Many species belong to the Streptococcus genus, which are Gram-positive, nonmotile cocci. They can be classified according to more than one scheme [1]. Their hemolytic capabilities on sheep blood agar define their division into three groups (β-, α-, and γ-hemolytic streptococci). Further classification subdivides these groups according to cell wall carbohydrate antigens into A, B, C, and other groups. The most important representative is S. pyogenes, which is a group A (beta-hemolytic) streptococcus (GABHS).

S. pyogenes causes a variety of diseases, the most common being pharyngitis and skin infections. The manifestations of pharyngitis are variable, from mild discomfort at swallowing to exudative pharyngitis with high fever [2]. In addition to throat pain, the manifestations may include chills, headache, and, in young children, abdominal pain, and vomiting. The possibility of local suppurative complications, such as peritonsillar abscess, should be checked if there is an intense pain [2]. Rarely, the pharyngitis is associated with scarlet fever.

Scarlet fever used to be a serious complication of streptococcal pharyngitis, but with the use of antibiotics, it is not considered an important threat today. However, serious conditions can develop following streptococcal infections. One is acute poststreptococcal glomerulonephritis [3], which presents with edema, hypertension, hematuria, and other urinary abnormalities. The disease is on the decline. Another sequel is rheumatic fever, an autoimmune disease initiated by S. pyogenes but dependent on the host’s immune responses. The development of the disease is associated with certain serotypes of the M protein, a cell wall component of S. pyogenes. Rheumatic fever can present as an inflammation of the joints, heart, central nervous system, or skin [3]. A large proportion of acquired heart disease cases in children originates from rheumatic fever [4]. Neuropsychiatric disorders can also follow streptococcal infections.

Superficial manifestations of streptococcal infection, other than pharyngitis, are skin conditions, such as impetigo, and erysipelas.

The most serious consequences of streptococcal infections stem from their ability to cause invasive diseases. These include sepsis, bacteremic pneumonia, necrotizing fasciitis and streptococcal toxic shock syndrome. Most of the mortality from streptococcal infections is associated with invasive disease and rheumatic fever [5]. The characteristics of an invasive streptococcal disease include systemic toxicity, hypotension, shock, multiple organ failure, rapid necrosis, and gangrene [3]. Several bacterial factors (for example pyrogenic exotoxins and nucleases) are thought to contribute to the pathogenesis of an invasive disease. [3].

Group B Streptococcus infections, caused by Streptococcus agalactiae, were thought to occur mainly in women after childbirth and in newborn babies. However, recently, the infection has appeared in nonpregnant adults, usually associated with comorbidities.

• Fever

  We described a 21-year-old Japanese patient with sore throat, fever, and diffuse erythema on the neck, trunk, and limbs. Erythema markedly appeared on the neck, axillary, antecubital, and popliteal fossae. [ncbi.nlm.nih.gov]

  Puerperal fever c. Surgical scarlet fever d. Myositis e. Necrotizing fasciitis 2. Localized a. Impetigo b. Ecthyma - hardbase c. Hidradenitis The above may be antecedent to acute glomerulonephritis. [atsu.edu]

• Wound Infection

  Redness, heat, edema, and streaking lymphangitis are hallmarks of the more acute, toxic forms of streptococcal skin and wound infections. Chills and fever commonly accompany such illnesses. B. Ecthyma C. [atsu.edu]

  Other types of common infections include skin and wound infections, ear and sinus infections, and infections in the lymph glands. [healthlinkbc.ca]

  Streptococcal and staphylococcal impetigo have similar lesions, including folliculitis, pyoderma, wound infection, lymphatic spread, and sepsis. [histopathology-india.net]

  The predominant diseases are as follows: Streptococcal p haryngitis ( strep throat, Fig. 2) Scarlet fever Rheumatic fever Glomerulonephritis Impetigo Cellulitis (almost anywhere on the body; see erysipelas below) Wound infections Bone infections Sinusitis [medicinenet.com]

• Malaise

  He had persistent fever (39.5 degrees C) and general malaise for 2 weeks. Intraoral examination revealed extremely inflamed and enlarged gingiva with spontaneous bleeding and suppuration. [ncbi.nlm.nih.gov]

  COMPLICATION : Acute Glomerulonephritis The major clinical and laboratory manifestations of acute post-streptococcal glomerulonephritis are: CLINICAL FEATURES LABORATORY FINDINGS Abrupt onset Hematuria, cylindruria Headache, malaise Proteinuria Edema, [atsu.edu]

  Early symptoms of TSS are nonspecific and often begin with influenza-like symptoms of mild fever and malaise. However, TSS often suddenly advances with symptoms of high fever, nausea, vomiting, diarrhea, skin rash, and a low blood pressure. [medicinenet.com]

  Erysipelas most commonly affects one side of the face or a single limb and may be accompanied by systemic symptoms such as fever, chills, and malaise. [ndnr.com]

• Sore Throat

  […] there's little proof they help) You can buy them from a supermarket or from a pharmacist without a prescription. your sore throat doesn't improve after a week you often get sore throats you're worried about your sore throat you have a sore throat and [nhs.uk]

  Group A streptococcal (GAS) infections can range from a mild skin infection or a sore throat to severe, life-threatening conditions. [my.clevelandclinic.org]

  Sore throat was statistically more frequent in FS (18/24 cases, 75%) than in Guillain-Barré syndrome (29/58 cases, 50%). In a series, however, the association of FS with group A streptococcal infection was not shown. [ncbi.nlm.nih.gov]

• Cough

  (If you have a sore throat as well as a cough, red eyes, hoarseness, diarrhoea, or a blocked-up nose then the cause is likely to be a viral infection, not streptococcal.) [netdoctor.co.uk]

  Wash your hands especially after coughing or sneezing and before preparing foods or eating. Coughs and sneezes should be covered. All wounds should be kept clean. Watch for signs of infection. [simcoemuskokahealth.org]

  These germs can be spread from child to child by sneezing, coughing and talking. Strep germs can also live long enough on objects like doorknobs, toys, cups, and eating utensils for kids to get them that way too. [kidspot.com.au]

  When a person infected with GAS breathes, coughs, or sneezes, the bacteria are spread through the air. If you breathe in air or touch objects contaminated with the bacteria you can become infected. [healthlinkbc.ca]

• Throat Irritation

  GAS infections can produce many different signs and symptoms: Pharyngitis (strep throat/ tonsillitis ): sore throat, irritation with swallowing, white patches on tonsils (exudates), swollen lymph nodes on the neck, fever; pharyngitis with fever and white [medicinenet.com]

• Nausea

  Early signs of Streptococcal toxic shock syndrome may include low blood pressure and shock, dizziness, confusion, red rash, nausea, vomiting and abdominal pain. [simcoemuskokahealth.org]

  Cellulitis can make you feel generally unwell, causing symptoms such as a high temperature, nausea, shivering and chills. [hse.ie]

  However, when it does, streptococcus can cause: pneumonia sepsis (a serious infection of the blood) meningitis toxic shock syndrome (toxins released into the blood causing fever, nausea and vomiting) a serious infection of the deeper layers of the skin [healthdirect.gov.au]

• Eczema

  Underlying skin diseases that predispose to streptococcal pyoderma, such as tinea capitis and eczema, may become more apparent. [atsu.edu]

  Impetigo Drug reaction Guttate psoriasis Nummular eczema Pityriasis rosea A: The most likely diagnosis is guttate psoriasis. [mdedge.com]

  The bacteria get into scrapes, cold sores, insect bites or patches of eczema. For more information, see HealthLinkBC File #81 Impetigo. Toxic shock syndrome (TSS) is a rare and serious result of an invasive GAS infection. [healthlinkbc.ca]

  An infection can also occur when the bacteria invade the skin as a result of the skin barrier being disrupted by another underlying skin condition, such as head lice, scabies or eczema. [hse.ie]

  A nonsteroidal alternative to impetiginized eczema in the emergency room. J Am Acad Dermatol. 2010;63(3):537-539. Tschudin-Sutter S, Frei R, Egli-Gany D, et al. [ndnr.com]

• Petechiae

  Cutaneous petechiae are not uncommon, and a scarlatiniform rash may be present. When the characteristic rash of scarlet fever exists, a clinical diagnosis can be made with increased confidence. [emedicine.medscape.com]

  Scarlet fever: pharyngitis symptoms (see above), pastia (pink or red lines formed of confluent petechiae, which are small purple or red spots in the skin caused by minor blood vessel breaks) that are found in skin creases, especially the flexor surface [medicinenet.com]

  Mouth wide open showing the throat Note the petechiae, or small red spots, on the soft palate. [en.wikipedia.org]

• Sweating

  These infections are potentially much more serious and even life-threatening (up to 25% of people who develop a severe invasive strep A infection die from it) and include; Pneumonia – a serious lung infection, causing sweats and high fever, persistent [netdoctor.co.uk]

  Symptoms include extreme tiredness, weakness, fever, chills, night sweats, and weight loss. The infection can progress, resulting in problems with heart function in some cases. [humanillnesses.com]

• Arthralgia

  We report the case of an immunocompetent child who showed monoarticular arthritis and fever, preceded by pharyngitis and arthralgias. [ncbi.nlm.nih.gov]

  The minor criteria include arthralgia, fever, elevated erythrocyte sedimentation rate, elevated C-reactive protein, or a prolonged PR interval [ 1 ]. [casesjournal.biomedcentral.com]

  Other minor Jones Criteria are fever, elevated ESR and arthralgia. One of the most serious complications is pancarditis, or inflammation of all three heart tissues. [en.wikipedia.org]

• Oliguria

  COMPLICATION : Acute Glomerulonephritis The major clinical and laboratory manifestations of acute post-streptococcal glomerulonephritis are: CLINICAL FEATURES LABORATORY FINDINGS Abrupt onset Hematuria, cylindruria Headache, malaise Proteinuria Edema, oliguria [atsu.edu]

  Some experts recommend use when there has been no clinical response after the first 6 hours of supportive therapy, or in cases in which an undrainable focus or persistent oliguria with pulmonary edema are present. [clinicaladvisor.com]

• Microscopic Hematuria

  Post-streptococcal acute glomerulonephritis was diagnosed on the basis of a high antistreptolysin O titer, hypocomplementemia, proteinuria, and microscopic hematuria. [ncbi.nlm.nih.gov]

• Headache

  Abstract We previously found that 97% of children diagnosed with chronic tension-type headaches had meningismus. [ncbi.nlm.nih.gov]

  Strep throat starts suddenly with a high fever, headache, swollen red throat and tonsils, swollen lymph nodes in the neck, white or yellow patches at the back of the throat and, in children, abdominal pain. [healthlinkbc.ca]

  COMPLICATION : Acute Glomerulonephritis The major clinical and laboratory manifestations of acute post-streptococcal glomerulonephritis are: CLINICAL FEATURES LABORATORY FINDINGS Abrupt onset Hematuria, cylindruria Headache, malaise Proteinuria Edema, [atsu.edu]

  Over-the-counter painkillers such as paracetamol, ibuprofen or aspirin can be used to relieve a headache, high temperature and any facial pain or tenderness. Read more about the treatment of sinusitis. [your.md]

  Symptoms include a stuffy nose, colored discharge (green, yellow, or tinged with blood) from the nose, tenderness around the eyes, and headache or a feeling of pressure in the head. [humanillnesses.com]

Early diagnosis of streptococcal infections is important not just for the treatment of the acute disease, but also to prevent complications [6], such as rheumatic fever [7]. Therefore, while culture is regarded as the most reliable method for the identification of Streptococcus species [3], decisions regarding treatment sometimes have to be made before the results are available because of the time required for growth of the bacterial cultures [7].

Several quick assays have been developed based on the immunological detection of the group-specific cell wall carbohydrate of GAS organisms. These assays use latex agglutination, enzyme immunoassay, and optical immunoassay; DNA is detected by PCR methods and chemiluminescent DNA probes [8]. These methods are very specific, but of variable sensitivity, although this has been reported to be high in some assays [6] [7] [8] [9]. Recommendations by the Infectious Diseases Society of America advocate the use of rapid antigen detection tests and/or cultures for the diagnosis of streptococcal pharyngitis, with negative immunological tests to be followed up by culturing the organism in populations at high risk for acute rheumatic fever (children and adolescents) [10].

Assaying for antistreptococcal antibodies in serum is most valuable for the diagnosis of rheumatic fever and other poststreptococcal diseases. In cases of necrotizing fasciitis, a frozen section biopsy can be used to identify or confirm the presence of the organism.

• Gram-Positive Bacteria

  Vancomycin View full drug information Vancomycin acts by inhibiting proper cell wall synthesis in gram-positive bacteria. [emedicine.medscape.com]

  positive bacteria belonging to the family streptococcaceae. [icd10data.com]

  Location: Lecture Hall 4Z, Alfred Nobels Allé 8, Karolinska University Hospital, Huddinge Abstract Streptococcus pyogenes and Staphylococcus aureus are Gram-positive bacteria that share many features, including clinical presentations and pathogenic mechanisms [openarchive.ki.se]

  However, S. dysgalactiae can also be group A. [1] S. pyogenes is a beta-hemolytic species of Gram positive bacteria that is responsible for a wide range of both invasive and noninvasive infections. [2] Infection of GAS may spread through direct contact [en.wikipedia.org]

• Gram-Positive Coccus

  Group A Strep (GAS) Infection Related Articles Group A Strep (GAS) Infection Facts Streptococcus pyogenes, also known as group A beta-hemolytic Streptococcus, or group A strep ( GAS ) is a gram-positive coccus (spherical bacteria) that is ubiquitous, [emedicinehealth.com]

  GENERAL DESCRIPTION Microbiology Streptococcus pyogenes, or Group A streptococcus (GAS), is a facultative, Gram-positive coccus which grows in chains and causes numerous infections in humans including pharyngitis, tonsillitis, scarlet fever, cellulitis [antimicrobe.org]

Even with prompt treatment of invasive group A Streptococcus, it remains the most common cause of infection that results in severe maternal morbidity and death in the world. [ncbi.nlm.nih.gov]

Abstract Pancarditis is a rare condition with a poor prognosis combining endocarditis, myocarditis with abscess formation, and purulent pericarditis. [ncbi.nlm.nih.gov]

What is the prognosis for group A streptococcal infections? The prognosis for mild GAS infections is usually good to excellent. [medicinenet.com]

Group G Streptococcus is rarely the infective etiology of perianal streptococcal dermatitis. This condition presents as a superficial well demarcated erythematous patch on clinical examination. [ncbi.nlm.nih.gov]

In recent epidemiological studies, Streptococcus dysgalactiae subsp. equisimilis (SDSE) has been isolated from severe invasive streptococcal infection. [ncbi.nlm.nih.gov]

The pathophysiology of the involuntary movements may be associated with sensorimotor cortex hyperexcitability. [ncbi.nlm.nih.gov]

Because the pathophysiology of invasive GAS infection is largely toxin mediated, the use of a protein synthesis inhibitor (eg, clindamycin) offers a theoretical advantage. [emedicine.medscape.com]

An immunological view of the pathophysiology of psoriasis. Clin Exp Dermatol 2001 ; 26 : 326 –32. Olivier C. Rheumatic fever - is it still a problem? J Antimicrob Chemother 2000 ; 45 (suppl): 13 –21. Leung DY, Travers JB, Norris DA. [jmg.bmj.com]

Hand washing remains the cornerstone of prevention as transmission can occur directly from an asymptomatic colonized healthcare provider, other patients, or a community-acquired source. [ncbi.nlm.nih.gov]

Figure 1 derived from Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: a public health perspective. [aafp.org]

1. Hamada S, Kawabata S, Nakagawa I. Molecular and genomic characterization of pathogenic traits of group A Streptococcus pyogenes. Proc Jpn Acad Ser B Phys Biol Sci. 2015;91(10):539-559.
2. Wessels MR. Streptococcal pharyngitis. N Engl J Med.2011;364(7):648-655.
3. Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev. 2000;13(3):470-511.
4. Pavone P, Parano E, Rizzo R, Trifiletti RR. Autoimmune neuropsychiatric disorders associated with streptococcal infection: Sydenham chorea, PANDAS, and PANDAS variants. J Child Neurol. 2006;21(9):727-736.
5. O’Loughlin RE, Roberson A, Cieslak PR, et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis. 2007;45(7):853-862
6. Smith JM, Bauman MC, Fuchs PC. An OIA for the direct detection of group A strep antigen. Lab. Med. 1995;26: 408–410.
7. Orda U, Gunnarsson R, Orda S, Fitzgerald M, Rofe G, Dargan A. Etiologic predictive value of a rapid immunoassay for the detection of group A Streptococcus antigen from throat swabs in patients presenting with a sore throat. Int J Infect Dis. 2016;45:32-35.
8. Leung AK, Newman R, Kumar A, Davies HD. Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis. Expert Rev Mol Diagn. 2006 Sep;6(5):761-766.
9. Lasseter GM, McNulty CAM, Hobbs FDR, Mant D, Little P. In vitro evaluation of five rapid antigen detection tests for group A beta-haemolytic streptococcal sore throat infections. Family Practice. 2009; 26: 437–444.
10. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102.