Group A streptococcal infections and acute rheumatic fever

Article Abstract:

Group A streptococcus, also called Streptococcus pyogenes, is a class of bacteria which causes a wide range of infections, including scarlet fever, pneumonia, and impetigo. Perhaps the most well known is acute pharyngitis, commonly called 'strep throat.' In the past, strep infections often led to serious complications, including rheumatic fever and glomerulonephritis. Rheumatic fever attacked the heart (most often the heart valves) and glomerulonephritis, the kidney. These complications have become less common in the 20th century. It is certain that the advent of antibiotics has helped to dramatically reduce the number of deaths due to rheumatic fever in the United States. However, the decline began prior to the discovery of penicillin. It is widely presumed that improvements in sanitation and public health have contributed to this decline. However, strep throat remains common, and why rheumatic fever should have declined so dramatically is simply not known. However, there has be a resurgence of rheumatic fever in the United States in the last several years. Since the previous review of the characteristics of Streptococcus pyogenes infections in The New England Journal of Medicine appeared 14 years ago, the resurgence of rheumatic fever perhaps provides a good reason to provide a more recent review. The basic characteristics of group A strep and the diseases it causes are discussed. Among the basic characteristics important to understanding group A strep is the M protein. This unusual protein covers the bacteria with a fuzzy coat which helps prevent them from being digested by white blood cells attempting to protect the body. There are different strains of group A streptococcus, each associated with different possible complications. For example, rheumatic fever is associated with some types of group A strep but not with others. How the bacterial infection actually leads to rheumatic fever remains unknown. History has shown that many diseases wax and wane for reasons unrelated to human medical intervention. It is not known if the current resurgence of rheumatic fever marks the beginning of a changing trend or merely a minor aberration in the continuing decline of the disease. Fortunately, even the recent resurgence is of a very small scale when compared with the prevalence of rheumatic fever in the past. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Demographic aspects, Rheumatic fever

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Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A

Article Abstract:

Group A streptococci are the bacteria responsible for throat infections and rheumatic fever, an infection affecting the heart muscle. Over the years, the incidence of the disease has been reduced because of early and preventive treatment with antibiotic drugs. Some investigators believe that the organism causing the rheumatic fever has changed and has developed greater virulence. In the Rocky Mountain area, 20 patients acquired a group A streptococcal infection with marked destruction of the area infected. Symptoms of shock appeared in 95 percent of the patients, 12 patients had the infection in their blood, 80 percent had some kidney involvement, 55 percent had acute respiratory distress syndrome and 30 percent of the patients died. When the bacteria were evaluated, a toxin similar to that found in scarlet fever was found in many samples. The serious toxic shock-like symptoms produced by this group A streptococcal infection warrant further studies. In the Rocky Mountain region, at least, a more virulent form of A streptococci has reappeared and produces the toxin associated with scarlet fever.

Analysis, Case studies, Causes of, Virulence (Microbiology), Shock

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Streptococcal infections of skin and soft tissues

Article Abstract:

Streptococcus (S.) pyogenes is a ubiquitous organism that can cause a wide variety of skin and soft tissue infections that are sometimes fatal. These group A streptococcal infections range from localized skin disease to necrotizing fasciitis (gangrene) with toxic shock and organ failure. The need for surgical removal of necrotic tissue in cases of deep-seated infection makes recognition of early symptoms of fasciitis crucial. The role of streptococcal toxins in toxic shock syndrome may be explained by their action as superantigens, which can activate an abnormal, massive immune response in infected individuals. The greater effectiveness of the antibiotic clindamycin over penicillin may be attributed to its ability to suppress certain immune responses as well as inhibit protein synthesis in S. pyogenes.

Care and treatment, Infection, Skin, Toxic shock syndrome, Gangrene

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