Strategies for Preventing Group A Streptococcal Adhesion and Infection

Abstract

Group A streptococci are responsible for a number of clinical syndromes including pharyngitis, impetigo, pneumonia, puerperal sepsis, and myositis. Recently, an increase in the incidence of streptococcal toxic shock syndrome and necrotizing fasciitis have been noted which have a high morbidity and mortality rate.25,140 Two nonsuppurative sequelae of group A streptococcal infections, acute rheumatic fever (ARF) and acute glomerulonephritis (AGN), are the most significant health problems stemming from group A streptococcal infections worldwide. Development of ARF is usually preceded by a streptococcal infection of the pharynx, whereas AGN may be caused by infections of either the skin or oral mucosa, but only by certain nephritogenic strains.20,153 Exactly how an antecedent streptococcal infection leads to ARF or AGN is unknown, but autoimmune humoral and cellular responses to infection are suspected of contributing to these diseases.