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Streptococcus (GAS)
Infection
Blok 26
Objective
Provide overview about diseases caused by
Streptococcal faringits
At a glance for non-suppurative
Introduction
Group A Streptococcus (GAS) or Streptococcus pyogenes
Leading pathogenic bacteria
Infects children and adolescent
Wide spectrum of infection and disease state benign till life-
threatning
Worldwild annually
> 600 million case of strep throat
> 100 million case of GAS pyoderm
GAS
Virulece factors :
Protein F
Protein M
Capsul
C5a peptidase
Streptolysin S
Streptolysin O
Streptococcus Pyrogenic
Exotoxin (SPE)
Hyaluronidase
Streptokinase
spectrum of clincal
manifestation
Mechanism :
Suppuration
DNAase A,B,C,D
Toxin elaboration
etc
Immune-mediated inflammation
Clinical Manifestaion
Suppurative
Non-suppurative
Pharyngitis
Scarlet fever
Impetigo
Eryseplas
Celullitis
Necrotizin fascitis
STSS
Pneumonia
ets
Rheumatic Fever
GNAPS
Certain psoriasi
Pharyngitis
Upper Respiratory Infection
Largest contribution on antibiotic usage
Incubation
2-4 days
Physical examination
Edematous and
hyperemic pharynx
Hypertrophy tonsil,
hyperemic, occasionally
with yellowish or
greyish exudate
Ptechiae and red
lymphadenopathy
Diangosis
Culutre
RADT
Not common in developing country
Clinical diffculut, overlapping between GAS
Mycoplasma, Chlamidya
Viral
Conjunctivitis
Fever
Cough
Headache
Scarlatiniform rash
Coryza
Diarrhea
Hoarse voice
Discrete Ulcerative
Stomatitis
Viral exanthems rash
Medication
Can be self-limited
Antibiotic :
Decrease duration of illness
Reduce contagious period
Reduce the incidence of complication
First line : Penicillin or Amoxicillin 50 mg/kg/day for 10
days
Allergic to penicillin
Cefadroxil 30 mg/kg/day 10 days
Clindamyycin 15 mg/kd/day 10 days
Azithromycin 10 mg/kg/day 5 days
Scarlet Fever
Disease in children
10% strept throat scarlet fever
Incubation : 12 hours 5 days
Fever, headache, vomiting, and abdominal
pain
After 1-2 days fine-grade sandpaper, from
desquamation
Flushing face with
circumoral pallor
Edematous and
hyperemic pharyx
Hypertrophy and
Tongue
Tongue coated
with white
membrane and
hypertrophy
papilla (white
strawberry
tongue)
After 2 days
desquamation on
white membrane
strawberry
tongue
Diagnosis
Clinical maifestation
RADT
Swab culture
Treatment
Penicillin class or erythromycin for 10 days
Complication : abscess, sinusitis, pneumonia,
Impetigo
Epidermal infection
Yellowish crust above
hyperemic skin
Small papule vesicle
pustule yellowish
curust (honey-colored
crust)
factor M 49 corerlates
with PSAGN
Therapy topical
muporicin
Erysipelas
Skin infecton that affects
lesion border
Fever
Cellulitis
Progressive acute skin
inflammation on dermis
and subcutaneous
tissue
Undemarcated border,
erythematous skin,
induration (+),
fluctuation, crepitation,
erosion, or bullae.
Regional
lympadenopahty
Pain on infected site
Necrotizing Fasciitis
Acute and very
progressif infection
subcutaneous
tissue till fascia and
muscles
Erythematous lesion
24-48 hours
purple with
hemorrhagic bullae
necrotic and
gangrene expose
of tendon and
muscles
Incidence followe
debridement
limb
Infection 1993)
A. Isolation GAS form
Sterile site
Non sterile site
B. Clinical manifestaton
1. Hypotension
2. Other severe clinical disoreder (2 or more)
Renal disorder
Coagulopathy
Liver disorder
Respiratory distress
Soft tissue necrosis
Erymathous macular rash with desquamation
Definiitve case
A1, B1, and B2
Probable case
A2, B1, and B3
Treatment
Antibiotic
Admission in ICU
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