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  Laboratory diagnosis of infections

Laboratory diagnosis of infections with Streptococcus pyogenes:

Specimens:

Depending on the place of infection specimens are gathered. The specimens comprise throat swabs or skin swabs, blood, pus, cerebrospinal fluid (i.e., CSF).

Cultivation and identification:

The primary cultivation medium employed for streptococci is blood agar. Str. pyogenes is detected primarily by its‚ β-hemolytic activity. The colonies are 1 mm in diameter and non-pigmented. They are catalase negative. Gram’s stained smear illustrates gram positive cocci in chains. Str. pyogenes is sensitive to bacitracin (i.e., 0.4 microgram disc). The species is recognized by serological detection of group antigen by immune precipitation or co-agglutination test employing specific antiserum.

Antibody detection:

Antibodies against antigen of Str. pyogenes are raised in post streptococcal sequelae. In rheumatic fever situations antistreptolysin O titer is elevated. Raised levels of serum antibodies to streptococcal hyaluronidase and DNAse B are also observed. In acute glomerulonephritis, elevated ASO tire is not noticed. Though elevated levels of antistreptococcal DNAse B are seen.

Treatment:

Str. pyogenes is susceptible to penicillin and a broad range of antibiotics. In condition of hypersensitivity to penicillin, erythromycin is generally a second choice. Treatment for 10 days will remove streptococci from the infected region. Surgery is necessary to eradicate damaged tissue in situation of necrotizing fasciitis since antibiotic penetration of infected regions is poor. In this situation clindamycin is favored over penicillin since it inhibits protein synthesis involving exotoxin.

Prevention and control:

Skin infection with Str. pyogenes is related with poor hygiene and can be barred by standard hygienic measures.

 

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