1. STREPTOCOCCUS GROUP A and B

2. Group B Streptococcus ● Group B Streptococcus is a bacterial infection of Streptococcus agalactiae. It is a facultative anaerobic bacteria that is gram positive with a cocci morphology found in chains. Many GBS strains are mainly encapsulated and are then serologically classified according to the presence of type-specific capsular polysaccharides. These capsules are important virulence factors and stimulators of antibody- associated immunity.

3. ● Group B Streptococcus in the Neonate: Early and late-onset ● Transmission of bacteria from mother to newborn occurs when the baby passes through the birth canal and comes into contact with the mother’s epithelial cells. ● Early-onset GBS is more dangerous and usually starts with a fever or abnormally low temperature, difficulty feeding, lethargy, breathing difficulties, rapid heart rate or slow heart rate. The most life threatening forms of infection are pneumonia, sepsis, and meningitis.

4. ● Group B Streptococcus in the Neonate: Early and late-onset ● Late-onset disease is similar to early-onset, yet less severe. ● Test- Blood cx, CSF cx, urine cx, CBC, chest x- ray, ABGs, and coagulation studies. ● Treatment- IV antibiotics, IV fluid, and medications to reverse shock, oxygen therapy, correction of clotting abnormalities and assisted ventilation.

5. ● Prevention and Treatment of GBS: the pregnant woman ● Risk-based approach- Emphasizes preventive treatment for expectant woman who are at high risk for GBS transmission. “A previous infant with invasive GBS, delivering at < 37 weeks gestation, having an intrapartum temperature  100.4°F, or rupture of membranes for  18 hours” according to the CDC. If a woman meet one or more of these criteria, the recommended treatment is to administer penicillin as and intrapartum antibiotic.

6. ● Prevention and Treatment of GBS: the pregnant woman ● Culture-based screening approach- Testing for GBS in an expectant mother’s 35-37 week of pregnancy. ● Collection of lower vaginal and rectal cultures. ● If a woman tests positive for GBS and is determined to be a carrier, she is offered intrapartum chemoprophylaxis, based on the test results. ● Neonates born to these mothers with GBS colonization should be monitored for 24 hours for signs of sepsis.

7. Group A Streptococcus ● Group A Streptococcal pharyngitis is an acute infection of the oropharynx and or nasopharynx. It is a gram-positive cocci that tends to grow in pairs and short chains. It can be identified by their sensitivity to bacitracin.

8. Group A Streptococcus ● Signs and Symptoms ● Often described as a sore scratchy throat, febrile with swollen glands and, especially in children, nausea and/or vomiting. ● There is a marked increase in redness and swelling of the tonsils possibly accompanied by white patches or streaks on the tonsils. ● The patient may have difficulty swallowing, and enlarged lymph glands in the neck.

9. Group A Streptococcus ● There may be tiny pinpoint red marks on the soft palate referred to as petechiae. ● Other findings may include a beefy red swollen uvula, excoriated nares (especially in infants), and a scarlitiniform rash.

10. Group A Streptococcus ● For the clinician to make a definitive diagnosis, he or she must do a throat culture. ● Rapid Strep Antigen ● Blood agar culture

11. ● Management of Group A Streptococcal Pharyngitis

12. ● Complications ● Peritonsillar abcess ● Scarlet fever ● Poststreptococcal glomerulonephritis ● Rheumatic fever

13. PANDAS ● PANDAS- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection ● Case Study ● Two year, nine month old male presents in the Emergency Department with inconsolable crying for one day.

14. PANDAS Diagnositic Criteria for PANDAS 1. Presence of Obsessive-compulsive disorder and/or a tic disorder 2. Pediatric onset of symptoms (age 3 years to puberty) 3. Episodic course of symptom severity 4. Association with Group A Beta-Hemolytic Streptococcal infection ( a positive throat culture for strep or history of scarlet fever) 5. Association with neurological abnormalities (motoric hyperactivity, or adventitious movements, such as choreiform movements