Infektionen mit β-hämolysierenden streptokokken der gruppe A (GABS) und streptokokkenfolgeerkrankungen

Abstract

Group A β-hemolytic streptococci (GABS) are among the most frequent causes of bacterial infections during childhood. In addition to well-known local infections, scarlet fever, and sepsis, streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF) have been noted with increasing frequency. NF can also be induced in children by superinfected varicella, which is associated with a higher mortality rate. Triggering factors include pathogen-specific capsular proteins, virulent factors, and toxins as superantigens. Immunological quick tests display high reliability, and PCR enables analyses of types and toxins. Furthermore, type-specific streptococcal sequelae can be caused by group C streptococci. Rheumatic fever is rather rare in industrialized nations, but cardiac involvement accurs more frequent than previously assumed. Chorea apparently correlates with neuronal antibodies, as do pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), and a series of cases of acute disseminated encephalomyelitis (ADEM) associated with streptococci have also been reported. No resistance to penicillin exists, but pathogenic persistence remains a problem. A 26-M valent vaccine is in clinical trials, but is still subject to controversy.