Overview
What is group A Streptococcus (GAS)?
Which disorders are caused by group A streptococcal (GAS) infection?
How many serologic groups have been identified for beta-hemolytic streptococci (BHS)?
What is the role of emm typing for the classification of group A streptococci (GAS)?
What distinguishes group A streptococci (GAS) from other serologic groups?
What is the basis for presumptive identification of a strain as a group A Streptococcus (GAS)?
Which disorders are included in the suppurative spectrum of group A streptococci (GAS) diseases?
What are the nonsuppurative sequelae of group A streptococci (GAS) infections?
How do group A streptococcal (GAS) infections cause scarlet fever and toxic shock syndrome (TSS)?
What is group A streptococci (GAS)?
What is the pathophysiology of group A streptococcal (GAS) infection?
Which cell wall antigens are found in group A streptococcal (GAS) infection?
What allows the survival of group A streptococci (GAS) and initiation of the disease process?
What is the role of surface components of group A streptococci (GAS) in adhesion?
What is the 2-step model of adhesion in group A streptococcal (GAS) infection?
What drives the evolving molecular activity of group A streptococci (GAS)?
What causes host cell damage and inflammatory response in group A streptococcal (GAS) infections?
What role do hemolysins have in group A streptococcal (GAS) infections?
What role do nucleases have in group A streptococcal (GAS) infections?
Which extracellular products may have a role in group A streptococcal (GAS) infections?
How often is acute pharyngitis caused by group A streptococci (GAS)?
Does group A Streptococcus (GAS) cause pneumonia?
What is the pathogenesis of necrotizing fasciitis in group A streptococcal (GAS) infection?
Does rheumatic fever (ARF) have a genetic predisposition?
What is the pathogenesis of acute rheumatic fever (ARF) in group A streptococcal (GAS) infections?
Does group A streptococcal (GAS) infection cause glomerulonephritis?
Does group A streptococcal (GAS) infection cause toxic shock syndrome (TSS)?
What is the pathogenesis of scarlet fever in patients with group A streptococcal (GAS) infection?
How often does scarlet fever occur in patients with group A streptococcal (GAS) infections?
Does group A streptococcal (GAS) infection cause central nervous system (CNS) disease?
Who is at risk for infection by group A streptococci (GAS)?
How is group A Streptococcus (GAS) transmitted?
What is the major route for transmission of group A streptococci (GAS)?
How do children with untreated acute infections spread group A streptococci (GAS)?
Can asymptomatic carriers transmit group A Streptococcus (GAS)?
What is the epidemiology of group A streptococcal (GAS) infections?
Does group A streptococcal (GAS) infection have a sex or racial predilection?
What are the age-related differences in the prevalence of group A streptococcal (GAS) infections?
How do suppurative complications occur in group A streptococcal (GAS) infections?
How common is empyema in patients with group A streptococcal (GAS) pneumonia?
What patient education resources are available for group A streptococcal (GAS) infections?
Presentation
What are the signs and symptoms of group A streptococcal (GAS) erysipelas?
Which diseases are caused by group A streptococcal (GAS) infection?
What are the symptoms of strep throat?
Which symptoms are exclusionary in the diagnosis of streptococcal pharyngitis (strep throat)?
What are the symptoms of streptococcal pharyngitis (strep throat) in infants and toddlers?
What are the less common symptoms of streptococcal pharyngitis (strep throat) in children?
What is the etiology of scarlet fever in patients with group A streptococcal (GAS) infections?
What are the signs and symptoms of group A streptococcal (GAS) cellulitis?
Do the risk factors for group A streptococcal (GAS) bacteremia vary by age?
What are the signs and symptoms of group A streptococcal (GAS) toxic shock syndrome (STSS)?
What are the Jones criteria for diagnosis of acute rheumatic fever (ARF)?
What are the signs and symptoms of poststreptococcal glomerulonephritis (PSGN)?
What are physical findings of streptococcal pharyngitis (strep throat)?
What are the physical exam findings of scarlet fever, and how does the rash develop?
Which physical findings suggest streptococcal pharyngitis (strep throat)?
Can a diagnosis of streptococcal pharyngitis (strep throat) be made clinically?
What are the signs and symptoms of streptococcal cellulitis?
What respiratory findings suggest group A streptococcal (GAS) infection?
Which disorders should be included in the differential diagnoses of scarlet fever?
Which symptoms suggest poststreptococcal glomerulonephritis (PSGN)?
What are the signs of sepsis in patients with group A streptococcal (GAS) infections?
What are the diagnostic criteria for streptococcal toxic shock syndrome (STSS)?
DDX
Workup
Which tests may be used in the workup of group A streptococcal (GAS) infection?
What is the criterion standard diagnostic test for streptococcal pharyngitis (strep throat)?
Which culture techniques are used to identify group A streptococcal (GAS) infections?
How is a diagnosis of poststreptococcal glomerulonephritis (PSGN) confirmed?
When is throat culture for group A streptococcal (GAS) infection contraindicated?
What testing is required for a diagnosis of acute rheumatic fever (ARF)?
What is the role of imaging studies in the workup of group A streptococcal (GAS) infection?
Which histologic findings suggest group A streptococcal (GAS) infection?
Treatment
Which procedures may be necessary for the management of group A streptococcal (GAS) infections?
What is the treatment for shock in patients with group A streptococcal (GAS) infection?
When is tonsillectomy indicated in children with streptococcal pharyngitis (strep throat)?
Which patients with group A streptococcal (GAS) infection should be hospitalized?
How is necrotizing fasciitis (streptococcal gangrene/fasciitis) managed?
When is rehabilitative care necessary in the treatment of group A streptococcal (GAS) infections?
What is the goal of therapy for streptococcal pharyngitis (strep throat)?
Is cephalosporin effective for the treatment of group A streptococcal (GAS) tonsillopharyngitis?
How is streptococcal pharyngitis (strep throat) managed if treatment fails and symptoms recur?
What is the most common reason for antibiotic failure in streptococcal pharyngitis (strep throat)?
What is the rate of group A streptococci (GAS) macrolide resistance?
What is the role of polyspecific IVIG in the treatment of streptococcal toxic shock syndrome (STSS)?
What is the role of clindamycin in the treatment of group A streptococcal (GAS) infections?
How likely are asymptomatic carriers to transmit group A streptococci (GAS) to close contacts?
When are follow-up throat cultures indicated in group A streptococcal (GAS) infections?
How are group A streptococcal (GAS) infections prevented?
Which specialists may be consulted in the treatment of group A streptococcal (GAS) infections?
Guidelines
What are the IDSA guidelines for the diagnosis of group A streptococcal (GAS) infections?
What are the IDSA guidelines for the treatment of group A streptococcal (GAS) infections?
Medications
What is the first-line drug of choice for treatment of group A streptococcal (GAS) infections?
Do group A streptococcal (GAS) isolates exhibit resistance to macrolides?
Are group A streptococcal (GAS) isolates susceptible to levofloxacin?
Are group A streptococcal (GAS) strains susceptible to 8 beta-lactam agents?
What is the rate of antibiotic resistance among group A streptococcal (GAS) isolates?
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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 a varicella-zoster infection. Leading edge aspirate of cellulitis grew S pyogenes. Although the patient responded to intravenous penicillin and clindamycin, operative débridement was necessary because of clinical suspicion of early necrotizing fasciitis.
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Streptococcus group A infections. Beta hemolysis is demonstrated on blood agar media.
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Streptococcus group A infections. M protein.
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Streptococcus group A infections. Erysipelas is a group A streptococcal infection of skin and subcutaneous tissue.
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Streptococcus group A infections. White strawberry tongue observed in streptococcal pharyngitis. Image courtesy of J. Bashera.
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Streptococcus group A infections. Streptococcal rash. Image courtesy of J. Bashera.
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Group A Streptococcus on Gram stain of blood isolated from a patient who developed toxic shock syndrome.
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Streptococcus group A infections. Necrotizing fasciitis of the left hand in a patient who had severe pain in the affected area.
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Streptococcus group A infections. Patient who had had necrotizing fasciitis of the left hand and severe pain in the affected area (from Image 8). This photo was taken at a later date, and the wound is healing. The patient required skin grafting.
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Streptococcus group A infections. Gangrenous streptococcal cellulitis in a patient with diabetes.
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Erythema secondary to group A streptococcal cellulitis.
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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 a varicella-zoster infection. Leading edge aspirate of cellulitis grew S pyogenes. Although the patient responded to intravenous penicillin and clindamycin, operative débridement was necessary because of clinical suspicion of early necrotizing fasciitis.
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Streptococcus group A infections. Necrotizing fasciitis rapidly progresses from erythema to bullae formation and necrosis of skin and subcutaneous tissue.
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Throat swab. Video courtesy of Therese Canares, MD; Marleny Franco, MD; and Jonathan Valente, MD (Rhode Island Hospital, Brown University).