Overview
Streptococcus spp. is the general term for a group of diseases caused by infection with streptococcus spp. The manifestations are varied and may include fever, sore throat, cough, sputum, rash, arthralgia, hematuria, foamy urine, etc. Generally, penicillin is used to fight the infection, supplemented by symptomatic treatment, early detection and treatment, the vast majority of the cures can be achieved, while a few have poor prognosis.
Definition
Streptococcal infection is a general term for a large group of diseases caused by bacterial infections of the genus Streptococcus.
Streptococci are chain-growing gram-positive cocci with 69 species and subspecies, widely distributed in nature, human and animal feces, and nasopharynx of healthy people, most of which are normal flora and do not cause disease.
Common pathogenic bacteria include group A Streptococcus, group B Streptococcus, Streptococcus Grass Green Streptococcus, and Streptococcus Pneumoniae, which can cause tonsillitis, scarlet fever, rheumatic fever, acute glomerulonephritis, pneumonia, and infective endocarditis, etc. [1].
Typing
Streptococcus types
There are many methods to classify streptococci, commonly used such as classification according to antigenic structure, biochemical reaction, hemolytic type and so on.
Classification according to antigenic structure
According to the antigenic structure, streptococci can be divided into groups A to H, K to V20.
Biochemical reaction classification
Such as according to the need for oxygen is divided into aerobic, partially anaerobic and anaerobic streptococci three categories, the first two types of human pathogenicity, anaerobic streptococci mainly for the mouth, the digestive tract, the genitourinary tract in the normal bacterial flora, in specific conditions pathogenic.
Classification of hemolytic types
According to the type of hemolysis caused by streptococci can be divided into type A, type B, type C hemolytic streptococci, group A streptococci are mostly type B hemolytic streptococci.
Type of infection
Different pathogenic bacteria cause different types of infection.
Group A Streptococcal Infections
Due to the interaction of the organism with different pathogenic factors, group A streptococcal infections can cause pharyngitis, tonsillitis, scarlet fever, skin abscesses, etc. They can also induce rheumatic fever, acute glomerulonephritis and other immune diseases.
Group B Streptococcus Infection
It mainly causes infections in postpartum, newborns and other immunocompromised people.
Streptococcus pneumoniae infection
Streptococcus pneumoniae mainly causes Streptococcus pneumoniae pneumonia, but can also cause other parts of the infection, such as osteomyelitis, meningitis, peritonitis, otitis media, mastoiditis and so on.
Streptococcus Grass Green Infection
It mainly causes infective endocarditis, but can also cause brain, liver and intra-abdominal infections.
Causes
Causes
The disease is mainly caused by streptococcal infections, and there are three basic conditions that lead to epidemics.
Sources of infection
Mainly streptococcal infections and carriers.
Route of transmission
Streptococcal infections can be transmitted through the respiratory tract by inhaling droplets containing the bacteria.
Streptococcus can also be transmitted through contact, hand contaminated with bacteria-containing sputum, blood, secretions, etc., or touching objects or utensils contaminated by these secretions, and then directly touching the mouth and nose with the hands and then infected.
Streptococcus can also invade the human body through broken skin and mucous membranes.
Susceptible people
People are generally susceptible to the disease, but the elderly and immunocompromised people are more susceptible.
Risk factors
People with the following risk factors are more likely to develop streptococcal infectious diseases, but this does not necessarily mean they will get sick.
Elderly people and children.
Chronic smokers and alcoholics.
People with skin trauma, such as postpartum, recent surgery, burns, etc.
Immunocompromised people, such as patients associated with organ transplantation, AIDS, diabetes mellitus, end-stage renal disease, malignant tumors, chronic obstructive pulmonary disease, asthma, and use of immunosuppressive drugs [2].
Symptoms
Main Symptoms
Group A streptococcal infection
Group A streptococcal infections can cause a variety of diseases, such as localized suppurative inflammation, scarlet fever, rheumatic fever, etc., and can have a variety of manifestations.
Localized purulent inflammation
Invasion of group A beta-hemolytic streptococcus through the pharynx can cause tonsillitis and pharyngitis, and it can also directly invade the nearby tissues through the lymph and cause sinusitis, otitis media, mastoiditis, etc. Invasion through the wound can cause puerperal infection and necrotizing fasciitis.
The manifestations are fever, sore throat, pus flow, earache, hearing loss, swelling and redness behind the ear.
Scarlet Fever
Scarlet fever is an acute respiratory infectious disease caused by group A beta-hemolytic streptococcus.
It manifests as fever, sore throat, diffuse red pinpoint rash all over the body, accompanied by skin flaking after the rash recedes, and in severe cases, headache, nausea, vomiting, depression, irritability, drowsiness, and unconsciousness.
Rheumatic fever
Rheumatic fever is a kind of rheumatic disease that occurs after the throat is infected with group A beta-hemolytic streptococcus, which can be recurrent and mainly involves joints, heart, skin and subcutaneous tissues.
Acute rheumatic fever can be preceded by fever and sore throat for 1~4 weeks, and then it can be followed by redness, swelling, heat, pain, dyskinesia in large joints such as knees and ankles, palpitation, shortness of breath, accelerated heart rate, pain in the precordial region, erythema of the skin on the trunk, and involuntary dance of the limbs, and other symptoms.
Acute glomerulonephritis
Most of them start sharply, with hematuria, proteinuria, edema and hypertension as the main clinical manifestations, which may be accompanied by transient renal function impairment, mostly seen after streptococcal infection.
Fever and sore throat may be present 1~3 weeks before the onset of the disease, followed by morning facial edema, lower limb edema, red or wash water urine, foamy urine, dizziness, headache, chest tightness, etc. A small number of patients may develop scarlet fever-like diffuse erythema.
Group B streptococcal infections
Neonatal infections include meningitis, respiratory distress syndrome or neonatal shock syndrome, which manifests as lethargy, poor feeding, yellowish skin, fever, convulsions, etc. The condition is aggressive and the mortality rate is high.
Maternal infection manifests as endometritis and postoperative wound infection, which manifests as fever, wound pus, etc., and even shock symptoms such as decreased blood pressure and increased heart rate.
Streptococcus pneumoniae infection
It mainly causes Streptococcus pneumonia, with symptoms such as high fever, cough and sputum, etc. If the inherent immune system of the lungs is not enough to resist the massive reproduction of Streptococcus pneumoniae, Streptococcus pneumoniae can be spread through the bloodstream, causing infections in various parts of the body, such as meningitis, osteomyelitis and peritonitis.
Pneumonia manifestations
Before the onset of the disease, there is often a history of rain and cold, excessive fatigue, drunkenness, and upper respiratory tract infection.
The onset of the disease is rapid, manifested by chills, high fever, cough, sputum, dyspnea, chest pain, some patients have blood in the sputum or coughing rust-colored sputum, and there may be headache, nausea, vomiting, abdominal discomfort, loss of appetite and other symptoms.
Extrapulmonary manifestations
Septic meningitis: it may manifest as high fever, headache, vomiting, generalized convulsions, and impaired consciousness.
Purulent osteomyelitis: manifested by malignant cold, high fever, vomiting, etc., swelling and pressure pain in the affected area, and pathologic fracture in case of severe bone destruction.
Peritonitis: there may be malignant cold, high fever, nausea, abdominal muscle tension, pressure pain, rebound pain, abdominal distension, and decreased exhaustion [5-8].
Streptococcus grass green infection
It mainly causes infective endocarditis.
It presents with low-grade fever, night sweats, fatigue, depression, weight loss, and erythema of the skin, as well as retinal hemorrhagic spots (Roth’s spots), painful nodules on the pads of the fingers and toes (Osler’s nodules), and painless hemorrhagic erythema on the palms of the hands and soles of the feet (Janeway’s damage).
Consultation
Department of Medicine
Department of Infectious Diseases
If you have fever, sore throat, cough, sputum, rash, etc., consult the Department of Infectious Diseases.
Respiratory Medicine
Consult the Department of Respiratory Medicine if you have cough, sputum, dyspnea, or chest pain.
Nephrology
If you have symptoms such as edema, reddish urine, foamy urine, etc., we recommend you to consult Nephrology.
Rheumatology
If there are symptoms such as pain in large joints such as knees and ankles, erythema on the trunk, and involuntary dancing of the limbs, it is recommended to consult the Department of Rheumatology and Immunology.
Preparation for medical treatment
Preparation for consultation: registration, preparation of documents, common problems
Tips for medical treatment
A full body checkup, abdominal ultrasound, CT scan of the chest and abdomen may be required, so you should wear loose-fitting clothes and avoid wearing clothes made of metal.
If you have a high fever before the consultation, you may first apply physical cooling, such as applying a warm towel to your forehead or wiping your armpits.
Preparation Checklist
Symptom checklist
Particular attention should be paid to the time of onset of symptoms, special manifestations, etc.
Is there fever? What is the highest temperature?
Is there any sore throat, cough, sputum, blood in sputum or rust-colored sputum?
Is there a skin rash, flaking?
Is there edema, hematuria, foamy urine?
Is there headache, nausea, vomiting?
List of medical history
Is there a history of rain and cold, overexertion, upper respiratory tract infection?
Is there any skin trauma?
Is there a history of impaired immune function, such as AIDS, chronic diseases (e.g., COPD, diabetes), use of immunosuppressive drugs, etc.?
Checklist
Test results from the last 1 month, which can be brought to the doctor’s appointment
Laboratory tests: blood test, liver function, kidney function, etc.
Imaging tests: Chest CT, Abdominal CT, etc.
Medication List
Medications used in the last 1 month, if available in boxes or packages, you may bring them with you to the doctor’s office
Antipyretic and analgesic: ibuprofen, acetaminophen, etc.
Antibiotics: penicillin, ceftriaxone, etc.
Diagnosis
Diagnosis is based on
Medical history
Patients with this disease may have the following history prior to the onset of the disease.
There may be a history of skin trauma, surgery.
There may be a history of exposure to rain and cold, overexertion, and upper respiratory tract infections.
There may be a history of impaired immune function, such as AIDS, chronic diseases (e.g., COPD, diabetes mellitus), and use of immunosuppressive drugs.
Clinical manifestations
Symptoms.
Symptoms of infection are related to the type of bacteria and the site of infection, and may include fever, cough, sputum, sore throat, earache, runny nose, and pus on the skin.
Physical signs
Localized infections are characterized by redness, swelling, and pain in the affected area.
In patients with scarlet fever, the doctor may find a diffuse, tiny rash over the body and a smooth, fleshy red tongue with red, swollen and raised tongue papillae, which resembles a prune, also known as prune tongue.
In patients with acute glomerulonephritis, the doctor may find edema of the eyelids and lower extremities.
In patients with lung infections, the doctor may hear diminished breath sounds or wet rales in the lungs, and the lungs may sound cloudy on percussion.
Laboratory Tests
Blood tests
White blood cell count and neutrophils may be elevated, and hemoglobin may be decreased.
Blood biochemistry
Patients with hepatic impairment may have elevated ghrelin and ghrelin; patients with renal impairment may have elevated creatinine; and in myocardial impairment, troponin may be elevated.
C-reactive protein, calcitonin
C-reactive protein and calcitoninogen are obviously elevated.
Urine routine
Patients with acute glomerulonephritis may have positive proteinuria and positive erythrocytes.
Pathogenetic examination
Bacterial culture of lesion secretion or blood may detect group A streptococcus or Streptococcus pneumoniae.
Immunologic examination
Antistreptococcal hemolysin O antibody test may be positive in most patients.
Patients with rheumatic fever may have increased immunoglobulin IgG, IgM, and IgA in the acute phase.
Patients with acute glomerulonephritis may have decreased complement C3.
Imaging
Different diseases have different imaging characteristics, and ultrasound, CT, magnetic resonance, etc. may be used to examine the lesions.
Rheumatic fever
Chest X-ray may reveal mild to moderate enlargement of the heart, predominantly in the left ventricle.
Ultrasound of the joints may reveal inflammatory changes, and fluid may be present.
Acute glomerulonephritis
Abdominal ultrasound reveals normal or mildly enlarged kidneys.
Streptococcus pneumoniae
Chest X-ray or chest CT reveals flaky hyperdense shadows, or large solid shadows involving multiple lung segments or entire lobes, and some patients will have pleural effusions.
Differential diagnosis
Streptococcal infections can cause a variety of diseases, each of which has a differential diagnosis that requires scientific diagnosis and treatment under the guidance of a doctor, and the following are mainly introduced here.
Scarlet fever
Rubella
Similarities: Both have fever and rash.
Differences: Rubella rash appears on the first day of illness, and the rash is similar to that of scarlet fever, but there is no diffuse redness of the skin, no flaking of the skin when the rash recedes, no inflammation of the pharynx, and there may be a decrease in the white blood cell count and an increase in the potency of the rubella virus-specific antibody.
Measles
Similarity: both have fever and rash.
Differences: Measles has normal skin between the rashes, measles mucous membrane spots may appear in the early stage of the disease, and there is hyperpigmentation after the rash subsides. Examination may find that the white blood cell count is not high or lowered. Measles epidemiology, vaccination history, etc. can help to differentiate.
Rheumatic fever
Rheumatoid arthritis
Similarities: Both have redness, swelling, heat and pain in many joints.
Differences: Rheumatoid arthritis is more common in small joints such as interphalangeal joints and metacarpophalangeal joints, accompanied by morning stiffness and fusiform swelling of the fingers, with joint deformities in the later stages, and less heart damage.
Osteoarthritis
Similarities: Both have pain in multiple joints.
Differences: Osteoarthritis is more common in weight-bearing joints, such as the knee joints, and can be improved with rest, with no erythema and no heart damage.
Acute glomerulonephritis
Urinary tract infection
Similarities: Both have hematuria and proteinuria.
Differences: urinary tract infections often have symptoms of urinary tract irritation such as frequent urination, urgency, and painful urination, a large number of leukocytes in the urine or even the presence of leukocyte tubular pattern, which can be relieved by anti-infective treatment.
Acute progressive glomerulonephritis
Similarities: both have edema, oliguria, and renal function impairment.
Differences: acute glomerulonephritis has a similar onset as acute nephritis, but renal function is progressively deteriorating and can be differentiated by renal puncture biopsy.
Streptococcus pneumoniae
Staphylococcal pneumonia
Similarities: both have high fever, cough and sputum.
Differences: Staphylococcal pneumonia has yellowish pus sputum and is prone to complicate lung abscess. Chest X-ray shows cavities and fluid air sac cavities, whereas Streptococcal pneumonia usually has no cavity formation.
Klebsiella pneumoniae
Similarities: both have high fever, cough and sputum.
Differences: Klebsiella pneumonia is characterized by brick-red jelly-like sputum, and chest X-rays show solid lung lesions, cellular abscesses, and interlobular dropout. Bacterial culture can differentiate the two [7-11].
Treatment
Aim of treatment: alleviate symptoms, prevent complications, and protect important organ functions.
Treatment principle: early, sufficient amount, sufficient course of anti-infection, combined with symptomatic and other treatments.
Symptomatic treatment
Pay attention to rest, avoid exertion, reduce physical exertion, pay attention to supplementary nutrition, ensure the supply of body heat.
When there is high fever, sore throat, arthralgia, oral ibuprofen, acetaminophen and other antipyretic and analgesic treatment can be given.
When there is cough and sputum, aminoglutethimide and acetylcysteine can be applied to relieve cough and resolve sputum.
When heart failure and edema occur, water and salt intake should be controlled, and diuretic treatment such as furosemide and hydrochlorothiazide can be applied.
When hypertension occurs, antihypertensive treatment such as valsartan and amlodipine can be given.
Anti-infection treatment
Penicillin is the preferred anti-infective treatment for streptococcal infections, which should be administered in sufficient quantity and course.
At present, commonly used penicillin G, amoxicillin, ampicillin and so on.
The general course of treatment is 7 to 10 days, and those with severe symptoms should increase the dosage or apply with other antibacterial drugs at the same time.
Surgical treatment
For lesions that have become suppurated, incision and drainage are needed if necessary along with anti-infective treatment.
Prognosis
Cure
If detected and treated early, the vast majority can be cured quickly.
In a small number of cases, the prognosis is not good because of hematogenous dissemination or complications such as sepsis and toxic shock.
Elderly and frail people and those with underlying diseases are prone to poor prognosis.
Hazards
Rheumatic fever or nephritis may still occur after recovery from scarlet fever.
Rheumatic fever involving the heart may have rheumatic heart disease, heart valve disease, which may lead to heart failure in severe cases.
Rheumatic fever presents with chorea, and in a few cases, neuropsychiatric symptoms may remain, such as involuntary twitching or vocalizations.
Acute glomerulonephritis may persist with large amounts of proteinuria, hypertension, and renal impairment.
Daily
Daily management
During the acute phase, rest is recommended to avoid exertion and reduce physical exertion.
Daily diet needs to be nutritionally complete with diversified food types to ensure nutrient intake.
Patients with acute glomerulonephritis can choose more lean meat, milk, eggs and other foods to supplement high-quality protein.
Need to be standardized under the guidance of the doctor, full amount, full course of medication.
Prevention
To prevent streptococcal infections and related diseases, relevant vaccinations can be carried out, and attention should be paid to strengthening physical fitness.
Vaccination with 23-valent Streptococcus pneumoniae polysaccharide vaccine can prevent Streptococcus pneumoniae infection.
There is no vaccine for scarlet fever. Close contact with confirmed or suspected cases should be avoided.
If diseases such as pharyngitis and tonsillitis exist, they should be actively treated and completely cured, which can help prevent acute glomerulonephritis and rheumatic fever.
Normally, attention needs to be paid to avoiding rain, overwork, drunkenness and so on.
It is recommended to do regular physical exercise to strengthen the resistance.
Pay attention to weather changes and increase or decrease clothing in time.