Internal Medicine

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

Streptococcal Infections Strongyloidiasis 1385

complications and prognosis

Complications

■Sequelae of streptococcus group A pharyngitis: acute rheumatic

fever and poststreptococcal glomerulonephritis (can also get from

impetigo)

Prognosis

■Good for most soft-tissue infections except necrotizing fasciitis;

20–70% mortality despite antibiotics

■In general, highest mortality in the elderly, immunocompromised,

presence of other co-morbidities; invasive pneumococcal disease

have a case-fatality rate of 40% in the elderly

■The prevalence of later heart disease after acute rheumatic fever

depends on the severity of heart disease during the initial attack

Prevention

■Pneumococcal vaccine:

■Contains capsular polysaccharides from 23 common infecting sero-

types of S. pneumoniae

■Studies show an efficacy of 60–70%, particularly in reducing bac-

teremia

■The U.S. Preventive Services Task Force recommends vaccines for

individuals >65, or institutionalized people >50, or if over 2 years

with cardiac, pulmonary disease, diabetes or asplenia

■Revaccination is not routinely recommended.

STRONGYLOIDIASIS

J. GORDON FRIERSON, MD

history & physical

History

■Infection due to infestation with strongyloides stercoralis

■Life cycle: pregnant females are embedded in wall of upper small

intestine, eggs laid which hatch in small intestine, producing filari-

form (infective) and rhabditiform (non-infective) larvae, which pass

in stool. Some filariform larvae re-invade through the small or large

bowel or perianal skin. In soil, rhabditiform larvae may become

infective filariform) and penetrate skin. Re-invading larvae pass in