Streptococcal

QHgNiOiS. Colourless crystals, m.p. 164 5-166-5" C. It is usually prepared by treating p-acetamidobenzenesulphonyl chloride with ammonia, and hydrolysing the acetyl derivative to the base. Used for the treatment of streptococcal infections, gonorrhoea, meningococcal meningitis and urinary infections. Liable to cause unpleasant reactions, such as nausea, cyanosis and skin rashes. 

Fig, 4. (a) Eigenvalues and distributions for the ct-carbon atoms in the 56-residue B l-domain of streptococcal protein G, from a 1 ns MD simulation in water (courtesy of Bort de Groot, Groningen). 

Both multiple-tube and membrane-filter methods are also available for testing for the fecal streptococcal group (20). These assays can be used to provide supplementary data regarding the bacteriological quaUty of water. Other fecal indicators should also be used concurrendy because of the survival characteristics of the fecal streptococci. 

These neutralizing antibodies may arise because of a prior streptococcal infection, or prior streptokinase treatment (80—82). Titers of antibodies sufficient to neutralize a complete dose of 1.5 million units of streptokinase may be present even one year after enzyme treatment (83). 

Compared to streptokinase, urokinase has been less extensively studied because of its high cost, ie, about 10 times that of a comparable treatment with streptokinase. In addition to the indications described for streptokinase, urokinase is indicated for use in patients with prior streptokinase treatment, or prior Streptococcal infection. Urokinase is commonly used at a loading dose of 4400 units /kg, with a maintenance intravenous infusion dose of 4400 units/kg/h for thromboses other than acute myocardial infarction. In the latter case, a much larger dose, ie, 0.5—2.0 million units/h or a bolus dose of 1.0 million units followed by a 60-min infusion with 1.0 million units, has been found optimal (106). An intracoronary dose of 2000 units/min for two hours was used in one comparative study with intracoronary streptokinase (107). In this study, urokinase exhibited efficacy equivalent to streptokinase with fewer side effects. Other studies with intracoronary urokinase have adrninistered doses ranging from 2,000 to 24,000 units/min with a reperfusion efficacy of 60—89% (108—112). In another urokinase trial, 2.0 million units were adrninistered intravenously, resulting in a thrombolytic efficacy of 60% (113). Effectiveness in terms of reduction in mortaUty rate has not been deterrnined because of the small number of patients studied. 

Therapeutic Function Enzyme Chemical Name Streptococcal fibrinolysin Common Name —... 

SB S8 S08.020 C5a peptidase Proposed target for vaccine against group B streptococcal infection... 

Scarlet fever is produced following infection with certain strains of Strep, pyogenes. These produce a potent toxin which causes an erythrogenic skin rash which accompanies the more usual effects of a streptococcal infection. 

Acute pharyngitis presents a diagnostic and therapeutic dilemma. The majority of sore throats are caused by a variety of viruses fewer than 20% are bacterial and hence potentially responsive to antibiotic therapy. However, antibiotics are widely prescribed and this reflects the difficulty in discriminating streptococcal from non-streptococcal infections clinically in the absence of microbiological documentation. Nonetheless, Strep, pyogenes is the most important bacterial pathogen and this responds to oral penicillin. However, up to 10 days treatment is required for its eradication fixm the throat. This requirement causes problems with compliance since symptomatic improvement generally occurs within 2-3 days. 

Staphylococcus aureus is responsible for a variety of skin infections which require therapeutic approaches different from those of streptococcal infections. Staphylococcal celluhtis is indistinguishable clinically from streptococcal cellulitis and responds to cloxacillin or flucloxacillin, but generally fails to respond to penicillin owing to penicillinase (/3-lactamase) production. Staphylococcus aureus is an important cause of superficial, localized skin sepsis which varies ftom small pustules to boils and occasionally to a more deeply invasive, suppurative skin abscess known as a carbuncle. Antibiotics are generally not indicated for these conditions. Pustules and boils settle with antiseptic soaps or creams and often discharge spontaneously, whereas carbuncles frequently require surgical drainage. Staphylococcus aureus may also cause... 

Penicillin is the dmg of choice for the treatment of group B streptococcal, meningococcal and pneumococcal infections but, as discussed earlier, CSF concentrations of penicillin are significantly influenced by the intensity of the inflammatoiy response. To achieve therapeutic concentrations within the CSF, high dosages are required, and in the case of pneumococcal meningitis should be continued for 10-14 days. 

A second errzyme, streptodornase, preserrt in streptococcal cirltiue filtrates, was observed to hqnefy pus. Streptodornase is a deoxyribonuclease which breaks down deoxyribonucleoprotein and DNA, both constituents of pits, with a consequent reduction in viscosity. Streptokinase and streptodornase together have been used to facilitate... 

Streptokinase Certain streptococcal strains Liquefying blood clots 2.4.1... 

Streptokinase and streptodornase are isolated following growth of non-pathogenic streptococcal producer strains in media containing excess glucose. They are obtained as a crude mixture from the culture filtrate and can be prepared relatively free of each other. They are commercially available as either streptokinase injection or as a combination of streptokinase and streptodornase. 

Once the organism has been identified and sensitivities are known, drug selection should be adjusted to reflect the susceptibilities of the organism. Streptococcal, staphylococcal, and enterococcal species sensitive to P-lactam antibiotics should be treated with continuous IP dosing to increase efficacy and minimize resistance.49 Peritonitis caused by S. aureus or P. aeruginosa are often associated with catheter-related... 

The antibiotic of choice for group B streptococcal disease is penicillin G, although ampicillin is an alternative.43 No resistance to either agent has been reported, and their narrow spectrum of activity makes them ideal choices.43 Resistance has developed with the use of alternative choices for penicillin-allergic patients. A treatment algorithm for group B Streptococcus is shown in Fig. 44—3, and dosing recommendations are shown in Table 44-5. 

Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease revised guidelines from CDC. Morb Mortal Wkly Rep (MMWR) 2002 51(RR-11 ) 1—22. 

Cuttate psoriasis presents as a sudden eruption of small, disseminated erythematosquamous papules and plaques, and is often preceded by a streptococcal infection 2 to 3 weeks prior. 

Centers for Disease Control and Prevention. Prevention of perinatal Group B streptococcal disease. Morbidity and Mortality Weekly Report (MMWR) 2002 51(RR11) 1-22. 

Identify clinical signs and symptoms associated with acute otitis media, bacterial rhinosinusitis, and streptococcal pharyngitis. 

Recommend appropriate adjunctive therapy for a patient with acute otitis media, acute bacterial rhinosinusitis, or streptococcal pharyngitis. 

The goals of therapy for streptococcal pharyngitis are to eradicate infection, reduce symptoms and infectivity, and prevent complications. 

Penicillin is the drug of choice for streptococcal pharyngitis, but cephalosporins may be appropriate alternative first-line agents owing to increasing failure rates after penicillin therapy. 

Does this child have streptococcal pharyngitis ... 

---