Prevention and treatment of neonatal group B streptococcal infection
Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves in Clinical Protocols in Labour, 2020
Pregnant women found to have group B streptococcal bacteruria at any stage antepartum should be offered treatment with oral penicillin four times a day for 10 days or erythromycin 500 mg four times a day if allergic to penicillin. Further urine cultures should be sent to check for clearance of group B streptococcal infection 72 h following cessation of antibiotics. All term babies delivered to mothers who were given antibiotics less than 4 h before delivery, or whose mothers should have had antibiotics but did not, should have neonatal surface cultures, full blood count with a differential white cell count, C-reactive protein and a blood culture sent. Asymptomatic twin siblings of babies who develop group B streptococcal disease must be fully screened and treated with intravenous antibiotics. The dose of penicillin should be 100 mg/kg/dose 12-hourly. The dose of gentamicin should be tailored to gestation and weight as given in the Neonatal Unit pharmacopeia.
The skin and subcutaneous tissues
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
The skin is a complex organ that provides protection from ultraviolet light and microbiological invasion. A carbuncle is a spreading necrotizing infection in the subcutaneous tissues, with pus and slough formation, similar to the changes that occur in a boil, but with many points of discharge through holes in the skin that appear when patches of necrotic skin slough. Erysipelas is an infection in the skin and subcutaneous tissues caused by a pathogenic Streptococcus. Tuberculosis of the skin is a rarity. Primary tuberculosis of the skin produces a persistent ulcer with undermined edges. Scattered soft macules may appear in the skin flexures, especially in the submammary areas and axillae of obese females. The word ‘mole’ is a lay term used to describe a brown spot or blemish on the skin. Prolonged exposure of the skin to sunlight can cause areas of hyperkeratosis of the skin, which may undergo malignant change.
Case 24: Purpura Hemorrhagica
Laurel J. Gershwin in Case Studies in Veterinary Immunology, 2017
Purpura hemorrhagica in horses is most frequently associated with infection by Streptococcus equi , the syndrome can occur with other diseases in which there is an antigen excess with circulating antibodies present. The pathogenesis of purpura hemorrhagica also involves similar immune mechanisms to that of systemic lupus erythematosus (SLE). This chapter presents the case study of country girl. Country Girl is a three-year-old Quarter Horse filly. Approximately one week after arrival at the new barn she became anorectic, depressed, and had a fever of 104°F. Country Girl received penicillin and the trainer was instructed to hot pack the abscessed lymph node until it was ready to be lanced. A complete blood count (CBC) showed a mild leukocytosis and neutrophilia, which was the only abnormality detected. Country Girl was diagnosed with purpura hemorrhagica due to the history of a recent Streptococcus equi infection together with the clinical signs of immunecomplex disease and the absence of evidence for alternative causes.
Streptococcal toxic shock syndrome with primary group A streptococcus peritonitis in a healthy female
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
A 47-year-old female with a history of chronic alcoholism presented with nausea, vomiting and mild epigastric tenderness. She reported subjective fever, abdominal fullness and loose, watery stools and had stable vitals on arrival. Examination was positive for mild epigastric tenderness with hepatic enlargement. Computed tomography of the abdomen showed circumferential thickening of the stomach wall, lower esophagus and the first part of the duodenum in addition to peritoneal ascites. She was admitted for alcohol-related gastritis, acute alcoholic hepatitis, and acute kidney injury. She was started on fluid resuscitation and supportive management. After 8-hours, the patient became hemodynamically unstable with subsequent intubation and fluid resuscitation. She was started on empiric antibiotics. Blood and ascitic fluid cultures were obtained showing group A beta-hemolytic streptococci (GAS). The patient was diagnosed with primary GAS peritonitis along with diffuse gastritis and streptococcal toxic shock syndrome. No cutaneous source of Streptococcus pyogenes was identified, and there was no personal or family history of streptococcal pharyngitis. Antibiotics were switched to IV ampicillin and clindamycin. However, the patient continued to deteriorate and succumbed to death within 2-days.
Group B streptococcal immunisation of pregnant women for the prevention of early and late onset Group B streptococcal infection of the neonate as well as adult disease
Published in Expert Review of Vaccines, 2017
Anna L. Kenchington, Ronald F. Lamont
Introduction: Early onset neonatal Group B streptococcal disease is preventable. Intrapartum antibiotic prophylaxis has resulted in a significant reduction in neonatal mortality and morbidity. National guidelines for the selection of women eligible for intrapartum antibiotic prophylaxis, whether screening-based or risk-based, differ according to the local burden of disease. Despite the introduction of intrapartum antibiotic prophylaxis, there remains a significant burden of disease, which can be resolved by better adherence to guidelines, rapid identification of maternal colonization or in the future, vaccination. Areas covered: The introduction of a vaccine to women in the third trimester is likely to further reduce the burden of disease and provide benefits beyond the prevention of early neonatal disease, including meningitis and disability following late onset disease. Development of specific polyvalent vaccines continues, but testing has challenges and may require surrogate markers or molecular-based techniques to manipulate antigenicity and immunogenicity. Expert commentary: Group B streptococcal vaccination using conjugated polyvalent vaccines against the major disease causing serotypes of Group B streptococcus, either alone, or in combination with a policy of intrapartum antibiotic prophylaxis, may decrease the burden of Group B streptococcus beyond that achieved by current use of intrapartum antibiotic prophylaxis alone.
Streptococcal Pharyngitis Leading to Corneal Ulceration
Published in Ocular Immunology and Inflammation, 2012
Tarra W. Millender, L. Barth Reller, Landon C. Meekins, Natalie A. Afshari
Purpose: To report a patient with a history of exposure keratopathy who presented with bilateral bacterial keratitis associated with streptococcal pharyngitis and use of bilevel positive airway pressure (BiPAP). Design: Case report. Methods: Pulsed-field gel electrophoresis of patient isolates from ocular and pharyngeal cultures. Results: Ocular and oropharyngeal cultures from a 24-month-old child with a history of cerebral palsy on BiPAP at night revealed the same strain of Streptococcus pyogenes. Conclusions: Use of mechanical ventilation, such as BiPAP, may precipitate inoculation of eye with respiratory or oropharyngeal pathogens. To the authors’ knowledge this is the first report demonstrating the association between concurrent streptococcal pharygitis, keratitis, and use of BiPAP.
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