What is Streptococcal Infection in Children?
Streptococcal infection leads to such diseases as scarlet fever, sore throat, glomerulonephritis, rheumatism, pyoderma, erysipelas, causes generalized processes like septicemia, etc. Streptococcal infection can cause complications of other diseases.
According to the international classification, there are:
- septicemia caused by group A streptococcus;
- septicemia caused by group D streptococcus;
- septicemia caused by streptococcus pnevmonine (pneumococcal septicemia);
- streptococcal septicemia, unspecified;
- other streptococcal septicemia.
Diseases caused by streptococci occur throughout the planet. Diseases of the skin characteristic of hot countries. Scarlet fever and sore throat are more common in countries where a cold and temperate climate prevails. Diseases are susceptible to children of any age, even newborns. The infection is transmitted by airborne and contact-domestic ways. Infection can also occur through infected food.
Fear is worth patients with angina, pneumonia, streptoderma, scarlet fever and other streptococcal diseases, as well as bacteria carriers without clinical manifestations.
Formally, all diseases that are caused by streptococci are referred to as infectious diseases. But with glomerulonephritis, rheumatism, etc., there is no contagiousness – the hallmark of infectious diseases. Therefore, only those that have all signs of an infectious disease should be included in the group of streptococcal infections: infectiousness, cyclical development of clinical symptoms, incubation period, the formation of specific immunity. These symptoms are characteristic of diseases caused by P-hemolytic streptococcus group A: angina, scarlet fever, pneumonia, bronchitis, erysipelas, pharyngitis, as well as some purulent-inflammatory diseases of newborns that are caused by streptococci of other groups: phlegmon, streptoderma, abscess, etc.
Causes of Streptococcal Infection in Children
Streptococci are Gram-positive bacteria with a diameter of 0.6 to 1 micron. They have a spherical or oval shape. They are arranged in pairs or chains.
Streptococci are divided into 21 groups by carbohydrate antigens of the cell wall. They are designated by letters from A to U. The disease in humans occurs mainly from group A streptococci. Streptococci of groups B, C and D are dangerous for newborns and infants. They cause endocarditis, severe sepsis, osteomyelitis, meningitis, urinary tract infections, etc. Group F Streptococci cause deep inflammatory processes in the mouth and respiratory tract.
Streptococci produce various enzymes and toxins: erythrogenic toxins (A, B, C), streptokinase A and B, streptolysins O and S, deoxyribonuclease, etc. The most toxic component that is produced by streptococcus is exotoxin. It damages the tissues of the body, suppresses the function of the reticuloendothelial system, affects the permeability of membranes, causes immunosuppression, etc.
Streptococci retain their properties at low ambient temperatures during drying. They “die” from the influence of disinfectants and from heating to the level of 56 ° C in 30 minutes. Months can persist on objects, in sputum, pus. Streptococcus group A can be killed with antibiotics, especially penicillin.
Pathogenesis during Streptococcal infection in children
In the pathogenesis of streptococcal diseases, a large role belongs to the toxic syndrome, which is associated mainly with erythrogenic toxin, as well as with the allergic syndrome, which is caused by sensitization to the protein structures of streptococcus and the tissues it has destroyed.
Symptoms of Streptococcal Infection in Children
Manifestations of streptococcal infection depend on the direction of the pathological process.
Streptococcus group A, as a rule, affect the upper respiratory tract, skin, hearing aid. In this group are the causative agents of erysipelas and scarlet fever in children. Diseases caused by infection with these microorganisms are divided into primary and secondary forms. Primary forms – diseases in which the “entrance gate” of the infection suffers: laryngitis, pharyngitis, otitis, angina, impetigo, etc.
Secondary forms develop as a result of the inclusion of autoimmune and toxic-septic mechanisms of inflammation in various organs and systems. These are diseases such as streptococcal vasculitis, glomerulonephritis and rheumatism.
Rare clinical forms of streptococcal infections include enteritis, necrotic inflammation of muscles and fascia, focal infectious lesions of organs and tissues, toxic shock syndrome. Group B streptococci are prone to mainly (but not only) newborns. Infants become infected intranatally. Streptococci of group B cause mainly the urinary tract.
Streptococcal infections of the newborn appear as bacteremia (30% of cases), pneumonia (32-35%) and meningitis. In ½ cases, symptoms begin to appear in the first 24 hours after birth. Such infections have an extremely severe course, death occurs in 37 cases out of 100. After the manifestation of bacteremia and meningitis, about 10–20% of the patients die, and 50% of those who survive have been diagnosed with developmental disorders.
Group B streptococcal infections often serve as the cause of postpartum endometritis, cystitis, adnexitis in puerperas and complications in the postoperative period during cesarean section.
Diagnosis of Streptococcal Infection in Children
Streptococcal infection of the mucous membrane of the pharynx and skin requires confirmation using bacteriological methods that allow the identification and identification of the pathogen. Before treatment, antibiotic susceptibility tests are carried out, since today many types of streptococcus have become resistant to antibiotics.
Rapid diagnosis of group A streptococci makes it possible to identify the pathogen in 15–20 minutes, while a pure culture is not isolated. But the identification of streptococci does not in all cases mean that it was they who provoked the pathological process (disease). The child may simply be a carrier, and the symptoms manifested by other viruses / bacteria / organisms.
Rheumatism and glomerulonephritis are almost always characterized by an increase in the titer of antibodies to streptococci already from the first days of exacerbation. Antibody titer to extracellular antigens is determined by neutralization.
If necessary, they examine the organs affected by streptococcal infection: examination by an otolaryngologist, ultrasound of the bladder, radiography of the lungs, etc.
Treatment of Streptococcal Infection in Children
The treatment is carried out by different specialists – depending on the form of the infection – a urologist, gynecologist, pulmonologist, dermatologist, etc. The etiological treatment of primary clinical forms of streptococcal infections is carried out with penicillin antibiotics. If the antibiotic has not proven effective in five days, it is canceled.
The antibiotic susceptibility test includes such drugs as azithromycin, erythromycin, oxacillin, clarithromycin, etc. Gentomycin, tetracycline preparations, and kanamycin are considered ineffective for treating streptococcal infections in children.
Also symptomatic and pathogenetic treatment should be applied, which depend on the clinical form of the disease. In secondary forms of streptococcal infection, it is often necessary to use long courses of antibiotic therapy, in which it is often prescribed drugs of prolonged action.
In recent years, it has been discovered that the course of the disease is positively affected by the use of immunostimulating agents and human immunoglobulin.
Prevention of Streptococcal Infection in Children
It is necessary to observe the measures of individual prophylaxis and personal hygiene, contacting those who have respiratory diseases. These measures include the wearing of masks, surface treatment and dishes, washing hands with soap and water.
The state of health of groups should be monitored: examinations in schools and kindergartens, isolation of sick children, necessary therapeutic measures, identification of hidden forms of carriage of streptococcal infections and their treatment.
In order to completely cleanse the body of the pathogen and cure the disease, the World Health Organization recommends the use of penicillins, according to the prescription of a doctor, for more than 10 days.
Important preventive measures that prevent the spread of nosocomial streptococcal infection. Because in hospitals there are children who have a weakened condition, because their organisms are many times more difficult to resist the disease, and their death is more likely.
To prevent infection of the mothers and newborns, you should follow the sanitary and hygienic standards and regime developed for the gynecology departments and maternity hospitals.