- Discussion:
-
gram positive coccus
- may be responsible for
toxic shock syndrome and
necrotizing fascitis;
- spetrum of streptococci pyogenes infections:
- most common cause of celluitis and lymphangitis;
- superficial form of infection is called impetigo which affects stratum corneum;
- ecthyma contagiosum describes shallow superficial dermal ulcers caused by a slightly deeper infectios;
- erysipelas is the term for streptococcal dermal cellulitis, often associated with lymphangitis
as it spreads along dermal lymphatics;
- cellulitis can spread to the dermal lymphatics as classical lymphangitis, commonly causeced by strep pyogenes;
-
necrotizing streptococal infections:
- acute gangrene: at level of fascia,
streptococci pyogenes, produces acute gangrene, a form of necrotizing fascitis;
- look for early rapid onset of marked tissue edema and redness w/ little pain, progressing to local
cyanosis & skin blistering;
- lymphangitis and lymphadenopathy are absent;
- soft tissue gas may be uncommon;
- treatment is parental penicillin, debridement, and measures to prevent edema;
- before antibiotics were available this was a surgical emergency mandating immediate amputation to
prevent streptococcal septicemia and death;
- Antibiotic Choices:
-
Pen G
-
1st Generation Cephalsporins
-
Clindamycin
-
Erythromycin
-
Penase Res Penicillins
- Chloramphenicol
-
Vancomycin -
Rifampin
- Misc:
- sulfa-derived antibiotics (sulfonamides / trimethoprim) are not generally effective in treating streptococcus infections;
Group A beta-hemolytic streptococcal osteomyelitis in children.
Streptococcus viridans vertebral osteomyelitis.
Bacteremia complicated by vertebral osteomyelitis due to Streptococcus bovis.
Group B streptococcal osteomyelitis in adults.
Vertebral osteomyelitis caused by group B streptococci (Streptococcus agalactiae) secondary to urinary tract infection.
Recurrent vertebral OM and psoas abscess caused by Strep constellatus and Fusobacterium nucleatum in a patient w/ atrial septal defect and an occult dental infection.
Clinical and diagnostic features of osteomyelitis occurring in the first three months of life.
Relapsing invasive group B streptococcal infection in adults.
Group B streptococcal vertebral osteomyelitis with bacteremia.
Streptococcal Toxic Shock Syndrome Presenting as Septic Knee Arthritis in a 5-Year-Old Child.
