Group A Hemolytic Streptococcus Pharyngitis

Group A hemolytic streptococcus, commonly found in Gram-positive bacteria as the causative bacteria such as skin infections and suppurative inflammation of the upper airway, causing a variety of clinical symptoms and tissue site of invasion by bacteria.Disease can be seen daily as well, in addition to acute pharyngitis, scarlet fever as there is a special type disease impetigo, or cellulitis flame. Cause otitis media, pneumonia, septic arthritis, osteomyelitis, meningitis, etc. In addition to these. In addition, rather than the direct action of bacteria, that through the immunological mechanism, cause rheumatic fever and acute glomerulonephritis are known. In addition, the pathogenesis, pathophysiology is unknown, accompanied by soft tissue necrosis, (streptococcal toxic shock syndrome) is a serious disease problem as hemolytic streptococcus infection causing fulminant septic shock is. Here, in infectious disease surveillance under the Infectious Diseases Control Law, we describe the group A hemolytic streptococcus pharyngitis has become a fixed point understanding disease type 4 infection.

of group A hemolytic streptococcus infection in temperate regions is a universal disease, but also found in subtropical regions, in tropical regions is a rare disease.

Hemolytic group A streptococcal pharyngitis, but can also occur in any age, most children of school age, in adults under the age of 3 cases and exhibits a typical clinical picture is small. According to the surveillance data of infectious diseases, the peak of the number of reports of two early summer has been observed from winter and spring. In recent years, there is a tendency to increase the overall number of reports, there is a possibility due to diagnostic technology has improved such as the spread of rapid diagnostic kit.
This disease is usually, in order to propagate through contact with the patient, the likelihood of contact when the opportunity to increase between people, many of infection in a group home, and schools. Infectious during the acute phase most strongly, and then gradually diminished. For the acute phase of infection rate between the brothers is the most high percentage, 25% have been reported. According to the studies using throat culture at the school, has been reported as 15 to 30% healthy carrier, it is believed that infection from healthy carrier is rare.

Streptococcus is a Gram-positive cocci, group Lancefield A ~ V (I, J are excluded) are classified according to antigenicity of the polysaccharides of the cell wall. Causative agent of this disease belongs to a group A of this, because it causes (complete hemolysis) β hemolysis on sheep blood agar added red blood cells, called β-hemolytic streptococcus group A (Streptococcus) hemolysis (α is incomplete hemolysis hemolysis, γ refers to a non-hemolytic). As the name of the fungal species (Streptococcus pyogenes Streptococcus pyogenes ) is used. Most of the hemolytic streptococcus group A has an M protein and T protein as an antigen protein on the cell surface, the antigenicity of these are further classified by type. To more than 100 M protein type, the T is a type of protein has been known about 0 to 5. In addition, it is believed that this fungus is secreted outside the cells by toxin-producing hemolysis, pyrogenic toxin (erythrogenic toxin), nucleic acid degrading enzymes, such as streptokinase, a protein agent various active, and cause various symptoms.

Clinical symptoms incubation period is a two to five days, about the infection in the incubation period is unknown. Developed sudden onset of fever and general malaise, by sore throat, often accompanied by vomiting. Pharyngeal wall is accompanied by leaching in the form of swelling tonsils, small strawberry tongue or soft palate petechiae. 

Case of scarlet fever, and 12 to 24 hours after the start of point-like fever-like skin rash erythema, sunburn-like occurrences (Photo 2) . The rash of large head needle, (sandpaper rash) to give a touch of the skin like sandpaper. Some (Pastia's sign) may appear to many parts of the wrinkles of the skin axilla, groin, etc. In particular, as they contain along this line. (Circumoral pallor) in facial skin rash that usually are not seen like this, forehead and cheeks flushed, looks only pallor around the mouth is characterized by (Photo 2) . In addition, as the change of tongue, early onset (white strawberry tongue) was observed tongue was covered with white moss, strawberry tongue and become (red strawberry tongue) and then peeling white moss. Membranous desquamation of the skin starts from the face from around the end of the first week, spread to all parts of the body before the third week.

As a complication, it may cause a non-suppurative disease rheumatic fever, acute glomerulonephritis, such as pneumonia, meningitis, or suppurative disease such as sepsis.

Pathogen diagnosis 
Is fundamental, but the bacteria can be separated by a throat culture, rapid diagnostic kit can also be used to detect the antigen polysaccharide group A. Sensitivity is equal to or greater than 80% specificity of rapid diagnostic kit is also generally high, because it depends on the amount of bacteria that is the amount of antigen, the data collection method is important monosaccharide pharynx.

Serological methods are available to see the rise of such antibody (ASK) antibody anti-streptolysin-O (ASO), anti-streptokinase antibody, become a reference for the diagnosis.

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