From the Guidelines
A Transesophageal Echocardiogram (TEE) is not routinely required for a diagnosis of Group A Streptococcus (GAS) infection, but should be considered if there is a high suspicion of infective endocarditis (IE) or other cardiac complications, as evidenced by the American Heart Association guidelines 1. When evaluating a patient with GAS infection, the primary concern is the potential for cardiac complications, such as infective endocarditis. According to the American Heart Association, TEE should be performed if initial transthoracic echocardiogram (TTE) images are negative or inadequate in patients with an ongoing suspicion for IE or when there is concern for intracardiac complications 1. Some key points to consider when deciding whether to order a TEE include:
- The presence of signs or symptoms suggesting cardiac involvement, such as new heart murmurs, signs of heart failure, or persistent fever despite appropriate antibiotic therapy
- The patient's risk factors for cardiac complications, such as a history of heart disease or previous infective endocarditis
- The response to treatment, including the effectiveness of antibiotic therapy in resolving symptoms and preventing complications In general, for uncomplicated GAS pharyngitis or skin infections that respond well to standard antibiotic therapy, cardiac imaging, including TEE, is unnecessary 1. However, if there is a high suspicion of IE or other cardiac complications, TEE should be performed as soon as possible after TTE, as it is significantly more sensitive than TTE for the detection of vegetations and abscesses 1.
From the Research
Diagnosis of Group A Streptococcus Infection
- A diagnosis of Group A Streptococcus (GAS) infection is typically made through a throat culture or rapid streptococcal antigen test 2, 3.
- The treatment of GAS infection usually involves antibiotic therapy, such as penicillin, to prevent complications like acute rheumatic fever (ARF) 4, 2, 3, 5.
Role of Transesophageal Echocardiogram (TEE) in GAS Infection
- There is no direct evidence to suggest that a TEE is required for the diagnosis of GAS infection 4, 2, 3, 5, 6.
- However, echocardiography (ECHO) may be used to diagnose cardiac complications like acute carditis or rheumatic heart disease (RHD) that can occur as a result of GAS infection 3, 5, 6.
- In some cases, a transthoracic echocardiogram (TTE) may be used to detect subclinical carditis, which is a major criterion for the diagnosis of ARF 5, 6.
Cardiac Complications of GAS Infection
- GAS infection can lead to cardiac complications like ARF and RHD, which can be diagnosed using echocardiography 3, 5, 6.
- The diagnosis of ARF relies on the revised Jones criteria, which include subclinical carditis detected by echocardiography as a major criterion 5.
- RHD is defined by valve regurgitation and/or stenosis, and can be diagnosed using echocardiography 5.