CPRS 24: Streptococcal Infection and Rheumatic Heart Disease Flashcards
Streptococcus pyogenes
Which group under lancefield grouping?
Which type of haemolysis?
Is it susceptible to bacitracin?
Group A
Beta Haemolysis
Bacitracin susceptible
Streptococcus agalactiae
Which group under lancefield grouping?
Which type of haemolysis?
Is it susceptible to bacitracin?
Group B
Beta Haemolysis
Bacitracin resistant
Streptococcus dysgalactiae
Which group under lancefield grouping?
Which type of haemolysis?
Is it susceptible to bacitracin?
Group C/G
Beta Haemolysis
Bacitracin resistant
Streptococcus pneumoniae Which group under lancefield grouping? Which type of haemolysis? Optochin sensitive or resistant? Bile soluble or insoluble?
non-groupable
Alpha/Gamma Haemolysis
Optochin sensitive
Bile soluble
Viridans streptococci Which group under lancefield grouping? Which type of haemolysis? Optochin sensitive or resistant? Bile soluble or insoluble?
Groups A/C/F/G
Alpha/Gamma Haemolysis
Optochin Resistant
Bile insoluble
Streptococcus bovis Which group under lancefield grouping? Which type of haemolysis? Optochin sensitive or resistant? Bile soluble or insoluble?
Group D
Alpha/Gamma Haemolysis
Optochin Resistant
Bile insoluble
Enterococci
Which group under lancefield grouping?
Group D
Streptococcus pyogenes - Which type of cocci? in what? - Which type of haemolysis - Susceptible to \_\_\_\_\_\_\_\_\_\_\_ - Virulence factors: \_\_\_\_\_\_\_\_\_\_ for systemic toxicity \_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_ for invasion and spread \_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_ for adhering
Streptococcus pyogenes - Gram positive cocci in chains - Which type of haemolysis: Beta - Susceptible to bacitracin - Virulence factors: Streptolysin O for systemic toxicity hyaluronidase and streptokinase for invasion and spread M protein and Capsule for adhering
Name 3 most important diseases caused by Streptococcus pyogenes
Name 2 serious diseases by Streptococcus pyogenes
Name 3 most important damages of Streptococcus pyogenes
- Scarlet fever
- Pharyngitis
- Streptococcal Toxic Shock Syndrome
Name 2 more important complications of infection by Streptococcus pyogenes
- Rheumatic fever
- Glomerulonephritis
Clinical Manifestation of Group A Streptococcus
For throat: Suggesting pharyngitis and Scarlet fever
Name 3
Clinical Manifestation of Group A Streptococcus
For throat: Suggesting pharyngitis and Scarlet fever
Name 3
- Strawberry tongue
- Facial flushing with perioral pallor (White around the mouth region)
- Day 2 rash: Deep bluish rash over the upper part of the chest, spreading centrifugally
Clinical Manifestation of Group A Streptococcus
For skin: Name 2
For soft tissue: Name 1
Clinical Manifestation of Group A Streptococcus
For skin: Name 2
- Erysipelas (Infection of upper skin layer)
- Cellulitis (Skin infection causing redness, swelling and pain)
For soft tissue: Name 1
- Necrotizing fasciitis (Infection of fascia, thin casing of the connective tissue)
Clinical Manifestation of Group A Streptococcus
Consider Streptococcal Toxic Shock Syndrome (STSS)
It has multiorgan involvement: Name the 2 organs
Name another syndrome that it would result
Kidneys, liver
Acute Respiratory Distress Syndrome
For diagnosis of Group A Streptococcus infection, we can use the following
- Blood culture
- Throat swab/ Skin Swab
- Rapid antigen detection test
Why is Anti-streptolysin O (ASO) titer NOT useful for acute stage diagnosis
Antibodies need time to develop
Treatment of Group A Streptococcus infection
Which antibiotic?
For Streptococcal Toxic Shock Syndrome, what antibiotics shall we add? Why?
Treatment of Group A Streptococcus infection
Which antibiotic? Penicillin
For Streptococcal Toxic Shock Syndrome, what antibiotics shall we add?
Clindamycin, Linezolid
They inhibit the toxin production
Acute Rheumatic Fever is caused by abnormal response to Group A Streptococcal infection. The consequence may result in _____________.
Rheumatic heart disease
To diagnose Acute Rheumatic Fever
You need 2 Major Criteria, or 1 major criteria plus 2 minor criteria.
Name the 5 Major criteria (CASSE)
Major (CASSE) Carditis Arthritis Subcutaneous nodules Sydenham's chorea (Muscle weakness) Erythema marginatum
To diagnose Acute Rheumatic Fever
You need 2 Major Criteria, or 1 major criteria plus 2 minor criteria.
Name the 4 Minor Criteria (FARP)
Minor (FARP) Fever Arthralgia Raised Erythrocyte Sedimentation Rate Prolonged PR interval
To have supportive evidence for Acute Rheumatic Fever
Name 2
- Elevated ASO (antibody against Group A Strept)
- Positive throat culture for Group A Strept
To treat Acute Rheumatic Fever
- to Clear group A streptococcus: _____
- to relive symptoms through anti-inflammatory ways: ________ and ________
- if there is uncontrolled heart failure _______
To treat Acute Rheumatic Fever
- to Clear group A streptococcus: Penicillin for 10 days
- to relive symptoms through anti-inflammatory ways: Aspirin and Corticosteroid
- if there is uncontrolled heart failure: Surgery
What is the difference between primary prophylaxis and secondary prophylaxis
Primary: Prevent first attack of acute rheumatic fever
Secondary: Prevent the recurrence of acute rheumatic fever to result in rheumatic heart disease
A delayed sequelae of Group A Streptococcus pharyngitis will lead to _____
Glomerulonephritis
Streptococcus agalactiae infection is due to ________
Raw fish consumption
Streptococcus agalactiae infection, what do the following groups present?
- Infants
- Pregnant woman
- Non-pregnant woman
Streptococcus agalactiae infection, what do the following groups present?
- Infants: Bacteremia without a focus
- Pregnant woman: Urinary Tract Infection
- Non-pregnant woman: Skin and Soft tissue infection, Septic arthritis, Osteomyelitis
Streptococcus dysgalactiae infection Name 3 clinical manifestations 1. 2. 3.
Streptococcus dysgalactiae infection Name 3 clinical manifestations 1. Pharyngitis 2. Skin and soft tissue infection 3. Septic arthritis
Consider streptococcus pneumoniae
- What shape? Gram positive or negative?
- Name 2 features
- Name 2 syndromes associated
- Name 1 prevention method
Consider streptococcus pneumoniae
- Gram positive diplococci
- Heavily encapsulated + Mucoid
- Otitis Media + Pneumonia/ Asthma/ COPD
- Name 1 prevention method: Vaccination (PPV or PCV)
Viridans Streptococci is
- A common ______ flora
- Name 2 clinical syndromes
- Suggest 1 treatment using antibiotics
Viridans Streptococci is
- A common oral flora
- Name 2 clinical syndromes: Dental caries, Endocarditis
- Suggest 1 treatment using antibiotics: Penicillin and Gentamicin (Synergistic effect with better treatment result)
Which type of Viridans Streptococci has a characteristic caramel smell
Streptococcus anginosus
Consider Streptococcus bovis
What is the difference between Biotype I and Biotype II
Consider Streptococcus bovis
What is the difference between Biotype I and Biotype II
Biotype I: Ferment Mannitol
Biotype II: Do not ferment Mannitol
Consider Enterococci
- Shape? G+ or G-?
- Name 2-3 clinical syndromes
- Sensitive to ________ (antibiotic)
- Resistant to _________ (antibiotic)
Consider Enterococci
- Gram positive cocci in chains
- Name 2-3 clinical syndromes: Urinary tract infection, Bacteremia, Endocarditis
- Sensitive to Ampicillin (antibiotic)
- Resistant to Nitrofurantoin (antibiotic)
