Streptococcal Disease

Streptococcal Disease

General Considerations 

In paediatric practice streptococcal infection is among the commonest causes of bacterial disease. Apart from the acute illness, it also produces serious non suppurative effects i.e. rheumatic fever and acute post streptococcal glomerulonephritis.

Treptococci produce enzymes toxins and haemolysins. Among the important ones are streptokinase, streptodornase, hyaluronidase, streptolysins (O&S), and erythrogenic toxins etc.

Epidemiology

Streptococcal infections are seen worldwide, in all races, and in both sexes. Streptococcal respiratory infections are common in winter months, whereas skin infections are often encountered in warmer season.

Infection by group A beta haemolytic streptococci is spread by droplets, therefore, overcrowding favours spread.

Clinical Manifestations

Infection with group A beta haemolytic streptococci may develop at various sites. Commonest are:

Streptococcal Pharyngitis: Acute onset of sore throat is accompanied with fever and vomiting. Often there is anorexia, dysphagia  and restlessness. Tonsils and pharynx may be acutely inflamed and covered with a purulent yellowish and patchy exudate. Palatal erythema, petechiae, and oedema may be present. Cervical lymphadenopathy is usual. There may be spread of infection producing sinusitis and otitis media. Rarely it may be complicated with parapharyngeal or retropharngeal abscess.

Scarlet Fever: This is a result of infection with  streptococci that elaborate erythrogenic toxin.

• Incubation period is 1-7 days.
• It has an acute onset, high fever, often with chills, sore throat, vomiting and headache.
• Rash appears 12-48 hours later which consists of red, punctate macules or fine papules. In individuals with dark skin, rash may be palpated more readily that it is seen, having the feeling of coarse sand paper. It appears in axillae, groin and neck, but within twenty four hours becomes generalized. Areas around the mouth are free of rash hence give an appearance of circumoral pallor.
• Pharynx and tonsils are inflamed, oedematous and may be covered with exudate.
• Tongue is also swollen and red. During the early days of illness it has a white coat through which red and oedematous papillae project (white strawberry tongue). After few days white coat desquamates and the whole surface of the tongue is red with prominent papillae (red strawberry tongue).
• The palate and uvula may also be oedematous and covered with petechiae.
• The temperature peaks on 2nd day of illness and dradually returns to normal over the next five to seven days. In patients who receive penicillin therapy the temperature usually drops to normal within twenty four hours and various stages of the illness may not be seen.

Pneumonia: It is not an uncommon complication of streptococcal infection. It frequently begins as bronchopneumonia, but may extend to form consolidation. Fever, chills, cough and chest pain are common symptoms. Pleuritis and empyema are complications.

Skin infections: 

• Impetigo
• Erysipelas