Streptococcal infections – the group of diseases including the infections caused by streptococcal flora of different types and the airways and integuments which are shown in the form of defeat. Carry streptococcal impetigo, a streptodermiya to streptococcal infections, streptococcal vaskulit, rheumatism, glomerulonefrit, an ugly face, quinsy, scarlet fever and other diseases. Streptococcal infections are dangerous by tendency to development of post-infectious complications from various bodies and systems. Therefore diagnostics includes not only identification of the activator, but also tool inspection of cardiovascular, respiratory and urinary systems.
Streptococcal infections – the group of diseases including the infections caused by streptococcal flora of different types and the airways and integuments which are shown in the form of defeat. Streptococcal infections are dangerous by tendency to development of post-infectious complications from various bodies and systems.
Characteristic of the activator
Streptococcus – a sort of the facultative and anaerobic grampolozhitelny spherical microorganisms steady in the environment. Streptococci are steady against drying, remain in the dried-up biological materials (a phlegm, pus) several months. At a temperature of 60 °C. perish in 30 minutes, under the influence of chemical disinfectants - in 15 minutes.
The tank and source of a streptococcal infection – the carrier of streptococcal bacteria or the patient of one of forms of an infection of people. The transfer mechanism – aerosol. The activator is allocated to patients at cough, sneezing, during the conversation. Infection occurs in the airborne way therefore the main sources of infection are people with primary damage of the top airways (quinsy, scarlet fever). At the same time at distance more than three meters it is impossible to catch already. Realization of alimentary and contact ways of transfer is in certain cases possible (through dirty hands, the infected food). Reproduction and long preservation of virulent properties is characteristic of streptococci of group A at hit in favorable nutrient medium of some foodstuff (milk, eggs, mollusks, ham, etc.).
The probability of emergence of purulent complications at infection with streptococci is high at persons with burns, wounds, pregnant, newborn, sick after operations. Group B streptococci usually cause infections of the urinogenital sphere and can be transferred at sexual contacts. Newborns often get an infection as a result of infection of amniotic waters and when passing patrimonial ways. The natural susceptibility of the person to streptococcal bacteria high, immunity type-specific also does not interfere with infection with streptococci of other look.
Clinical forms of a streptococcal infection
Symptomatology of streptococcal infections are extremely diverse in view of a large number of probable localizations of the center of an infection, types of the activator. Besides, intensity of clinical manifestations depends on the general condition of the organism infected. Streptococci of group A are inclined to damage of the top airways, the hearing aid, leather (streptodermiya), causative agents of scarlet fever and an ugly face concern to this group.
The diseases which developed as a result of defeat by these microorganisms can be divided into primary and secondary forms. Primary forms represent failure inflammatory infectious diseases of the bodies which became infection gate (pharyngitis, laryngitis, quinsy, otitis, impetigo etc.). Secondary forms develop as a result of turning on of autoimmune and toksiko-septic mechanisms of development of an inflammation in various bodies and systems. With the autoimmune mechanism of development treat secondary forms of streptococcal infections rheumatism, glomerulonefrit and streptococcal vaskulit. Toksino-infektsionny necrotic defeats of soft fabrics, meta - and peritonzillyarny abscesses, streptococcal sepsis have character.
Rare clinical forms of streptococcal infections: necrotic inflammation of muscles and fastion, enteritis, syndrome of toxic shock, focal infectious defeats of bodies and fabrics (for example, abscess of soft fabrics). Group B streptococci in the majority cause infections in newborns though meet at any age. It is connected with primary defeat by this activator of urinogenital ways and infection of newborns intranatalno.
Streptococcal infections of newborns are shown in the form of bacteremia (30% of cases), pneumonia (32-35%) and meningitis. In half of cases the infection is shown clinically in the first days of life. At the same time streptococcal infections of newborns proceed extremely hard, mortality among the diseased makes about 37%. Meningitis and bacteremia can be shown later. In that case about 10-20% of the diseased perish, and at a half of survivors note development violations.
Streptococcal infections of group B quite often are the reason of postnatal endometritises, cystitis, adneksit at women in childbirth and complications in the postoperative period when performing Cesarean section. Streptococcal bacteremia besides can be noted at persons with the expressed easing of immune properties of an organism (the elderly people sick with diabetes, an immunodeficiency syndrome, malignant new growths). Quite often against the background of the proceeding SARS streptococcal pneumonia develops. The green streptococcus can be the cause of development of endocarditises and the subsequent valvate defects. Streptococci of the mutans group cause caries.
Diagnosis of streptococcal infections
Etiologichesky diagnosis of a streptococcal infection of a mucous membrane of a throat and integuments demands a bacteriological research with allocation and identification of the activator. The exception can be considered scarlet fever. As now many forms of streptococcal bacteria were taken a certain resistance to antibiotics of some groups, the careful microbiological research and implementation of the test for sensitivity to antibiotics is necessary. Diagnostics made in sufficient volume promotes the choice of effective tactics of treatment.
Express diagnostics of streptococci of group A allow to establish the activator within 15-20 minutes from the moment of capture of the analysis without allocation of true culture. However identification of presence of streptococci not always means that they are an etiologichesky factor of pathological process, this fact can speak also about a usual carriage. Rheumatism also glomerulonefrit practically always are characterized by increase in a caption of antibodies to streptococci about the first days of an aggravation. The caption of antibodies to extracellular anti-genes is defined by neutralization reaction. If necessary examination of the bodies affected with a streptococcal infection is conducted: survey of the otolaryngologist, X-ray analysis of lungs, ultrasonography of a bladder, ECG, etc.
Treatment of streptococcal infections
Depending on a form of a streptococcal infection treatment is carried out by the gynecologist, the urologist, the dermatologist, the pulmonologist or other experts. Etiologichesky treatment of primary clinical forms of streptococcal infections consists in purpose of a course of antibiotics of a penicillinic row to which streptococci have quite high sensitivity. If inefficiency of an antibiotic at application is revealed its more than five days, medicine is changed. It is desirable to make the test of culture of the activator for sensitivity to medicines different (erythromycin, , , , etc.) groups for the purpose of more reliable choice of an antibiotic. Practice shows that medicines of a tetracycline row, gentamycin and are inefficient.
Pathogenetic and symptomatic treatment depends on a clinical form of a disease. In need of purpose of long courses of antibiotic treatment (at secondary forms of a streptococcal infection) quite often appoint medicines of the prolonged action. Recently positive influence on the course of a disease of use of immunoglobulin of the person and immunoexcitants is noted.
Prevention of streptococcal infections
Prevention of infection with a streptococcal infection means measures of personal hygiene and individual prevention at contacts in narrow collective with the persons having respiratory diseases: wearing a mask, processing of ware and surfaces on which microorganisms, washing of hands with soap could get. The general prevention consists in implementation of systematic control over the state of health of collectives: routine inspections at schools and kindergartens, isolation of the revealed patients, adequate medical actions, detection of the latent forms of a carriage of a streptococcal infection and their prolechivaniye. For release of an organism from the activator and full treatment of WHO recommends use of penicillin not less than within 10 days.
Special attention needs to be paid to prevention of intrahospital infection with a streptococcal infection as infection in a hospital of the patient who is in the weakened state, many times more probably and the course of an infection at such patients is much heavier. The prevention of infection of women in labor and newborns consists in careful respect for the sanitary and hygienic norms and the mode developed for offices of gynecology and maternity hospitals.