How to treat a streptococcal infection and how to diagnose it? Methods for effective treatment of streptococcal throat infection and elimination of symptoms.

Streptococcus is one of those pathogenic microbes that are normally found in the microflora of any person. The bacterium lives on the mucous membrane of the nose and pharynx, in the respiratory tract, large intestine and genitourinary organs, and for the time being does not cause any harm to its host. Streptococcal infections occur only in conditions of weakened immunity, hypothermia, or ingestion immediately a large number unfamiliar strain of pathogens.

Not all varieties of streptococci are dangerous to human health, moreover, in this group there are even microbes that are beneficial. The very fact of bacterial carriage should not become a cause for alarm, because it is almost impossible to avoid it, just as it is impossible to completely eradicate streptococcus from your body. And strong immunity and observance of elementary rules of personal hygiene give every reason to expect that the disease will bypass you.

However, everyone is concerned about what to do if you or your loved ones do get sick: what medications to take, and what complications to worry about. Today we will tell you absolutely everything about streptococcus and the diseases that it causes, as well as methods for diagnosing and treating streptococcal infections.

What is streptococcus?

Scientifically, streptococcus is a member of the Streptococcaceae family, a spherical or ovoid asporogenic Gram-positive facultative anaerobic bacterium. Let's look into these complex terms and "translate" them into simple human language: streptococci have the shape of a regular or slightly elongated ball, do not form spores, do not have flagella, are not able to move, but they can live in conditions total absence oxygen.

If you look at streptococci through a microscope, you can see that they never occur alone - only in pairs or in the form of regular chains. In nature, these bacteria are very widespread: they are found in the soil, and on the surface of plants, and on the body of animals and humans. Streptococci are very resistant to heat and freezing, and even lying in roadside dust, they retain the ability to reproduce for years. However, they are easily defeated with penicillin antibiotics, macrolides or sulfonamides.

In order for a streptococcal colony to begin to actively develop, it needs a nutrient medium in the form of serum, sweet solution or blood. In laboratories, bacteria are artificially created favorable conditions in order to observe how they multiply, ferment carbohydrates, release acid and toxins. A colony of streptococci forms a translucent or greenish film on the surface of a liquid or solid nutrient material. Her research chemical composition and properties allowed scientists to determine the pathogenicity factors of streptococcus and to establish the causes of the development of streptococcal infections in humans.

Causes of Streptococcal Infections

The cause of almost all streptococcal infections is beta-hemolytic streptococcus, since it is it that is capable of destroying red blood cells- erythrocytes. In the process of life, streptococci secrete a number of toxins and poisons that have a detrimental effect on the human body. This explains the unpleasant symptoms of diseases caused by streptococcus: pain, fever, weakness, nausea.

Streptococcus pathogenicity factors are as follows:

Streptolysin is the main poison that violates the integrity of blood and heart cells;

Scarlatinal erythrogenin - a toxin that dilates capillaries and causes a skin rash in scarlet fever;

Leukocidin - an enzyme that destroys immune blood cells - leukocytes, and thereby suppresses our natural defense against infections;

Necrotoxin and lethal toxin are poisons that cause tissue necrosis;

Hyaluronidase, amylase, streptokinase and proteinase are the enzymes by which streptococci devour healthy tissue and spread throughout the body.

At the site of introduction and growth of a colony of streptococci, a focus of inflammation occurs, which worries a person with severe pain and swelling. As the disease develops, toxins and poisons secreted by bacteria are carried through the bloodstream throughout the body, so streptococcal infections are always accompanied by general malaise, and in severe cases, large-scale intoxication, up to vomiting, dehydration and clouding of consciousness. The lymphatic system reacts to the disease by engorgement of the lymph nodes located near the focus of inflammation.

Since the streptococci themselves and their metabolic products are foreign to our body, the immune system reacts to them as a powerful allergen and tries to develop antibodies. Most dangerous consequence of this process are autoimmune diseases, when our body ceases to recognize the tissues altered by streptococcus and begins to attack them. Examples of formidable complications: glomerulonephritis, rheumatoid arthritis, autoimmune inflammation of the membranes of the heart (endocarditis, myocarditis, pericarditis).

Streptococcus groups

Streptococci are divided into three groups according to the type of hemolysis of red blood cells:

Alpha-hemolytic or green - Streptococcus viridans, Streptococcus pneumoniae;

Beta-hemolytic - Streptococcus pyogenes;

Non-hemolytic - Streptococcus anhaemolyticus.

For medicine, it is streptococci of the second type, beta-hemolytic, that matter:

Streptococcus pyogenes - the so-called pyogenic streptococci that cause angina in adults and scarlet fever in children, and give serious complications in the form of glomerulonephritis, rheumatism and endocarditis;

Streptococcus pneumoniae - pneumococci, which are the main culprits of pneumonia and sinusitis;

Streptococcus faecalis and Streptococcus faecies are enterococci, the most tenacious bacteria of this family, causing purulent inflammation in abdominal cavity and heart;

Streptococcus agalactiae is the bacterium responsible for most streptococcal lesions of the genitourinary organs and postnatal inflammation of the uterine endometrium in parturient women.

As for the first and third types of streptococci, green and non-hemolytic, they are simply saprophytic bacteria that feed on humans, but almost never cause serious diseases, because they do not have the ability to destroy red blood cells.

In fairness, it is worth mentioning the beneficial bacteria from this family - lactic streptococcus. With its help, everyone's favorite dairy products are made at dairies: kefir, curdled milk, fermented baked milk, sour cream. The same microbe helps people with lactase deficiency - this is rare disease, expressed in a deficiency of lactase - an enzyme necessary for the absorption of lactose, that is, milk sugar. Sometimes thermophilic streptococcus is given to infants to prevent severe regurgitation.

Streptococcus in adults

In adults, beta-hemolytic streptococcus most often causes acute tonsillitis, that is, sore throat, or pharyngitis - less severe inflammation upper division oropharynx. Much less often, this bacterium causes otitis media, caries, pneumonia, dermatitis, and erysipelas.

Pharyngitis

Streptococcal pharyngitis always starts suddenly, because it has a very short duration. incubation period, and is characterized by very vivid symptoms: sharp pain when swallowing, subfebrile (low) temperature, chills and general weakness. It is so painful for the patient to swallow that sometimes he completely loses his appetite. Dyspeptic disorders rarely accompany streptococcal pharyngitis, but it is often complicated by an increase and soreness. submandibular lymph nodes, hoarseness of voice and superficial, dry cough.

The therapist at the reception quickly diagnoses pharyngitis with the help of a visual examination of the pharynx: the mucous membrane is edematous, bright red, covered with a grayish coating, the tonsils are swollen, in some places scarlet follicles in the form of a donut are visible. Streptococcal pharyngitis is almost always combined with a runny nose, and the mucus is transparent and so abundant that it can cause maceration (soaking) of the skin under the nose. The patient is prescribed local antiseptics for the throat in the form of a spray or lozenges, there is no need to take antibiotics inside.

Usually this disease goes away as suddenly as it started, and does not last long - 3-6 days. Victims of pharyngitis are mostly young, or vice versa, elderly people with weakened immune systems who have been in contact with a sick person, used his dishes or a toothbrush. Although pharyngitis is considered a widespread and non-serious disease, it can lead to very unpleasant complications.

The consequences of pharyngitis can be:

Purulent otitis,

tonsillar abscess,

• Lymphadenitis;

• Osteomyelitis.

Angina

Streptococcal tonsillitis (acute tonsillitis) can turn into a real disaster for an adult patient, especially the elderly, because untimely and poor-quality treatment of this disease often causes terrible complications in the heart, kidneys and joints.

Factors contributing to the development of acute streptococcal tonsillitis:

The weakening of the general and local immunity;

hypothermia;

Recent other bacterial or viral infection;

Negative impact of external factors;

Prolonged contact with a sick person and his household items.

Angina begins as suddenly as pharyngitis - the night before, it becomes painful for the patient to swallow, and the next morning the throat is completely covered by the infection. Toxins are carried through the bloodstream throughout the body, causing swollen lymph nodes, high fever, chills, weakness, restlessness, and sometimes confusion and even convulsions.

Symptoms of angina:

severe sore throat;

Febrile temperature;

Body aches;

Headache;

Submandibular lymphadenitis;

Swelling and redness of the mucous membrane of the pharynx;

Enlarged tonsils;

The appearance on the mucous throat of a loose grayish or yellowish coating, and sometimes purulent plugs;

In young children - dyspeptic disorders (diarrhea, nausea, vomiting);

In blood tests, severe leukocytosis, C-reactive protein, ESR acceleration.

Streptococcal angina has two types of complications:

Purulent - otitis, sinusitis, flux;

Non-purulent - rheumatism, glomerulonephritis, toxic shock syndrome, myocarditis, endocarditis, pericarditis.

Angina is treated with local antiseptics, but if inflammation cannot be stopped within 3-5 days, and the body is engulfed in total intoxication, antibiotics have to be resorted to to prevent complications.

Streptococcus in children

Streptococci are very dangerous for newborn babies: if it occurs intrauterine infection, a child is born with a high temperature, subcutaneous bruising, bloody discharge from the mouth, difficulty breathing, and sometimes with inflammation of the meninges. Despite the high level of development of modern perinatal medicine, it is not always possible to save such children.

All streptococcal infections in children are conditionally divided into two groups:

Primary - tonsillitis, scarlet fever, otitis media, pharyngitis, laryngitis, impetigo;

Secondary - rheumatoid arthritis, vasculitis, glomerulonephritis, endocarditis, sepsis.

The undisputed leaders in the incidence in children are tonsillitis and scarlet fever. Some parents consider these diseases to be completely different, and some, on the contrary, confuse them with each other. In fact, scarlet fever is a severe form of streptococcal tonsillitis, accompanied by a skin rash.

Scarlet fever

The disease is highly contagious and spreads among children preschool institutions and schools at the speed of wildfire. Scarlet fever usually affects children between the ages of two and ten, and only once, since a strong immunity is formed to the disease. It is important to understand that the cause of scarlet fever is not streptococcus itself, but its erythrogenic toxin, which causes severe poisoning of the body up to clouding of consciousness and a red rash, by which a pediatrician can accurately distinguish scarlet fever from ordinary tonsillitis.

It is customary to distinguish three forms of scarlet fever:

Light - the disease lasts 3-5 days and is not accompanied by large-scale intoxication;

Medium–lasts a week, differs severe poisoning body and a large area of ​​rashes;

Severe - can drag on for several weeks and go into one of pathological forms: toxic or septic. Toxic scarlet fever is manifested by loss of consciousness, dehydration and convulsions, and septic scarlet fever is manifested by severe lymphadenitis and necrotic tonsillitis.

Scarlet fever, like all streptococcal infections, has a short incubation period and strikes the child suddenly, and lasts an average of 10 days.

Scarlet fever symptoms:

high fever, chills, body aches, headache, and severe pain when swallowing;

Rapid pulse, tachycardia;

General weakness, lethargy, drowsiness;

nausea, diarrhea, vomiting, dehydration, loss of appetite;

Characteristic puffy face and unhealthy luster of the conjunctiva;

Very strong increase and soreness of the submandibular lymph nodes, up to the inability to open the mouth and swallow food;

Redness of the skin and the appearance of small roseola or papules on them, first on the upper part of the body, and after a few days on the limbs. It looks like goosebumps, and on the cheeks the eruption merges and forms a scarlet crust;

Paleness of the nasolabial triangle in combination with cherry lips;

Coating of the tongue with a gray coating, which disappears after three days, starting from the tip, and the whole surface becomes scarlet with protruding papillae. The tongue resembles a raspberry in appearance;

Pastia's syndrome - the accumulation of a rash in the folds of the skin and a strong judgment;

Clouding of consciousness up to fainting, less often - delirium, hallucinations and convulsions.

Painful symptoms increase during the first three days from the onset of the disease, and then gradually subside. The number and severity of the rash decreases, the skin becomes whitish and dry, sometimes in a child on the palms and feet it comes off in whole layers. The body produces antibodies to erythrotoxin, so if children who have had scarlet fever again encounter the pathogen, this only leads to a sore throat.

The moderate and severe forms of this disease require adequate and timely antibiotic therapy, as well as careful child care and follow-up measures to strengthen his immunity, for example, rest in a sanatorium and a course of multivitamins.

Streptococcus in pregnant women

One of the reasons why expectant mothers should be very scrupulous in matters of personal hygiene is staphylococcus aureus, which can easily enter the genital tract with improper wiping, prolonged wearing of underwear, the use of non-sterile intimate hygiene products, touching the genitals with dirty hands and unprotected genitals. contacts. Of course, streptococcus is normally present in the microflora of the vagina, but the body of a pregnant woman is weakened, and natural defense mechanisms may not be enough to contain the infection.

The following streptococci are of the greatest importance in the development of pregnancy pathology:

Streptococcus pyogenes causes tonsillitis, pyoderma, cystitis, endometritis, vulvitis, vaginitis, cervicitis, glomerulonephritis, postpartum sepsis, as well as intrauterine infection of the fetus with all the ensuing consequences;

Streptococcus agalactiae can also cause endometritis and inflammatory diseases of the genitourinary organs in the mother, and cause meningitis, sepsis, pneumonia and neurological disorders in the newborn.

If a dangerous concentration of streptococci is found in a smear in a pregnant woman, local sanitation is carried out using antibacterial suppositories. And with full-blown streptococcal infections, such as tonsillitis, the situation is much worse, since most antibiotics, to which streptococcus is sensitive, are strictly contraindicated during pregnancy. The conclusion is banal: expectant mothers need to carefully protect their health.

Complications and consequences of streptococcus

Streptococcal infections can cause the following complications:

Purulent otitis media;

severe forms allergies;

Rheumatoid arthritis;

Chronic lymphadenitis;

Inflammation of the heart membranes - endocarditis, myocarditis, pericarditis;

Pulpitis - inflammation of the contents of the teeth;

Toxic shock syndrome;

Glomerulonephritis;

Acute rheumatic fever;

Angina and pharyngitis are complicated by acute rheumatic fever in about 3% of cases. The decisive moment in the prevention of this terrible consequence of streptococcal infections is timely and adequate antibiotic therapy. Previously, when there were not so many powerful and safe antibiotics in the arsenal of physicians, acute respiratory infections were very common, and caused the death of young and healthy people from a common cold.

Acute glomerulonephritis, that is, autoimmune inflammation of the kidneys, develops in about 10% of patients 2-3 weeks after suffering "on their feet", untreated streptococcal infection. Children suffer from glomerulonephritis much more often than adults, but they have a milder course of the disease, and usually does not cause fatal consequences.

The most dangerous to life and health are autoimmune lesions of the heart muscle, connective tissue and joints. Endocarditis sometimes turns into heart disease and causes severe forms of heart failure. Rheumatoid arthritis is an incurable disease that gradually immobilizes a person and leads to death from suffocation. Fortunately, such formidable complications develop in less than 1% of cases of streptococcal infections.

Diagnosis of streptococcus

For the diagnosis of streptococcal infections, blood tests, urine, sputum, nasal mucus, scrapings from the surface of the skin (for erysipelas) and from the mucous membrane of the oropharynx (for pharyngitis and tonsillitis), as well as smears from the vagina or urethra for diseases of the urogenital area are used.

The most common methods for diagnosing streptococcus are as follows:

Using a sterile cotton swab, a laboratory assistant takes a swab from the surface of the pharynx, places the test material in blood agar and keeps it for a day in a closed flask at a temperature of 37 ° C, then evaluates the result using a microscope, isolates a colony of bacteria with hemolysis and subcultures it into blood or sugar broth . There, streptococci after three days give a pronounced benthic and parietal growth, and in color and characteristic look colonies, it is possible to draw a conclusion about the serogroup of the pathogen and select the appropriate antibiotic;

If there is a suspicion of sepsis, 5 ml of blood is taken from the patient and inoculated into sugar broth with thioglycol. The material is incubated at 37°C for eight days, subcultured twice into blood agar, on the fourth and eighth days. At healthy person the blood is sterile, and the patient will experience growth of bacterial colonies, by the nature of which one can conclude about the strain of the pathogen;

The method of serodiagnosis allows you to determine the presence of antibodies to streptococcus in the patient's blood, as well as their number, and thus confirm or refute the diagnosis;

Latex agglutination reaction and ELISA are methods for rapid diagnosis of streptococcal infections by blood;

Differential diagnosis is necessary in order to distinguish a streptococcal infection from a very similar, staphylococcal one.

For example, a sore throat caused by streptococcus is much more contagious, manifests itself with very severe pain, more often turns into a purulent form and causes complications. But Staphylococcus aureus is difficult to sanitize and constantly leads to reinfection of the patient.

Answers to important questions about streptococcus

Forewarned is forearmed. That is why most people, first of all, are trying to figure out how dangerous this or that bacterium is in practice, how to protect themselves from infection, and what exactly to do if you encounter a pathogen. We will try to answer in detail the most FAQ about streptococcus.

How is streptococcal infection transmitted?

The source of infection is almost always a sick person and his household items: dishes, toothbrush, towel, handkerchief. It is almost impossible to pick up a bacterium from an asymptomatic carrier.

Streptococcus is transmitted in the following ways:

contact;

Airborne;

You can cause a streptococcal infection of the genital organs on your own, if you do not follow the basic rules of personal hygiene. But the most dangerous from the point of view of infection are people with sore throat or pharyngitis, with whom you stand next to while talking, coughing and sneezing. In second place, you can put unwashed or stale foods that bring streptococcus into the body and cause dyspeptic disorders and food poisoning.

There are factors that significantly increase the likelihood of developing streptococcal infections:

Endocrine pathologies;

Immune diseases, such as HIV;

Concomitant viral and anaerobic infections: SARS, chlamydia, mycoplasmosis;

Chronic diseases of the gastrointestinal tract: gastritis, ulcers, intestinal dysfunction.

Streptococcal infections are highly seasonal: this bacterium literally follows the viruses and spreads among people in late autumn and early winter, just during the wave of the general incidence of acute respiratory infections and influenza. The worst thing is that streptococcus significantly complicates the course of colds, but if the doctor has not diagnosed it, then he will not prescribe antibiotics, because viruses are indifferent to them. That is why, with severe intoxication and persistent colds, it is imperative to take tests.

How do staphylococci differ from streptococci?

Staphylococcus is a spherical gram-positive anaerobic bacterium with a diameter of 0.5-1 microns. It has no organs of movement, does not produce spores. Some strains of staphylococcus are combined into capsules or form L-forms, that is, they completely or partially lose their cell wall, but retain the ability to divide. Staphylococcus is a conditionally pathogenic microbe, that is, it causes a disease only under certain conditions, and the rest of the time it is simply present in the body, without showing itself. Surprisingly, all listed features characteristic of streptococcus. The same shape and diameter, the same class of bacteria.

There are only a few signs by which staphylococcus can be distinguished from streptococcus:

Staphylococci are grouped in irregular shapes in the form of grape bunches, rarely stick together in pairs or are alone. And streptococci always form pairs or line up in the correct chain;

Staphylococci rarely form capsules, but in streptococci, almost all strains are encapsulated using hyaluronic acid shells;

Staphylococci rarely turn into L-forms, but streptococci do it very easily;

Staphylococcus never causes epidemiological outbreaks, and the diseases it causes develop only against the background of reduced immunity. Streptococcus, on the other hand, is highly contagious and often causes seasonal cold epidemics.

Streptococcus in the throat, what to do?

If you just found streptococcus in the analysis of a smear from the throat, you do not need to do anything at all. It is not the test results that are treated, but a specific disease. Any person who has had pharyngitis or tonsillitis at least once has streptococcus almost certainly present on the mucous membrane of the throat, but as long as the immunity is at the proper level, nothing threatens you.

As we mentioned above, streptococcus is an opportunistic pathogen, that is, it is an integral part of a healthy microflora. A healthy microflora is not one in which there are only “good” bacteria, but one where they are in balance. And if for the person himself streptococcus is a “bad” bacterium, then you should not forget that it can be bad for some other representatives. pathogenic flora and prevent them from reproducing. The enemy of my enemy is my friend.

The second reason why you should not touch a streptococcus found in the throat, but not causing disease, is the effect of adaptation to antibiotics. Attempts to inflict a “preemptive strike” on the infection turn out to be that the bacteria do not completely disappear, but only adapt to antibacterial drugs, mutate and pass on to their descendants genetic information about the enemy. And then, when there is a really serious reason for taking antibiotics, the drugs may be useless.

In a swab from the throat and nose of a healthy person, the following streptococci can normally be detected:

Streptococcus mutans;

Streptococcus pyogenes;

Streptococcus pneumoniae.

With any of these types of bacteria, you can and should get along peacefully. Even sucking on lozenges for a sore throat in the absence of a sore throat or spraying antibacterial sprays will bring instead of benefit huge harm not to mention oral antibiotic pills. Such preventive measures you, along with streptococcus, will kill someone else, destroy the entire microflora of the pharynx and force your body to build it again. And it is still unknown what will come of it. Therefore, if streptococcus is simply present in your throat, do with it, as in the well-known saying: "do not touch famously while it is quiet."

What does the presence of streptococcus in a vaginal smear mean?

Keeping this rule in mind, a qualified doctor will never prescribe antibiotics to a patient, either locally or orally, if he simply sees streptococci in her smear. Invading the microbiological balance of healthy genital organs is unwise for the same reason as in the case of the throat: if the existing background does not cause inflammation, then it does not need to be corrected.

The very presence of streptococcus in a vaginal smear may indicate the following processes:

Peaceful coexistence of all representatives of microflora;

Dysbacteriosis;

Sexually transmitted infection.

If there are very few streptococci in the smear, and on the contrary, there are a lot of Doderlein sticks, then we are talking about the first option. If there are more streptococci than Doderlein sticks, but the number of leukocytes in the field of view does not exceed 50 pieces, we are talking about the second option, that is, vaginal dysbacteriosis. Well, if there are a lot of leukocytes, then a diagnosis of "bacterial vaginosis" is made, which is specified depending on the type of the main pathogen. It can be not only streptococcus, but also staphylococcus, gerdnerella (gardnerellosis), trichomonas (trichomoniasis), candida (candidiasis), mycoplasma (mycoplasmosis), ureaplasma (ureaplasmosis), chlamydia (chlamydia) and many other microorganisms.

Thus, the treatment of streptococcus in the vagina, as well as the eradication of any other pathogen, is carried out only if its amount in the smear is disproportionately large and is accompanied by severe leukocytosis. All such sexual infections have very vivid symptoms, and a smear examination is necessary in order to determine the culprit and select the appropriate antibiotic.

Streptococcus treatment

The treatment of streptococcal infections is carried out by the specialist in whose area of ​​responsibility the focus of inflammation is located: colds are treated by a therapist, scarlet fever by a pediatrician, dermatitis and erysipelas by a dermatologist, urogenital infections by a gynecologist and urologist, and so on. In most cases, the patient is prescribed antibiotics from the group of semi-synthetic penicillins, but if they are allergic, they resort to macrolides, cephalosporins or lincosamides.

The following antibiotics are used to treat streptococcal infections:

Benzylpenicillin - injection, 4-6 times a day;

Phenoxymethylpenicillin - adults 750 mg, and children 375 mg twice a day;

Amoxicillin (Flemoxin Solutab) and Augumentin (Amoxiclav) - in the same dosage;

Azithromycin (Sumamed, Azitral) - adults 500 mg once on the first day, then 250 mg every day, for children the dosage is calculated based on 12 mg per kg of weight;

Cefuroxime - 30 mg injection per kg body weight twice a day, orally 250-500 mg twice a day;

Ceftazidime (Fortum) - injection once a day, 100 - 150 mg for each kg of weight;

Ceftriaxone - injection once a day, 20 - 80 mg per kg of weight;

Cefotaxime - injectable once a day, 50-100 mg per kg of body weight, only in the absence of effect from other antibiotics;

Cefixime (Supraks) - orally 400 mg once a day;

Josamycin - orally once a day, 40-50 mg per kg of body weight;

Midecamycin (Macropen) - orally once a day, 40-50 mg for each kg of weight;

Clarithromycin - orally once a day, 6-8 mg per kg of body weight;

Roxithromycin - orally 6-8 mg per kg of body weight;

Spiramycin (Rovamycin) - orally twice a day, 100 units for each kg of weight;

Erythromycin - orally four times a day, 50 mg per kg of body weight.

The standard course of treatment for streptococcal infection takes 7-10 days. It is very important not to stop taking the drug immediately after feeling better, to avoid skipping and not to change the dosage. All this causes multiple relapses of the disease and significantly increases the risk of complications. In addition to intramuscular, intravenous, or oral antibiotics, topical antibacterial sprays, gargles, and lozenges are used to treat streptococcus. These drugs significantly accelerate recovery and facilitate the course of the disease.

Most effective drugs for topical treatment of streptococcal infections of the oropharynx are as follows:

Bioparox - antibiotic based aerosol latest generation Fuzafungina, sprayed into the throat and nasal passages;

Ingalipt - sulfanilamide antibacterial aerosol for the throat;

Tonsilgon N - a local immunostimulant and antibiotic of plant origin in the form of drops and dragees;

Geksoral - antiseptic aerosol and solution for gargling;

Chlorhexidine is an antiseptic, sold separately as a solution, and is also included in many tablets for sore throats (Anti-Angina, Sebidina, Pharyngosepta);

Cetylpyridine - antiseptic, contained in Septolete tablets;

Dichlorobenzene alcohol is an antiseptic, found in many aerosols and lozenges (Strepsils, Ajisept, Rinza, Lorsept, Suprima-ENT, Astrasept, Terasil);

Iodine - found in aerosols and solutions for gargling (Iodinol, Vokadin, Yoks, Povidone-iodine).

Lizobakt, Immunal, IRS-19, Imunorix, Imudon - local and general immunostimulants.

If antibiotics were taken orally to treat a streptococcal infection, drugs will be needed to restore normal microflora internal organs:

• Bifidumbacterin;

• Bifiform.

Treatment of streptococcus in young children is carried out with the addition of antihistamines:

Claritin;

It would be useful to take prophylactic vitamin C, which strengthens the walls of blood vessels, improves the immune status and detoxifies the body. AT difficult situations doctors use a special streptococcal bacteriophage for treatment - this is an artificially created virus that devours streptococci. Before use, the bacteriophage is tested by placing it in a flask with the patient's blood and monitoring its effectiveness. The virus does not cope with all strains, sometimes you have to resort to a combined pyobacteriophage. In any case, this measure is justified only when the infection cannot be stopped with antibiotics, or the patient is allergic to all topical types of antibacterial drugs.

It is very important to follow the correct regimen during the treatment of streptococcal infections. A serious illness with severe intoxication of the body requires being in bed. It is active movements and work during the period of illness that are the main prerequisites for the development of serious complications in the heart, kidneys and joints. To remove toxins, you need a lot of water - up to three liters daily, both in pure form and in the form of warm medicinal tea, juices and fruit drinks. Warm compresses on the neck and ears can be placed only if the patient does not have a fever.

In acute tonsillitis and pharyngitis, one should not irritate the throat with too hot, or vice versa, ice food. rough food also unacceptable - it injures the inflamed mucous membrane. It is best to eat cereals, mashed soups, yogurts, soft curds. If the patient has no appetite at all, you do not need to stuff him with food, this will only result in nausea and vomiting. Digestion is a process for which our body spends a lot of energy. Therefore, during the treatment of streptococcal infection, when the digestive organs are already working poorly, and the body is poisoned with toxins, fasting with plenty of fluids may be more useful than good nutrition.

Of course, children suffering from streptococcal tonsillitis or scarlet fever need the most careful care. Every hour and a half, the child is given a warm lime or chamomile tea, apply cool lotions to inflamed eyes and a hot forehead, lubricate itchy and flaky skin with baby cream. If the baby is able to gargle, you need to do this as often as possible using chamomile or sage infusion. After recovery from a severe form of scarlet fever, small patients are advised to rest in a sanatorium, take prophylactic multivitamins, immunostimulants, pro- and prebiotics.

streptococci- bacteria are spherical in shape, arranged in chains. They are part of the microflora but can cause severe infections in immunocompromised people. Streptococci do not form spores, therefore they are quite unstable in the environment. They die under the influence of sunlight, disinfectants and antibiotics.

Streptococci are part of the normal human microflora and make up 30-60% of the bacteria contained in the pharynx. They enter the body with food, and feed on food debris and desquamated epithelium. Different types streptococci colonize various parts of the body: the oral cavity, gastrointestinal tract, mucous membrane of the respiratory tract and genital organs, skin.

With a decrease in the protective properties of the body, streptococci, which are part of the microflora, begin to actively multiply and acquire pathogenic properties. Bacteria or their toxins enter the bloodstream and cause serious illness - streptococcal infections. During the period of illness, a person becomes dangerous to others, as he releases a large number of pathogenic streptococci.

In countries with a temperate climate, diseases caused by streptococcus are one of the most common groups of pathologies. In the cold season, the incidence reaches 10-15 cases per 100 people.

History of study. Streptococci have been studied for more than 150 years since their discovery in 1874. Scientists have created several classifications to systematize the huge number of species of these bacteria. The cell wall of streptococci may contain various proteins and specific polysaccharides. Based on this, 27 species of streptococcus are divided. They differ in "place of residence", properties, ability to cause diseases. Each group is designated by a letter of the Latin alphabet. For example, group A streptococcus is the most common, and group B streptococcus can cause pneumonia and sepsis in newborns.

Depending on the ability to destroy (hemolyze) erythrocytes, they are divided into 3 groups:

• Alpha hemolytic - partial hemolysis of red blood cells
• Beta-hemolytic: complete hemolysis. The most pathogenic (pathogenic).
• Gamma-hemolytic: non-hemolytic streptococci.

What is streptococcus?

Streptococcus properties:

• stain well with aniline dyes, so they are classified as gram-positive bacteria.
• do not form a dispute
• form a capsule
• motionless
• stability in the external environment:
  • dust, dried sputum and pus can persist for months. At the same time, their pathogenicity decreases - they cannot cause severe forms of the disease.
  • tolerate freezing well
  • heating to 56 degrees kills them for half an hour
  • disinfectant solutions. funds are destroyed within 15 minutes
• Facultative anaerobes - can exist in the air or without it. Due to this feature, streptococci colonize the skin and can circulate in the blood.

• Hemolysins(streptolysins)
  • Hemolysin O - destroys erythrocytes, has a toxic effect on heart cells, suppresses the immune system by inhibiting leukocytes.
  
  
  • Hemolysin S - destroys red blood cells, has a toxic effect on body cells. Unlike hemolysin O, it is a weak antigen - it does not stimulate the production of antibodies.
• Leukocidin- affects leukocytes (neutrophils and macrophages). Turns off phagocytosis - the process of digestion of bacteria by immune cells. Violates the water-electrolyte balance in the intestinal cells, causing staphylococcal diarrhea.
• Necrotoxin- causes necrosis (death) of cells, which contributes to purulent fusion of tissue and the formation of abscesses.
• lethal toxin- causes death when administered intravenously.
• Erythrogenic toxin- a specific toxin released during scarlet fever. Causes a red rash. It suppresses the immune system, destroys platelets, allergises the body, suppresses the immune system, causes an increase in temperature.

• Hyaluronidase- splits the cell membranes of the connective tissue. Membrane permeability increases, which contributes to the spread of inflammation.
• Streptokinase(fibrinolysin) - destroys fibrin, which limits the focus of inflammation. This contributes to the spread of the process and the formation of phlegmon.

• Capsule containing hyaluronic acid - protects bacteria from phagocytes, promotes their spread.


• Protein M(capsule component) makes phagocytosis impossible. The protein adsorbs fibrin and fibrinogen (the basis of connective tissue) on its surface. It causes the formation of antibodies, including to connective tissue proteins. Thus, it provokes the development of autoimmune reactions. 2 weeks after infection with streptococcus, the immune system begins to produce antibodies that mistake connective tissue for protein M. This is the mechanism for the development of autoimmune diseases: rheumatoid arthritis, vasculitis, glomerulonephritis.

Method of infection with streptococcus

Mechanisms of transmission:

• Airborne- the main route of infection with streptococcus. Bacteria are released into the environment with droplets of saliva in the form of an aerosol. It occurs when coughing, sneezing, talking. The droplets remain suspended in the air. A healthy person inhales and becomes infected.
• Domestic– droplets of contaminated saliva dry up and deposit on objects (towels, personal belongings) or settle in house dust. At cold air temperatures and high humidity, streptococci remain viable for a long time. Infection can occur through dirty hands.
• Sexual. Streptococcal infections of the urogenital tract are transmitted during sexual intercourse.
• food(alimentary) route of infection. Products become infected with streptococcus in the process of preparation, during the sale. The most dangerous products that do not pass heat treatment: dairy products, compotes, butter, products with cream, salads, sandwiches. They cause outbreaks of streptococcal tonsillitis and pharyngitis.
• From mother to child. The child becomes infected from the mother through contaminated amniotic fluid or during the passage of the birth canal. Group B streptococcus is found in 10-35% of women. During childbirth, 0.3% of babies become infected. As a result of infection, the newborn may develop sepsis or pneumonia. In the US, pregnant women are given a vaginal microflora test at 36 weeks of gestation. If bacteria are detected, a course of antibiotic therapy is prescribed. In our country, a smear for the detection of streptococcus in pregnant women is not a mandatory test.

What diseases does streptococcus cause?

A newborn becomes infected with group B streptococcus while passing through the birth canal. Another option is infection with group A streptococcus in utero through the mother's blood or in the first days of life from a patient or carrier. The disease may appear immediately after birth or after a few weeks.

Symptoms of the infectious process in streptococcus

The most common symptoms of an infectious process in streptococcus:

Diagnosis of streptococcus

Purpose of the study:

• identify the pathogen
• distinguish streptococcal infection from other diseases
• determine the properties of the pathogen and sensitivity to antibiotics

First day. Put the collected material on a plate with a dense nutrient medium (5% blood agar) and in a test tube with glucose broth. The test tubes are placed in a thermostat, where the optimum temperature for bacterial growth is maintained at 37 degrees.

Second day. Take out test tubes and examine the formed colonies. On dense media, streptococcus colonies look like flat grayish plaques. In test tubes with liquid media streptococcus grows in the form of crumbs at the bottom and near the walls. Suspicious colonies are stained and examined under a microscope. If streptococcus is found in the test tubes, then it is subcultured into test tubes on broth with blood to isolate a pure culture. This is necessary to identify the properties of streptococcus.

Third day. From a pure culture, the type of streptococcus is determined using a precipitation reaction with typical sera and an agglutination reaction on glass.

Antibiotic susceptibility definitions. Method using antibiotic disks

A suspension containing streptococci is applied to the surface of a dense nutrient medium in a Petri dish. Disks impregnated with solutions of various antibiotics will also interfere there. The cup is left overnight in a thermostat for bacterial growth.

After 8-10 hours, the result is evaluated. Bacteria do not grow around antibiotic discs.

• The highest sensitivity to the antibiotic around which the diameter of the zone of growth inhibition is the largest.
• Medium growth zone - streptococcus is moderately resistant (resistant) to this antibiotic.
• Growth of bacteria directly near the disk - streptococcus is not sensitive to this antibiotic.

Streptococcus treatment

Treatment of streptococcal infection with antibiotics

Do I need an antibiogram to treat a streptococcal infection?

Antibiogram allows you to prescribe rational antibiotic therapy. Stop the growth of streptococci and avoid prescribing expensive, potent antibiotics that have a number of side effects.

Doctors usually have data on the sensitivity of streptococcus in a given region or hospital. The accumulated experience allows you to quickly prescribe treatment without determining sensitivity to antibiotics. Therefore, in some cases, an antibiogram is not done, but a course of treatment is carried out with one of the above drugs.

What are the consequences of a streptococcal infection?

Occur on the 5th day of the disease:

• paratonsillar abscess - accumulation of pus around the tonsils
• otitis media - inflammation of the middle ear
• sinusitis - inflammation of the sinuses
• meningitis - inflammation of the lining of the brain
• secondary abscesses of internal organs (liver, kidneys)
• pneumonia - purulent foci of inflammation of the lung tissue
• sepsis is a common inflammatory disease associated with the circulation of streptococcus and their toxins in the blood
• septic toxic shock is an acute reaction of the body to the presence of bacteria and toxins in the body.

• Acute rheumatic fever is a connective tissue disease that primarily affects the heart, joints, and nervous system.
• post-streptococcal acute glomerulonephritis - inflammation of the kidneys
• rheumatic heart disease - damage to the heart, which is accompanied by damage to the valves
• rheumatoid arthritis - systemic disease in which small joints are predominantly affected.

Microorganisms that are part of the human microflora, under adverse conditions, can enter the bloodstream and provoke serious diseases. Why is there an active reproduction of streptococci, what effect do bacteria have on the body, how can the infection be dealt with?

• spherical shape;
• lack of disputes;
• arrangement in the form of chains;
• the ability to damage the skin;
• the ability to survive in the blood in the absence of oxygen.

Weakened immunity causes a sharp increase in the number of bacteria that have a toxic effect on the body. The spread of infection often begins with the oral cavity - the place of the highest concentration of the pathogen. Once in the blood, the microorganism spreads throughout the body, affecting organs and systems:

• nasopharynx;
• gastrointestinal tract;
• skin;
• urethra;
• the woman's vagina;
• lymph nodes;
• muscles;
• bones;
• lungs;
• heart;
• liver;
• kidneys;
• brain.

Streptococcus, spreading through the lymph and blood throughout the body, causes purulent inflammatory processes. bacteria can for a long time to be preserved in sputum, dust. You can cope with the causative agent of infection if you use the following methods:

• the use of antibiotics;
• usage disinfectants– kill bacteria in 15 minutes;
• heating linen to a temperature of 60 degrees - ironing, washing - eliminate germs after 30 minutes.

Why streptococci get into the blood

Weakening of immunity, in which streptococcal infections develop, can cause all sorts of reasons. Microorganisms secrete enzymes that promote the absorption of bacteria into the blood and lymphatic system, and their further distribution throughout the body. With a decrease defensive forces streptococci begin to attack the body. This is possible in the presence of diseases and pathological conditions:

• injuries of the mucous membranes of the nasopharynx;
• diseases endocrine system;
• hypothermia;
• diabetes;
• flu;
• SARS;
• tuberculosis;
• sore throats;
• HIV infection;
• burns;
• cuts.

Factors that provoke the entry of streptococcus into the blood include:

• use of drugs, alcohol;
• smoking;
• chronic fatigue;
• stressful situations;
• sleep disorders;
• hypovitaminosis - lack of trace elements and vitamins;
• poor diet;
• lack of physical activity;
• work in hazardous conditions without protective equipment.

The risk of getting streptococcus into the blood occurs in the following cases:

• self-removal of the boil;
• placement of a catheter in the bladder;
• hygiene violations in gynecological examination;
• dental operations;
• removal of the tonsils;
• drug abuse;
• use for pedicure, manicure of a poorly processed tool.

Transmission routes

Microorganisms can enter the blood of a healthy person from a carrier of infection, a patient with scarlet fever, tonsillitis. The disease is caused by bacteria that are in the microflora of the body. Experts distinguish such ways of transmission of the pathogen:

• contact-household - through dirty hands, the use of common hygiene items, other people's things;
• airborne - when coughing, talking, sneezing, bacteria with drops of saliva, mucus get from a sick person to a healthy one.

Inflammatory processes can begin if bacteria enter the body through the alimentary (food) route as a result of the use of:

• food products prepared in violation of sanitary standards, hygiene rules;
• dishes with insufficient heat treatment;
• poorly washed fruits and vegetables;
• products with a broken expiration date, incorrect storage temperature;
• products that are not subject to heat treatment - salads, creams, compotes.

Bacteria can get to a person if he violates the rules of genital hygiene. Often, infection occurs in the following ways:

• sexual - during sexual contact with an infected partner without using a condom;
• placental - from a sick mother to a fetus during pregnancy;
• when the child passes through the genital tract affected by streptococcus during childbirth.

Impact on the body

There are a large number of streptococcal bacteria, which differ in their effect on the human body. In medicine, it is customary to distinguish 3 groups of infectious agents depending on the hemolysis (destruction) of red blood cells. The least dangerous are alpha-hemolytic streptococci. This group includes the following varieties:

• streptococcus mutans - causes the development of caries;
• streptococcus viridans - provokes angina, pharyngitis, scarlet fever, tonsillitis;
• Streptococcus pyogenes - leads to the occurrence of cervicitis, vaginitis, endometritis.

The alpha-hemolytic group includes microorganisms that are used by the food and pharmaceutical industries. The beneficial bacteria are:

• Streptococcus thermophilus - used to make cheese, sour cream, yogurt;
• Streptococcus salivarius - are used in the production of sucking lozenges for sore throats, pharyngitis, are components of medicines as a probiotic.

There is a group of gamma-streptococci that are considered non-hemolytic - they do not cause the destruction of red blood cells. The greatest danger is represented by bacteria that completely destroy red blood cells. Beta-hemolytic streptococci lead to serious diseases. This group includes such pathogens:

• streptococcus faecalis - contributes to the development of purulent-septic inflammation of the peritoneum, endocarditis;
• streptococcus gallolyticus - provokes rectal cancer;
• streptococcus agalactiae - causes postpartum inflammation mucous membranes of the uterus.

Bacteria release toxins into the bloodstream that poison the body. These substances include:

• hemolysins - suppress white blood cells, weaken the immune system, act on body cells;
• lethal toxin - when administered intravenously, leads to death;
• leukocidin - violates the water-electrolyte balance in the intestine, provokes diarrhea, upsets the process of digestion of bacteria by immune cells, affects leukocytes (macrophages, neutrophils);
• erythrogenic toxin - causes a rash with scarlet fever, allergies, reduces immunity;
• necrotoxin - leads to tissue necrosis.

Enzymes that produce harmful bacteria are of great danger. When exposed to them, biochemical reactions are accelerated. The group includes the following substances:

• Fibrinolysin (streptokinase) - destroys fibrin, which limits the site of inflammation, which leads to the spread of infection.
• Hyaluronidase - promotes the breakdown of cell membranes of connective tissues. This causes the zone to expand inflammatory process, the appearance of abscesses.

Signs of the presence of streptococcus in the blood

The spread of harmful microorganisms with the bloodstream, lymph flow is characterized by the appearance of symptoms of diseases. They have differences depending on the specific pathology, but there are common signs. The patient may experience symptoms of intoxication of the body:

• headache;
• increase in body temperature;
• chills;
• dizziness;
• pain in joints, muscles;
• high fatigue;
• lack of appetite;
• nausea;
• weakness;
• sweating;
• vomit;
• lethargy.

With the development of a streptococcal infection, the following symptoms are possible:

• suppuration, redness at the site of penetration of bacteria;
• enlarged lymph nodes;
• pressure drop;
• the appearance of a rash on the skin;
• pain, sore throat;
• difficulty swallowing;
• the formation of pustules on the tonsils;
• tissue necrosis;
• state of shock from the action of toxins;
• stomach ache;
• kidney damage (according to the results of a urinalysis);
• violation of urination;
• vaginal discharge;
• dehydration of the body;
• disturbance of consciousness;
• insomnia;
• change in smell;
• runny nose;
• cough.

What diseases are caused by streptococci

Inflammatory infectious processes are provoked by microorganisms of several groups. Diseases differ in the place of localization, the severity of the course. Physicians distinguish such varieties of pathogens of streptococcal pathologies and their influence:

In adults

Streptococcal infection can affect a person of any age group. In adults, pathologies of the upper respiratory tract, genitourinary system, and skin are often observed. When affected by bacteria, the following diseases can occur:

In children

Streptococcal infections often occur in newborns. Infection occurs from the mother in utero or during childbirth. Diseases are severe, the onset of death is not ruled out. At baby possible occurrence of such pathologies:

• meningitis - body temperature rises, regurgitation, refusal to eat, convulsions, impaired consciousness occur;
• pneumonia - a cough appears, respiratory arrest is possible;
• sepsis - there is an earthy shade of the skin, a rash, high body temperature.

Older children become infected in crowded places - schools, kindergartens. Streptococcal microorganisms cause diseases that occur in adults:

• tonsillitis - redness of the throat, abscesses, swallowing problems appear;
• otitis - there are severe pain in the ears, the inability to sleep;
• scarlet fever - a red rash appears all over the body;
• pharyngitis - accompanied by dryness, sore throat;
• bronchitis - there is a painful cough;
• erysipelas- the skin turns red, the temperature rises, rashes appear.

In pregnant women

Weakening of immunity while expecting a child can provoke the development of streptococcal infections in a woman. Pathogenic bacteria can cause placental rupture, premature birth, infection of the fetus, its intrauterine death. The development of pathologies is caused by such microorganisms:

Complications

It is important to treat streptococcal infections in a timely manner. The spread of the pathogen through the blood and lymphatic system can lead to the development of serious pathologies in a few days. Early complications caused by streptococcus include toxic shock, a reaction to the presence of bacteria. Possible inflammatory pathologies of organs:

• pneumonia - lung tissue;
• meningitis - meninges;
• sinusitis - nasal sinuses;
• angina - tonsils;
• otitis - middle ear;
• sepsis - blood poisoning;
• secondary abscess (purulent fusion of tissues) of the kidneys, liver.

Streptococcal infection can provoke allergic reactions, an aggressive attitude of immune cells towards one's own body. All this leads to the appearance late complications, which occur about a month after the disease. There is a development of such pathologies:

• rheumatoid arthritis - damage to the small joints of the limbs;
• rheumatic heart disease - a disease of the heart with damage to its valves;
• glomerulonephritis - an inflammatory process in the kidneys;
• acute rheumatic fever - a violation of the functions of the nervous system, joints, heart.

Streptococci in the blood can lead to the appearance of such serious pathologies:

• myocarditis (inflammation of the heart muscle);
• vasculitis (diseases of the veins, arteries);
• endocarditis (disorders of the heart valves);
• chronic lymphadenitis(inflammation of the lymph nodes);
• loss of voice
• purulent abscess lungs;
• erysipelas;
• pulpitis (diseases of the tissues of the tooth);
• allergies;
• pericarditis (damage to the serosa of the heart).

Diagnostics

The main method for detecting an infection caused by streptococci is a bacteriological examination of a smear. Diagnostics should solve several problems. These include:

• identification of the causative agent of the disease;
• differentiation of streptococcal infection from other pathologies;
• determination of the sensitivity of streptococci to antibiotics - antibiogram.

For microbiological analysis, a biomaterial is used, which is placed in a special environment. Its choice depends on the pathology, localization of the lesion, is made with a sterile material, instrument:

For sowing on a special nutrient medium, material is taken for analysis:

To conduct an immunochromographic analysis - an antigenic test, which is based on the interaction of an antibody and an antigen, use blood, urine and mucus. The same materials are sown on a nutrient medium for bacterial examination:

Streptococcus blood test

Laboratory research play an important role in the diagnosis of infections. A healthy person does not have streptococcus in the blood. Its presence in the analyzes is evidence of a serious inflammatory process that has spread throughout the body. For diagnosis, the following methods are used:

1. The latex agglutination test is a rapid method in which, in the event of an infection, the antibody-antigen complex precipitates.
2. ASLO (AntiStreptoLysin-O) is a method of serodiagnosis. Determines the presence of antibodies that are produced as a response to the action of streptococci, characterized by accuracy.

To conduct a blood test for the presence of streptococci, the following diagnostic methods are used:

1. PCR (polymerase chain reaction) - determines the pathogen even by one DNA molecule.
2. Standard Research- Placement of venous blood on a special medium. The growth of bacteria indicates the presence of pathogenic microorganisms. Additional identification of streptococcus is required.
3. ELISA (enzymatic immunoassay) of blood - by the presence of specific antibodies (immunoglobulins) to pathogens (antigens) reveals the type of bacteria, the stage of development of the disease.

After the diagnosis, identification of the pathogen and its sensitivity to medicines, the doctor chooses the tactics of treatment. The primary task is the destruction of streptococci that have spread through the blood throughout the body. To do this, use the following scheme of therapy:

• Impact on the body with antibiotics from the groups of penicillins, macrolides, cephalosporins - for local application and systemic treatment.
• Increasing the protective forces by taking immunomodulators, vitamin complexes.
• Detoxification of the body with drugs.

Since antibiotic therapy adversely affects the microflora, it is necessary to restore it with the help of probiotics and prebiotics. The course of treatment of streptococcal infections includes the following methods:

• the use of antihistamines in the event of allergic reactions;
• symptomatic treatment– lowering the temperature, eliminating skin itching, pain;
• rinsing with decoctions of medicinal plants, antiseptic solutions;
• treatment of concomitant diseases;
• compresses on the throat;
• plentiful drink;
• diet food.

Medical therapy

After a blood test for streptococcal infection has been performed and the pathogen has been identified, antibiotic therapy is prescribed. The choice of drugs depends on the microorganism and its sensitivity to drugs. When streptococci are detected, the following antibiotics are often used:

• penicillins - Ampicillin, Amoxicillin, Benzylpenicillin;
• cephalosporins - Ceftriaxone, Ceftazidime, Cefixime;
• macrolides - Claritomycin, Azithromycin;
• sulfonamides - Sulfalen, Sulfadimetoksin;
• topical preparations - throat sprays - Ingalipt, Bioparox.

The treatment regimen for streptococcal infections includes the use of such drugs:

• immunostimulants - Imudon, Immunal, IRS-19;
• antiseptics for local treatment - Hexoral, Chlorhexidine, Miramistin;
• preparations for restoring intestinal microflora after antibiotic treatment - Bifidumbacterin, Linex, Bifiform;
• drugs for removing toxins from the body - Enterosgel, Albumin, Atoxil.

An important role is given symptomatic therapy infections caused by streptococcus. Doctors prescribe these medications:

• in the event of allergic reactions - antihistamines Loratadin, Suprastin, Claritin;
• to reduce high temperature body - antipyretic Ibuprofen, Paracetamol;
• in case of vomiting, nausea - Cerucal, Motilium;
• to eliminate nasal congestion - vasoconstrictor drugs Farmazolin, Knoxprey.

Folk remedies

If streptococci are found in the blood, it is unacceptable to self-medicate. The use of folk remedies can only be an addition to the course of therapy prescribed by the doctor. With lesions of the oral cavity, it is useful to rinse several times a day until the symptoms disappear. To do this, use a decoction of medicinal plants. Two tablespoons of raw materials are poured with boiling water (0.5 liters), insisted for an hour. To prepare the product, you can use:

• chamomile flowers, calendula;
• herb sage, succession.

As natural remedies for streptococcal infections, it is advisable to eat onions and garlic, which have antimicrobial effects. To increase the protective forces, it is recommended to drink 100 ml of rosehip infusion daily. Treatment is carried out three times a day, until complete recovery. To prepare the composition you will need:

1. Take a liter thermos.
2. Put in it 100 grams of dried rose hips.
3. Pour in boiling water.
4. Leave overnight.
5. Strain in the morning, start treatment.

Prevention

To avoid the development of infection caused by streptococcus, which spreads through the blood, it is necessary to maintain hygiene. Simple rules will help to protect yourself from serious consequences. Disease prevention includes the following activities:

• carrying out regular wet cleaning in the room;
• the use of vegetables, fruits only in washed form;
• observance of intimate hygiene;
• washing hands after visiting public places, before eating;
• frequent ventilation of the room;
• use of personal hygiene products;
• cleaning vacuum cleaner and air conditioner filters.

To prevent infection with streptococci, you need to take care of your health. The following preventive actions should be taken:

• to strengthen immunity, carry out hardening, take walks in nature;
• increase physical activity;
• exclude hypothermia of the body;
• avoid stressful situations;
• include in the diet foods rich in trace elements, vitamins.

You can avoid the spread of streptococcus through the blood, the development of infection, if you follow simple rules:

1. Eliminate all foci of infection, sanitize teeth, tonsils, and skin.
2. Avoid contact with sick people.
3. Do not attend dental offices if hygiene rules are known to be violated there.
4. Do not do manicures, pedicures in salons where, according to customer reviews, high-quality tool processing is not performed.
5. Accept vitamin complexes.
6. Disinfect the room where the patient was.

Video

In the comments, they asked to write an article about hemolytic streptococcus. I decided to do general review on streptococci and provide links to more detailed information on hemolytic streptococcus.

Classification of cocci

cocci are spherical bacteria. Depending on the structural features of their cell wall, Gram stain(the method was proposed in 1884 by the Danish physician G.K. Gram) cocci turn blue or red. If bacteria turn blue, they are called gram-positive(gram+). If they turn red, then gram-negative(gram-). Gram staining in microbiology was done by every medical student.

GRAM-POSITIVE cocci:

• staphylococci (from staphylo- bunches) - have the shape of grape bunches,
• streptococci - look like chains,
• enterococci - arranged in pairs or short chains. They cause infective endocarditis (in 9% of cases), lesions of the genitourinary system and intestinal dysbacteriosis.

Genus streptococci and genus enterococci belong to the same family Streptococcaceae [Streptococcus Acee], because they are very similar to each other, including the lesions caused.

GRAM-NEGATIVE cocci:

• Neisseria (usually arranged in pairs):
  • gonococci (Neisseria gonorrhoeae) - causative agents of gonorrhea,
  • meningococci (Neisseria meningitidis) - causative agents of nasopharyngitis, meningitis and meningococcemia.

A common property of cocci is that they are aerobes(that is, they use oxygen for development) and do not know how to form spores (that is, it is easier to destroy cocci than spore-forming bacteria that are resistant to external environmental factors).

Classification of streptococci into serogroups A, B, C, ...

By the proposal Rebecca Lancefield(1933), according to the presence of specific carbohydrates in the cell wall, streptococci are divided into 17 serogroups(the most important are A, B, C, D, G). Such a separation is possible with the help of serological (from lat. serum- serum) reactions, i.e. by determining the required antigens by their interaction with known antibodies of standard sera.

Group A Streptococcus

Most human diseases are caused β-hemolytic streptococci from serogroup A. Almost all of them belong to the same species - S. pyogenes(Streptococcus pyogenes, pyogenic streptococcus, read [Streptococcus pyogenes]). It's streptococcus in honey. literature is sometimes referred to as an abbreviation BGSA - beta-hemolytic streptococcus serogroup A. In the cold season, its carriage in the nasopharynx of schoolchildren reaches 20-25% .

S. pyogenes has been known since antiquity, but its incidence peaked in the 19th century. It calls:

Early Complications caused by the introduction of infection into other parts of the body through the blood (hematogenous) and lymphatic (lymphogenic) pathways. Any dangerous infection can spread this way, not just streptococci.

Late Complications associated with systemic inflammation and autoimmune mechanism, that is, the immune system begins to destroy its own healthy tissues and organs. About this mechanism - next time.

For more information on lesions caused by GABHS, I advise you to read on the website antibiotic.ru: infections caused by group A beta-hemolytic streptococcus.

Instructive and dramatic story postpartum sepsis(puerperal fever), the victims of which were hundreds of thousands of mothers and the founder of antiseptics ( infection control science) - Hungarian obstetrician Ignaz Philip Semmelweis(Semmelweis). I can't help but tell you more.

The young doctor Semmelweis, after graduating from the University of Vienna, remained working in Vienna and soon wondered why the mortality rate during childbirth in the hospital reached 30-40% and even 50%, far exceeding the mortality rate during home births. In 1847, Semmelweis suggested that this phenomenon was somehow connected with the transfer of infection ("cadaveric poison") from the pathological and infectious diseases departments of the hospital. In those years, doctors often practiced in morgues (“anatomical theaters”) and often resorted to delivering directly from a corpse, wiping their hands with new handkerchiefs. Semmelweis ordered hospital staff to first dip their hands in bleach solution and only then approach a woman in labor or a pregnant woman. Mortality among women and newborns will soon decreased by 7 times(from 18% to 2.5%).

However, Semmelweis's idea was not accepted. Other doctors openly laughed at his discovery and at himself. The head physician of the clinic where Semmelweis worked forbade him to publish statistics on the decrease in mortality, threatening that “ considers such a publication a denunciation”, and soon fired Semmelweis from work altogether. Trying to somehow convince his colleagues, Semmelweis wrote letters to leading doctors, spoke at medical conferences, organized “master classes” on his own money to teach his method, and in 1861 published a separate work “ Etiology, essence and prevention of puerperal fever', but it was all useless.

Even the death of a German doctor Gustav Michaelis did not convince the then medical community. Michaelis also laughed at Semmelweis, but nevertheless decided to test his method in practice. When the mortality of patients fell several times, the shocked Michaelis could not stand the humiliation and committed suicide.

Hounded and misunderstood during his lifetime by his contemporaries, Semmelweis went mad and spent the rest of his days in a psychiatric hospital, where in 1865 he died of the same sepsis from which women in childbirth died before its discovery. Only in 1865, 18 years after the discovery of Semmelweis and, coincidentally, in the year of his death, did an English doctor Joseph Lister offered to fight the infection with phenol (carbolic acid). It was Lister who became the founder of modern antiseptics.

Group B Streptococcus

This includes S. agalactiae[Streptococcus agalactie], which lives in the gastrointestinal tract and in the vagina of 25-45% of pregnant women. When the fetus passes through the birth canal of the mother, its colonization occurs. S. agalactiae causes bacteremia and neonatal meningitis with a mortality rate of 10-20% and residual effects half of the survivors.

In young people and adults, S. agalactiae often causes streptococcal pneumonia as a complication after SARS. By itself, S. agalactiae does not cause pneumonia, but after the flu - easily.

S. pneumoniae (pneumococcus)

Non-hemolytic (green) streptococci

In addition to the classification mentioned above Rebecca Lancefield(for serogroups A, B, C, ...), classification is also used Brown(1919), which is based on the ability of streptococci to cause hemolysis (destruction) of red blood cells when growing on media with ram's blood. According to Brown's classification, streptococci are:

• α-hemolytic: cause partial hemolysis and greening of the environment, therefore α-hemolytic streptococci are also called green streptococci. They do not interact with Lancefield group sera.
• β-hemolytic: complete hemolysis.
• γ-hemolytic: invisible hemolysis.

The group of viridescent streptococci is sometimes combined under common name S. viridans.

Non-hemolytic (α-hemolytic, green) streptococci include S. anginosus, S. bovis, S. mittis, S. sanguis and others. They live in the oral cavity, where they make up to 30-60% of the entire microflora, and also live in the intestines.

Typical lesions - bacterial endocarditis(inflammatory processes in the endocardium of the heart valves). Viridescent streptococci account for 25-35% of all pathogens of bacterial endocarditis. Since there are a lot of green streptococci in the mouth, they easily enter the bloodstream (this is called bacteremia) during dental procedures, brushing teeth, etc. Passing through the cavities of the heart, green streptococci often settle on the heart valves and lead to their malignant lesions.

The frequency of bacteremia (figures from a lecture at BSMU):

• with periodontal intervention - in 88% of cases,
• when removing a tooth - 60% of cases,
• tonsillectomy (removal of the tonsils) - 35%,
• bladder catheterization - 13%,
• tracheal intubation - 10%.

Bacterial (infectious) endocarditis is a type of sepsis (« blood poisoning»; Unlike bacteremia in sepsis, bacteria multiply in the bloodstream rather than just circulating). Treatment of endocarditis is very difficult, and without antibiotic treatment, mortality from bacterial endocarditis within a year is close to 100%. Long-term use of high doses of antibiotics is used. If the patient has heart defects, there are artificial valves heart or he has previously had bacterial endocarditis, the risk of re-infection becomes too great. Such people are given a prophylactic dose of antibiotics before visiting the dentist. At lectures on internal medicine at BSMU, we were given the following scheme:

• inside 2 g amoxicillin 1 hour before the procedure,
• alternative drugs inside - cephalexin, clindamycin, azithromycin, clarithromycin,
• if swallowing is impossible - 2 g ampicillin intramuscularly or intravenously 0.5 hours before the procedure.

Non-hemolytic streptococci also include the bacterium S. mutans[streptococcus mutans], widely known for which is the causative agent of caries. This bacterium ferments the sugar that enters the mouth into lactic acid. Lactic acid causes demineralization of teeth. In principle, many bacteria in the mouth can ferment sugar to lactic acid, but only S. mutans and lactobacilli can do this at low pH values, that is, in an acidic environment. Therefore, after eating, it is recommended to brush your teeth or at least rinse your mouth thoroughly. Scientists do not give up hope to create a vaccine against S. mutans, which will simultaneously become a vaccine against caries.

Features of antibacterial therapy for streptococci

As I mentioned, everything streptococcal tonsillitis require the prescription of antibiotics. It is curious that despite the long-term use of penicillins, pyogenic streptococcus has not yet developed resistance to beta-lactam antibiotics - penicillins and cephalosporins, which are usually prescribed for a period of 10 days for tonsillitis and scarlet fever. Even if the next day from the start of treatment nothing bothers you, the course cannot be interrupted. If the patient is allergic to penicillins, then they are prescribed macrolides, although in 30% or more cases, streptococcus is resistant to them. Used for macrolide resistance lincomycin.

You can read more about antibiotic treatment in the article Antibacterial therapy for streptococcal tonsillitis and pharyngitis.

Asymptomatic carriage of group A beta-hemolytic streptococcus is not considered to require antibiotic treatment.

curious to know

Similarly, until resistance to penicillins develops and pale treponema(pale spirochete) - the causative agent of syphilis. Syphilis is treated in much the same way as many years ago. True, the doses of penicillin have since increased significantly.

Unlike pyogenic streptococcus Pneumococcus is often resistant to a number of beta-lactam antibiotics.

Streptokinase

Group A beta-hemolytic streptococcus, in addition to other pathogenicity factors, produces a protein streptokinase, which dissolves blood clots and allows bacteria to spread throughout the patient's body. On the basis of streptokinase in domestic medicine, a drug is used to restore blood flow in a thrombosed vessel in case of acute infarction myocardium, however, it is highly allergenic and can lead to severe allergic reactions, especially with repeated use.

In world practice, instead of streptokinase, for example, alteplase(actilyse) - a recombinant drug (obtained using genetic engineering). It is safer and has fewer side effects, but is much more expensive and therefore rarely used.

Update March 9, 2013

The other day I saw it on sale in pharmacies in Moscow rapid test "Streptatest", which allows to detect the presence of group A beta-hemolytic streptococcus in throat infections in 10 minutes. "Streptatest" allows you to distinguish streptococcal infection, which requires antibiotics, from sore throats of other origins, when antibiotics are not needed. See website for details http://streptatest.ru/.

Streptococcal infection is a group of diseases that causes pathological processes in the respiratory tract and skin. Infections of this type are present in the body of a healthy person. The development of the disease is possible only if there is a favorable environment for this. Children and pregnant women are most susceptible to the disease.

Etiology

Group A streptococcus contributes to the development of the pathological process. Often this organism coexists with Staphylococcus aureus. In a child, the cause of infection is the following factors:

• weakened immunity;
• previously transferred infectious or inflammatory diseases;
• long-term drug treatment.

As for adults, the following etiological factors can be the cause of the development of an infectious disease:

• long-term antibiotic treatment;
• chemotherapy, taking glucocorticosteroids;
• heartburn;
• frequent infectious or viral diseases.

Just like a child, adults can develop the disease only in the case of a weakened immune system. That is why streptococcal infections are most susceptible to children and pregnant women. It is also not uncommon for cases when infection took place in a hospital.

The risk group includes people of the following category:

• pregnant women;
• with skin injuries (burns, mechanical damage);
• undergoing major surgery.

Infection can occur in the following ways:

• placental - from an infected mother to a child;
• sexually;
• from a sick person to a healthy person.

The greatest danger is posed by a person whose upper respiratory tract is infected.

General symptoms

The most common streptococcal infection affects the skin and throat. The development of the disease depends on the general health and age of the patient. But in most cases, the development of streptococcal infection passes rapidly.

At the initial stage, you can observe the following symptoms:

• weakness and malaise, for no apparent reason;
• nausea and vomiting;
• unstable temperature, rises to 38-40 degrees at night;
• chills, fever;
• the appearance of rashes on the skin.

If the inflammatory process has developed on the skin, then the following signs may be added to the general list of symptoms:

• in the affected area, the skin has an elevated temperature;
• the affected areas become red or bright pink;
• small and large bubbles with liquid are formed;
• after a while, the blisters burst and crust over.

It should be noted that such manifestations of streptococcal infection can form on the wings of the nose and even cheeks.

With regard to streptococcal respiratory tract infection, the following symptoms are possible:

• increased body temperature;
• sore throat;
• swollen lymph nodes;
• formation of plaque on the tonsils.

If a streptococcal infection affects genitourinary system, then the following symptoms are possible:

• pain when urinating;
• discharge;
• discomfort during intercourse.

The child is most often diagnosed with streptococcal infection of the respiratory tract and skin.

Types of streptococci

According to the official classification, there are three groups of streptococci:

• alpha streptococcus;
• beta streptococcus;
• gamma streptococcus.

The greatest danger to the human body are infections of the beta group. They affect the throat, upper respiratory tract, genitourinary system and skin. The other two groups are not harmful to health, as they are not able to destroy red blood cells.

Respiratory damage

Group A streptococci can cause the development of diseases such as:

The most common diseases with lesions of the throat. Hemolytic streptococci provoke such diseases. Children and the elderly are at risk.

At the initial stage, a child or adult may experience the following symptoms:

• elevated temperature;
• sore throat, for no apparent reason;
• malaise and weakness.

As the infection progresses, the following symptoms appear:

• redness of the throat;
• purulent plaque on the throat;
• red, swollen tonsils.

In some cases, the child may have enlarged submandibular lymph nodes.

It should be noted that any disease in the throat area can be infectious. Therefore, self-medication means endangering not only yourself, but also those around you.

In this case, streptococcal tonsillitis is most often diagnosed. If left untreated, there can be a serious complication. The infectious process can affect the kidneys, liver, and even the cardiovascular system.

Because children's body much weaker than an adult, infections are much easier to provoke the development of the disease. Symptoms of streptococcal angina in a child are as follows:

• sore throat;
• elevated temperature;
• refusal to eat, apathy;
• headache;
• small rash on the skin.

It should be noted that angina can affect the functioning of the heart and kidneys if treatment is not started in a timely manner.

At the first symptoms, you should immediately consult a doctor. If a child complains of a sore throat, this does not mean a streptococcal infection. But also hope for a simple SARS, and treat the child folk remedies, is also fraught with consequences. Streptococcal infection in children requires only qualified treatment.

Streptococcus on the skin

Erysipelas on the skin can manifest itself in the form of such symptoms:

• a clear distinction between healthy and affected skin;
• the affected areas become bright crimson or red;
• touching the skin causes pain;
• elevated temperature is observed in the affected areas;
• bubbles form with liquid, which burst and become covered with a crust.

In some cases, such a clinical picture may be supplemented by general malaise and nausea.

Most often, erysipelas of the skin affects the lower extremities. Somewhat less often pathological process affects upper limbs and facial skin. In a child, such a disease is diagnosed much less frequently than an inflammatory process in the throat area. The main treatment of the inflammatory process on the skin is aimed at the consumption of antibiotics and vitamins of group C.

In addition, streptococcal infection can provoke the development. This disease has several subspecies, it develops quite quickly. Conflicts (vesicles with purulent contents) form on the skin, which burst and become covered with a crust. In some cases, such pathological formations on the skin can leave scars.

If you start treatment for early stage, significant complications can be avoided. Self-medication, in this case, is not recommended.

Diagnostics

After a personal examination and clarification of the anamnesis, laboratory and instrumental diagnostic methods are carried out. Laboratory tests in this case include the following:

• antibiotic susceptibility testing;
• smear examination;
• rapid test for group A streptococci.

Instrumental research methods are carried out only in exceptional cases. It is possible to conduct such studies:

• radiography of the lungs;

Only on the basis of the results of the tests, the doctor can make an accurate diagnosis and prescribe the correct treatment.

Treatment

Treatment of streptococcal infections is possible only on the prescription of a competent doctor. Self-medication can only aggravate the development of an infectious or inflammatory process and lead to the development of other diseases.

In most cases, streptococcal infections are treated with antibiotics. In addition, the patient is prescribed drugs for the general strengthening of the immune system. In some cases, immunoglobulins and immunostimulating agents may be prescribed.

As shows medical practice, antibiotic treatment brings the most positive results in a relatively short period of time.

Prevention

Streptococcal infection in children and adults can be prevented if fairly simple preventive measures are put into practice:

• hygiene;
• a balanced diet rich in minerals and vitamins;
• timely and correct treatment of all diseases.

If the infection has made itself felt, you should immediately consult a doctor, and not self-medicate.

Is everything correct in the article from a medical point of view?

Answer only if you have proven medical knowledge