who had ARF – penicillin

or Sulfadiazine Streptococcal carriers • Co-pathogens • Compliance problems • Duration: months or years • Tonsillectomy is not indicated • Treatment: – Rifampin – Clindamycin