Strep. Throat

Strep. throat and beta Strep. group A: Why is it important?

Strep. throat, caused by beta hemolytic Streptococcus, group A, or Strep. pyogenes, is a very common illness in children. Although less common in newborns and adults, infections in these groups can occur, especially during outbreaks, which seem to happen at least once or twice each year, often during winter months.

Strep. throat is usually a self limiting infection and will resolve itself after 2 to 4 days of extreme discomfort. So why are physicians anxious to treat Strep. infections?

The answer lies with secondary infections or sequelia caused by this organism. In a small percentage of cases, the Strep. will colonize the heart valves, and cause endocarditis, or even the kidneys, causing glomerulonephritis, both very serious and even life threatening diseases. It had also been implicated in rheumatic fever, puerperal sepsis, and necrotizing fascitis. 2,3

From a microbiologist’s point of view, an interesting fact is that group A Strep. In the evolutionary scheme of things, it is one of very few organisms that have never developed resistance to the antibiotics, Penicillin and Ampicillin. Amoxicillin is still the drug of choice. The presence of other beta lactamase-producing bacteria can protect gp A Strep. from eradication by Amoxicillin. 4. In such cases, treatment with Amoxicillin in combination with clavulanic acid (Augmentin) may be necessary.

1. Endocarditis caused by group A beta-hemolytic Streptococcus in an infant: a case report review.
Winterbotham A, Riley S, Kavanaugh-McHugh A, Dermody TS
Clin Infect Dis. 1999 July;29(1): 196-8. Review

2. Pathogenesis of group A streptococcal infections.
Henningham A, Barnett TC, Maamary PG, Walker MJ.
Discov Med. 2012 May;13(72):329-42

3. Group A streptococcus.
Martin JM, Green M.
Semin Pediatr Infect Dis. 2006 Jul;17(3):140-8

4. The role of beta-lactamase-producing bacteria in the persistence of strepococcal tonsillar infection
Brook I.
Rev Infect Dis. 1984 Sep-Oct;6(5):601-7