What Tests Do Health Care Professionals Use To Diagnose Group B Strep Infection
In newborns and in adults, isolation of the GBS bacteria is necessary for a definitive diagnosis. Laboratory studies that isolate the organism from certain body fluids, such as blood, cerebrospinal fluid , and urine, help establish the diagnosis. For screening of pregnant women, a health care professional will obtain a swab of a woman’s vaginal and rectal area to screen for GBS infection at 35-37 weeks of gestation. Test results can take a few days. A lumbar puncture may need to be performed when meningitis is suspected. A health care professional may order imaging studies such as a chest X-ray to evaluate whether pneumonia is present.
Immediate Action Required: Go To A& e Or Phone 999 If:
- you have a blotchy, red rash that does not fade or change colour when you place a glass against it
- you experience drowsiness or confusion
- you have a seizure or fit
- you have an inability to tolerate bright lights known as photophobia
- you have a stiff neck
- you have a rapid breathing rate
- your baby becomes floppy and unresponsive or stiff with jerky movements
- your baby is becoming irritable and not wanting to be held
- your baby is crying unusually
You should dial 999 immediately and request an ambulance if you think you or someone around you has bacterial meningitis.
Is It Possible To Prevent Group B Strep Infection
At this point in time, the best measure for preventing GBS infection is through routine screening during pregnancy. This testing has served to decrease the overall number of early onset GBS infections in newborns by about 80% since aggressive preventive measures were instituted in the 1990s. In pregnant women, routine screening for colonization with GBS is strongly recommended. This screening test is performed between 35-37 weeks of gestation. The test involves using a sterile swab to collect a sample from both the vaginal and rectal areas, with results usually available within 24-72 hours.
Antibiotic administration during labor to pregnant women colonized with GBS and for those with the risk factors outlined above can help decrease the transmission of GBS infection, and thus decrease the incidence of early onset GBS disease in newborns.
Although there is currently no licensed vaccine available for the prevention of GBS infection, there is research under way to try to develop one for use in the future. Further information about GBS can be found at the U.S. Centers for Disease Control and Prevention website .
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Additional Immune Response Considerations
Chemokines and Cytokines
These are signaling molecules released by innate and adaptive immune cells and receptors to direct other immune cells to the infected tissues . Chemokines are examples of cytokines that attract cells to the infected site. In addition to recruiting cells, they promote inflammation . TNF-, a well-studied pro-inflammatory cytokine, inhibits growth and dissemination of pneumococci . Together TNF- and IFN- can enhance clearance of pathogens by activating phagocytes. T cells, monocytes, and macrophages produce TNF- . The phagocyte-activating cytokines are suggested to be inhibited by autolysin activity in pneumococci .
The elderly experience chronic low-grade age-associated inflammation . This involves constant low levels of pro-inflammatory cytokines such as TNF- and IL-6. The inflammatory state of the elderly is worsened due to increased NF-B activation and the secretion of pro-inflammatory cytokines such as TNF- from senescent cells . High concentrations of TNF- have been correlated with higher disease incidences . Inflammaging induces the expression of host proteins which enhances S. pneumoniae adhesion, and is often accompanied by other morbidities that increase risk of S. pneumoniae infections .
Acute Phase Serum Proteins
How You Get Strep Throat
Group A strep live in the nose and throat and can easily spread to other people. It is important to know that some infected people do not have symptoms or seem sick. People who are infected spread the bacteria by coughing or sneezing, which creates small respiratory droplets that contain the bacteria.
People can get sick if they:
- Breathe in those droplets
- Touch something with droplets on it and then touch their mouth or nose
- Drink from the same glass or eat from the same plate as a sick person
- Touch sores on the skin caused by group A strep
Rarely, people can spread group A strep through food that is not handled properly . Experts do not believe pets or household items, like toys, spread these bacteria.
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Pearls And Other Issues
There are two vaccines commonly used for S. pneumoniae. The pneumococcal polysaccharide vaccine, PPSV23, and the pneumococcal conjugate vaccine, PCV13. In immunocompetent individuals, five doses of PCV13 are recommended during infancy and childhood. A repeat dose of PCV13 at age 65 is recommended followed by a dose of PSV23 one year later. In randomized control trials, PCV13 was shown to prevent the first episode of vaccine-serotype pneumococcal pneumonia. Although these vaccines have made great strides in decreasing S. pneumoniae pneumonia, there a number of serotypes not included in these vaccines. Although between the two vaccines the most prevalent serotypes are covered, there are approximately 90 serotypes in total and the vaccine will not foster immunity in all serotypes. Finally, it has been shown that influenza vaccination has a strong association with better outcomes and a decreased rate of pneumonia.
Survival In The Bloodstream
Once the bacteria escape into the bloodstream, capsular polysaccharide becomes the most important virulence determinant and is responsible for inhibiting phagocytosis. The chemical structure and amount of CPS present on the surface of the bacteria contribute to the differential ability of different serotypes to survive in the blood . Mutants lacking capsule are essentially avirulent , requiring 10,000 to 100,000-fold more bacteria to kill a mouse than the encapsulated parent strain following intraperitoneal injection. It is believed that CPS inhibits phagocytosis by preventing phagocytes from physically reaching opsonizing serum components, such as complement, CRP, mannose-binding proteins, and antibodies that are deposited on the cell wall and by giving the bacteria a negative charge which repels a close association with leukocytes . Formation of antibody to the serotype specific CPS marks the initiation of clearance of the infection, as antibodies to CPS are highly opsonic and are protective against subsequent pneumococcal challenge with the same serotype . The fact that capsular antibodies are so effective forms the basis of current effective pneumococcal vaccines.
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People Above 65 Years Old
The effectiveness of the immune system of the person begins to diminish as the person starts to age. As an effect of which, the immune system of the elderly people the system has fewer chances to protect the body and battle probable infections or diseases. Hence, elderly people are more prone to be getting several forms of pneumococcal diseases.
Treatment Of Streptococcal Skin Infection
It can be difficult to distinguish clinically between skin infection caused by streptococci and other bacteria such as Staphylococcus aureus. Antibiotics should therefore be chosen to cover the most likely organisms. Flucloxacillin is more appropriate than simple penicillin as it treats both Staphylococcus and strep.
If the laboratory has confirmed streptococcal infection, then the most appropriate antibiotic is usually penicillin. All streptococci in the Lancefield group are very sensitive to penicillin. Those patients with penicillin allergy may be given erythromycin or a cephalosporin , which are effective against most streptococci although some erythromycin resistance is emerging. In very severe S. pyogenes infections, such as necrotising fasciitis, clindamycin may be added to penicillin as very large numbers of bacteria may overwhelm penicillin’s mechanism of action.
Pneumococcal skin infections are generally treated with penicillin but low levels of resistance have recently been reported. In more serious infections, ceftriaxone or vancomycin may be more appropriate.
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Risk Of Pneumococcal Disease
Certain groups are at increased risk of infection, including:
- children aged under two years
- children under five years with underlying medical conditions predisposing them to invasive pneumococcal disease
- Aboriginal and Torres Strait Islander children, especially in central Australia
- Aboriginal and Torres Strait Islander people
- people aged 65 years and over
- people with weakened immune systems
- people with chronic diseases such as diabetes, lung disease, cancer or kidney disease
- people who have impaired spleen function or have had their spleen removed
- people who smoke tobacco.
How Group A Strep Spreads
Group A strep bacteria live in your nose and throat. They spread through droplets from coughing or sneezing or by direct contact with the mucus. You might breathe droplets in if youre close enough when an infected person coughs or sneezes. As well, the droplets may land on a solid object that you touch later. This type of contact may also occur if people who are infected blow their nose and touch an object before washing their hands. Either way, if the bacteria are transferred to your hand or fingers and you put your hand to your face, you can become infected.
If the skin is infected, as with cellulitis or impetigo, the bacteria must come in contact with a spot of skin that had an open area, such as a cut, scrape, or bite. The opening may be so tiny that you didnt notice anything beforehand. Impetigo is common among young children as they share toys and play together.
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Factors That Predispose To Pneumococcal Infection
S. pneumoniae is a prototypic extracellular bacterial pathogen host defenses against infection rely, as noted earlier, on the interaction between antibody, complement, and phagocytic cells, specifically neutrophils. Both primary and secondary clinical conditions and underlying mechanisms may hamper the immunologic capacity of the host and predispose to pneumococcal infection . Although these risks include defects in anatomy, antibody production, complement, and phagocytes , cell-mediated abnormalities in T and natural killer cells do not figure prominently among them. These predisposing conditions do, however, include underlying liver, kidney, heart, and lung dysfunction diabetes alcoholism, and malignancies, particularly in older adults, which may invoke a more subtle constellation of predisposing risks.
Regarding antibody production in older adults, both the number of naïve T cells and B cells may decrease with advancing age,137-139 as may the subsets of IgM memory B cells proposed to respond preferentially to polysaccharide antigens.105,140-143 These perturbations and decreased responses to pneumococcal polysaccharides have been most closely related to weight loss and frailty rather than to age alone.144,145 Studies have been begun to distinguish between innate age-dependent immunosenescence and the effects of accumulated underlying disease and frailty on age-related immune dysfunction, particularly decreased responses to vaccination.
Diseases Caused By Pneumococci
Pneumococcal diseases include
Gram stain and culture
Pneumococci are readily identified by their typical appearance on Gram stain as lancet-shaped diplococci.
The characteristic capsule can be best detected using the Quellung test. In this test, application of antiserum followed by staining with India ink causes the capsule to appear like a halo around the organism. The capsule is also visible in smears stained with methylene blue.
Culture confirms identification antimicrobial susceptibility testing should be done. Serotyping and genotyping of isolates can be helpful for epidemiologic reasons . Differences in virulence within a serotype may be distinguished by techniques such as pulsed-field gel electrophoresis and multilocus sequence typing.
The urine antigen detection test has high specificity but poor sensitivity and is greatly influenced by concurrent bacteremia. The positive predictive value is high . However, the negative predictive value is low, so a negative urine antigen test should not be used to rule out pneumococcal disease.
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What Is The Treatment For Streptococcus Pneumonia
The treatment of the pneumococcal disease that is caused by the Streptococcus bacteria is the consumption of antibiotics. Although there are many kinds of bacteria that cause pneumococcal diseases that have become resistant to many kinds of antibiotics that treat them. This is referred to as antibiotic resistance. In these cases, the doctors might also suggest a combination of antibiotics for treating the disease.
Hence, treating pneumococcal disease include using a broad-spectrum antibiotic. The broad-spectrum antibiotic works towards preventing a wide range of bacteria. As the minute detail of the bacteria that mostly refers to its sensitivity is known, it becomes easier to direct the antibiotics to heal it. Many pneumococcal diseases like otitis media, bronchitis, trachea bronchitis, sinusitis, and conjunctivitis are mainly treated using antibiotics.
However, there might also be people who would not require any treatment or consumption of any antibiotic. This happens in cases where the person is suffering from a mild pneumonia infection.
What Is Pneumonia Exactly
Pneumonia is an infection in the gas-exchanging units of the lung , says Michael Niederman, M.D., clinical director of pulmonary and critical care medicine at Weill Cornell Medical College in New York. Translation: the air sacs in your lungs become inflamed or even fill with fluid or pus, which interferes with your bodys ability to deliver oxygen to your blood.
About half the time, its due to bacteria, says Dr. Edelman. The other half the time, its due to viruses. The most common type of pneumonia is caused by the bacteria streptococcus pneumoniae, in the same family of bacteria that causes strep throat. Influenza is also a key virus that can spur pneumonia, and fungi can be a culprit, too. The novel coronavirus, of course, can also cause pneumonia, albeit one with a longer incubation period than, say, the flu, says Dr. Dasgupta.
Pneumonia develops if the organism overwhelms the patients host defenses, says Dr. Niederman. This basically means that a foreign bug takes over your immune system, even if youre generally healthy. Thats because certain organisms, like those associated with the flu, can be particularly hostile or invade your body in large numbers.
Enhancing Healthcare Team Outcomes
Streptococcal pneumonia is best managed with an interprofessional team that includes a pulmonologist, an infectious disease expert, an ICU nurse, a pharmacist, a respiratory therapist, and a dietitian. Patients need to be educated on the importance of vaccination and its benefits. In addition, patients should be advised to stop smoking and remain compliant with antibiotics. Since many patients with pneumonia are frail, a dietary consult should be sought to help improve the calorie intake. Others may need rehabilitation to restore muscle mass and increase exercise endurance.
The prognosis for patients with streptococcal pneumonia depends on the underlying risk factors, comorbidity, age, the extent of lung involvement, the need for mechanical ventilation and the type of antibiotic. Overall, the pneumonia is associated with high morbidity and mortality. Even those who survive tend to have residual deficits in lung mechanics and recovery is prolonged. Patients in the ICU tend to have the highest mortality approaching 3-20%.
What Is Pneumococcal Pneumonia
Simply put, itâs an infectious, potentially serious bacterial lung disease. The symptoms can hit without warning and can take you out of your routine for weeks. It could even put you in the hospital.
Did you know there is more than one type of pneumonia? Although pneumonia always means an infection of the lungs, there are actually many different types. Two of the most common types are viral and bacterial.
The most common type of bacterial pneumonia is called pneumococcal pneumonia.
Pneumococcal pneumonia can be serious. Symptoms can come on quickly, and can include cough, fatigue, high fever, shaking chills, and chest pain with difficulty breathing. Some symptoms can last weeks or longer.
In severe cases, pneumococcal pneumonia can lead to hospitalization. Or in some cases, even death.
Pneumococcal pneumonia is not a cold or the flu. It is a bacterial lung disease, while the flu and cold are caused by viruses.
In some cases, pneumococcal pneumonia can cause part of your lung to fill up with mucus, making it hard to breathe.
You can catch pneumococcal pneumonia through coughing or close contact. It can strike anywhere, anytimeâand may hit quickly and without warning.
Itâs not just old and unhealthy people who are at risk for pneumococcal pneumonia. If you are 65 or older, you may be at increased risk for pneumococcal pneumonia, even if you are otherwise healthy. Thatâs because as you get older, your immune system becomes less able to respond to infections.
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Host Immune System Responses To S Pneumoniae
We have discussed above the virulence factors that aid in ensuring S. pneumoniae can evade the hosts immune system. On the other hand, there are several host defenses that recognize S. pneumoniae, act rapidly, and clear the pathogen before it can cause pneumococcal diseases. Protection from S. pneumoniae is dependent on the state of the hosts immune system. Age plays a role in how successful the immune system will be at clearing the infection by S. pneumoniae. Children under the age of five and the elderly are at higher risk for contracting pneumococcal diseases . This is due to infants having a naïve immune system, whereas the elderly are experiencing immunosenescence . A variety of immune cells are involved in the innate and adaptive immune responses. The most important immune cellular and humoral components for defending against pneumococcal infections are summarized in the following sections including how aging may affect their ability to defend the host.
How Is Pneumonia Diagnosed
Sometimes pneumonia can be difficult to diagnose because the symptoms are so variable, and are often very similar to those seen in a cold or influenza. To diagnose pneumonia, and to try to identify the germ that is causing the illness, your doctor will ask questions about your medical history, do a physical exam, and run some tests.
Your doctor will ask you questions about your signs and symptoms, and how and when they began. To help figure out if your infection is caused by bacteria, viruses or fungi, you may be asked some questions about possible exposures, such as:
- Any recent travel
- Exposure to other sick people at home, work or school
- Whether you have recently had another illness
Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when you inhale.
If your doctor suspects you may have pneumonia, they will probably recommend some tests to confirm the diagnosis and learn more about your infection. These may include:
- Blood tests to confirm the infection and to try to identify the germ that is causing your illness.
- Chest X-ray to look for the location and extent of inflammation in your lungs.
- Pulse oximetry to measure the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream.
- Sputum test on a sample of mucus taken after a deep cough, to look for the source of the infection.
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