Streptococcus : Wheeless' Textbook of Orthopaedics

- 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