1. Streptococcal Serology
Terry Kotrla

2. Introduction Gram-positive Beta hemolytic
Spherical, ovoid or lancet shaped
Pairs or chains

3. Divided into Serotypes or groups
Two major outer proteins M and T
Eighteen interior proteins knows as Lancefield grouping
Streptococcus pyogenes belong to Lancefield group A
M protein chief virulent factor

4. Numerous Exoantigens
Exoantigens are produced and excreted and include:
Streptolysin O
Dnase
Hyaluronidase
Nicotinamide Adenine Dinucleotidase
Streptokinase
Patients react to exoantigens by producing antibodies

5. Characteristics Two major sites of infection
Upper respiratory tract
Skin
If infections left untreated can lead to post-streptococcal sequelae
Acute glomerulonephritis
Rheumatic fever

6. Upper Respiratory Sore Throat Tonsillar exudate Fever Chills
20% school children carriers

7. Skin Impetigo Lesions on extremities Commonly on face
Pustular and crusty

8. Suppurative Complications
Suppurate -To generate pus; as, a boil or abscess suppurates.
Erysipelas
Necrotizing fasciitis
Scarlet fever

9. Erysipelas
Infection involves the dermis and lymphatics and is a more superficial subcutaneous infection of the skin than cellulitis.
characterized by intense erythema, induration and a sharply demarcated border.

10. Necrotizing Fasciitis

11. Scarlet Fever Strep bacteria produces a toxin that causes a rash
Sandpapery
Peels

12. Non-Suppurative Inflammatory response elsewhere in the body.
Damaging sequelae to strep infection
Rheumatic Fever
Post-Streptococcal glomerulonephritis

13. Rheumatic Fever
Delayed consequence of an untreated upper respiratory infection with group A streptococci
Causes serious, debilitating damage to the heart.
Associated with large amount of M protein and a capsule
Due to immune response against Strep antigens similar to heart antigens.

14. Rheumatic Fever
This is the heart of a 44 year old woman who had rheumatic fever and had been treated for congestive heart failure for about one year.

15. Poststreptococcal glomerulonephritis
Follows strep infection of skin or pharynx
Characterized by damage to glomeruli of kidneys
Deposition of Ag-Ab complexes, activation of complement.
Inflammatory response causes damage.

16. Poststreptococcal glomerulonephritis
Most common in children 2-12
Symptoms:
Hematuria
Proteinuria
Edema
hypertension

17. Poststreptococcal glomerulonephritis
The scattered capillary wall granular deposits in acute poststreptococcal glomerulonephritis also stain for complement (immunofluorescence with antibody to C3)

18. Laboratory Testing Culture and identification
Rapid Strep Tests from throat swab
Detection of Streptococcal antibodies
Anti-Streptolysin O (ASO) titer