GABHS, Group A beta hemolytic streptococcus

Clinic

• Group A β-hemolytic streptococcus can cause infections of the throat and skin.
• These may vary from very mild conditions to severe, life-threatening diseases due to host immune function stability.

Most common

• Impetigo / Cellulitis / Erysipelas / Necrotizing fasciitis / Lymphangitis

• Pharyngitis: 15–30% of childhood cases and 10% of adults

Less common

• Bacteremia / Severe infections /Shock / Multisystem organ failure
• Septic arthritis / Osteomyelitis
• Vaginitis Esp in pre-pubescent girls
• Meningitis
• Sinusitis
• Pneumonia: Pulmonary alveolus

Note that meningitis, sinusitis and pneumonia can all be caused by Group A Strep, but are much more commonly associated with Streptococcus pneumoniae and should not be confused.)

Complications

• Poststreptococcal glomerulonephritis

• Streptococcal toxic shock syndrome (STSS)

• Rheumatic fever

• PANDAS

Rubrics

1. THROAT - INFLAMMATION - Pharynx
2. THROAT - INFLAMMATION - Tonsils
3. Throat- Membrane
4. Skin - Eruption - Eczema
5. General - Abscess - Gangrenous
6. SKIN - ERYSIPELAS
7. CHEST - INFLAMMATION -HEART; Myoocardium
8. CHEST - INFLAMMATION -HEART; Periocardium
9. CHEST - INFLAMMATION -HEART; Endocardium
10. CHEST - INFLAMMATION - Lungs
11. EAR - INFLAMMATION - Media
12. SKIN - ERUPTIONS - impetigo
13. GENERALS - INFLAMMATION - Joints; of
14. GENERALS - INFLAMMATION - Bones; of
15. GENERALS - INFLAMMATION - Bones; of- Bone marrow of
16. GENERALS - INFLAMMATION - cellulitis
17. GENERALS - INFLAMMATION - Lymphatic vessels
18. GENERALS - INFLAMMATION - Muscles; of
19. FEMALE GENITALIA/SEX - INFLAMMATION - Vagina
20. KIDNEYS - INFLAMMATION
21. HEAD - INFLAMMATION - Meninges
22. GENERALS - CHOREA
23. Mind - Anxiety
24. Mind - Mood- changeable
25. GENERALS - SEPTICEMIA, blood poisoning
26. Mind - Gesture makes, Tic, Nervous
27. Mind - Gesture makes, Finger, mouth, children put fingers into the

Eliminated rubrics:	High intensified rubrics
THROAT - INFLAMMATION - Pharynx THROAT - INFLAMMATION - Tonsils Throat- Membrane Skin - Eruption - Eczema SKIN - ERYSIPELAS GENERALS - INFLAMMATION - Joints; of	Throat- Membrane Skin - Eruption - Eczema General - Abscess - Gangrenous SKIN - ERUPTIONS - impetigo CHEST - INFLAMMATION -HEART; Endocardium GENERALS - INFLAMMATION - Lymphatic vessels GENERALS - INFLAMMATION - Bones; of- Bone marrow of

Research

• Myositis: Streptococcal myositis is a rare, often fatal, acute infection of the muscle, caused by an invasive group A beta-haemolytic streptococcus. It is characterized by muscle necrosis without abscess formation, and, in contrast to necrotising fasciitis, does not primarily affect the subcutaneous tissue or skin.

Ref: Dalal M, Sterne G, Murray DS. Streptococcal myositis: a lesson. Br J Plast Surg. 2002 Dec;55(8):682-4. doi: 10.1054/bjps.2002.3953. PMID: 12550125.

• Sinusitis: Rhino-, influenza, and para-influenza viruses are the most frequent viral causes of sinusitis. The most common bacterial isolates from children and adult patients with community-acquired acute bacterial sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. Staphylococcus aureus and anaerobic organisms (Prevotella and Porphyromonas, Fusobacterium, and Peptostreptococcus spp.) are the commonest isolates in chronic rhinosinusitis (CRS).

Ref: Brook I. Microbiology of chronic rhinosinusitis. Eur J Clin Microbiol Infect Dis. 2016 Jul;35(7):1059-68. doi: 10.1007/s10096-016-2640-x. Epub 2016 Apr 16. PMID: 27086363.

• Dermatitis / Eczema

• Balanitis / Vaginitis: Streptococcus pyogenes (group A Streptococcus) is the etiological agent of perineal infection in children, consisting of perianal infection, vulvovaginitis and balanitis.

Ref: Randjelovic G., Otasevic S., Mladenovic-Antic S.et al. Streptococcus pyogenes as the cause of vulvovaginitis and balanitis in children. Pediatr Int. 2017; 59: 432

Special feature

GABHS Arthritis

• GBS had now become the most common pathogen for bacterial septic arthritis (37.7%), while Staphylococcus aureus was the second most common causative pathogen (23.4%).

• Unique clinical characteristics are

• More number of joint involvements which were more likely (70%) to be oligo-polyarthritis. (Oligoarthritis is defined as arthritis affecting 2 to 4 joints during the first six months of disease.)The majority of patients in other bacterial septic arthritis in our study were affected in one joint as monoarthritis.

• Knee is the most commonly affected joint in both groups.

Upper extremities and axial joint involvements were more common in GBS septic arthritis than other bacterial septic arthritis.

Tenosynovitis is extremely common in GBS septic arthritis (39.1%) which has seldomly presented before in other bacterial septic arthritis (2.1%).

CNS and ocular infections were commonly found in GBS septic arthritis more than other bacterial septic arthritis

GABHS Pharyngitis

Most common features are

• Sore throat
• Temperature greater than 100.4°F (38°C)
• Tonsillar exudates
• Cervical adenopathy

Lymphangitis

• Lymphangitis is inflammation of the lymphatic channels that occur as a result of infection at a site distal to the channel and may spread within hours.
• Group A beta-haemolytic streptococci are the most common causes of bacterial lymphangitis and, in severe cases, can lead to bacteraemia, sepsis and death

Ref: Yamamoto LG. Treatment of skin and soft tissue infections. Pediatr Emerg Care 2017;33:49–55. Review doi:10.1097/PEC.0000000000001001

Related disease

• Sydenham's chorea
• PANDAS
• Rheumatic fever

Remedies

1. ARS, MERC, SUL
2. LACH , PHOS, BELL
3. Hep, Kali-i, Nat-m, Nit-ac, Bry, Tub
4. Bar-c, Am-c