Group A Streptococcal Infection Workup

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

Laboratory Studies

As noted, culture of group A streptococci is the criterion standard for diagnosis.

Depending on disease manifestations, cultures of pharyngeal secretions, blood, cerebrospinal fluid, joint aspirate, leading edge aspirate of cellulitis, skin biopsy specimen, epiglottic secretions, bronchoalveolar lavage fluid, thoracocentesis fluid, or abscess fluid may be sources for locating the organism. In cases of suspected necrotizing fasciitis, a frozen section biopsy obtained in the operating room may be of great value in confirming the diagnosis and may aid in defining how much surgical debridement of devitalized tissue is necessary.

As discussed elsewhere in this article, serologic assays (antistreptococcal antibodies) are a potential useful adjunct for diagnosis. Other ancillary laboratory tests (eg, CBC count, WBC count, erythrocyte sedimentation rate, C-reactive protein) may be useful depending on the manifestations of disease under consideration. This is discussed in a disease-by-disease fashion in Medical Care.

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Imaging Studies

Various imaging studies may be warranted for streptococcal pneumonia, septic arthritis, osteomyelitis, brain abscess, and for complications of streptococcal infection, such as acute rheumatic fever or glomerulonephritis.

Possible imaging studies include plain radiography, CT scanning, ultrasonography, echocardiography, and radioisotope renal scanning.

For CNS manifestations, such as chorea or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) syndrome, modalities such as MRI or positron emission tomography/single-photon emission CT (PET/SPECT) may be valuable. These are addressed on a disease-by-disease basis in Medical Care.

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Other Tests

Other tests, depending on disease syndrome, can be very diverse in nature. For example, a histopathologic analysis of skin biopsy specimens, which may need to be analyzed intraoperatively, is warranted in cases of suspected necrotizing fasciitis. Calculation of creatinine clearance may be valuable in assessing the extent of renal dysfunction for nephritis. These issues are reviewed by disease in Medical Care.

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Procedures

Necessary procedures for the management of the diverse nature of group A streptococcal infections may include endotracheal intubation, thoracocentesis, lumbar puncture, abscess or skin aspiration, and even surgical debridement of devitalized tissue. These issues are reviewed by disease in Medical Care.

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Histologic Findings

As noted above, histologic analysis of skin biopsies may be an important tool in the diagnosis of streptococcal necrotizing fasciitis. In this setting, one of the hallmarks of the histologic findings is the absence of inflammatory cells, which suggests the necrotic, avascular nature of the affected tissue.

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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.

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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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