About Group A Streptococcal Infection

Strep A infections, scientifically known as Group A Streptococcal infection, are commonly recognized with the general public as strep throat due to its prevalence among people of all ages but more commonly, children. However, what most individuals do not know is that group A Strep (GAS) infections can range drastically. GAS infections can go from being as common as a sore throat or mild rash to as serious as a life-threatening condition, such as streptococcal toxic shock syndrome. What can help mitigate these common and sometimes fatal infections is knowledge, recognition, and quick acting. In addition to standard precautions which should be taken in any health care setting it is pertinent to know of the other precautionary measures and when they should be used. GAS falls under what are known as droplet precautions.

Strep A also known as Streptococcus is a bacteria pathogen that can cause several types of infections from minor illnesses such as strep throat (most common) to more severe things such as scarlet fever, impetigo, necrotizing fasciitis (flesh eating disease), rheumatic fever and post- streptococcal glomerulonephritis (rare) (CDC, 2018). The first description of streptococcal infection is accredited to an Austrian surgeon known as Theodor Billroth. In 1874 Billroth described cases of erysipelas and wound infections, calling them small organisms in either isolated or arranged pairs and sometimes in chains. Later, in 1978 Louise Pasteur gave the formal introduction of streptococci when he isolated the microorganisms from the uteruses and blood of women with puerperal fever and showed that it was responsible for the disease that caused the highest mortality rate of women and newborns at that time.

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On through to the first part of the 20th century, as studies continued, early research on the biology and physiology of streptococci showed different classifications of the organisms in various groups and identified one of the groups as group A streptococcus. The bacterial infection, group A strep, is the initial cause for strep throat that live in the nose and throat and can easily be spread to other people by bacteria droplets that exit the body through coughing or sneezing. People can then either breath in those droplets or touch a surface where those droplets have contaminated. Anyone can encounter and get group A strep, but it is more common in children between 5–15 years of age. The adults that are more at risk of catching the infection are those who are parents of children through these ages or those who are around children these ages daily, such as individuals involved in child care. Crowded places such as schools increase the risk of rapid contraction of the infection among many individuals.

The most common sign and symptoms of group A strep is a sore throat, pain when swallowing, fever, red swollen tonsils with white patches of pus (sometimes), red spots on the roof of the mouth, and swollen lymph nodes at the neck (CDC, 2018). Even then, the only way to determine if a person has group A strep is through a test known as a rapid strep test. Another test known as a throat culture involves swabbing the back of the throat with a sterile swab. If the rapid test is positive, then a Dr. can go ahead and prescribe antibiotics such as penicillin or amoxicillin (CDC, 2018). If the rapid test is negative, but the Dr. still believes it to be strep then they will take the swab culture and allow it to sit and see if the group A strep bacteria grows from the swab. Most of the time the second culture is not performed on adults if the rapid strep test is negative. But, with children the second test is usually performed because children are more at-risk of rheumatic fever whereas adults are not.

Strep throat is categorized into a disease-specific precaution known as droplet. Droplet precautions are described as microorganisms. These microorganisms are transferred by direct or indirect contact. In contact to contact transmission, the respiratory droplets carrying the infectious pathogens transmit the infection when they travel a short distance directly from the respiratory tract of the infected individual to the mouth, conjunctivae, or nasal mucosa of the recipient (bpc book, pg 35). Droplets can be spread by simply coughing, sneezing, or talking. In the instance of skin lesions healthcare staff are required to wear a gown and gloves in order to protect the patient as well as other patients.

Practicing good hygiene is the best way to prevent the spread of group A strep. There are multiple ways to try and prevent group A strep from reoccurring. Washing your hands thoroughly and efficiently and wearing a mask are some of the simplest ways to prevent droplet transmission. “Wash for up to 30 seconds; wash longer if the hands have come into contact with body fluids, an infectious wound, or a contaminated patient” (bpc book, pg 33). Included in proper hand hygiene techniques would be the use of disposable gloves. Disposable gloves are made up of latex or non-latex material as well as being powered or non-powered inside the glove. These types of gloves act as a barrier between the patient and the healthcare providers hands. Masks are a way of avoiding the spread of droplet microorganisms that are transmitted when coughing or sneezing.

In a hospital setting, the patient would be admitted into a private room to prevent microorganisms from being transferred to other patients. Healthcare staff working with the patient would be required to wear a mask upon entering the patient’s room. If the patient was to be transported to a different or private room, the patient would have to have a surgical mask on to prevent the spread of group A strep to others while being transported.

Group A Streptococcal (GAS) Infections can affect the Physical Therapy setting in such a way that dependent on the infection, as well as Physical Therapist setting, standard, droplet, and or contact precautionary measures will need to be taken. However, seeing as GAS can travel about 3-feet (90-centimeters) droplet precautionary measures will in most cases be the most pertinent. And, whether it be inpatient or outpatient setting, modifications of some sort will need to be made.

A patient in an inpatient setting being treated to restore ADL due to spasticity caused by a stroke has just become stable. Seeing as the patient is now stable it is important to begin treatment as soon as possible. The Physical Therapist has recommended education of patient on frequent repositioning of body in order to avoid the development of pressure ulcers. The Physical Therapist has also recommended range of motion exercises, along with gentle stretching of tighter muscles. On the third day of treatment the Physical Therapist Assistant observes patient has not eaten food and is showing discomfort while swallowing. Upon questioning, the patient reports of nausea along with a persistent headache.

PTA is concerned that patient might have contracted group A strep. PTA findings are reported to attending nurse. Upon testing it is discovered that the patient has tested positive for GAS. Planned treatment for the day had included walking outside of the patient’s room with a walker, with a set goal of 50-feet. As a result of positive GAS, treatment for the day must be modified. The patient must remain confined to room for a period of 24hours while antibiotics are being administered and PTA must wear a face mask when entering the patient’s room. Other than this patient treatment will be able to continue as normal.

By the fifth day of patient treatment the patient has shown significant strides in range of motion exercises and is performing proper technique with gentle stretching of tighter muscles. The patient is now walking 150-170-feet with little to no assistance. However, on the sixth day PTA observes in patients chart that patient fell in the shower the previous night and acquired a wound on their right olecranon process. PTA checks vitals and records a raised temp of 100.4°F. Next, the PTA inspects wound, signs of swelling and redness are present. Seeing as temp is raised and open wound is showing signs of swelling and redness the PTA reports findings to nurse, and for precautionary measures leaves designated equipment in room. The following day the PTA discovers on the patient’s chart that the patient has tested positive for a type of Invasive GAS, known as Necrotizing Fasciitis. Patient treatment postponed due to patient requiring immediate surgery for treatment of invasive GAS. Treatment by PTA to resume as soon as patient is stable.

If the PTA had not been knowledgeable of GAS and its associated diseases it is likely that the infection could have been transmitted from the patient to the PTA, and from the PTA to other patients. Or, the infection could have been transmitted from the patient to other patients due to lack of isolation precautions. In addition, concerning invasive GAS, the patient’s limbs and life were possibly saved due to the PTAs awareness, knowledge, and quick acting.

Although these scenarios were in an inpatient setting, similar circumstances could easily have taken place in an outpatient setting. In such a case the patient would have to stay home for at least 24-hours while antibiotics were being taken and or wear a mask to protect the public from infectious droplets. In the case of suspecting invasive GAS in an outpatient setting the PTA would report to the PT where the PT would then recommend the patient/client see a physician immediately.

Bibliography

Fairchild, OShea, R. K., & Washington, R. D. (2018). Pierson and Fairchilds Principles & Techniques of Patient Care. St. Louis, MO: Elsevier. Ferretti J, Köhler W. History of Streptococcal Research. 2016 Feb 10. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2016-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK333430/
Group A Streptococcal (GAS) Disease. (2018, November 01). Retrieved from https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html
Important News! (n.d.). Retrieved from https://www.stroke.org/
Strep throat: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved from https://medlineplus.gov/ency/article/000639.htm
Types of Group A Streptococcal Infections. (2019, January 30). Retrieved from https://www.niaid.nih.gov/diseases-conditions/group-strep-types

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