Streptococcal aftermath: Symptoms, origins, remedies, and additional insights

Streptococcal aftermath: Symptoms, origins, therapy, and further details

Post-Streptococcal Disorders: Understanding Their Symptoms, Causes, Diagnosis, and Treatment

Post-streptococcal disorders are immune-mediated complications that can arise following infections with group A beta-hemolytic Streptococcus, a type of bacteria responsible for a range of infections collectively known as "streptococcal infections." These disorders include PANDAS, acute rheumatic fever, and post-streptococcal glomerulonephritis (PSGN), each with distinct symptoms, causes, diagnostic features, treatments, and risk factors.

Common Symptoms

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) mainly presents with sudden onset of neuropsychiatric symptoms such as obsessive-compulsive behaviors, tics, anxiety, or mood changes, typically in children after streptococcal infections.
Acute Rheumatic Fever symptoms include migratory arthritis, carditis (inflammation of the heart), chorea (involuntary movements), erythema marginatum (rash), and subcutaneous nodules.
Post-Streptococcal Glomerulonephritis (PSGN) presents with kidney-related symptoms such as dark, reddish-brown urine, decreased urine output, swelling (especially face, around eyes, hands, feet), hypertension, and fatigue.

Causes

These conditions are caused by an immune response triggered by previous GAS infections like strep throat, scarlet fever, or skin infections such as impetigo. The body's immune system mistakenly attacks its own tissues (heart valves, kidneys, brain, joints) after these infections.

Diagnosis

Diagnosis relies on clinical features plus evidence of recent GAS infection such as positive throat swabs, rapid strep tests, or elevated streptococcal antibody titers (e.g., ASO titer). PSGN diagnosis involves detection of kidney involvement signs (urinalysis showing proteinuria and hematuria, elevated blood pressure, sometimes kidney biopsy in severe cases). Acute rheumatic fever is diagnosed using the Jones criteria which include clinical features and evidence of recent GAS infection. PANDAS diagnosis is clinical, based on sudden neuropsychiatric symptom onset following GAS infection.

Treatment

Antibiotics (usually penicillin or amoxicillin) to eradicate the GAS bacteria and prevent ongoing infection or transmission are commonly used. For PSGN, treatment focuses on managing symptoms such as swelling and high blood pressure; antibiotics may be given but do not alter kidney damage directly. Acute rheumatic fever treatment includes antibiotics plus anti-inflammatory agents (aspirin or corticosteroids) to reduce inflammation and prevent complications. PANDAS treatment may involve antibiotics and immunomodulatory therapies.

Risk Factors

Risk factors for acute rheumatic fever include age (being between 5-15 years old), living in crowded conditions, lack of access to primary healthcare, and regularly consuming sugar-sweetened beverages. Risk factors for PANDAS include having repeated streptococcal infections, a family history of autoimmune disease, a family history of rheumatic fever, and being male and between the ages of 3-12 years old.

Additional Points

Most people recover without complications, but in PSGN, rare long-term kidney damage can occur, more commonly in adults. Prevention via good hygiene and early antibiotic treatment of GAS infections reduces the risk of developing these sequelae. Streptococcal bacteria inside a person's body can hide from the immune system by placing molecules on their cell wall that mimic molecules found on a person's heart, joints, skin, and brain tissues, a process known as "molecular mimicry." When a person's immune system recognizes the molecules of the streptococcal bacteria as foreign to the body, it produces antibodies to attack the bacteria via an immune response. However, a person's immune system may also mistakenly attack the body's own cells that the bacteria mimicked, causing inflammation and the development of various types of post-streptococcal disorders. Streptococcal infections can cause several postinfectious diseases, which medical professionals may refer to as "post-streptococcal disorders."