STREPTOCOCCUS

GROUP A and B

Group B Streptococcus● Group B Streptococcus is a

bacterial infection of Streptococcus agalactiae. It is a facultative anaerobic bacteria that is gram positive with a cocci morphology found in chains. Many GBS strains are mainly encapsulated and are then serologically classified according to the presence of type-specific capsular polysaccharides. These capsules are important virulence factors and stimulators of antibody-associated immunity.

● Group B Streptococcus in the Neonate: Early and late-onset

● Transmission of bacteria from mother to newborn occurs when the baby passes through the birth canal and comes into contact with the mother’s epithelial cells.

● Early-onset GBS is more dangerous and usually starts with a fever or abnormally low temperature, difficulty feeding, lethargy, breathing difficulties, rapid heart rate or slow heart rate. The most life threatening forms of infection are pneumonia, sepsis, and meningitis.

● Group B Streptococcus in the Neonate: Early and late-onset

● Late-onset disease is similar to early-onset, yet less severe.

● Test- Blood cx, CSF cx, urine cx, CBC, chest x-ray, ABGs, and coagulation studies.

● Treatment- IV antibiotics, IV fluid, and medications to reverse shock, oxygen therapy, correction of clotting abnormalities and assisted ventilation.

● Prevention and Treatment of GBS: the pregnant woman

● Risk-based approach- Emphasizes preventive treatment for expectant woman who are at high risk for GBS transmission. “A previous infant with invasive GBS, delivering at < 37 weeks gestation, having an intrapartum temperature 100.4°F, or rupture of membranes for 18 hours” according to the CDC. If a woman meet one or more of these criteria, the recommended treatment is to administer penicillin as and intrapartum antibiotic.

● Prevention and Treatment of GBS: the pregnant woman

● Culture-based screening approach- Testing for GBS in an expectant mother’s 35-37 week of pregnancy.

● Collection of lower vaginal and rectal cultures.● If a woman tests positive for GBS and is

determined to be a carrier, she is offered intrapartum chemoprophylaxis, based on the test results.

● Neonates born to these mothers with GBS colonization should be monitored for 24 hours for signs of sepsis.

Group A Streptococcus

● Group A Streptococcal pharyngitis is an acute infection of the oropharynx and or nasopharynx. It is a gram-positive cocci that tends to grow in pairs and short chains. It can be identified by their sensitivity to bacitracin.

Group A Streptococcus

● Signs and Symptoms● Often described as a sore

scratchy throat, febrile with swollen glands and, especially in children, nausea and/or vomiting.

● There is a marked increase in redness and swelling of the tonsils possibly accompanied by white patches or streaks on the tonsils.

● The patient may have difficulty swallowing, and enlarged lymph glands in the neck.

Group A Streptococcus

● There may be tiny pinpoint red marks on the soft palate referred to as petechiae.

● Other findings may include a beefy red swollen uvula, excoriated nares (especially in infants), and a scarlitiniform rash.

Group A Streptococcus

● For the clinician to make a definitive diagnosis, he or she must do a throat culture.

● Rapid Strep Antigen● Blood agar culture

● Management of Group A Streptococcal Pharyngitis P a tie n t W ith a S ore T h ro a t

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● Management of Group A Streptococcal Pharyngitis

● Complications● Peritonsillar abcess● Scarlet fever● Poststreptococcal glomerulonephritis● Rheumatic fever

PANDAS

● PANDAS- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection

● Case Study● Two year, nine month old male presents in the Emergency Department with inconsolable crying for one day.

PANDAS

• Diagnositic Criteria for PANDAS• 1. Presence of Obsessive-compulsive disorder and/or a tic disorder• 2. Pediatric onset of symptoms (age 3 years to puberty)• 3. Episodic course of symptom severity• 4. Association with Group A Beta-Hemolytic Streptococcal infection ( a

positive throat culture for strep or history of scarlet fever)• 5. Association with neurological abnormalities (motoric hyperactivity, or

adventitious movements, such as choreiform movements