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- Discussion:
      - gram positive coccus 
      - spetrum of streptococci pyogenes infections:
             - most common cause of celluitis and lymphangitis;
             - superficial form of infection is called impetigo which affects stratum corneum;
             - ecthyma contagiosum describes shallow superficial dermal ulcers caused by a slightly deeper infectios;
             - erysipelas is the term for streptococcal dermal cellulitis, often associated with lymphangitis as it spreads along dermal lymphatics;
             - cellulitis can spread to the dermal lymphatics as classical lymphangitis, commonly causeced by strep pyogenes; 
             - in children may cause rheumatic fever;

- Group A strep:  Streptococcus pyogenes (GAS)
      - may be responsible for toxic shock syndrome and necrotizing fascitis
      - frequent pathogen in humans: 5-15% of the population is believed to harbor the bacterium without showing signs of accompanying disease;
      - usually causes relatively mild illnesses, such as streptococcal sore throat (strep throat) and streptococcal skin infections (impetigo);
      - may cause more serious illnesses such as scarlet fever, rheumatic fever, postpartum fever, wound infections, and pneumonia.
      - less often group A strep bacteria can invade the blood, muscle and fat tissue, or lungs and cause a serious and often life-threatening infections;
       - necrotizing streptococal infections:
               - acute gangrene: at level of fascia, streptococci pyogenes, produces acute gangrene, a form of necrotizing fascitis;
               - look for early rapid onset of marked tissue edema and redness w/ little pain, progressing to local cyanosis & skin blistering; 
               - lymphangitis and lymphadenopathy are absent;
               - soft tissue gas may be uncommon; 
               - treatment is parental penicillin, debridement, and measures to prevent edema;
               - before antibiotics were available this was a surgical emergency mandating immediate amputation to prevent streptococcal septicemia and death;
               - references:
                       - Group A Streptococcal (GAS) Disease

                       - Musculoskeletal complications of varicella.
                       - Orthopaedic manifestations of invasive group A streptococcal infections complicating primary varicella.
                       - An Aggressive Group A Streptococcal Cellulitis of the Hand and Forearm Requiring Surgical Debridement
                       - Fatal group A streptococcal infection with toxic shock syndrome: complicating minor orthopedic trauma.
                       - Streptococcal Toxic Shock Syndrome Presenting as Septic Knee Arthritis in a 5-Year-Old Child.
                       - Severe group A streptococcal infection and streptococcal toxic shock syndrome.
                       - Orthopaedic manifestations of invasive group A streptococcal infections complicating primary varicella
                       - Case records of the MGH. Case 2-2009. A 25-year-old man with pain and swelling of the right hand and hypotension.
                       - Enhancing a Cryptic Killer
                       - Sacramento girl needed amputations after 5-hour wait at emergency room
                       - Invasive Streptococcus pyogenes after allograft implantation--Colorado, 2003.
                       - Group A beta-hemolytic streptococcal osteomyelitis in children. 
                       - [Deep venous thrombosis caused by severe infection with group A streptococci]
                       - A Cluster of Surgical Wound Infections Due to Unrelated Strains of Gr A Strep
                       - Complication of a closed Colles-fracture: necrotising fasciitis with lethal outcome. A case report
                       - The Wound Care Team: A New Source of Group A Streptococcal Nosocomial Transmission
                       - Acute Lymphangitis. NEJM Case Records

- Group B strep: (s. agalactiae)
        - e-medicine: Streptococcus Group B Infections 
        - references: 
                - Relapsing invasive group B streptococcal infection in adults.
                - Group B streptococcal vertebral osteomyelitis with bacteremia
                - Group B streptococcal osteomyelitis in adults.
                - Vertebral osteomyelitis caused by group B streptococci (Streptococcus agalactiae) secondary to urinary tract infection.
                - Group B streptococcal prosthetic joint infections
                - Outcome of Penicillin-Susceptible Streptococcal Prosthetic Joint Infection Treated with Debridement and Retention of the Prosthesis
                - Successful antimicrobial therapy and implant retention for streptococcal infection of prosthetic joints.

                - Group B streptococcus in prosthetic hip and knee joint-associated infections.
                - Clinical Features of Group B Streptococcus Prosthetic Joint Infections and Molecular Characterization of Isolates

- Group C strep:
        - Group C streptococcal infection in a prosthetic joint
        - Streptococcus Dysgalactiae Subspecies Dysgalactiae Infection after Total Knee Arthroplasty: A Case Report

- Group D:
         - enterococcus:
         - s. bovis (non enterococcus)
                - Late Streptococcus bovis infection of knee arthroplasty and its association with carcinoma of the colon: a case report.
                - Bacteremia complicated by vertebral osteomyelitis due to Streptococcus bovis.
                - Late infection of a total knee arthroplasty with Streptococcus bovis in association with carcinoma of the large intestine.
                - Streptococcus bovis-infected total hip arthroplasty

- Non Grouped Strep:
          - Streptococcus Viridans:
                   - alpha hemolytic (non hemolytic) and non pyogenic strep (viridans = green in Latin)
                   - may be normal flora of the oropharyngeal (including S. mutans), urogenital, and gastrointestinal tract;
                   - can make up 30-60% of the total micro flora of the mouth;
                   - most commonly isolated aerobic bacteria in postoperative bacteraemia
                   - frequent cause of endocarditis;
                   - references:
                           - Antimicrobial prophylaxis in oral surgery and dental procedures
                           - Streptococcus viridans vertebral osteomyelitis.
                           - Septic arthritis due to Streptococcus sanguis
                           - Acute septic arthritis due to Streptococcus sanguis

          - Streptococcus pneumoniae (note association with multipe myleloma)
                   - [A prosthetic joint infection caused by Streptococcus pneumoniae: a case report and review of the literature]
                   - Bone and joint infection due to Streptococcus pneumoniae in two immunocompetent adults.
                   - Pneumococcal septic arthritis: review of 190 cases
                   - Multifocal osteomyelitis with Streptococcus pneumoniae in a patient with Waldenström macroglobulinemia: a case report  

- Antibiotic Choices:
        - Pen G 
        - 1st Generation Cephalsporins 
        - Clindamycin 
              - effective against streptococcus and most staph aureus.
              - may shut down toxin production from strep;
              - references:
                    - Growth phase-dependent effect of clindamycin on production of exoproteins by Streptococcus pyogenes
                    - Effect of antibiotics on group A Streptococcus exoprotein production analyzed by two-dimensional gel electrophoresis
        - Erythromycin
        - Penase Res Penicillins
        - Chloramphenicol
        - Vancomycin
        - Rifampin

 Recurrent vertebral osteomyelitis and psoas abscess caused by Streptococcus constellatus and Fusobacterium nucleatum in a patient with atrial septal defect and an occult dental infection.

Clinical and diagnostic features of osteomyelitis occurring in the first three months of life.

Successful antimicrobial therapy and implant retention for streptococcal infection of prosthetic joints

What killed Mozart? Orthopaedist reviews the theories and points to eighteenth century medical treatment

 Streptococcus species Group G and Group C Streptococci, Viridans Group, Nutritionally Variant Streptococci

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Sunday, April 26, 2015 3:27 pm

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