Streptococcal infection in children

Streptococcal infection in children and adults is a disease caused by bacteria of the group Streptococcus. It can be divided microbiologically, depending on the properties of the bacteria, or clinically, depending on the type of disease that it causes. During growth of bacteria on nutrient medium (blood agar) around each colony beta-hemolytic Streptococcus formed a certain zone:

• clear area of hemolysis (i.e., the area in which is completely decomposed blood),
• the zone of incomplete hemolysis, characterized by green areas, typical for the growth of alpha-hemolytic Streptococcus (usually Streptococcus viridans).

Gamma-hemolytic streptococci do not produce hemolysis at all.

Another classification, using carbohydrates that are present in the cell wall, divide streptococci into groups A-H and K-T.

Causes and risk factors

Beta-hemolytic streptococci of group A (usually Streptococcus pyogenes) are the most virulent (virulence is an individual characteristic of a pathogen such as a bacterium or virus that expresses the degree of pathogenicity of a specific microbial strain compared to other strains of this species, it is also possible to say that certain strains of different virulence, virulence is determined by, for example, the ability of a microbe to cause disease or to result in death).

Beta-haemolytic streptococci group A the child and the adult can cause the following diseases:

• pharyngitis,
• tonsillitis (i.e., acute inflammation of the tonsils, or the disease known as angina),
• scarlet fever (in Latin, the disease is called "skarlatina", and is an infectious disease caused by bacteria of the genus Streptococcus, the symptoms of which are characterized by fever, sore throat and nose, skin rash), pneumonia (i.e. pneumonia),
• rheumatic fever (rheumatic fever is a dangerous inflammatory disease that develops as a complication of poorly treated or untreated strep throat caused by Streptococcus And),
• glomerulonephritis (inflammation of the glomeruli of the kidneys – renal cluster, is an autoimmune disease – a disease caused by abnormal aggression's own immune system against the human body),
• are the common causes and skin infections and sepsis (sepsis designation comes from the word "sepo" = to rot, pus, is characteristic of the General reaction to the infection).

The streptococci of group D include enterococci (e.g., Enterococcus faecalis, Enterococcus durans, Enterococcus faecium, previously Streptococcus faecalis, Streptococcus durans and Streptococcus faecium) and non-enterococci (Streptococcus bovis and Streptococcus equinus). For most diseases caused by streptococci of group D, are responsible Streptococcus faecalis or Streptococcus Bovis. Other streptococci are distinguished by their ability to grow in 40% bile and to hydrolyze (hydrolysis – chemical reaction of decomposition, which comes to absorbing water) esculin (esculin is a selective differentiating soil nutrient used in Microbiology to isolate and differentiate between the enterococci from group D streptococci, and esculin, in itself, is a flavonoid). Enterococci identifitseerida by the reaction PYR.

Enterococcus faecalis in a child and adult cause diseases such as:

• endocarditis,
• urinary tract infection,
• intra-abdominal sepsis,
• cellulite (cellulite is indicated by a diffuse, acute inflammation involving the solid tissues and not hollow-body organs, the symptoms are characterized by redness of the tissues, edema and infiltration of the affected areas white blood cells),
• infection and bacteremia (ie, penetration and spread of bacteria into human bloodstream).

Enterococci, which are resistant to antibiotics of the aminoglycoside in combination with antibiotics acting on cell wall growth, causing very serious and, in General, hard-to-treat infections, especially among people admitted to hospitals. In addition, group b Streptococcus can cause serious infectious diseases in the child, such as neonatal sepsis, and endocarditis, and septic arthritis (for example infectious arthritis, accompanied by sepsis).

Streptococcus groups C and G are referred to as pyogenes – like organisms, and from bacteria of Streptococcus pyogenes are resistant to the antibiotic Bacitracin. Very often they are isolated from animals occurring in the human body, Lodge in (i.e., live) throat, digestive system, vagina and skin.

Streptococcus groups C and G can cause severe purulent infections, such as:

• laryngitis (inflammation of the larynx),
• inflammation of the lungs (pneumonia),
• cellulite (skin lesions, symptoms of which manifest inequalities of the skin in the affected area, and in areas with inadequate blood flow and lymphatic drainage, from a cosmetic point of view of the affected area characterizes this sign as "habitot" of the skin primarily in the buttocks and thighs),
• pyoderma (purulent inflammation of the skin),
• erysipelas (erysipelas is a relatively common acuteinfectious disease of the skin and subcutaneous tissues, which accompanies systemic symptoms),
• impetigo (a contagious skin infection that affects the surface layer),
• wound infection,
• postpartum sepsis (i.e., puerperal fever, i.e., infection of the birth canal),
• neonatal sepsis,
• endocarditis,
• septic arthritis,
• post-streptococcal glomerulonephritis.

In the treatment of these diseases mostly used drugs from the group of antibiotics such as penicillin, vancomycin, cephalosporins and erythromycin. Antibodies against an extracellular antigen of Streptococcus group A play an important role in diagnostic tests done for diagnosis of diseases caused by streptococci. Clinically, streptococcal infection can be divided into 3 groups:

• Microbolometers, i.e. kolonizirali human streptococci with no clinically obvious infections.

• Acute disease, which is often purulent, and induced an invasive penetration of the streptococci in the tissues of the body.

• Late purulent complications.

Purulent complications include:

• the inflammatory stage of acute rheumatic fever,
• chorea (it is random and unpredictable involuntary movements, short, quick, often on the end parts of the legs and in the Orofacial region, i.e., in the region of the mouth and face, usually aggravated by movement, speech and emotions. An example is a typical "dance walk»),
• glomerulonephritis.

These complications, in most cases occur 2 weeks after clinically manifested clinically latent (i.e., without obvious clinical symptoms accompanying the process) streptococcal infection, the time period may be shorter, but longer than 2 weeks.

Treatment

Secondary infection caused by bacteria belonging to the streptococci group, can jeopardize a person's life, especially in the case of immunocompromised individuals and children. Infectious diseases caused by streptococci such as septicemia, puerperal sepsis, endocarditis and pneumonia (see above explanation), is a very frequent cause of death in the era before antibiotics. These diseases, however, remain very serious and at the present time, especially if the causative agent is the bacterium Enterococcus.

At that time, as Streptococcus from group A, and Streptococcus viridans are almost always sensitive to penicillin antibiotics, enterococci are relatively resistant to commonly used antibiotics, and require the introduction of combinations of drugs of this group, generally used in combinations of aminoglycosides with penicillin or ampicillin.

In some areas allocated to bacterial strains of enterococci that are resistant even to high doses of gentamicin and other aminoglycoside antibiotics group and, moreover, won't work against them synergetic (i.e., mutually reinforcing) effect when the drug is administered simultaneously with penicillin.

Unfortunately, currently there is no reliable bactericidal antibiotic treatment of infections caused by streptococcal strains.

Primary streptococcal infection of the upper respiratory tract, including scarlet fever, in most cases has a favorable prognosis, this means that the temperature gradually subsides within a few days, and up to two weeks, usually the person is fully recovered. If the treatment used antibiotics, this is usually reduces the duration of the disease, especially in the case of the disease in young children. Effect of antibiotics, unfortunately, is very low in the treatment of clinical signs of streptococcal pharyngitis (ie, inflammation of the throat) in adolescents and adults.

The positive effect of antibiotic therapy is to prevent the development of local purulent complications (such as, for example, a peritonsillar abscess i.e. a collection of pus in a confined space near the tonsils), as well as preventing inflammation of the middle ear, paranasal sinuses, and maxillary bones.

But the most important reason for use of antibiotics in the treatment of a person suffering from primary streptococcal infections of the upper respiratory tract, is to prevent purulent complications, which, unfortunately, in some cases followed by the untreated infection caused by Streptococcus belonging to group A. for treatment by far proven infections caused by Streptococcus group A, the most appropriate antibiotic is penicillin.

A single intramuscular injection of benzathine-penicillin G at a dose of 600000-900000 units (usually introduced 50,000 units per kilogram of body weight) for young children and 1.2 million units, administered by intramuscular injection in adults and adolescents, are successful treatment is sufficient.

However, because intramuscular injections of medications (i.e., administration of the drug intramuscularly) is painful, as a rule, for the treatment of streptococcal infections in preference to the introduction of penicillin G or V in the form of oral pills, but only if it can be guaranteed the correct use of antibiotics.

For children who suffer from chronic angina (i.e., sustained inflammation of the tonsils), especially if there arerecurrent symptoms, is the preferred antibiotic Clindamycin (the antibiotic that is usually served in a dose of 8-25 mg per kilogram body weight for 24 hours, 3-4 daily doses).

Not suitable for treatment of streptococcal infections antibiotics of tetracycline group, and not only because of the current large number of bacterial strains of streptococci belonging to group A, which are resistant to these antibiotics, but also because these drugs have adverse side effects on the organism of young children. Especially noteworthy is the negative effect on the growth of connective tissue (e.g. bones or teeth).

Protiwastmaticescoe treatment is often delayed (usually about 1-2 days), namely, until that time, until the defeat of streptococcal infection is finally confirmed microbiologically. The risk of non-purulent or purulent complications of streptococcal pharyngitis (i.e., strep throat, caused by the bacterium Streptococcus), fortunately, is not increased.

If you suspect a streptococcal infection, usually, the treatment starts from the introduction of antibiotics from group of penicillins in the form of oral tablets, and at the same time, infected tissue is taken for microbiological studies. In that case, if the diagnosis of infection with Streptococcus is not subsequently confirmed, antibiotic treatment can be terminated immediately. Otherwise, antibiotic therapy is ongoing, it is possible to change the form of acceptance form of tablets is replaced with intravenous administration of antibiotics.

Other clinical symptoms a person suffering from a streptococcal infection (e.g., sore throat, headache or fever) are facilitated by drugs from the group of analgesics (i.e., painkillers) or antipyretic drugs (i.e., group of drugs, the result of which reduces fever).

Bed rest the patient does not in all cases necessary, unless required by the clinical condition of the person. Isolation of the patient suffering from streptococcal infection other healthy individuals is not currently required. Family members or friends who show clinical signs of infectious streptococcal disease or have a history of some of the consequences of streptococcal infectious diseases, must undergo microbiological testing, and if test results are positive, enter the appropriate antibiotic therapy.