Group A strep infection

Group A strep infections

The Group A beta hemolytic Streptococcus germ causes numerous infections, chiefly of the respiratory tract, but also involving other organ systems, chiefly the skin and lungs. The throat infections themselves are rarely serious and ordinarily, like most repiratory infections, are handled by the immune system without too much difficulty. Unfortunately, the immune system of humans tends to get confused in fighting off this germ, and forms antibodies that can cross react with the blood vessels in various organs of the body. This is called a vasculitis. The characteristic vasculitis of Strep infection is scarlet fever or scarletina.

Streptococal pharyngitis (strep throat) is a bacterial infection most common in school age children during the winter and spring months. It is spread by coughing and sneezing of infectious droplets with subsequent inhalation by the next victim. Direct contact with the secretions via touching contaminated items or drinking from the same glass works well to spread the disease. The incubation period is two to five days. Siblings of cases have a roughly 50% chance of becoming infected, whereas only about 20% of their parents will get the disease.

Strep symptoms include sore throat, fever, ear pain, abdominal pain, and headache. There may be swollen and perhaps tender lymph nodes in the neck, bright red tonsils, and dark red hemorrhagic petechiae on the soft palate and uvula. A characteristic sandpapery rash on the arms, trunk and especially in the panty area is sometimes present and highly specific (scarletina). Perhaps 20% of infected individuals have no symptoms, but are still quite contagious, which limits efforts to contain the spread of the disease.

Diagnosis is by symptoms and physical findings, and should be confirmed by laboratory test, either overnight strep culture or a rapid antigen detection test. The rapid tests are not 100% reliable, but while the rapid tests miss a few cases (false negatives) the additional cost of the overnight backup test for all negatives is thought by some researchers to be not justified.

Streptococcal disease runs its course and will dissipate without antibiotic treatment, however it is treated for several reasons. First and obviously, treatment returns the patient to wellbeing sooner than nontreatment (by only about a day, in controlled studies). Second, the spread of the disease is reduced by eradicating active sources of the germ. Third, it is treated to prevent rare but very serious complications of rheumatic fever, sepsis, and pneumonia.

Streptococcal pharyngitis is easily treated with penicillin and parents should not push for broader spectrum antibiotics such as cephalosporins "because he is so sick - give him something strong!" The patient will not get better any sooner, and broad spectrum antibiotics increase the risk of other bacteria in the body becoming resistant to antibiotics. Erythromycin is the alternate drug of choice for the penicillin allergic child. Your child should have at least 24 hours of antibiotic treatment and be fever free before returning to school.

To prevent rheumatic fever, it is critically important for your child to finish the entire prescribed course of antibiotic for streptococcal throat infection.

Now the most feared and dangerous complication of infection with Group A streptococcus is necrotising fasciitis. This infection occurs in children most frequently as a complication of chickenpox infection with secondary infection of the sores as they heal. The possibility of this potentially devastating complication is probably one of the better arguments for use of the chickenpox vaccine.

A somewhat unusual or unexpected strep infection is perianal disease. This presents as an intensely red rash around the anus, which is usually mistaken for a yeast infection (Candida). However, antifungal medications such as nystatin cream are useless. The rash disappears promptly with oral penicillin or erythromycin treatment. Intertrigo, infection of moist crease areas, is most often due to Candida albicans (yeast) infection. It may however be caused by Group A Streptococcus, as well. If your child has a persistent "yeast infection" in an armpit or groin crease that does not clear with antifungal treatment, it might be such a streptococcal infection. A culture test of the skin will tell the tale.

Group A streptococcus can also cause toxic shock syndrome.

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