1. Streptococcus pyogenes Team Case Study 2

2. The Diagnosis Ben Fallerez is a 12 year old boy going to school in France. He complained of a sore throat. The initial diagnosis was Streptococcal pharyngitis. The boy was treated with penicillin, but the symptoms did not resolve. A recurrent infection led the physician to perform a culture and sensitivity. The organism was identified as Streptococcus pyogenes and was reported as being resistant to penicillin.

3. Streptococcus pyogenes Group A Streptococcus Gram positive Non-motile Non-spore forming Occurs in chains Has a capsule Adheres to surfaces such as cell walls

4. People most susceptible Elderly Immune suppressed Chronic cardiac or respiratory disease Diabetics with skin lesions African-Americans Indians Children of elementary school age

5. Diseases caused by S. pyogenes Bacterial pharyngitis, tonsillitis, sinusitis, lymphadenitis, endocarditis, meningitis Septicemia Impetigo Upper respiratory tract infections Glomerulonephritis Rheumatic fever Scarlet fever

6. Resistance Displayed by Organism Treatment with penicillin killed all sensitive S. pyogenes, letting S. pyogenes resistant to penicillin grow Non-compliance Over-prescribing of antibiotics

7. Exchange of DNA DNA exchanged through transformation

8. Treatment of penicillin resistant S. pyogenes 500 mg erythromycin qid for 10 days If resistant to that: 450 mg clindamycin qid for 10 days

9. Prognosis S. pyogenes is benign, self-limiting disease Symptoms did not subside, was re-evaluated and given different antibiotics because initial pathogen developed resistance to first antibiotic If he complies, his prognosis is good

10. Precautions Take entire prescription Monitor for signs of an active infection Re-evaluate with a physical examination and a throat culture and sensitivity to verify pathogen is treated and guarantee no further complications

11. Works Cited Bingen, E. “Resistance to Macrolides in Streptococcus pyogenes in France in Pediatric Patients”. June 2000. Antimicrobial Agents and Chemotherapy. 10 October 2006. http.//www.punmedcentral.nih.gov/articlerend er.fcgi?artid=89896. Gilbert, M.D., David, et al. The Sanford Guide to Antimicrobial Therapy. 36 th ed. Sperryville: Antimicrobial Therapy Inc., 2006.

12. Works Cited “Group A Streptococcus (GAS) Disease”. Center for Disease Control and Prevention. 11 October 2005. 2 October 2006. http://www.cdc.gov/nicdod/dbind/diseaseinfo/gro upastreptococcal_t.htm. http://www.cdc.gov/nicdod/dbind/diseaseinfo/gro upastreptococcal_t.htm McGlaughlin, RN, Eileen. “Medical Encyclopedia Info on Strep Throat”. 31 January 2001. 8-11. 7 October 2006. http://www.medicineonline.com/reference/health/ menshealth/conditionsanddiseases. http://www.medicineonline.com/reference/health/ menshealth/conditionsanddiseases

13. Works Cited Nurses Quick Check Diseases. Philadelphia: Lippencott, Williams & Wilkins, 2005 Patterson, Maria Jevitz. “Streptococcus” Medmicrobook. 2 October 2006. http://gsbs.utmb.edu/microbook/ch013.ht m. http://gsbs.utmb.edu/microbook/ch013.ht m Safani, PhD, M. Physicians’ Drug Manual. 2005. 7 October 2006. http://www.medicallibrary.org/library/secur e/Physicians_Drug_Resource.pdf. http://www.medicallibrary.org/library/secur e/Physicians_Drug_Resource.pdf

14. Works Cited Todar, K. “Streptococcus pyogenes”. 2002. Todar’s Online Textbook of Bacteriology. 7 October 2006. http://textbookofbacteriology.net/streptoco ccus.html. http://textbookofbacteriology.net/streptoco ccus.html