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49 Cards in this Set

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Streptococci:

- Gram what?
- Catalase what?
Positive

Negative
Alpha Hemolysis:

- what happens here?
- appearance?
- which streptoccocus? x2
Partial RBC lysis

Greenish discoloration

Streptococcus Pneumoniae
"Viridians" Strept.
Beta Hemolysis:

- what happens here?
- appearance?
- which streptococcus? x2
Complete lysis of RBC's

Clear zone

GAS (Streptococcus Pyogenes)
GBS (Streptococcus Agalactiae)
Gamma Hemolysis:

- what happens here?
- appearance?
No RBC lysis

No change
Antigenic Classification:

- Group A Streptococci (GAS)
- Group B Streptococci (GBS)
- Group D Streptococci (GDS)
- Non-groupable
Streptococcus pyogenes

Streptococcus agalactiae

Enterococci

Streptococcus pneumoniae
S. Pyogenes:

- gram what
- oxygen dependency
- cell wall antigens x2
- hemolytic activity
- catalase
- capsule?
Positive

Facultative

M-proteins
Group A carbohydrates

Beta hemolytic (complete lysis)

Negative

Usually
S. Pyogenes ASYMPTOMATICALLY colonize where?

Especially prevalent in which population group?
Upper respiratory tract

Children 5-15
S. Pyogenes can colonize TRANSIENTLY where?

This type of colonization is higher with whom? x2
Transient Skin Carriage

Open wounds or skin disease
Live in areas with high S. Pyoderma infections
In patients with S. Pyogenes pharyngitis, what is a common way for bacterium spread?
Respiratory droplets (pharyngitis),

or food or water
Describe the ability of S. Pyogenes to survive on dry surfaces?
Can do it for a long time.
In contrast to other Streptococci diseases, what is unique and distinguishing about S. Pyogenes?
Can cause disease in otherwise healthy individuals
T/F - Most Pharyngitis is caused by GAS Beta Hemolytic.
False,

mostly viral
What is "Strep Throat," and what are the associated symptoms? x7
Pharyngitis caused by S. Pyogenes

Sore Throat
HA
Erythematous Posterior Pharynx
+/- Exudate
Pharyngitis

Fever & Malaise
What are some suppurative complications from Pharyngitis? x4
Peritonsilar Cellulitis or Abscesses

Retropharyngeal Abscesses

Otitis Media

Mastoiditis
What kind of complication is Acute Rheumatic Fever?
Non-suppurative complication of Pharyngitis

Not a complication of skin infections
What are the symptoms of Acute Rheumatic Fever? x3
Polyarthritis

Carditis

Chorea
What is the treatment of Acute Rheumatic Fever?
Prevention by treating Pharyngitis
What kind of complication is scarlet fever?
Non-suppurative complication of Pharyngitis AND Skin infection
What is the cellular/microbiological etiology of scarlet fever?
Exotoxins from bacteriophage infected strains (lysogenic conversion) of S. Pyogenes
Symptoms of scarlet fever. x4
Scarlet-red rash (spares face)

Fever

Skin desquamation (post rash)

Strawberry tongue
Describe the complication of acute glomerulonephritis.
Non-suppurative complication of pharyngitis or pyoderma
Symptoms of glomerulonephritis. x4
Inflammation of renal glomeruli with:

HTN
Edema

Hematuria
Proteinuria
Prognosis of acute glomerulonephritis.
Excellent, especially for kids.

Some adults have progressive, irreversible loss of renal function
List three skin diseases associated with S. Pyogenes.
Impetigo (pyoderma)

Cellulitis

Erysipelas
Describe the progression of impetigo (pyoderma)

Common in?
Starts out as red papules

Develops into vesicles with clear, yellow contents

Develops into pustules filled with bacteria

Common in children (around mouth) associated with poor hygiene & moist climate
Describe cellulitis.

Possibly from what assault?

Complications?
Infection involving Skin & deeper subcutaneous tissue.

Burns, surgical wounds, illicit drug use

Can lead to bacteremia
Describe erysipelas.

What other symptoms usually accompany erysipelas? x5
Infection of superficial skin (dermis) only.

Fever
Inflammation
Lymph node enlargement,
Local pain

Chill
S. Pyogenes Pneumonia:

- usually preceded by what? x2
- symptoms x3
- associated by preceding what Dz?
- mortality?
Viral infection
Chronic pulmonary disease

Fever
Chills
Productive cough with Blood-tinged sputum

Bacteremia (15%)

Rate is 30%
Streptococcus Toxic Shock Syndrome

- transmission?
- associated with what strains?
- pathogenesis?
Penetration of skin lesion
(chickenpox blister, cut, surgery...)

Strep. pyogenes strains that cause skin disease
(NOT the ones that cause pharyngitis)

GAS multiply at site of infection,
producing TOXINS
Streptococcus TSS symptoms. x5
Bacteremia

Impaired clotting

Toxins & shit in body

Constitutional symptoms
(fever, chills, malaise, N/V/D)

Hypotension
Most patients with Streptococcus TSS will also eventually develop what horrible Dz?
Necrotizing fascitis
What are the three major differences with Streptococcus TSS when compared to Staphylococcus TSS?
1. Uncommon rash/desquamation

2. Frequent bacteremia

3. Higher mortality - 50%
(staph is 5%)
When to suspect TSS?
Pt has

INFECTED SKIN LESION
+
FEVER

(with or without PAIN)
Treatment for Streptococcus TSS

- Antibiotics used?
- Tx protocol
Clindamycin + PCN

Prompt & Aggressive for
EXPLORATION & DEBRIDEMENT

Antibiotics with IV fluids
(IV to counteract caplillary leak)
T/F - The use of PCN is effective against Streptococcus TSS.
False

Not very effective at killing large numbers of slow growing organisms

Thus, stack with clindamycin
Necrotizing Fasciitis course of disease.
Enter through trauma or trivial wounds

Skin involved LATER on

Toxins destroy tissue (3 cm/hr)

Bacteremia

Shock,
Multiple organ failure
Death
What are the symptoms of necrotizing fascitis?

Which one will bring the patient in to the hospital?
Flu-like symptoms
Diarrhea
Vomiting

PAiN localized and out of proportion to wound
(brings pt in)
Treatment for necrotizing fasciitis. x3
Aggressive antibiotics

Surgical Debridement

Symptoms treatment
What is M protein?

What does it do?

How does it do it? x3
Major virulence factor

ANTI-PHAGOCYTIC
(against neutrophils)

Binds fibrinogen

Sequesters C4b
(decreases C3b deposition)

Sequesters Factor H
(decreases C3b deposition)
In streptococcus pyogenes, what does streptolysin S & O do.
Lysis of erythrocytes, leukocytes, and platelets
List all the Strep. Pyogenes virulence factors and give brief description of their actions. x8
M Protein (antiphagocytic)
Capsule (antiphagocytic)

DNase ( for better bacterial spread)
Streptokinase (for spread)
Lipoteichoic acid (shock)

Superantigen (shock)
Streptolysin S & O (kills immune cells)
C5a peptidase (degrades C5a, thus impairing chemotaxis)
What 2 TYPES of complications can arise from Strep. Pyogenes Pharyngitis?
Supparative

Non-Supparative
List the NON-supparative complications of Strep. Pharyngitis and include what differentiates them. x3
Acute Rheumatic Fever
(non-supparative complication of Strep pharyngitis ONLY, and not from skin infections)

Scarlet Fever
(complication of BOTH strep pharyngitis AND skin infecitons)

Acute Glomerulonephritis
(complication of BOTH strep pharyngitis OR pyoderma)
Necrotizing Fascitis

- initial symptoms

- Sx that usually brings the pt to seek Tx
Initial
- flu-like symptoms
- N/V/D

Localized Pain Out of Proportion to Apparent Wound/Trauma
Streptococcus pyogenes Bacteremia

- especially dangerous if?

- RARELY follows what?
- OFTEN follows what?

- Mortality rate?
if consequence of wound infections, pneumonia, NF, & TSS

rarely follows localized infections

complication of NF or TSS

40% in pts with NF/TSS and Bacteremia
Strep. Pyogenes Bacteremia

- symptoms x3
Fever that is very high

Chills

Exhaustion
Strep. Pyogenes Treatment

- for impetigo
ORAL
Cloxacillin, cephalexin, cefadroxin, & Cefaclor

TOPICAL
Mupirocin
Strep. Pyogenes Treatment

- For other infections EXCEPT TSS, NF, and impetigo
PCN
Strep. Pyogenes Treatment

- for TSS and NF
Clindamycin + PCN

IV gluids
IV gamma globulins (neutralize toxins)

Surgical debridement