0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50
1382 Streptococcal Infections➣Presents as acute onset polyarthritis (75%), insidiously as carditis
or uncommonly with chorea
■Pneumonia
➣S. pneumoniae: most common cause of community acquired
pyogenic pneumonia
➣Presents with productive cough, high fevers, and pleuritic chest
pain
➣Malaise and shortness of breath common
➣Ill-appearing
■Meningitis
➣S. pneumoniae: most common cause of bacterial meningitis in
adults
➣Present with rapid onset of fever, headaches, altered mental
status
➣Meningismus is common
➣Focal neurologic findings and obtundation are more common
than in meningococcal meningitis
■Endocarditis
■Viridans streptococci: most common cause of native valve endo-
carditis, particularly if underlying valvular disease
➣Insidious onset with a subacute course over several weeks before
diagnosis
➣Present with fever and constitutional signs (weight loss, anorexia,
fatigue) as well as the usual diagnostic hallmarks of endocarditis
(murmurs, peripheral stigmata etc)
➣Also seen in S. pneumoniae, S. bovis (50% also have bowel malig-
nancy), Streptococci groups C and G
■Neonatal sepsis
➣Group B streptococci: cause of neonatal sepsis, bacteremia and
meningitis
➣Also thought to be the etiology for endometritis, peripartum
infections or septic abortionstests
Laboratory
■Basic blood studies:
■Normal or elevated WBC (compare to baseline especially in HIV
patients) with neutrophil predominance; abnormal liver function
tests in systemic disease and shock; elevated creatinine phospho-
kinase levels may be clue in necrotizing fasciitis; high C-reactive