Streptococcus
pyogenes
Team Case Study 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.
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
People most susceptible







Elderly
Immune suppressed
Chronic cardiac or respiratory disease
Diabetics with skin lesions
African-Americans
Indians
Children of elementary school age
Diseases caused by S.
pyogenes







Bacterial pharyngitis, tonsillitis, sinusitis,
lymphadenitis, endocarditis, meningitis
Septicemia
Impetigo
Upper respiratory tract infections
Glomerulonephritis
Rheumatic fever
Scarlet fever
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
Exchange of DNA

DNA exchanged through transformation
Treatment of penicillin
resistant S. pyogenes



500 mg erythromycin qid for 10 days
If resistant to that:
450 mg clindamycin qid for 10 days
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
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
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. 36th ed. Sperryville:
Antimicrobial Therapy Inc., 2006.
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.
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.
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.
Safani, PhD, M. Physicians’ Drug Manual.
2005. 7 October 2006.
http://www.medicallibrary.org/library/secur
e/Physicians_Drug_Reso urce.pdf.
Works Cited

Todar, K. “Streptococcus pyogenes”. 2002.
Todar’s Online Textbook of Bacteriology.
7 October 2006.
http://textbookofbacteriology.net/streptoco
ccus.html.