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Sheet1DiseaseOrganismPresentationPreventionDiagnosis TreatmentPharyngitisGroup A Strep (streptococcus pyogenes)Sudden onset of: Fever, sore throat, nausea, malaise, tender cervical lymphadenopathywithout treatment Rheumatic Fever may developculture on single blood agar plate (80-90% senstivie) Rapid antigen test (< sensitive)Penicillin G injection Penicillin VK PO QIDx10 Amoxicillin BID x 10 Macrolides (PCN allergy)Tetracycline, Cephalosporin, Macrolide, Penicillin, Vancomycin, anti-staph penicillin, Licomycin, Sulfonamides, Linezolid, Aminoglycosides, Fluoroquinolones, RifampinScarlet FeverGroup A Strep (streptococcus pyogenes)Diffuse red rash similar to sunburn with superimposed fine red papules most intense in groin and axilla, leaves fine desquamation. Flushed face w/ circumoral pallor, strawberry tonguewithout treatment Rheumatic Fever may developculture on single blood agar plate (80-90% senstivie) Rapid antigen test (< sensitive)Penicillin G injection Penicillin VK PO QIDx10 Amoxicillin BID x 10 Macrolides (PCN allergy)ImpetigoStaphlycoccus (temperate) or Group A Streptococcus (tropical) Gram +Macules, vesicles, bullae, and honey colored crusting most often involving the face presentation/cultureWash with soap and water and use Topical agents: Mupriocin (Bactroban) or Retapamulin (Altabax) or if systemic use Cephalexin (Keflex) BID or Doxycycline (Vibramycin) BIDErysipelas Group A Strep (streptococcus pyogenes) or Staphlycoccus Well demarcated superficial cellulitis presentation/cultureSystemic/Face - Parenteral Penicillin if IV drug use/diabetes cover strep as well Arthritis Group A Strep (streptococcus pyogenes)Occurs with cellulitis, fever, joint pain Parenteral Abx Necrotizing Fasciitis Group A Strep (streptococcus pyogenes)Severe cellulitis and pt is toxic, may have little pain, usually following skin trauma presentation/cultureBeta-lactams w/ surgical debridement Streptococcal Toxic Shock SyndromePyogenic erythrotoxin (Scarlet Fever) causes massive release of inflammatory cytokines Invasion of skin, soft tissue, ARDS, and renal failure with mortality rates to 80%contacts may be reservoirs Beta-lactams Pneumococcal Pneumonia Streptococcal Pneumoniae Sudden onset of fever, chills, rigors, productive cough w/pleuritic chest pain, bronchial breath sounds, slow onsetX-ray - lobar consolidation/effusion, Gram stain, Sputum cultureTreat Empirically: Amoxicillin BID x 7-10 Penicillin allergic: Azithromycin (Zithromax) Clarithromycin (Biaxin)If penicillin resistance is high treat with Ceftriazone (Rocephin) or oral plouroquinolones (Levaquin) Pneumococcal Meningitis Streptococcal Pneumoniae Rapid onset of fever, headache, meningismus, AMS, absence of rash/focal neuro deficits Labs - CSF >1000 WBC w/ >60% PML, glucose