Streptococcus pyogenes

Team Case Study 2

The Diagnosis

Ben Fallerez is a 12 year old boy going to school in France. He complained of a sore throat. The initial diagnosis was Streptococcal pharyngitis. The boy was treated with penicillin, but the symptoms did not resolve. A recurrent infection led the physician to perform a culture and sensitivity. The organism was identified as Streptococcus pyogenes and was reported as being resistant to penicillin.

Streptococcus pyogenes

Group A Streptococcus Gram positive Non-motile Non-spore forming Occurs in chains Has a capsule Adheres to surfaces

such as cell walls

People most susceptible

Elderly Immune suppressed Chronic cardiac or respiratory disease Diabetics with skin lesions African-Americans Indians Children of elementary school age

Diseases caused by S. pyogenes

Bacterial pharyngitis, tonsillitis, sinusitis, lymphadenitis, endocarditis, meningitis

Septicemia Impetigo Upper respiratory tract infections Glomerulonephritis Rheumatic fever Scarlet fever

Resistance Displayed by Organism

Treatment with penicillin killed all sensitive S. pyogenes, letting S. pyogenes resistant to penicillin grow

Non-compliance Over-prescribing of antibiotics

Exchange of DNA

DNA exchanged through transformation

Treatment of penicillin resistant S. pyogenes

500 mg erythromycin qid for 10 days If resistant to that: 450 mg clindamycin qid for 10 days

Prognosis

S. pyogenes is benign, self-limiting disease Symptoms did not subside, was re-evaluated

and given different antibiotics because initial pathogen developed resistance to first antibiotic

If he complies, his prognosis is good

Precautions

Take entire prescription Monitor for signs of an active infection Re-evaluate with a physical examination and

a throat culture and sensitivity to verify pathogen is treated and guarantee no further complications

Works Cited

Bingen, E. “Resistance to Macrolides in Streptococcus pyogenes in France in Pediatric Patients”. June 2000. Antimicrobial Agents and Chemotherapy. 10 October 2006. http.//www.punmedcentral.nih.gov/articlerender.fcgi?artid=89896.

Gilbert, M.D., David, et al. The Sanford Guide to Antimicrobial Therapy. 36th ed. Sperryville: Antimicrobial Therapy Inc., 2006.

Works Cited

“Group A Streptococcus (GAS) Disease”. Center for Disease Control and Prevention. 11 October 2005. 2 October 2006. http://www.cdc.gov/nicdod/dbind/diseaseinfo/groupastreptococcal_t.htm.

McGlaughlin, RN, Eileen. “Medical Encyclopedia Info on Strep Throat”. 31 January 2001. 8-11. 7 October 2006. http://www.medicineonline.com/reference/health/menshealth/conditionsanddiseases.

Works Cited

Nurses Quick Check Diseases. Philadelphia: Lippencott, Williams & Wilkins, 2005

Patterson, Maria Jevitz. “Streptococcus” Medmicrobook. 2 October 2006. http://gsbs.utmb.edu/microbook/ch013.htm.

Safani, PhD, M. Physicians’ Drug Manual. 2005. 7 October 2006. http://www.medicallibrary.org/library/secure/Physicians_Drug_Resource.pdf.

Works Cited

Todar, K. “Streptococcus pyogenes”. 2002. Todar’s Online Textbook of

Bacteriology. 7 October 2006. http://textbookofbacteriology.net/streptococcus.html.