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