Streptococcal infection symptoms

The clinical symptoms of streptococcal infection are diverse and depend on the type of pathogen, the localization of the pathological process and the state of the infected organism. Diseases caused by group A streptococci can be divided into primary, secondary and rarely occurring forms. The primary forms include streptococcal lesions of the ENT organs (angina, pharyngitis, ARI, otitis, etc.), skin (impetigo, ectima), scarlet fever, erysipelas. Among secondary forms, diseases with an autoimmune mechanism of development (non-nasal) and toxic-septic diseases are distinguished. Secondary forms of the disease with an autoimmune development mechanism include rheumatism, glomerulonephritis, vasculitis, and to toxic-septic diseases - metatonsillar and peritonsillar abscesses, necrotic soft tissue lesions, septic complications. The rare forms include necrotic fasciitis and myositis; enteritis; focal lesions of internal organs, STS, sepsis, etc.

Clinico-laboratory symptoms of streptococcal infection with signs of invasion:

• The fall of systolic blood pressure to a level of 90 mm Hg. And below.
• Multiorgan lesions involving two organs and more:
  • kidney damage: Creatinine content in adults is equal to or greater than 2 mg / dl, and in children is twice the age limit;
  • coagulopathy: the number of platelets is less than 100x10 ⁶ / l; increased intravascular coagulation; insignificant fibrinogen content and the presence of its decay products;
  • liver damage: the age norm of the content of transaminases and total bilirubin is exceeded twice or more:
  • acute RDS: acute onset of diffuse pulmonary infiltration and hypoxemia (there are no signs of heart damage); increased capillary permeability; a common edema (the presence of fluid in the pleural or peritoneal region); a decrease in albumin in the blood;
  • a common erythematous spotted rash with desquamation of the epithelium;
  • necrosis of soft tissues (necrotic fasciitis or myositis).
• Laboratory criteria - allocation of group A streptococcus

The cases of streptococcal infection are divided into:

• probable - the presence of clinical signs of the disease in the absence of laboratory confirmation or in the allocation of another pathogen; allocation of group A streptococcus from the body's non-sterile media;
• confirmed - the presence of the listed signs of the disease with the allocation of streptococcus group A of the usually sterile body media (blood, cerebrospinal fluid, pleural or pericardial fluid).

There are four stages of development of an invasive form of streptococcal infection:

• Stage I - the presence of a localized focus and bacteremia (in severe forms of tonsillopharyngitis and streptodermia, blood cultures are recommended);
• II stage - circulation of bacterial toxins in the blood;
• III stage - pronounced cytokine response of the macroorganism:
• IV stage - damage to internal organs and toxic shock or coma.

Young people are more often ill. Invasive form of streptococcal infection is characterized by a rapid increase in hypotension, multiorgan lesions, RDS, coagulopathy, shock and high lethality. Predisposing factors: diabetes mellitus, immunodeficiency states, diseases of the vascular system, use of glucocorticoids, alcoholism, chicken pox (in children). Provoking moment can serve as a minor superficial injury, hemorrhage into soft tissues, etc.

Necrotizing fasciitis (streptococcal gangrene)

• Confirmed (established) case:
  • necrosis of soft tissues involving the fascia;
  • systemic disease, including one or more symptoms: shock (blood pressure drop below 90 mm Hg), disseminated intravascular coagulation, internal organs (lungs, liver, kidneys);
  • the allocation of group A streptococcus from usually sterile body media.
• Supposed case:
  • presence of the first and second signs, as well as serological confirmation of streptococcal (group A) infection (4-fold increase in antibodies to streptolysin O and DNase B);
  • presence of the first and second signs, as well as histological confirmation of soft tissue necrosis caused by gram-positive pathogens.

Necrotic fasciitis can be caused by minor damage to the skin. External signs: swelling; erythema red, and then - cyanotic color; the formation of rapidly opening vesicles with a yellowish liquid. The process encompasses not only the fascia, but also the skin and muscles. On the 4th-5th day there are signs of gangrene; on the 7-10th day - a sharp outline of the affected area and detachment of tissues. Symptoms of streptococcal infection are rapidly increasing, early multiorgan (kidney, liver, lung) and systemic lesions, acute RDS, coagulopathy, bacteremia, shock (especially in the elderly and people with concomitant diabetes, thrombophlebitis, immunodeficiency state) develop rapidly. A similar flow of the process is possible in practically healthy people.

Streptococcal gangrene differs from fasciitis of another etiology. It is characterized by a transparent serous exudate diffusely permeating the flabby whitish fascia without signs of purulent fusion. From clostridial infection, necrotizing fasciitis is distinguished by the absence of crepitation and gas evolution.

Streptococcal myositis is a rare form of invasive streptococcal infection. The main symptoms of streptococcal infection - severe pain, not corresponding to the severity of external signs of the disease (swelling, erythema, fever, sensation of muscle strain). Characteristically, the rapid growth of signs of local necrosis of muscle tissue, multiorgan lesions, acute distress syndrome, coagulopathy, bacteremia, shock. Mortality - 80-100%.

The toxic shock syndrome is a disease that poses a direct threat to life. In 41% of the cases, the entrance gates of the infection are localized infection of soft tissues; lethality - 13%. Pneumonia - the second most frequent primary source of infection in the blood (18%); lethality - 36%. Invasive streptococcal infection in 8-14% of cases leads to the development of the syndrome of toxic shock (lethality - 33-81%). The toxic shock syndrome caused by Group A streptococcus is superior to the toxic shock syndrome of another etiology in terms of the severity of the clinical picture, the rate of increase in hypotension and organ damage, and the level of mortality. Characteristic is the rapid development of intoxication. Symptoms of shock appear in 4-8 hours and depend on the localization of the focus of primary infection. For example, with the development of the toxic shock syndrome in the background of a deep skin infection with the involvement of soft tissues, the most frequent initial symptom is sudden intense pain (the main reason for seeking medical help). In this case, objective symptoms (swelling, tenderness) at the initial stages of the development of the disease may be absent, which is the cause of erroneous diagnoses (influenza, muscle or ligament rupture, acute arthritis, gout attack, deep vein thrombophlebitis, etc.). Cases of the disease with a lethal outcome in practically healthy young people are described.

Severe pain, depending on its location, may be associated with peritonitis, myocardial infarction, pericarditis, pelvic inflammatory disease. Pain is preceded by the appearance of an influenza-like syndrome: fever, chills, muscle pain, diarrhea (20% of cases). Fever is found in about 90% of patients; infection of soft tissues, leading to the development of necrotic fasciitis - in 80% of patients. In 20% of the hospitalized, the development of endophthalmitis, myositis, perihepatitis, peritonitis, myocarditis and sepsis is possible. In 10% of cases hypothermia is probable, in 80% - tachycardia, hypotension. All patients show progressive renal dysfunction, in half of patients - acute respiratory distress syndrome. As a rule, it appears already against the background of hypotension and is characterized by severe shortness of breath, pronounced hypoxemia with the development of diffuse pulmonary infiltrates and pulmonary edema. In 90% of cases, intubation of the trachea and mechanical ventilation is necessary. More than 50% of patients observe disorientation in time and space; in some cases, the development of coma. Half of the patients who had normal blood pressure at the time of hospitalization showed progressive hypotension within the next 4 hours. Often, there is an internal combustion syndrome.

Extensive necrotic changes in soft tissues require surgical sanitation, fasciotomy and, in some cases, amputation of limbs. Clinical picture of the shock of streptococcal genesis is distinguished by a certain torpidity and propensity for persistence, which is resistant to ongoing therapeutic measures (antibiotic therapy, administration of albumin, dopamine, saline solutions, etc.).

The defeat of the kidneys precedes the development of hypotension, which is characteristic only of streptococcal or staphylococcal toxic shock. Characterized by hemoglobinuria, increased creatinine levels 2.5-3 times, a decrease in albumin concentration and serum calcium level, leukocytosis with a shift to the left, an increase in ESR, a decrease in hematocrit almost twofold.

Lesions caused by Group B streptococci are found in all age categories, but among them is the pathology of newborns. In 30% of children, bacteremia is detected (without a specific focus of primary infection), in 32-35% - pneumonia, and in others - meningitis, often occurring during the first 24 hours of life. Diseases of newborns are severe, lethality is 37%. Often children have meningitis and bacteremia, 10-20% of children die, and 50% of survivors report residual disorders. In the parturients, group B streptococci cause postpartum infections: endometritis, urinary tract lesions, and complications of surgical wounds in cesarean section. In addition, Group B streptococci are capable of causing lesions of the skin and soft tissues, pneumonia, endocarditis and meningitis in adults. Bacteremia is observed in elderly people suffering from diabetes mellitus, peripheral vascular diseases and malignant neoplasms. Especially it is necessary to note streptococcal pneumonia arising on a background of ARVI.

Streptococcus serological groups C and G are known as zoonotic pathogens, although in some cases they can lead to local and systemic inflammatory processes in humans. Greening streptococci can cause bacterial endocarditis. Smaller in importance, but incomparably more frequent symptoms of streptococcal infection - carious lesions of the teeth caused by streptococci of the mutans group (S. Mutans, S. Mitior, S. Salivarius, etc.).

[1], [2], [3], [4], [5]