Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

Streptococcal Infections 1381

Signs & Symptoms

■Pharyngitis

➣Primarily seen in Group A streptococci

➣Incubation 2–4 days

➣Sudden onset of sore throat with pain on swallowing, fevers,

headaches, malaise

➣Large, hyperemic tonsils with or without grayish-white exudates;

cervical lymphadenopathy

■Scarlet fever

➣Any streptococcal infection that elaborates pyrogenic exotoxins;

usually with pharyngitis

➣Diffusely erythematous; superimposed fine red papules;

blanches on pressure; “strawberry tongue”; Can be followed by

desquamation

■Skin and soft-tissue infections

➣Usually due to Group A streptococci; Groups B, C and G also

possible

■Erysipelas:

➣Well demarcated raised inflammation that usually involves the

face

➣Can spread rapidly with swelling

➣Fever and chills common

■Cellulitis:

➣Presents with pain, erythema and swelling; lesions are not raised

or well-demarcated

■Necrotizing fasciitis:

➣Presents as severe cellulitis, but pain out of proportion to findings

➣Anesthesia of the skin as the infection rapidly extends along the

deep muscle fascia

■Streptococcal toxic shock syndrome may develop with the sudden

onset of shock and multiorgan failure

■Rheumatic fever

➣Follows group A streptococcal pharyngeal infections (not skin

infections)

➣Inflammatory lesions involving the heart (carditis), joints (arthri-

tis), subcutaneous tissue (subcutaneous nodules), skin (ery-

thema marginatum begins as a macule that enlarges with a clear

center) and central nervous system (Sydenham’s chorea)

➣Non-specific manifestations: heart block, fever, arthralgias and

acute-phase reactants (increased erythrocyte sedimentation

rate, positive C reactive protein)