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Streptococcal Infection: Diagnosis and Treatment

Every infectious disease has its causative agents - pathogenic or conditionally pathogenic microorganisms. The former invade the body from the outside, while the latter belong to a small part of the natural microflora and become active only under favorable conditions for reproduction.

The etiology of an infection is determined by its classification into groups - viruses, bacteria, protozoan microorganisms, fungi, worms, or simple parasites. Among the numerous bacteria, streptococci are considered particularly dangerous. They trigger severe pathologies, up to toxic shock with a high likelihood of a fatal outcome. In this article, we will discuss the specifics of streptococcal infection, its treatment methods, and prevention.

Streptococcal Infections

The source of infection can be an infected child or adult. Routes of streptococcus transmission include:

Aerogenic - during close contact with an infected person, including asymptomatic carriers of the infection.
Foodborne - through contaminated food, such as dairy and fermented products.
Contact-household - through objects contaminated with bacteria.
Intranatal - if a woman's reproductive system is affected by streptococcal infection.

Due to the high contagiousness of the pathogens, there is a risk of an epidemic among socially organized children.

Classification of Streptococci

Streptococcus are Gram-positive facultative aerobic bacteria. They inhabit the skin, gastrointestinal tract, oral mucosa, and urogenital organs in small quantities. The bacterial family comprises 83 representatives, with the following being causally significant:

A-hemolytic Streptococcus - causes purulent infections, inflammatory heart pathologies, and pneumococcal pneumonia.
B-hemolytic Streptococcus - includes five groups of dangerous agents (A, B, C, D, F, G). Streptococcus pyogenes from group A is considered the most active, causing diseases of the ENT organs, respiratory system, acute inflammations of the heart and kidneys, and severe, hard-to-cure skin lesions.

These bacteria are quite resistant to environmental factors. They can withstand temperatures up to 60°C and can resist antiseptics and sanitizers for a quarter of an hour. In dried sputum and pus, they can remain viable for several months.

Virulence Factors

Streptococci are known for their high virulence, which is the ability to quickly invade and harm the host organism. The main factors contributing to the microorganisms' ability include:

Rapid colonization and dissemination;
Evasion of the immune defense;
Instant binding to specific receptors for entry into the host organism's cells.

Pathogens produce substances that destroy tissues, as well as exotoxins that trigger the development of a cytokine storm. This is the main cause of toxic shock and a fatal outcome. By penetrating through the mucous membranes of the throat or skin lesions, the pathogen forms a bacterially active focus that includes conditionally pathogenic microflora. Streptococci release toxic substances into the blood, leading to a systemic immune response, including the release of cytokines, histamine, and the synthesis of immunoglobulins. With a significant bacterial load and a weakened immune system, the organism cannot mount a worthy defense against the pathogen. The course of the disease can be extremely severe, treatment can be lengthy, and the risk of post-infection complications is high.

Diseases Caused by Streptococci

Active β-hemolytic Streptococcus group A causes diseases with varying symptoms and courses. The clinical picture of streptococcal infection depends on the localization of the inflammatory focus, bacterial load, and the patient's pre-existing conditions. Due to the pathogen's resilience, it is quite challenging to find an effective treatment for infectious diseases.

Streptococcal Pharyngitis

The inflammation is localized on the posterior wall of the throat, specifically in the mucous membrane. The incubation period lasts 2-3 days, followed by the onset of acute symptoms, including pain when swallowing saliva, enlargement, and tenderness of the cervical lymph nodes, and fever. In approximately 20% of patients, the infection involves the lymphoid tissue of the tonsils, leading to the development of pharyngotonsillitis. The disease is characterized by high fever, the formation of seropurulent plugs on the tonsillar mucosa, and excruciating throat pain. A possible complication is a peritonsillar abscess.

Scarlet Fever

Acute inflammation of the throat is frequently diagnosed in preschool-age children. Scarlet fever begins with high fever and signs of systemic intoxication. Characteristic symptoms include a swollen bright-red tongue, fine-papular rashes primarily on the face and upper body. Mild cases of the disease may allow outpatient treatment, but small children are often hospitalized due to the risk of purulent-inflammatory complications.

Skin Infections

In children, streptoderma is common, while in adults, it can manifest as erysipelas or streptococcal phlegmon. The initial signs of streptoderma are vesicles filled with serous fluid, which transform into pustules, leading to the formation of dense crusts on the skin. Children often scratch the itchy rashes, transferring the streptococcus to healthy areas of the skin, complicating treatment. Speeding up recovery involves the forced opening of vesicles followed by skin treatment with Fukorcin and antibacterial ointments.

Erysipelas is a superficial skin inflammation, while phlegmon is a deep inflammatory lesion that spreads to the subcutaneous fat tissue. Both conditions are associated with headaches, fever, insomnia, and regional lymphadenitis.

Necrotizing Fasciitis

A purulent inflammation of connective tissue, accompanied by the death of skin cells and the subcutaneous fat layer in the affected area. It is characterized by rapid development, severe course, frequent complications, and a risk of fatality. The pathogenesis is closely related to vascular thrombosis, which leads to oxygen deficiency in the soft tissues.

Toxic Shock Syndrome (TSS)

A significant portion of TSS cases is linked to the use of superabsorbent hygiene tampons during menstruation. This extremely severe somatic condition is caused by hypercytokinemia, an overproduction of cytokines in response to the body's exposure to streptococcal toxins. This leads to the disruption of informational links between T-lymphocytes, resulting in an attack on the body's own cells. Vascular permeability sharply increases, blood pressure drops, intercellular space is filled with plasma, and multiple organ failure develops. The lungs and heart are affected first, followed by kidney and liver failure.

Late ComplicationsThe mechanism of late complications is not fully understood. The main pathologies include glomerulonephritis, sepsis, necrotic myositis, and rheumatic fever.

Diagnosis

The causative agent of the active form of the disease or the detection of infection carriage can be identified through laboratory analysis of biomaterial (skin scraping, throat swab). Bacteriological culture is used for diagnosis. When colonies of streptococcus are found, an antibiotic susceptibility test is additionally performed to determine resistance to different types of antibiotics.

Treatment

Medications for etiotropic therapy are selected for both children and adults based on the results of laboratory diagnosis. Many hemolytic streptococci are sensitive to antibiotics of the penicillin group. If penicillin treatment is ineffective, macrolides such as Zithromax, Azithromycin, or Clarithromycin are used as replacements. To prevent microbial flora imbalance, probiotics and prebiotics are prescribed in parallel. Additionally, symptomatic treatment is administered based on the clinical presentation of the disease. Among modern medications, the use of Streptococcal Bacteriophage is recommended - a solution for mucous membrane irrigation, applications, enemas, and syringing.