From the Guidelines
Post-streptococcal complications include acute rheumatic fever and post-streptococcal glomerulonephritis, which can develop following untreated group A streptococcal infections, and early diagnosis and treatment with appropriate antibiotics significantly reduces the risk of these complications. The most common complications of post-streptococcal infections are:
- Acute rheumatic fever, which typically occurs 2-3 weeks after streptococcal pharyngitis and can affect the heart, joints, skin, and brain, potentially leading to permanent heart valve damage.
- Post-streptococcal glomerulonephritis, which occurs 1-2 weeks after streptococcal pharyngitis or 3-6 weeks after skin infections, causing kidney inflammation with symptoms of hematuria, proteinuria, edema, and hypertension.
Treatment for acute rheumatic fever involves:
- Penicillin (benzathine penicillin G 1.2 million units IM once, or penicillin V 500 mg orally twice daily for 10 days) to eradicate the bacteria.
- Anti-inflammatory medications like aspirin (80-100 mg/kg/day divided in 4 doses) for joint inflammation.
- Corticosteroids for severe carditis. Long-term prophylaxis with benzathine penicillin G 1.2 million units IM every 3-4 weeks or penicillin V 250 mg orally twice daily is recommended to prevent recurrence of acute rheumatic fever, as noted in the guidelines by the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee 1.
Treatment for post-streptococcal glomerulonephritis is supportive, with:
- Fluid and salt restriction.
- Diuretics for edema.
- Antihypertensives if needed, as suggested in the commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis 1.
These complications result from immune cross-reactivity where antibodies against streptococcal antigens mistakenly attack human tissues due to molecular mimicry. The Infectious Diseases Society of America has published guidelines for the diagnosis and management of group A streptococcal pharyngitis, which include recommendations for antimicrobial therapy and prevention of recurrent episodes 1.
In summary, early diagnosis and treatment of streptococcal infections with appropriate antibiotics, such as penicillin, is crucial in reducing the risk of post-streptococcal complications, and long-term prophylaxis may be necessary to prevent recurrence of acute rheumatic fever.
From the Research
Complications of Post-Streptococcal Infections
The complications of post-streptococcal infections can be severe and varied. Some of the possible complications include:
- Acute post-streptococcal glomerulonephritis (APSGN) 2, 3, 4, 5
- Acute rheumatic fever (ARF) 2, 3
- Rheumatic heart disease 2, 3
- Chronic kidney disease 4, 5
- Pulmonary congestion 4
- Nephritic syndrome 4
- Poststreptococcal reactive arthritis (PSReA) 6
Characteristics of Complications
The characteristics of these complications can vary, but some common features include:
- APSGN: hematuria, oliguria, hypertension, and edema 2, 4, 5
- ARF: fever, subcutaneous nodules, and cardiac murmurs 2, 3
- PSReA: nonmigratory arthritis, lack of response to aspirin or nonsteroidal anti-inflammatory agents, and extra-articular manifestations such as vasculitis and glomerulonephritis 6
Diagnosis and Treatment
Diagnosis of these complications is typically made through laboratory tests and imaging studies. Treatment is often symptomatic, and may include antibiotics to prevent further complications 4, 5. In some cases, corticosteroids may be used to control inflammation 2.