What Is the Treatment For Group A Strep?

Group A Streptococcus (GAS), also known as Streptococcus pyogenes, is one of the most important pathogens in human bacterial infections. GAS can invade any part of the human body, but upper respiratory tract infections are the most common, followed by skin and soft tissue infections. GAS can cause purulent diseases and non-purulent complications. GAS is also an indirect cause of rheumatic fever and acute glomerulonephritis, an allergic disease. In recent years, the serious infection caused by GAS, the increase in the incidence of invasive group A streptococcal infections, and the serious consequences caused by it have also caused greater attention to this type of bacterial infection.

Basic Information

nickname: Streptococcus pyogenes infection
English name: streptococcal infection
Visiting department: Internal medicine

Common locations: Pharynx, respiratory tract, skin and soft tissue
Common causes: Group A Streptococcus
Common symptoms: High fever, sore throat, sore body, fatigue, headache, etc.

Causes of group A streptococcal infections

The pathogen is group A streptococcus. Pathogens can reside in the mouth and can survive for weeks in sputum and exudates. The pathogenicity of streptococcus is related to the bacterial composition and the toxins and enzymes it produces. Streptococcal infection can still be transmitted through skin wounds, and nasopharyngeal or wound infection with toxic streptococci is an important cause of skin wound infections. Dry secretion particles or dander can be spread through the air or indirectly through hands or handkerchiefs. Streptococci spread in the air or pollute the environment and appliances. They can also spread such bacterial infections. Postpartum infections can be transmitted by a midwife with pharyngeal infections or infected infants in the nursery.

At present, transmission of streptococcal infections from foods contaminated with streptococci, such as milk or dairy products, is rare. Invasive group A streptococcal infections are often life-threatening with toxic shock syndrome (TSS). Infection often occurs in healthy adults, mostly in people between the ages of 20 and 50, and incidence in children has also been reported. The disease can spread from person to person.

Clinical manifestations of streptococcal infection in group A

Respiratory tract infection

(1) The incubation period of acute pharyngitis and acute tonsillitis is usually 2 to 4 days. Sudden onset of illness, chills or chills with high fever of about 39 , sore throat is obvious, and intensified when swallowing. In addition, there are still soreness, fatigue, and headache. Nausea, vomiting and diarrhea are more common in children.

(2) Scarlet fever In addition to the clinical manifestations of acute tonsillitis , scarlet fever also has special manifestations such as rash. The rash usually appears within 24 hours after the onset, and there are still other special manifestations. The typical rash is based on diffuse redness and redness of the whole body, widely spreading scarlet rashes with a dense, uniform, point-like point-like size, which refers to a decrease in post-congestion, and a fine sand-like sensation upon contact. May present with a bleeding rash.

2. Skin and soft tissue infections

(1) The clinical manifestations of erysipelas are local skin inflammation with chills, fever, and obvious symptoms of poisoning.

(2) Streptococcal pustular disease is impetigo with superficial skin infection. It is more common in children aged 2 to 5 years or military soldiers with poor sanitary conditions, and it is more common in summer.

(3) Other infections with streptococcal cellulitis can occur during burns or wound infections; recurrent cellulitis often occurs in cases of impaired lymphatic circulation, such as those with filariasis and breast tumor radical surgery for axillary lymph node resection .

(4) The clinical manifestations of invasive group A streptococcal infection are toxic shock syndrome, necrotizing fasciitis and myositis, cellulitis, and often accompanied by multiple organ failure.

Group A Streptococcus infection test

Surrounding blood

The total number of white blood cells and neutrophils are increased, those with pyogenic complications are higher, and those with severe infections, such as TSS patients, can be left-shifted, and eosinophils can increase to 5% to 10% after scarring . TSS patients' platelet counts are normal at the onset and then decline.

2. Urine routine

Proteinuria can occur in patients with high fever, and urine protein increases with nephritis, and red blood cells and casts appear. Uncomplicated urine disappears after fever regression.

3. Etiological examination

For the etiological examination of patients with acute pharyngitis and tonsillitis, throat swab culture should be performed first. If sampling, culture and methods are correct, most patients can get positive results, only about 10% of patients are false negative.

4. Other

Patients with TSS may have symptoms such as reduced pulmonary function, decreased blood oxygen saturation, decreased liver function, renal function, and hypoproteinemia.

Diagnosis of group A streptococcal infection

The positive results of throat swab culture are still the "gold standard" for the diagnosis of group A streptococcal pharyngitis or tonsillitis. Rapid antigen detection test kits (RADTs) developed in recent years have been used as auxiliary diagnostic methods for throat swab culture. When RADTs are negative, the results of throat swab culture are needed to confirm the diagnosis.

Group A streptococcal infection treatment

1. Patients with acute group A streptococcal pharyngitis or tonsillitis should be treated with antibacterial drugs, and sufficient treatment courses must be completed to achieve the purpose of removing bacteria in the lesion.

There are many antibacterial drugs, but penicillin is still the first choice. Penicillin and its analogues: penicillin intramuscular injection; those who use procaine penicillin daily intramuscular injection. Patients who are allergic to penicillin can choose various preparations of erythromycin. Patients are allergic to penicillin, but they are not severe enough to respond to anaphylactic shock. They can also be cautiously replacing one of the first-generation or second-generation cephalosporin antibiotics.

2. The selection of antibacterial drugs for erysipelas and streptococcal pustules is the same as for pharyngitis and tonsillitis.

3. For antibacterial treatment of invasive group A streptococcal infections, a broad-spectrum antibacterial agent should be promptly administered as an empirical treatment at the time of onset. Once the pathogenic bacteria are identified, a high dose of penicillin should be administered intravenously, and those with penicillin allergy can be changed First-generation cephalosporins, except for patients with a history of anaphylactic shock to penicillins.

4. In addition to antibacterial treatment, it should be under close supervision at the beginning of the disease, and it is often necessary to implement assisted breathing applications, hemodialysis, necrotizing fascial resection, and abscess drainage.

5. The application of specific antibodies to neutralize toxins is still under study. It has also been reported that intravenous administration of immunoglobulins can help reduce mortality.