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Group B Streptococcus● Group B Streptococcus is a
bacterial infection of Streptococcus agalactiae. It is a facultative anaerobic bacteria that is gram positive with a cocci morphology found in chains. Many GBS strains are mainly encapsulated and are then serologically classified according to the presence of type-specific capsular polysaccharides. These capsules are important virulence factors and stimulators of antibody-associated immunity.
● Group B Streptococcus in the Neonate: Early and late-onset
● Transmission of bacteria from mother to newborn occurs when the baby passes through the birth canal and comes into contact with the mother’s epithelial cells.
● Early-onset GBS is more dangerous and usually starts with a fever or abnormally low temperature, difficulty feeding, lethargy, breathing difficulties, rapid heart rate or slow heart rate. The most life threatening forms of infection are pneumonia, sepsis, and meningitis.
● Group B Streptococcus in the Neonate: Early and late-onset
● Late-onset disease is similar to early-onset, yet less severe.
● Test- Blood cx, CSF cx, urine cx, CBC, chest x-ray, ABGs, and coagulation studies.
● Treatment- IV antibiotics, IV fluid, and medications to reverse shock, oxygen therapy, correction of clotting abnormalities and assisted ventilation.
● Prevention and Treatment of GBS: the pregnant woman
● Risk-based approach- Emphasizes preventive treatment for expectant woman who are at high risk for GBS transmission. “A previous infant with invasive GBS, delivering at < 37 weeks gestation, having an intrapartum temperature 100.4°F, or rupture of membranes for 18 hours” according to the CDC. If a woman meet one or more of these criteria, the recommended treatment is to administer penicillin as and intrapartum antibiotic.
● Prevention and Treatment of GBS: the pregnant woman
● Culture-based screening approach- Testing for GBS in an expectant mother’s 35-37 week of pregnancy.
● Collection of lower vaginal and rectal cultures.● If a woman tests positive for GBS and is
determined to be a carrier, she is offered intrapartum chemoprophylaxis, based on the test results.
● Neonates born to these mothers with GBS colonization should be monitored for 24 hours for signs of sepsis.
Group A Streptococcus
● Group A Streptococcal pharyngitis is an acute infection of the oropharynx and or nasopharynx. It is a gram-positive cocci that tends to grow in pairs and short chains. It can be identified by their sensitivity to bacitracin.
Group A Streptococcus
● Signs and Symptoms● Often described as a sore
scratchy throat, febrile with swollen glands and, especially in children, nausea and/or vomiting.
● There is a marked increase in redness and swelling of the tonsils possibly accompanied by white patches or streaks on the tonsils.
● The patient may have difficulty swallowing, and enlarged lymph glands in the neck.
Group A Streptococcus
● There may be tiny pinpoint red marks on the soft palate referred to as petechiae.
● Other findings may include a beefy red swollen uvula, excoriated nares (especially in infants), and a scarlitiniform rash.
Group A Streptococcus
● For the clinician to make a definitive diagnosis, he or she must do a throat culture.
● Rapid Strep Antigen● Blood agar culture
● Management of Group A Streptococcal Pharyngitis P a tie n t W ith a S ore T h ro a t
A d ap ted fro m S loa ne P D , e t a l., ed s. E ssen tia ls o f fam ily m e d ic ine . 3d ed . B a lt im ore :W illia m s a n d W ilk in s , 1 99 8 :6 29
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N u m b er o f s ig ns an d sym p tom s p re se n t1 . L ack o f cou g h .
2 . H is to ry o f fev e r.3 . T o ns illa r e xu da te
● Management of Group A Streptococcal Pharyngitis
● Complications● Peritonsillar abcess● Scarlet fever● Poststreptococcal glomerulonephritis● Rheumatic fever
PANDAS
● PANDAS- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection
● Case Study● Two year, nine month old male presents in the Emergency Department with inconsolable crying for one day.
PANDAS
• Diagnositic Criteria for PANDAS• 1. Presence of Obsessive-compulsive disorder and/or a tic disorder• 2. Pediatric onset of symptoms (age 3 years to puberty)• 3. Episodic course of symptom severity• 4. Association with Group A Beta-Hemolytic Streptococcal infection ( a
positive throat culture for strep or history of scarlet fever)• 5. Association with neurological abnormalities (motoric hyperactivity, or
adventitious movements, such as choreiform movements