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Non-Group A Streptococcal Cellulitis

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1. Non-Group A Streptococcal Cellulitis

Non-Group A Streptococcal Cellulitis Non-Group A Streptococcal Cellulitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Non-Group (...) A Streptococcal Cellulitis Non-Group A Streptococcal Cellulitis Aka: Non-Group A Streptococcal Cellulitis , Non-Group A Streptococcus Cellulitis , Non-Group A Strep Cellulitis From Related Chapters II. Pathophysiology caused by Non-Group A Beta Hemolytic III. Predisposing Conditions Bypass with saphenous vein graft extends along saphenous venectomy course Often recurrent episodes Associated with and often allows portal of entry Radical pelvic surgery, radiation or Pelvic node cancer Involves vulva, inguinal

2018 FP Notebook

2. Non-Group A Streptococcal Cellulitis

Non-Group A Streptococcal Cellulitis Non-Group A Streptococcal Cellulitis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Non-Group (...) A Streptococcal Cellulitis Non-Group A Streptococcal Cellulitis Aka: Non-Group A Streptococcal Cellulitis , Non-Group A Streptococcus Cellulitis , Non-Group A Strep Cellulitis From Related Chapters II. Pathophysiology caused by Non-Group A Beta Hemolytic III. Predisposing Conditions Bypass with saphenous vein graft extends along saphenous venectomy course Often recurrent episodes Associated with and often allows portal of entry Radical pelvic surgery, radiation or Pelvic node cancer Involves vulva, inguinal

2015 FP Notebook

3. Cellulitis (Overview)

and molecular characteristics of invasive and noninvasive skin and soft tissue infections caused by group A Streptococcus. J Clin Microbiol . 2011 Oct. 49(10):3632-7. . . Miller LS, Cho JS. Immunity against Staphylococcus aureus cutaneous infections. Nat Rev Immunol . 2011. 11:505-18. . Baddour LM, Bisno AL. Recurrent cellulitis after saphenous venectomy for coronary bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association (...) not diminished in facial cellulitis as a result of immunizations [ ] Amoxicillin-clavulanate, cefpodoxime, cefdinir Age < 1 y/ more severe disease require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes

2014 eMedicine.com

4. Cellulitis (Overview)

and molecular characteristics of invasive and noninvasive skin and soft tissue infections caused by group A Streptococcus. J Clin Microbiol . 2011 Oct. 49(10):3632-7. . . Miller LS, Cho JS. Immunity against Staphylococcus aureus cutaneous infections. Nat Rev Immunol . 2011. 11:505-18. . Baddour LM, Bisno AL. Recurrent cellulitis after saphenous venectomy for coronary bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association (...) not diminished in facial cellulitis as a result of immunizations [ ] Amoxicillin-clavulanate, cefpodoxime, cefdinir Age < 1 y/ more severe disease require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes

2014 eMedicine.com

5. Cellulitis (Follow-up)

bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med . Aug 1985. 79(2):155-9. Kalliola S, Vuopio-Varkila J, Takala AK, Eskola J. Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J . Sep 1999. 18(9):806-10. Cieslak TJ, Rajnik M, Roscelli JD. Immunization against Haemophilus influenzae type B fails to prevent orbital (...) require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes common; may be associated with rigors, extreme fatigue, myalgias, and hypotension; some associated with tinea pedis (toe web cultures may

2014 eMedicine.com

6. Cellulitis (Follow-up)

bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med . Aug 1985. 79(2):155-9. Kalliola S, Vuopio-Varkila J, Takala AK, Eskola J. Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J . Sep 1999. 18(9):806-10. Cieslak TJ, Rajnik M, Roscelli JD. Immunization against Haemophilus influenzae type B fails to prevent orbital (...) require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes common; may be associated with rigors, extreme fatigue, myalgias, and hypotension; some associated with tinea pedis (toe web cultures may

2014 eMedicine.com

7. Cellulitis (Treatment)

bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med . Aug 1985. 79(2):155-9. Kalliola S, Vuopio-Varkila J, Takala AK, Eskola J. Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J . Sep 1999. 18(9):806-10. Cieslak TJ, Rajnik M, Roscelli JD. Immunization against Haemophilus influenzae type B fails to prevent orbital (...) require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes common; may be associated with rigors, extreme fatigue, myalgias, and hypotension; some associated with tinea pedis (toe web cultures may

2014 eMedicine.com

8. Cellulitis (Treatment)

bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med . Aug 1985. 79(2):155-9. Kalliola S, Vuopio-Varkila J, Takala AK, Eskola J. Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J . Sep 1999. 18(9):806-10. Cieslak TJ, Rajnik M, Roscelli JD. Immunization against Haemophilus influenzae type B fails to prevent orbital (...) require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes common; may be associated with rigors, extreme fatigue, myalgias, and hypotension; some associated with tinea pedis (toe web cultures may

2014 eMedicine.com

9. Cellulitis (Diagnosis)

and molecular characteristics of invasive and noninvasive skin and soft tissue infections caused by group A Streptococcus. J Clin Microbiol . 2011 Oct. 49(10):3632-7. . . Miller LS, Cho JS. Immunity against Staphylococcus aureus cutaneous infections. Nat Rev Immunol . 2011. 11:505-18. . Baddour LM, Bisno AL. Recurrent cellulitis after saphenous venectomy for coronary bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association (...) not diminished in facial cellulitis as a result of immunizations [ ] Amoxicillin-clavulanate, cefpodoxime, cefdinir Age < 1 y/ more severe disease require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes

2014 eMedicine.com

10. Cellulitis (Diagnosis)

and molecular characteristics of invasive and noninvasive skin and soft tissue infections caused by group A Streptococcus. J Clin Microbiol . 2011 Oct. 49(10):3632-7. . . Miller LS, Cho JS. Immunity against Staphylococcus aureus cutaneous infections. Nat Rev Immunol . 2011. 11:505-18. . Baddour LM, Bisno AL. Recurrent cellulitis after saphenous venectomy for coronary bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association (...) not diminished in facial cellulitis as a result of immunizations [ ] Amoxicillin-clavulanate, cefpodoxime, cefdinir Age < 1 y/ more severe disease require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes

2014 eMedicine.com

11. Cellulitis (Follow-up)

bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med . Aug 1985. 79(2):155-9. Kalliola S, Vuopio-Varkila J, Takala AK, Eskola J. Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J . Sep 1999. 18(9):806-10. Cieslak TJ, Rajnik M, Roscelli JD. Immunization against Haemophilus influenzae type B fails to prevent orbital (...) require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes common; may be associated with rigors, extreme fatigue, myalgias, and hypotension; some associated with tinea pedis (toe web cultures may

2014 eMedicine Emergency Medicine

12. Cellulitis (Overview)

and molecular characteristics of invasive and noninvasive skin and soft tissue infections caused by group A Streptococcus. J Clin Microbiol . 2011 Oct. 49(10):3632-7. . . Miller LS, Cho JS. Immunity against Staphylococcus aureus cutaneous infections. Nat Rev Immunol . 2011. 11:505-18. . Baddour LM, Bisno AL. Recurrent cellulitis after saphenous venectomy for coronary bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association (...) not diminished in facial cellulitis as a result of immunizations [ ] Amoxicillin-clavulanate, cefpodoxime, cefdinir Age < 1 y/ more severe disease require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes

2014 eMedicine Emergency Medicine

13. Cellulitis (Diagnosis)

and molecular characteristics of invasive and noninvasive skin and soft tissue infections caused by group A Streptococcus. J Clin Microbiol . 2011 Oct. 49(10):3632-7. . . Miller LS, Cho JS. Immunity against Staphylococcus aureus cutaneous infections. Nat Rev Immunol . 2011. 11:505-18. . Baddour LM, Bisno AL. Recurrent cellulitis after saphenous venectomy for coronary bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association (...) not diminished in facial cellulitis as a result of immunizations [ ] Amoxicillin-clavulanate, cefpodoxime, cefdinir Age < 1 y/ more severe disease require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes

2014 eMedicine Emergency Medicine

14. Cellulitis (Treatment)

bypass surgery. Ann Intern Med . Oct 1982. 97(4):493-6. Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med . Aug 1985. 79(2):155-9. Kalliola S, Vuopio-Varkila J, Takala AK, Eskola J. Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J . Sep 1999. 18(9):806-10. Cieslak TJ, Rajnik M, Roscelli JD. Immunization against Haemophilus influenzae type B fails to prevent orbital (...) require intravenous antibiotic Third-generation cephalosporin (Rocephin) Lower extremity -- Complicating saphenous venectomy site after coronary bypass grafting No pathogen identifiable in most infections, but it is likely to be streptococcal (> staphylococcal) Non-group A beta-hemolytic streptococci most likely organism; S aureus less common Recurrent episodes common; may be associated with rigors, extreme fatigue, myalgias, and hypotension; some associated with tinea pedis (toe web cultures may

2014 eMedicine Emergency Medicine

15. Streptococcal Infection, Group A (Diagnosis)

for differentiation of pathogenic streptococcal species, group A organisms can be identified more cost effectively by numerous latex agglutination, coagglutination, or enzyme immunoassay procedures. (See Workup.) Group A strains can also be distinguished from other groups by their sensitivity to bacitracin. A disc that contains 0.04U of bacitracin inhibits the growth of more than 95% of group A strains, whereas 80-90% of nongroup A strains are resistant to this antibiotic. The bacitracin disc test is simple (...) described by Lancefield, beta-hemolytic streptococci can be divided into many groups based on the antigenic differences in group-specific polysaccharides located in the bacterial cell wall. More than 20 serologic groups have been identified and designated by letters (eg, A, B, C). Of the nongroup A streptococci, group B is the most important human pathogen (the most common cause of neonatal sepsis and ), although other groups (particularly group G) have occasionally been implicated as causes of . (See

2014 eMedicine Pediatrics

16. Streptococcal Infection, Group A (Overview)

for differentiation of pathogenic streptococcal species, group A organisms can be identified more cost effectively by numerous latex agglutination, coagglutination, or enzyme immunoassay procedures. (See Workup.) Group A strains can also be distinguished from other groups by their sensitivity to bacitracin. A disc that contains 0.04U of bacitracin inhibits the growth of more than 95% of group A strains, whereas 80-90% of nongroup A strains are resistant to this antibiotic. The bacitracin disc test is simple (...) described by Lancefield, beta-hemolytic streptococci can be divided into many groups based on the antigenic differences in group-specific polysaccharides located in the bacterial cell wall. More than 20 serologic groups have been identified and designated by letters (eg, A, B, C). Of the nongroup A streptococci, group B is the most important human pathogen (the most common cause of neonatal sepsis and ), although other groups (particularly group G) have occasionally been implicated as causes of . (See

2014 eMedicine Pediatrics

17. Necrotising fasciitis

fasciitis is a polymicrobial infection with an anaerobe such as Bacteroides or Peptostreptococcus and a facultative anaerobe such as an Enterobacteriaceae or non-group A streptococcus. Hoadley DJ, Mark EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 28-2002. A 35-year-old long-term traveler with a rapidly progressive soft-tissue infection. N Engl J Med. 2002 Sep 12;347(11):831-7. http://www.ncbi.nlm.nih.gov/pubmed/12226155?tool=bestpractice.com Childers (...) is crucial, but is considered adjunctive to surgical management. Empiric antibiotics should cover major bacterial aetiological agents, and group A streptococcal toxin production that can accompany type II necrotising fasciitis. Definition Necrotising fasciitis is a life-threatening subcutaneous soft-tissue infection that may extend to the deep fascia, but not into the underlying muscle. The causal organisms may be aerobic, anaerobic, or mixed flora. Two main clinical forms exist. Type I necrotising

2018 BMJ Best Practice

19. CRACKCast E075 – Upper Respiratory Tract Infections

-pharyngeal abscess The most common viral, bacterial, and non-infectious causes of sore throat (list at least 8) Viral – MOST common cause of acute pharyngitis Rhinovirus Adenovirus HSV 1&2 Influenza CMV EBV Varicella-zoster virus Hepatitis virus Bacterial Group A beta-hemolytic streptococcus Non-group A strep. Neisseria gonorrhoeae Neisseria meningitidis Mycoplasma pneumoniae Chlamydia trachomatis Corynebacterium diphtheriae influenzae Non-infectious causes: Systemic disease: Kawasaki’s, SJS, cyclic (...) WiseCracks [1] List 5 suppurative and 5 non-suppurative complications of GABHS Suppurative Tonsillopharyngeal cellulitis or abscess Otitis media Sinusitis Necrotizing fasciitis Streptococcal bacteremia Meningitis or brain abscess, a rare complication resulting from direct extension of an ear or sinus infection or from bacteremic spread Jugular vein septic thrombophlebitis Non Suppurative Acute rheumatic fever (ARF) Scarlet fever Streptococcal toxic shock syndrome Acute glomerulonephritis Pediatric

2017 CandiEM

20. Streptococcus Group A Infections (Overview)

for differentiation of pathogenic streptococcal species, group A organisms can be identified more cost effectively by numerous latex agglutination, coagglutination, or enzyme immunoassay procedures. (See Workup.) Group A strains can also be distinguished from other groups by their sensitivity to bacitracin. A disc that contains 0.04U of bacitracin inhibits the growth of more than 95% of group A strains, whereas 80-90% of nongroup A strains are resistant to this antibiotic. The bacitracin disc test is simple (...) described by Lancefield, beta-hemolytic streptococci can be divided into many groups based on the antigenic differences in group-specific polysaccharides located in the bacterial cell wall. More than 20 serologic groups have been identified and designated by letters (eg, A, B, C). Of the nongroup A streptococci, group B is the most important human pathogen (the most common cause of neonatal sepsis and ), although other groups (particularly group G) have occasionally been implicated as causes of . (See

2014 eMedicine.com

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