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Time Completed: 01:42:54

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154
26

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Microbiology

Pathogens

Question 103 of 180

Streptococcus pyogenes is commonly implicated in all of the following infective diseases EXCEPT for:

Answer:

Gas gangrene is a life-threatening infection caused by toxin-producing Clostridium species, primarily Clostridium perfringens, and characterised by rapidly progressive muscle necrosis, gas production and sepsis.
Microorganism Streptococcus Pyogenes
Gram stain Gram positive
Shape Cocci (chains)
Catalase Negative
Oxygen requirements Facultative anaerobe
Haemolysis Beta-haemolytic (Group A)
Additional features Produces haemolytic exotoxin
Reservoir Skin and nasopharynx
Common diseases Acute tonsillitis, skin & soft tissue infections, necrotising fasciitis
Toxin-mediated reactions Scarlet fever, toxic shock syndrome
Post-infectious immune-mediated reactions Rheumatic fever, erythema nodosum, acute glomerulonephritis

Transmission

Streptococcus pyogenes (Group A beta-haemolytic streptococci) is carried asymptomatically in the nasopharynx of 5 - 30% of the population, more commonly in children. Spread occurs via respiratory droplets or by direct contact with infected wounds on the skin.

Clinical Disease

Streptococcus pyogenes causes a wide range of infectious disease including:

  • Local nasopharyngeal spread
    • Pharyngitis
    • Tonsillitis
    • Peritonsillar abscess
    • Sinusitis
    • Otitis media
    • Pneumonia (rarely)
    • Meningitis
  • Skin and soft tissue infection
    • Impetigo
    • Erysipelas
    • Wound infections
    • Necrotising fasciitis
    • Septic arthritis
    • Osteomyelitis
  • Toxin-mediated reactions
    • Scarlet fever
    • Streptococcal toxic shock syndrome
    • Puerperal fever
  • Postinfectious immune-mediated sequelae
    • Rheumatic fever
    • Post-streptococcal glomerulonephritis
    • Erythema nodosum

Treatment

Benzylpenicillin is usually the treatment of choice. Amoxicillin or phenoxymethylpenicillin may be used for oral therapy in less severe infections. Macrolides are an alternative for patients with allergy.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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