STREP INFXNS
BETA HEMOLYTIC STREP—-CLASSIFIED BY CELL WALL CHARBOHYDRATES INTO LANCEFIELD’S GROUPS AND BY T-PROTEINS INTO GRIFFITH’S TYPES
CAUSE PHARYNGO-ADENO-TONSILLITIS IN PEDS—-REALLY A SCHOOL AGE Dz—–RARE FOR UNDER 3 AND OVER 18—PROBABLY SOME RECEPTOR PHENOM
IT COSTS $100 TO PROVE THAT YOUR PT HAS A 90% CHANCE OF NOT HAVING THE Dz—-OFTEN BETTER TO JUST TREAT—-ALSO A HIGH NUMBER OF Asx CARRIERS
SOME EVIDENCE THAT RECOLONIZING THE PHARYNX WITH NL FLORA (ALPH HEMOLYTIC STREP) MAY DECREASE THE RECURRENCE RATE
REC DAILY CLEANING OF RETAINERS AND ORAL APPLIANCES—REGULAR CHANGING OF TOOTHBRUSHES
ADULT SUPRAGLOTTITIS
SECOND Dz = SCARLET FEVER
FOLLOWS GABHS INFXN BY 3-5 DAYS
FLUSHED FACE
CIRCUMORAL PALLOR
PASTIAS LINES (INCREASED ERYTHEMA IN ANTECUBITAL FLEXOR CREASES)
WHITE STRAWBERRY TONGUE
BRANNY FINE SAND PAPER RASH—-LATER DESQUAMATES
HIGH ASO AND DNASE B TITERS
Rx PCN TO AVOID RARE GABHS SEQUELAE (PSGN/RHEUMATIC HEART Dz)—-SYDENHAM’S CHOREA (ST. VITUS DANCE)
(STREP PNEUMO IS STILL THE LEADING ISOLATE IN BOTH UPPER AND LOWER RESP TRACT INFXNS)
CELLULITTIS—-DIFFUSE INFLAMMATORY RESPONSE–INFXN THROUGH THE TISSUE PLANES = VASCULAR INFLAMMATION
ERYSIPELAS—MORE DERMAL, A MORE VIRULENT STREP CELLULITIS, AN ADVANCING BORDER, RED/HOT TENDER, TENSE
PRIMARILY GABHS—BULLAE MAY FORM
ASCENDING LYMPHANGITIS
IMPETIGO/PYODERMA—TYPE 49 STREP—-MORE EPIDERMAL, SUPERFICIAL SKIN INFXN, VESCICULAR OR PUSTULAR (STREP = HONEYCRUSTING) OR STAPH AUREUS—THE TERM ESCHAR IS SOME TIMES USED HERE
PHLEGMON—-DIFFUSE SOFT TISSUE INFLAMMATION(PANCREATITIS)—USUALLY STAPH OR STREP—-RX IV ABX
MELENEY’S CELLULITIS (S.A. AND PEPTOSTREPTOCOCCUS)
Rx: DEBRIDE, IV ABX, HBO
“SURGICAL”-NECROTIZING FASCIITIS = CERVICAL NECROTIZING CELLULITIS = HOSPITAL GANGRENE = “FLESH EATING BACTERIA” = MALIGNANT ULCER = PHAGEDENA—-POLYMICROBIAL(ANAROBES AND AEROBES)/DESTRUCTIVE—USUALLY A VIRULENT GROUP A STREP WITH TISSUE TOXIC ENZYMES–NECK IS THE MOST COMMON SITE—-GIVE CLEOCIN AS A COMPONENT OF ANTIMICROBIAL THERAPY AS IT DECREASES THE TOXIN PRODUCTION FROM THE STREP—-ALSO ANTITOXINS, ANTI-INFLAMMATORY MEDS, DEBRIDEMENT AND HYDRATION
D5 ½ NS + 20 KCL/L AT 75 CC/HOUR—–UNASYN 3 G IV Q 6—–CLEOCIN 900MG IV Q 8
CONSIDER HBO
DIBETICS AT A MUCH HIGHER RISK—-GET SUGARS UNDER CONTROL
REGIONAL HYPESTHESIA IS A SERIOUS WARNING SIGN—-INCICATIVE OF AN UNDERLYING NECROTIZING PROSCESS
MUST MONITOR METABOLIC STATUS—CORRECT ANY ACIDOSIS
CT SCAN—TREMENDOUS SOFT TISSUE EDEMA CONFORMING TO THE FASCIAL PLANES OF THE NECK—-ALSO SCAN THE CHEST TO R/O MEDIASTINAL INVOLVEMENT—MAY SEE SOME AIR—LOOK FOR THIS
MAY PAPATE SOME CREPITANCE
MAY JUST NEED TO OPEN AND START DSG CHANGES WITH 1/4 STRENGTH DAKIN-DAUFRESNE SOLUTION!
OPEN EARLY—USUALLY NO FRANK PURULENCE—–RATHER A THIN SEROSANGINOUS “DISHWATER” LIKE DRAINAGE
START CLEOCIN AND UNASYN EARLY—–WATCH RENAL PARAMETERS—ESPECIALLY WITH REGARDS TO CONTRASTED SCANS
DEBRIDE IN OR Q 3 DAYS—-COVER WITH STSG ONLY AFTER WOUND HAS GRANULATED (OR CONSIDER A DP FLAP)