Group A Streptococcal Infection Clinical Presentation

  • Author: Mark R Schleiss, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 29, 2010
 

History

History, physical, and causes of group A streptococcal infections are reviewed by disease in Medical Care.

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Physical

Infection with group A streptococci includes a wide variety of manifestations. Classic acute disease involves the skin and oropharynx, but any organ system may be involved. Complications can include toxic shock syndrome (TSS) and multiple-organ system disease. Long-term complications (nonsuppurative sequelae) include acute rheumatic fever (which, in turn, may include any of several major and minor manifestations involving the heart, joints, skin, and CNS) and poststreptococcal glomerulonephritis (PSGN).

A study from the University of Pittsburgh School of Medicine established a patient-reported outcome measure (Strep-PRO) for assessing symptoms of group A Streptococcus pharyngitis from the child's point of view.[8] Preliminary data suggest that the scale effectively measures both pain and overall functional status and support the use of Strep-PRO as a measure of outcome in future clinical trials.

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Causes

Streptococcus pyogenes can be present on healthy skin for at least a week before lesions appear. Spread is via skin contact, not via the respiratory tract, although impetigo serotypes may colonize the throat.

Person-to-person transmission is the route by which S pyogenes is primarily spread, although foodborne and waterborne outbreaks have been documented. Neither spread of organisms by fomites nor transmission from animals (eg, family pets) appears to play a significant role in contagion.

S pyogenes is highly communicable and can cause disease in healthy people of all ages who do not have type-specific immunity against the specific serotype responsible for infection.

Respiratory droplet spread is the major route for transmission of strains associated with upper respiratory tract infection, although skin-to-skin spread is known to occur with strains associated with streptococcal pyoderma.

Children with untreated acute infections spread organisms by airborne salivary droplet and nasal discharge. The incubation period for pharyngitis is 2-5 days. Children are usually not infectious within 24 hours after appropriate antibiotic therapy has been started, an observation that has important implications for return to the daycare or school environment. Individuals who are streptococcal carriers (chronic asymptomatic pharyngeal and nasopharyngeal colonization) are not usually at risk of spreading disease to others because of the generally small reservoir of often-avirulent organisms.

Fingernails and the perianal region can harbor streptococci and can play a role in disseminating impetigo.

Multiple streptococcal infections in the same family are common. Both impetigo and pharyngitis are more likely to occur among children living in crowded homes and in suboptimal hygienic conditions.

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Contributor Information and Disclosures
Author

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

José Rafael Romero, MD  Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev. Jul 2000;13(3):470-511. [Medline].

  2. Beal B. Assigning emm Types and Subtypes. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/biotech/strep/assigning.htm. Accessed January 2, 2008.

  3. McGregor KF, Spratt BG, Kalia A, et al. Multilocus sequence typing of Streptococcus pyogenes representing most known emm types and distinctions among subpopulation genetic structures. J Bacteriol. Jul 2004;186(13):4285-94. [Medline].

  4. Kaplan EL, Chhatwal GS, Rohde M. Reduced ability of penicillin to eradicate ingested group A streptococci from epithelial cells: clinical and pathogenetic implications. Clin Infect Dis. Dec 1 2006;43(11):1398-406. [Medline].

  5. Erdem G, Mizumoto C, Esaki D, et al. Group A streptococcal isolates temporally associated with acute rheumatic fever in Hawaii: differences from the continental United States. Clin Infect Dis. Aug 1 2007;45(3):e20-4. [Medline].

  6. Martin JM, Green M, Barbadora KA, Wald ER. Group A streptococci among school-aged children: clinical characteristics and the carrier state. Pediatrics. Nov 2004;114(5):1212-9. [Medline].

  7. O'Loughlin RE, Roberson A, Cieslak PR, et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis. Oct 1 2007;45(7):853-62. [Medline].

  8. Shaikh N, Martin JM, Casey JR, et al. Development of a patient-reported outcome measure for children with streptococcal pharyngitis. Pediatrics. Oct 2009;124(4):e557-63. [Medline].

  9. [Guideline] The Working Group on Severe Streptococcal Infections. Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. JAMA. Jan 20 1993;269(3):390-1. [Medline].

  10. Markowitz M, Gerber MA, Kaplan EL. Treatment of streptococcal pharyngotonsillitis: reports of penicillin's demise are premature. J Pediatr. Nov 1993;123(5):679-85. [Medline].

  11. [Guideline] Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. Mar 24 2009;119(11):1541-51. [Medline].

  12. Dale JB. Group A streptococcal vaccines. Infect Dis Clin North Am. Mar 1999;13(1):227-43, viii. [Medline].

  13. Steer AC, Batzloff MR, Mulholland K, Carapetis JR. Group A streptococcal vaccines: facts versus fantasy. Curr Opin Infect Dis. Dec 2009;22(6):544-52. [Medline].

  14. Bisno AL. Group A streptococcal infections and acute rheumatic fever. N Engl J Med. Sep 12 1991;325(11):783-93. [Medline].

  15. Cohen-Poradosu R, Kasper DL. Group A streptococcus epidemiology and vaccine implications. Clin Infect Dis. Oct 1 2007;45(7):863-5. [Medline].

  16. Dajani AS. Current therapy of group A streptococcal pharyngitis. Pediatr Ann. May 1998;27(5):277-80. [Medline].

  17. Gibofsky A, Kerwar S, Zabriskie JB. Rheumatic fever. The relationships between host, microbe, and genetics. Rheum Dis Clin North Am. May 1998;24(2):237-59. [Medline].

  18. Kaplan EL. Recent epidemiology of group A streptococcal infections in North America and abroad: an overview. Pediatrics. Jun 1996;97(6 Pt 2):945-8. [Medline].

  19. Olive C. Progress in M-protein-based subunit vaccines to prevent rheumatic fever and rheumatic heart disease. Curr Opin Mol Ther. Feb 2007;9(1):25-34. [Medline].

  20. Peter G, Smith AL. Group A streptococcal infections of the skin and pharynx (first of two parts). N Engl J Med. Aug 11 1977;297(6):311-7. [Medline].

  21. Randolph MF, Gerber MA, DeMeo KK, et al. Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis. J Pediatr. Jun 1985;106(6):870-5. [Medline].

  22. Shulman ST. Streptococcal pharyngitis: diagnostic considerations. Pediatr Infect Dis J. Jun 1994;13(6):567-71. [Medline].

  23. Shulman ST, Stollerman G, Beall B, Dale JB, Tanz RR. Temporal changes in streptococcal M protein types and the near-disappearance of acute rheumatic fever in the United States. Clin Infect Dis. Feb 15 2006;42(4):441-7. [Medline].

  24. Steer AC, Danchin MH, Carapetis JR. Group A streptococcal infections in children. J Paediatr Child Health. Apr 2007;43(4):203-13. [Medline].

  25. Stevens DL. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerg Infect Dis. Jul-Sep 1995;1(3):69-78. [Medline].

  26. Stevens DL. The flesh-eating bacterium: what's next?. J Infect Dis. Mar 1999;179 Suppl 2:S366-74. [Medline].

  27. Stevens DL, Gibbons AE, Bergstrom R, et al. The Eagle effect revisited: efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. J Infect Dis. Jul 1988;158(1):23-8. [Medline].

  28. Tanz RR, Poncher JR, Corydon KE. Clindamycin treatment of chronic pharyngeal carriage of group A streptococci. J Pediatr. Jul 1991;119(1 ( Pt 1)):123-8. [Medline].

  29. Tsevat J, Kotagal UR. Management of sore throats in children: a cost-effectiveness analysis. Arch Pediatr Adolesc Med. Jul 1999;153(7):681-8. [Medline].

  30. Wannamaker LW. Differences between streptococcal infections of the throat and of the skin. I. N Engl J Med. Jan 1 1970;282(1):23-31. [Medline].

  31. Zerr DM, Alexander ER, Duchin JS, et al. A case-control study of necrotizing fasciitis during primary varicella. Pediatrics. Apr 1999;103(4 Pt 1):783-90. [Medline].

 
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Invasive soft tissue infection due to Streptococcus pyogenes. This child developed fever and soft tissue swelling on the fifth day of varicella-zoster infection. Leading edge aspirate of cellulitis grew S pyogenes. Although the patient responded to intravenous penicillin and clindamycin, operative debridement was necessary because of clinical suspicion of early necrotizing fasciitis.
 
 
 
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