Internal Medicine

What is strep infection?

The term streptococcus refers to a specific type of bacteria that share certain common microbiological and biochemical properties.
This includes, for example, that they take on the same color in a certain microbiological coloration (the so-called Gram coloration) and arrange themselves in the same way in the light microscope.
In addition, streptococci are extremely diverse and even belong to the most diverse families of bacteria. Depending on the location and bacterial strain, one streptococcal infection is completely different from the other and must therefore be viewed individually.

Causes of Streptococcal Infection

Streptococci do not necessarily have to occur as an external infection: Many types of streptococci are naturally already present on the lining of the intestines, vagina, mouth and throat.

However, these types of streptococci can also trigger an infection if they get from the mucous membrane into the bloodstream or if - relative to the other types of bacteria in the natural skin flora - they multiply too much and become overwhelming.
The latter can be the case, for example, when other types of bacteria die due to certain circumstances, giving the streptococci more opportunities to multiply and better conditions.
Another risk factor for strep infection is a weak immune system. Babies as well as older people are therefore particularly at risk of contracting a streptococcal infection. Statistically speaking, people who receive immunosuppressive drugs (that is, drugs that deliberately suppress the immune system) are more likely to be affected by streptococcal infections.

Diagnosing streptococcal infection

If a streptococcal infection is suspected as the cause of the symptoms, a sample of the infected tissue or of the surface can be taken as evidence. Depending on the location of the infection, blood, nerve fluid or urine are taken as a sample or a smear is made.

Cultivation of the pathogen can then be attempted from this material.
This means that the material is placed on a nutrient medium that provides all the conditions on which the suspected streptococcus or other bacterial strains can grow well.
Later it can be concluded from the growth which strain it is now.

It should be noted, however, that this cultivation can be carried out particularly well from liquid material.
Blood, urine or a swab from the mucous membrane are good starting materials for diagnostic cultivation.
Growing skin material, for example, is far less promising. Skin diseases that could be caused by a strep infection are therefore more likely to be diagnosed by the symptoms.

Read more on the topic at: Streptococcal sepsis

These tests and quick tests are there

If the affected area is easily accessible manually, a smear can be taken from this area.
The material from this smear can then be tested for certain types of strep.

This makes sense if you suspect a certain streptococcal infection and would like to use a corresponding antibiotic for therapy in a timely manner, or for prevention in pregnant women.
Otherwise, the newborn may become infected with streptococci at birth.

However, a rapid test is only used to get another indication of a probable infection. For an actual diagnosis and proof of a streptococcal infection, cultivation should be carried out in any case, not least in order to be able to better assess or prove the effectiveness of any antibiotic that may have already been used.

At this point, the editors recommend the following article: Streptococcus rapid test

I recognize a strep infection by these symptoms

The symptoms of strep infection depend on where the infection is located.
In most cases, streptococcal infections lead to inflammation, which is then noticeable in the form of symptoms such as swelling, reddening, overheating, pain and possibly even the formation of pus in the relevant area.
This is the case, for example, with tonsillitis, sinus infections, middle ear or bladder infections, all of which can be triggered by streptococci.
Fever can also be a symptom of this group of diseases.

However, there are other possible causes of this inflammation, and most of the time it causes the same symptoms as a strep infection.

A distinction is often hardly possible based on the symptoms alone. However, there are also diseases that can only be caused by streptococci.

These include, for example, scarlet fever. The symptoms are for example

Fever,
Nausea,
inflammation in the throat and tonsils,
Difficulties swallowing,
and a typical rash of small red spots that leave out the area around the mouth.

The course of the disease

The course of a streptococcal infection is largely dependent on various factors such as bacterial strain, location and immune status of the person concerned.
An infection with streptococci on the tonsils and in the throat and throat area can have both very mild and very severe courses with or without late complications.

Streptococcal infections can often take on chronic forms and persist for a long time, as can be the case with streptococcal infections in the vagina or mouth.

In order to be able to assess the course of a streptococcal infection, it is advisable to provide information about the respective disease in particular.

Rash from strep infection

A streptococcal infection can also make itself felt through changes in the skin.
As mentioned above, scarlet fever, for example, shows a typical rash, the so-called scarlet fever rash.
This is characterized by small, tightly packed red dots.
The rash can appear all over the body, but it usually leaves the area around the mouth, which is noticeably pale.

In connection with scarlet fever, flaking also sometimes occurs on the skin, fingers, toes, palms of the hands and the soles of the feet. This phenomenon can occur while the infection is still symptomatic or up to two weeks after the actual infection.

There are also streptococcal infections that specifically affect the skin and are therefore only expressed there.

This includes the erysipelas, an inflammation of the skin with corresponding symptoms of inflammation. As described above, this includes reddening, swelling, overheating and pain in the affected area and, in some cases, additional febrile temperatures.
Another skin infection caused by streptococci can be impetigo contagiosa. This is a conspicuous skin disease due to the formation of blisters and crusts, which occurs particularly in babies and young children.

Streptococcal infection on the throat and tonsils

If a streptococcal infection affects the throat area, it is usually an inflammation inside the throat or in the throat area.
The typical streptococcal infections in this area include tonsillitis and the typical childhood disease scarlet fever.

Symptoms of tonsillitis include, for example, difficulty swallowing, swollen tonsils covered with pus, and swollen lymph nodes in the head and neck area.

Viruses are also often the cause of tonsillitis.
A distinction must therefore be made as to which type of pathogen is present here.
In the case of tonsillitis caused by streptococci, antibiotics should be used as a treatment option.

In the case of recurrent or persistent tonsillitis, removal of the tonsils can be considered as a therapeutic measure. Scarlet fever should also be treated with antibiotics to avoid serious complications to the heart, kidneys, and joints.
Symptoms of scarlet fever are fever, nausea or vomiting and the symptoms of simple tonsillitis described above.

A red, grainy tongue and pale skin around the mouth are also typical. If the highly contagious disease scarlet fever is suspected, a doctor should be consulted immediately and contact with other people should be avoided if possible.

Read more on the topic at: Scarlet Fever and tonsillitis

Streptococcal infection in the vagina

Streptococci already belong to a certain extent to the natural vaginal flora. However, if the flora is out of balance, infection and consequent inflammation of the vagina can result.

Another reason for a streptococcal infection in the vagina can be streptococci that have entered the vagina from the outside - for example, starting from the rectum, where certain other streptococcal strains are at home.
If such foreign streptococcus species get into the vagina from the outside, they can displace the natural flora on the mucous membrane through their own growth and also cause an infection.
Symptoms of a strep infection in the vagina include itching, burning, or unusual discharge.

Treatment options are antibiotics here too. Because of the risk of the infection spreading upwards to the uterus and ovaries, the infection should be treated as promptly and effectively as possible.

Caution is also advised in pregnant women: If the vagina is colonized by the so-called group B streptococci (or B streptococci), the bacteria can be transmitted to the newborn at birth and cause inflammation of the lungs (pneumonia), the Meningitis or the lining of the heart (endocarditis).

Therefore, there is a screening program for pregnant women, either based on a rapid test for these streptococci or based on risk factors.
The treating gynecologist should be able to provide more detailed advice on this.

Read more on the topic under: Meningitis

Streptococcal infection of the teeth and gums

A number of bacteria naturally live on our oral mucosa, including strains of streptococci.
These usually have no consequences, but under certain circumstances they can cause illness.

First and foremost, this includes tooth decay: This occurs when the tooth has already been severely and permanently attacked by, for example, sugary foods, and plaque has also formed with bacteria that cause caries.
Of these bacteria, the so-called Streptococcus mutans, a certain subspecies of the streptococci, is the most prominent representative.

If the food continues to supply sugar, the bacteria can now process it into an acid that gradually attacks the tooth enamel.
If these prerequisites persist for a long time, tooth decay, i.e. tooth decay, can occur in places. Furthermore, streptococci can get into the bloodstream through an injury to the gums, for example from brushing your teeth, and cause serious diseases of the heart.
However, this is extremely rarely the case.

Therapy and the most suitable antibiotic

Antibiotic therapy is almost always necessary in the case of an infection by streptococci.
Otherwise, if left untreated, the infection can spread and cause all sorts of serious and, most importantly, avoidable complications.

The choice of antibiotic depends on the localization and the type of infection, which usually allow many conclusions to be drawn about the pathogen.
The group of penicillins is a very common class of active substances used in many types of streptococcal infections.

These include, for example, the active ingredients amoxicillin and piperacillin.

However, penicillins are relatively often the cause of drug allergies or intolerance and must then be replaced by other types of antibiotics.

The treating doctor must then decide which antibiotic is the best. If necessary, a sample of the pathogen can be sent to a microbiological laboratory, where the pathogen is examined for its sensitivity to certain antibiotics, which can then be considered as possible antibiotics.

Duration and forecast

With timely and adequate treatment, the prognosis of streptococcal infection is extremely good.

However, no general statement can be made about the duration of a streptococcal infection:
It is of fundamental importance here what type of streptococcus it is, where the infection is localized and what the immune system of the affected person is.
With scarlet fever in particular, however, it should be borne in mind that if left untreated, the disease can lead to late complications that damage the heart and kidneys in the long term.

The administration of a suitable antibiotic therefore improves the prognosis of this infection enormously and should therefore be urgently considered.

How contagious is that?

No comprehensive statement can be made on the risk of infection for all types of streptococcal infections.
For example, while scarlet fever is a highly contagious infection, the risk of infection with tooth decay is known to be rather low.

This is because the term streptococci is a group of bacteria with very different properties.
It is therefore worthwhile to find out about the type of streptococcal infection present and to proceed accordingly.