637:
incidence and severity of group A streptococci. With more space for individuals to reside in, it provides the bacteria with less opportunities to spread from person to person. This is especially important considering an estimated 500,000 deaths worldwide all occurring after acute rheumatic fever, invasive infection, or subsequent heart disease can be accredited to GAS. This number is quite large, often leaving the health care system encumbered, since 91 percent of patients infected with invasive GAS need to be hospitalized with 8950–11,500 episodes and 1050-1850 deaths taking place each year. A later study that occurred from 2005 to 2012 found that there were 10,649-13,434 cases consequently resulting in 1136-1607 deaths per year.
511:
781:(PSGN) is an uncommon complication of either a strep throat or a streptococcal skin infection. It is classified as a type III hypersensitivity reaction. Symptoms of PSGN develop within 10 days following a strep throat or 3 weeks following a GAS skin infection. PSGN involves inflammation of the kidney. Symptoms include pale skin, lethargy, loss of appetite, headache, and dull back pain. Clinical findings may include dark-colored urine, swelling of different parts of the body (edema), and high blood pressure. Treatment of PSGN consists of supportive care.
66:
40:
535:. The rapid pyrrolidonyl arylamidase (PYR) test is commonly used, wherein a positive reaction confers a presumptive identification of group A beta-hemolytic streptococci if the appearance and clinical context is consistent. GBS gives a negative finding on the PYR test test. There are also latex agglutination kits which can distinguish each of the main groups seen in clinical practice.
808:(pediatric acute-onset neuropsychiatric syndrome) and CANS (childhood acute neuropsychiatric syndrome). The CANS/PANS hypotheses include different possible mechanisms underlying acute-onset neuropsychiatric conditions, but do not exclude GABHS infections as a cause in a subset of individuals. PANDAS, PANS and CANS are the focus of clinical and laboratory research but remain unproven.
622:
Cases of GAS are still present today, but were also evident before World War I. This was shown by a training camp located in Texas, where a harmful strain of pneumonia complicating measles was caused by a strain of
Streptococcus. Existence of streptococci strains was additionally found in World War
636:
of GAS) which is indicated by the change in numerous hospitals from containing wards allocated for the sole purpose of treating rheumatic fever to hardly seeing the disease at all. Environmental factors, such as less crowding and the increase of family living space, can account for the reduction in
180:
may be more susceptible to certain diseases caused by GAS than other persons with intact immune systems. A 2019 study shows that GAS's evasion of immune detection is facilitated by protein S, an extracellular and cell wall-associated protein that enables it to camouflage itself by binding fragments
1914:
O'Loughlin, R. E.; Roberson, A.; Cieslak, P. R.; Lynfield, R.; Gershman, K.; Craig, A.; Albanese, B. A.; Farley, M. M.; Barrett, N. L.; Spina, N. L.; Beall, B. (2007-10-01). "The
Epidemiology of Invasive Group A Streptococcal Infection and Potential Vaccine Implications: United States, 2000-2004".
501:
guidance is that, for a number of reasons, close contacts should not receive antibiotics unless they are symptomatic but that they should receive information and advice to seek immediate medical attention if they develop symptoms. However, guidance is clearer in the case of mother-baby pairs: both
1958:
de
Loizaga SR, Arthur L, Arya B, Beckman B, Belay W, Brokamp C, Hyun Choi N, Connolly S, Dasgupta S, Dibert T, Dryer MM, Gokanapudy Hahn LR, Greene EA, Kernizan D, Khalid O, Klein J, Kobayashi R, Lahiri S, Lorenzoni RP, Otero Luna A, Marshall J, Millette T, Moore L, Muhamed B, Murali M, Parikh K,
482:
Severe Group A streptococcal infections often occur sporadically but can be spread by person-to-person contact. Close contacts of people affected by severe Group A streptococcal infections, defined as those having had prolonged household contact in the week before the onset of illness, may be at
159:
Group A β-hemolytic streptococcus can cause infections of the throat and skin. These may vary from very mild conditions to severe, life-threatening diseases. Although it is not completely clear what causes different people to develop different diseases as a result of infection with the same
631:
were carried out in a 20 yearlong (1953/1954-1973/1974) study performed in
Nashville, TN. Also, from 1972 to 1974, recurring GAS illness was observed with a prevalence of 19 percent in school-aged children as well as a prevalence rate of 25 percent in families. The severity of streptococcal
683:
Although common in developing countries, ARF is rare in the United States, possibly secondary to improved antibiotic treatment, with small isolated outbreaks reported only occasionally. It is most common among children between 5 and 15 years old and occurs 1–3 weeks after an untreated GAS
613:
The 30-valent N-terminal M-protein-based vaccine as well as the M-protein vaccine (minimal epitope J8 vaccine) are two vaccines for GAS that are currently getting close or becoming clinical studies, however, other vaccines using conserved epitopes are progressing.
680:(ARF) is a complication of respiratory infections caused by GAS. The M-protein generates antibodies that cross-react with autoantigens on interstitial connective tissue, in particular of the endocardium and synovium, that can lead to significant clinical illness.
1573:
Falagas ME, Vouloumanou EK, Matthaiou DK, Kapaskelis AM, Karageorgopoulos DE (2008). "Effectiveness and safety of short-course vs long-course antibiotic therapy for group a beta hemolytic streptococcal tonsillopharyngitis: a meta-analysis of randomized trials".
804:(pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections), a condition thought to be triggered by GABHS infections. The PANDAS hypothesis is unconfirmed and unsupported by data, and two new categories have been proposed:
759:, can occur months after an initial attack, causing jerky involuntary movements, muscle weakness, slurred speech, and personality changes. Initial episodes of ARF, as well as recurrences, can be prevented by treatment with appropriate antibiotics.
2330:
594:
is appropriate if deep oropharyngeal abscesses are present, in conjunction with aspiration or drainage. In cases of streptococcal toxic shock syndrome, treatment consists of penicillin and clindamycin, given with intravenous immunoglobulin.
1371:
Guidelines for management of contacts of cases of invasive group A streptococcal disease (GAS) including streptococcal toxic shock syndrome (STSS) and necrotising fasciitis. Toronto, Ontario: Ministry of Health; 1995. Available at:
598:
For toxic shock syndrome and necrotizing fasciitis, high-dose penicillin and clindamycin are used. Additionally, for necrotizing fasciitis, surgery is often needed to remove damaged tissue and stop the spread of the infection.
752:(usually over the spine or other bony areas) and a red expanding rash on the trunk and extremities that recurs over weeks to months. Because of the different ways ARF presents itself, the disease may be difficult to diagnose.
103:
that is responsible for a wide range of infections that are mostly common and fairly mild. If the bacteria enters the bloodstream, the infection can become severe and life-threatening, and is called an invasive GAS (iGAS).
514:
Example of a workup algorithm of possible bacterial infection in cases with no specifically requested targets (non-bacteria, mycobacteria etc.), with most common situations and agents seen in a New
England setting. Main
1609:
HOUSER HB, WANNAMAKER LW, RAMMELKAMP CH, DENNY FW, BRINK WR, HAHN EO, DINGLE JH (1950). "Prophylaxis of acute rheumatic fever by treatment of the preceding streptococcal infection with various amounts of penicillin".
562:
The treatment of choice is penicillin, and the duration of treatment is around 10 days. Antibiotic therapy (using injected penicillin) has been shown to reduce the risk of acute rheumatic fever. In individuals with a
218:
The invasive infections caused by Group A β-hemolytic streptococcus tend to be more severe and less common. These occurs when the bacterium is able to infect areas where bacteria are not usually found, such as
1810:
Nelson, George E.; Pondo, Tracy; Toews, Karrie-Ann; Farley, Monica M.; Lindegren, Mary Lou; Lynfield, Ruth; Aragon, Deborah; Zansky, Shelley M.; Watt, James P.; Cieslak, Paul R.; Angeles, Kathy (2016-08-15).
502:
mother and baby should be treated if either develops an invasive GAS infection within the first 28 days following birth (though some evidence suggests that this guidance is not routinely followed in the UK).
623:
II. An epidemic of streptococcal infection in the United States Navy during this war indicated that this type of disease was able to exist and spread in formerly unexposed individuals by environments that
487:. This increased risk may be due to a combination of shared genetic susceptibility within the family, close contact with carriers, and the virulence of the Group A streptococcal strain that is involved.
1048:
Wierzbicki, I. H.; Campeau, A.; Dehaini, D.; Holay, M.; Wei, X.; Greene, T.; Ying, M.; Sands, J. S.; Lamsa, A.; Zuniga, E.; Pogliano, K.; Fang, R. H.; Larock, C. N.; Zhang, L.; Gonzalez, D. J. (2019).
606:
is most commonly patient noncompliance, but in cases where patients have been compliant with their antibiotic regimen, and treatment failure still occurs, another course of antibiotic treatment with
456:
worldwide, causing serious infection and, if not promptly diagnosed and treated, death in newly delivered mothers. Severe GAS disease may also occur in healthy persons with no known risk factors.
2417:
602:
No instance of penicillin resistance has been reported to date, although since 1985, many reports of penicillin tolerance have been made. The reason for the failure of penicillin to treat
1177:"Incidence and clinical and microbiological features of invasive and probable invasive streptococcal group A infections in children and adults in the Brussels-Capital Region, 2005–2020"
2386:
737:
Further endocarditis can develop with aseptic vegetations along the valve closure lines, in particular the mitral valve. Chronic rheumatic heart disease mostly affects the
883:
Zorzoli, Azul; Meyer, Benjamin H.; Adair, Elaine; Torgov, Vladimir I.; Veselovsky, Vladimir V.; Danilov, Leonid L.; Uhrin, Dusan; Dorfmueller, Helge C. (18 October 2019).
627:
types of group A streptococci preferred. In later years, a positive test result for the presence of group A streptococci was found in 32.1 percent of individuals after
2275:
Fact Sheet "Group A Streptococcal
Infections", dated March 1999. As a work of the U.S. Federal Government without any other copyright notice, this is assumed to be a
2410:
1175:
Zangarini L, Martiny D, Miendje Deyi VY, Hites M, Maillart E, Hainaut M, Delforge M, Botteaux A, Matheeussen V, Goossens H, Hallin M, Smeesters P, Dauby N (2023).
554:
present in the environment and the large amount of time and number of people that will be needed for appropriate trials for safety and efficacy of the vaccine.
195:
The non-invasive infections caused by GAS tend to be less severe and more common. They occur when the bacteria colonizes the throat area, where it recognizes
493:
policies internationally reflect differing views of how the close contacts of people affected by severe Group A streptococcal infections should be treated.
2838:
2403:
550:
infection, although research has been conducted into the development of one. Difficulties in developing a vaccine include the wide variety of strains of
1717:"Polyspecific Intravenous Immunoglobulin in Clindamycin-treated Patients With Streptococcal Toxic Shock Syndrome: A Systematic Review and Meta-analysis"
1547:
1253:
2694:
1384:
857:
59:
1325:
1227:
1772:
Kim KS, Kaplan EL (1985). "Association of penicillin tolerance with failure to eradicate group A streptococci from patients with pharyngitis".
838:
778:
646:
1959:
Sanyahumbi A, Shakti D, Stein E, Shah S, Wilkins H, Windom M, Wirth S, Zimmerman M, Beck AF, Ollberding N, Sable C, Beaton A (August 2021).
684:
pharyngitis, but caution is advised when interpreting the demographics of the contemporary picture of pediatric cases in the United States.
2828:
885:"Group A, B, C, and G Streptococcus Lancefield antigen biosynthesis is initiated by a conserved α-d-GlcNAc-β-1,4-l-rhamnosyltransferase"
1373:
789:
3240:
3064:
2445:
1896:
1149:
1102:
1050:"Group A Streptococcal S Protein Utilizes Red Blood Cells as Immune Camouflage and Is a Critical Determinant for Immune Evasion"
2669:
2649:
510:
723:
1668:"Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess"
392:
Some strains of group A streptococci (GAS) cause severe infection. Severe infections are usually invasive, meaning that the
115:
as a treatment for group A streptococcus, cases of iGAS are an increasing problem, particularly on the continent of Africa.
2377:
987:
Carapetis, JR; Steer, AC; Mulholland, EK; Weber, M (November 2005). "The global burden of group A streptococcal diseases".
2572:
2381:
2272:
711:(involuntary, purposeless movement). The most common clinical finding is a migratory arthritis involving multiple joints.
1452:
3207:
2881:
2490:
2589:
1666:
Allewelt, M.; Schüler, P.; Bölcskei, P. L.; Mauch, H.; Lode, H.; Study Group on
Aspiration Pneumonia (February 2004).
587:
2395:
546:
infections are best prevented through effective hand hygiene. No vaccines are currently available to protect against
497:
and the US CDC recommend close contacts see their doctor for full evaluation and may require antibiotics; current UK
2867:
1411:"Public health management of group A streptococcal infection in mother-baby pairs in England; a case series review"
2622:
464:
417:
144:
734:
can develop with a classic friction rub that can be auscultated. This will give increasing pain upon reclining.
730:. One of the most serious complications is pancarditis, or inflammation of all three heart tissues. A fibrinous
3102:
3096:
2803:
2710:
2663:
2509:
2390:
1961:"Rheumatic Heart Disease in the United States: Forgotten But Not Gone: Results of a 10 Year Multicenter Review"
564:
498:
380:
135:
129:
2141:
Zibordi F, Zorzi G, Carecchio M, Nardocci N (March 2018). "CANS: Childhood acute neuropsychiatric syndromes".
1551:
741:, which can become thickened with calcification of the leaflets, often causing fusion of the commissures and
3053:
2764:
2559:
1326:"Interim UK guidelines for management of close community contacts of invasive group A streptococcal disease"
763:
3159:
2952:
2611:
2566:
2515:
2276:
1280:"Familial transmission of a serious disease producing group A streptococcus clone:case reports and review"
100:
84:
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3173:
3012:
2822:
2758:
2533:
1388:
861:
688:
677:
279:
232:
125:
89:
176:
of GAS can influence the epigenetics of the host. Furthermore, persons with suppressed or compromised
1348:
800:
autoimmune process. Its potential effect was described in 1998 by the controversial hypothesis called
111:
or sores on the skin. GAS infections can cause over 500,000 deaths per year. Despite the emergence of
3186:
3165:
2833:
2772:
2552:
2545:
2041:
Dale RC (December 2017). "Tics and
Tourette: a clinical, pathophysiological and etiological review".
666:
583:
228:
65:
2091:
Marazziti D, Mucci F, Fontenelle LF (July 2018). "Immune system and obsessive-compulsive disorder".
246:
In addition, infection of GAS may lead to further complications and health conditions, namely acute
192:
and show no symptoms. These carriers are less contagious than symptomatic carriers of the bacteria.
2728:
2688:
2538:
2441:
2008:
1715:
Parks, Tom; Wilson, Clare; Curtis, Nigel; Norrby-Teglund, Anna; Sriskandan, Shiranee (2018-11-01).
749:
704:
700:
460:
161:
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2256:
2116:
2066:
652:
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)
368:
251:
1128:
2176:
Wilbur C, Bitnun A, Kronenberg S, Laxer RM, Levy DM, Logan WJ, Shouldice M, Yeh EA (May 2019).
1641:
826:
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2158:
2108:
2058:
2020:
1990:
1940:
1932:
1892:
1850:
1832:
1789:
1754:
1736:
1697:
1689:
1619:
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1529:
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1301:
1208:
1079:
1004:
969:
916:
834:
742:
484:
54:
1385:"Disease Listing, Group a Streptococcal, General Info | CDC Bacterial, Mycotic Diseases"
884:
722:
serology test must confirm the GAS infection. Other minor Jones
Criteria are fever, elevated
3150:
2238:
2197:
2189:
2150:
2100:
2050:
1980:
1972:
1924:
1884:
1840:
1824:
1781:
1744:
1728:
1679:
1583:
1519:
1511:
1500:"Strategies in the development of vaccines to prevent infections with group A streptococcus"
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1422:
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1188:
1069:
1061:
996:
959:
906:
896:
756:
719:
449:
433:
374:(*Note that meningitis, sinusitis and pneumonia can all be caused by Group A Strep, but are
318:
196:
173:
140:
1813:"Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012"
2923:
2637:
2464:
708:
656:
453:
247:
224:
2363:
1278:
Gamba MA, Martinelli M, Schaad HJ, Streuli RA, DiPersio J, Matter L, et al. (1997).
3081:
2202:
2177:
1985:
1960:
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1812:
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1716:
1524:
1499:
1437:
1410:
1203:
1176:
1074:
1049:
911:
628:
607:
576:
97:
39:
1785:
1000:
531:
is performed to show Gram-positive cocci in chains. Then, the organism is cultured on
3234:
2718:
2627:
2480:
1684:
1667:
1453:"Pyrrolidonyl Arylamidase (PYR) Test: Principle, procedure and results—microbeonline"
797:
696:
661:
494:
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327:
212:
177:
120:
2260:
2243:
2226:
2120:
2070:
1153:
1106:
3059:
2744:
2292:
Streptococcus pyogenes: Basic
Biology to Clinical Manifestations [Internet]
2104:
793:
767:
738:
731:
568:
472:
445:
421:
296:
200:
1469:
2054:
1888:
1065:
3213:
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2958:
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2012:
1427:
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591:
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has entered parts of the body where bacteria are not usually found, such as the
204:
2154:
1193:
3141:
3126:
3115:
2978:
2859:
2787:
2632:
2606:
2432:
2339:
727:
572:
532:
528:
476:
425:
413:
409:
346:
312:
271:
267:
240:
169:
165:
112:
1936:
1836:
1740:
1693:
1022:
901:
3086:
2993:
2850:
2813:
2658:
2436:
2428:
2358:
1976:
364:
355:
336:
236:
227:. The diseases that may be caused as a result of this include streptococcal
207:) where it causes 15–30% of the childhood cases and 10% of adult cases, and
148:
79:
2300:
2252:
2211:
2162:
2112:
2062:
2024:
1994:
1944:
1854:
1758:
1701:
1623:
1595:
1533:
1344:
1212:
1083:
1008:
973:
920:
833:. Vol. 2 (26th ed.). Philadelphia: Elsevier. pp. 1871–1878.
215:
is also a non-invasive infection caused by GAS, although much less common.
2322:
1793:
1305:
3018:
2942:
2899:
2792:
2499:
2469:
2193:
1828:
1732:
624:
471:. Early recognition and treatment are critical. Diagnostic tests include
429:
393:
350:
263:
208:
796:
are hypothesized to arise in a subset of children as a result of a post-
3032:
2915:
2455:
2271:
Note: Elements of the original text of this article are taken from the
1152:. New York City Department of Health and Mental Hygiene. Archived from
633:
632:
infections has decreased over the years, and so has rheumatic fever (a
452:
users and homeless also are at high risk. GAS is an important cause of
441:
359:
300:
17:
2017:
Streptococcus pyogenes : Basic Biology to Clinical Manifestations
1324:
Health Protection Agency, Group A Streptococcus Working Group (2004).
527:
Diagnosis is by a swab of the affected area for laboratory testing. A
2334:
1587:
1515:
805:
801:
715:
651:
437:
405:
340:
291:
287:
189:
2295:. Oklahoma City, OK: University of Oklahoma Health Sciences Center.
2289:
Ferretti, Joseph J; Stevens, Dennis L; Fischetti, Vincent A (2016).
1928:
1296:
1279:
964:
947:
827:"274. Nonpneumococcal streptococcal infections and rheumatic fever"
199:. The two most prominent infections of GAS are both non-invasive:
509:
468:
397:
322:
220:
108:
2019:. Oklahoma City: University of Oklahoma Health Sciences Center.
1129:"Streptococcal Infections: What is Group A Strepotococcus (GAS)"
401:
331:
283:
275:
185:
2399:
1548:"Initiative for Vaccine Research (IVR) – Group A Streptococcus"
825:
Stevens, Dennis L.; Bryant, Amy E.; Hagman, Melissa M. (2020).
1642:"Group A Streptococcal Infections Treatment & Management"
948:"Group A Streptococcus Epidemiology and Vaccine Implications"
770:
histologically and RHD is a non-inflammatory sequela of ARF.
860:. Centers for Disease Control and Prevention. Archived from
315:
can be associated with these infections, but is not typical.
2387:
Group A streptococcal infections—Frequently Asked Questions
1254:"After Boy's Death, Hospital Alters Discharging Procedures"
766:. ARF is an acute inflammatory reaction with pathognomonic
172:
factors are the source of such variation. Indeed, the many
2011:; Beaton, A.; Raghu, A.; Steer, A.; Carapetis, J. (2016).
479:
as well as cultures of blood or fluid from a wound site.
107:
Infection of GAS may spread through direct contact with
2178:"PANDAS/PANS in childhood: Controversies and evidence"
1105:. New York City Department of Health a. Archived from
211:. These may be effectively treated with antibiotics.
1879:
Quinn, Robert W. (1982), "Streptococcal Infections",
941:
939:
937:
2312:
3197:
3149:
3140:
3113:
3079:
3043:
3002:
2986:
2977:
2940:
2897:
2849:
2812:
2801:
2786:
2742:
2709:
2680:
2648:
2597:
2588:
2526:
2498:
2489:
2478:
2463:
2454:
2349:
2316:
2227:"Treatment of PANDAS and PANS: a systematic review"
2013:"Acute Rheumatic Fever and Rheumatic Heart Disease"
1150:"Streptococcal Infections (Invasive Group A Strep)"
1103:"Streptococcal Infections (Invasive Group A Srtep)"
53:
32:
139:, which cause other types of infections. Several
1409:Howard, SJ; Stoker, K; Foster, K (16 June 2015).
2086:
2084:
2082:
2080:
1498:Good MF, Batzloff MR, Pandey M (November 2013).
1029:. U.S. Department of Health & Human Services
2225:Sigra S, Hesselmark E, Bejerot S (March 2018).
412:. Those at greatest risk include children with
143:contribute to the pathogenesis of GAS, such as
2136:
2134:
2132:
2130:
1415:Antimicrobial Resistance and Infection Control
946:Cohen-Poradosu, Ronit; Kasper, Dennis (2007).
829:. In Goldman, Lee; Schafer, Andrew I. (eds.).
2411:
1319:
1317:
1315:
8:
1228:"An Infection, Unnoticed, Turns Unstoppable"
714:Other indicators of GAS infection such as a
579:have been shown to be effective treatments.
184:Humans may also carry the GAS either on the
2036:
2034:
1550:. World Health Organization. Archived from
1493:
1491:
687:ARF is often clinically diagnosed based on
3146:
2999:
2983:
2809:
2798:
2594:
2495:
2486:
2475:
2460:
2418:
2404:
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2313:
1027:Centers for Disease Control and Prevention
64:
38:
29:
2242:
2201:
1984:
1844:
1748:
1683:
1523:
1464:
1462:
1436:
1426:
1295:
1202:
1192:
1097:
1095:
1093:
1073:
963:
910:
900:
852:
850:
762:It is important to distinguish ARF from
2695:Cutaneous Streptococcus iniae infection
1635:
1633:
1504:Human Vaccines & Immunotherapeutics
817:
1909:
1907:
1874:
1872:
1870:
1868:
1866:
1864:
1805:
1803:
459:All severe GAS infections may lead to
1023:"Group A Streptococcal (GAS) Disease"
858:"Group A Streptococcal (GAS) Disease"
779:Post-streptococcal glomerulonephritis
774:Post-streptococcal glomerulonephritis
647:Post-streptococcal glomerulonephritis
7:
2829:Staphylococcal scalded skin syndrome
343:(more common in pre-pubescent girls)
1672:Clinical Microbiology and Infection
755:A neurological disorder, Sydenham
25:
3065:Clostridial necrotizing enteritis
1883:, Springer US, pp. 525–552,
1685:10.1111/j.1469-0691.2004.00774.x
118:There are many other species of
76:Group A streptococcal infections
2670:Group B streptococcal infection
2618:Group A streptococcal infection
2378:Group A streptococcal infection
2244:10.1016/j.neubiorev.2018.01.001
1181:Eur J Clin Microbiol Infect Dis
889:Journal of Biological Chemistry
33:Group A streptococcal infection
2105:10.1016/j.psyneuen.2018.04.013
1881:Bacterial Infections of Humans
989:The Lancet Infectious Diseases
748:Other findings of ARF include
378:more commonly associated with
1:
2382:National Institutes of Health
1786:10.1016/S0022-3476(85)80392-9
1001:10.1016/S1473-3099(05)70267-X
790:Obsessive–compulsive disorder
384:and should not be confused.)
151:, and extracellular enzymes.
3208:Erysipelothrix rhusiopathiae
2055:10.1097/MOP.0000000000000546
1917:Clinical Infectious Diseases
1889:10.1007/978-1-4757-1140-0_29
1817:Clinical Infectious Diseases
1721:Clinical Infectious Diseases
1066:10.1016/j.celrep.2019.11.001
952:Clinical Infectious Diseases
278:which can be complicated by
164:, it is suspected that host
1428:10.1186/2047-2994-4-S1-P107
1252:Jim Dwyer (July 18, 2012).
1226:Jim Dwyer (July 11, 2012).
588:amoxicillin/clavulanic acid
3257:
2155:10.1016/j.ejpn.2018.01.011
1194:10.1007/s10096-023-04568-y
181:of lysed red blood cells.
2623:Streptococcal pharyngitis
465:multisystem organ failure
418:suppressed immune systems
46:
37:
3241:Streptococcal infections
3103:Pseudomembranous colitis
3097:Clostridioides difficile
2391:Health Protection Agency
2093:Psychoneuroendocrinology
1333:Commun Dis Public Health
902:10.1074/jbc.RA119.009894
519:groups are included as "
499:Health Protection Agency
381:Streptococcus pneumoniae
299:AKA strep pharyngitis –
136:Streptococcus pneumoniae
130:Streptococcus agalactiae
3054:Clostridium perfringens
2765:Urinary tract infection
1977:10.1161/JAHA.120.020992
764:rheumatic heart disease
424:; elderly persons with
3160:Ureaplasma urealyticum
2953:Listeria monocytogenes
2657:bacitracin resistant,
2516:Pneumococcal infection
2277:public domain resource
831:Goldman-Cecil Medicine
524:
250:and poststreptococcal
101:Gram-positive bacteria
85:Streptococcus pyogenes
48:Streptococcus pyogenes
3181:Mycoplasma pneumoniae
3174:Mycoplasma genitalium
3013:Clostridium botulinum
2759:Enterococcus faecalis
2534:Viridans streptococci
2231:Neurosci Biobehav Rev
2182:Paediatr Child Health
2143:Eur J Paediatr Neurol
1060:(10): 2979–2989.e15.
678:Acute rheumatic fever
673:Acute rheumatic fever
513:
440:; and persons taking
280:necrotizing fasciitis
233:necrotizing fasciitis
126:group B streptococcus
90:group A streptococcus
3187:Mycoplasma pneumonia
3166:Ureaplasma infection
2876:novobiocin resistant
2834:Toxic shock syndrome
2773:Enterococcus faecium
864:on December 19, 2007
667:Toxic shock syndrome
584:ampicillin/sulbactam
274:– infections of the
229:toxic shock syndrome
3119:(non-spore forming)
2729:Streptococcus bovis
2689:Streptococcus iniae
2437:Infectious diseases
1455:. 12 November 2013.
1156:on November 6, 2012
895:(42): 15237–15256.
750:erythema marginatum
705:erythema marginatum
162:pathogenic bacteria
60:Infectious diseases
3027:Clostridium tetani
2910:Bacillus anthracis
2527:optochin resistant
2442:Bacterial diseases
2350:External resources
2194:10.1093/pch/pxy145
1829:10.1093/cid/ciw248
1733:10.1093/cid/ciy401
1258:The New York Times
1232:The New York Times
1109:on 6 November 2012
565:penicillin allergy
525:
369:pulmonary alveolus
252:glomerulonephritis
155:Types of infection
3228:
3227:
3224:
3223:
3199:Anaeroplasmatales
3136:
3135:
3075:
3074:
2973:
2972:
2969:
2968:
2893:
2892:
2782:
2781:
2738:
2737:
2705:
2704:
2584:
2583:
2373:
2372:
2043:Curr Opin Pediatr
1554:on March 22, 2006
1421:(Suppl 1): P107.
840:978-0-323-55087-1
743:chordae tendineae
699:of large joints,
691:, which include:
523:" at bottom left.
485:risk of infection
388:Severe infections
174:virulence factors
141:virulence factors
73:
72:
27:Medical condition
16:(Redirected from
3248:
3151:Mycoplasmataceae
3147:
3127:Finegoldia magna
3000:
2984:
2882:S. saprophyticus
2810:
2799:
2595:
2496:
2487:
2476:
2461:
2420:
2413:
2406:
2397:
2314:
2304:
2265:
2264:
2246:
2222:
2216:
2215:
2205:
2173:
2167:
2166:
2138:
2125:
2124:
2088:
2075:
2074:
2038:
2029:
2028:
2009:Sika-Paotonu, D.
2005:
1999:
1998:
1988:
1965:J Am Heart Assoc
1955:
1949:
1948:
1911:
1902:
1901:
1876:
1859:
1858:
1848:
1807:
1798:
1797:
1769:
1763:
1762:
1752:
1727:(9): 1434–1436.
1712:
1706:
1705:
1687:
1663:
1657:
1656:
1654:
1652:
1637:
1628:
1627:
1606:
1600:
1599:
1588:10.4065/83.8.880
1570:
1564:
1563:
1561:
1559:
1544:
1538:
1537:
1527:
1516:10.4161/hv.25506
1495:
1486:
1485:
1483:
1481:
1466:
1457:
1456:
1449:
1443:
1442:
1440:
1430:
1406:
1400:
1399:
1397:
1396:
1387:. Archived from
1381:
1375:
1369:
1363:
1362:
1360:
1359:
1353:
1347:. Archived from
1330:
1321:
1310:
1309:
1299:
1275:
1269:
1268:
1266:
1264:
1249:
1243:
1242:
1240:
1238:
1223:
1217:
1216:
1206:
1196:
1172:
1166:
1165:
1163:
1161:
1146:
1140:
1139:
1137:
1135:
1125:
1119:
1118:
1116:
1114:
1099:
1088:
1087:
1077:
1045:
1039:
1038:
1036:
1034:
1019:
1013:
1012:
984:
978:
977:
967:
943:
932:
931:
929:
927:
914:
904:
880:
874:
873:
871:
869:
854:
845:
844:
822:
450:Intravenous drug
434:vascular disease
319:septic arthritis
197:epithelial cells
96:is a species of
78:are a number of
69:
68:
42:
30:
21:
3256:
3255:
3251:
3250:
3249:
3247:
3246:
3245:
3231:
3230:
3229:
3220:
3193:
3132:
3109:
3071:
3039:
2965:
2936:
2924:Bacillus cereus
2889:
2845:
2790:
2778:
2734:
2701:
2676:
2644:
2638:Rheumatic fever
2580:
2522:
2467:
2465:Lactobacillales
2450:
2424:
2374:
2369:
2368:
2345:
2344:
2325:
2311:
2288:
2285:
2283:Further reading
2269:
2268:
2224:
2223:
2219:
2175:
2174:
2170:
2140:
2139:
2128:
2090:
2089:
2078:
2040:
2039:
2032:
2007:
2006:
2002:
1971:(16): e020992.
1957:
1956:
1952:
1913:
1912:
1905:
1899:
1878:
1877:
1862:
1809:
1808:
1801:
1771:
1770:
1766:
1714:
1713:
1709:
1665:
1664:
1660:
1650:
1648:
1640:Khan, Zartash.
1639:
1638:
1631:
1608:
1607:
1603:
1572:
1571:
1567:
1557:
1555:
1546:
1545:
1541:
1497:
1496:
1489:
1479:
1477:
1470:"Group A Strep"
1468:
1467:
1460:
1451:
1450:
1446:
1408:
1407:
1403:
1394:
1392:
1383:
1382:
1378:
1370:
1366:
1357:
1355:
1351:
1328:
1323:
1322:
1313:
1284:Clin Infect Dis
1277:
1276:
1272:
1262:
1260:
1251:
1250:
1246:
1236:
1234:
1225:
1224:
1220:
1174:
1173:
1169:
1159:
1157:
1148:
1147:
1143:
1133:
1131:
1127:
1126:
1122:
1112:
1110:
1101:
1100:
1091:
1047:
1046:
1042:
1032:
1030:
1021:
1020:
1016:
986:
985:
981:
945:
944:
935:
925:
923:
882:
881:
877:
867:
865:
856:
855:
848:
841:
824:
823:
819:
814:
787:
776:
709:sydenham chorea
675:
657:Rheumatic fever
643:
629:throat cultures
620:
582:Treatment with
560:
541:
508:
454:puerperal fever
416:; persons with
390:
248:rheumatic fever
157:
63:
28:
23:
22:
15:
12:
11:
5:
3254:
3252:
3244:
3243:
3233:
3232:
3226:
3225:
3222:
3221:
3219:
3218:
3217:
3216:
3203:
3201:
3195:
3194:
3192:
3191:
3190:
3189:
3177:
3170:
3169:
3168:
3155:
3153:
3144:
3138:
3137:
3134:
3133:
3131:
3130:
3122:
3120:
3111:
3110:
3108:
3107:
3106:
3105:
3092:
3090:
3082:Clostridioides
3077:
3076:
3073:
3072:
3070:
3069:
3068:
3067:
3062:
3049:
3047:
3041:
3040:
3038:
3037:
3036:
3035:
3023:
3022:
3021:
3008:
3006:
2997:
2981:
2975:
2974:
2971:
2970:
2967:
2966:
2964:
2963:
2962:
2961:
2948:
2946:
2938:
2937:
2935:
2934:
2933:
2932:
2930:Food poisoning
2920:
2919:
2918:
2905:
2903:
2895:
2894:
2891:
2890:
2888:
2887:
2886:
2885:
2873:
2872:
2871:
2868:S. epidermidis
2855:
2853:
2847:
2846:
2844:
2843:
2842:
2841:
2836:
2831:
2818:
2816:
2807:
2804:Staphylococcus
2796:
2784:
2783:
2780:
2779:
2777:
2776:
2769:
2768:
2767:
2750:
2748:
2740:
2739:
2736:
2735:
2733:
2732:
2721:
2715:
2713:
2707:
2706:
2703:
2702:
2700:
2699:
2698:
2697:
2684:
2682:
2678:
2677:
2675:
2674:
2673:
2672:
2654:
2652:
2646:
2645:
2643:
2642:
2641:
2640:
2635:
2630:
2625:
2620:
2603:
2601:
2592:
2586:
2585:
2582:
2581:
2579:
2578:
2570:
2563:
2556:
2549:
2542:
2530:
2528:
2524:
2523:
2521:
2520:
2519:
2518:
2505:
2503:
2493:
2484:
2473:
2458:
2452:
2451:
2449:
2448:
2439:
2425:
2423:
2422:
2415:
2408:
2400:
2394:
2393:
2384:
2371:
2370:
2367:
2366:
2364:article/971097
2354:
2353:
2351:
2347:
2346:
2343:
2342:
2326:
2321:
2320:
2318:
2317:Classification
2310:
2309:External links
2307:
2306:
2305:
2284:
2281:
2267:
2266:
2217:
2168:
2149:(2): 316–320.
2126:
2076:
2049:(6): 665–673.
2030:
2000:
1950:
1929:10.1086/521264
1923:(7): 853–862.
1903:
1897:
1860:
1823:(4): 478–486.
1799:
1764:
1707:
1678:(2): 163–170.
1658:
1629:
1612:J Lab Clin Med
1601:
1576:Mayo Clin Proc
1565:
1539:
1510:(11): 2393–7.
1487:
1458:
1444:
1401:
1376:
1364:
1311:
1297:10.1086/513636
1290:(6): 1118–21.
1270:
1244:
1218:
1187:(5): 555–567.
1167:
1141:
1120:
1089:
1040:
1014:
995:(11): 685–94.
979:
965:10.1086/521263
933:
875:
846:
839:
816:
815:
813:
810:
786:
783:
775:
772:
768:Aschoff bodies
689:Jones Criteria
674:
671:
670:
669:
664:
659:
654:
649:
642:
639:
619:
616:
608:cephalosporins
577:cephalosporins
559:
556:
540:
537:
507:
504:
444:treatments or
389:
386:
372:
371:
362:
353:
344:
334:
325:
316:
304:
303:
294:
178:immune systems
156:
153:
98:beta-hemolytic
71:
70:
57:
51:
50:
44:
43:
35:
34:
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
3253:
3242:
3239:
3238:
3236:
3215:
3212:
3211:
3210:
3209:
3205:
3204:
3202:
3200:
3196:
3188:
3185:
3184:
3183:
3182:
3178:
3176:
3175:
3171:
3167:
3164:
3163:
3162:
3161:
3157:
3156:
3154:
3152:
3148:
3145:
3143:
3139:
3129:
3128:
3124:
3123:
3121:
3118:
3117:
3112:
3104:
3101:
3100:
3099:
3098:
3094:
3093:
3091:
3088:
3084:
3083:
3078:
3066:
3063:
3061:
3058:
3057:
3056:
3055:
3051:
3050:
3048:
3046:
3042:
3034:
3031:
3030:
3029:
3028:
3024:
3020:
3017:
3016:
3015:
3014:
3010:
3009:
3007:
3005:
3001:
2998:
2995:
2991:
2990:
2985:
2982:
2980:
2976:
2960:
2957:
2956:
2955:
2954:
2950:
2949:
2947:
2945:
2944:
2939:
2931:
2928:
2927:
2926:
2925:
2921:
2917:
2914:
2913:
2912:
2911:
2907:
2906:
2904:
2902:
2901:
2896:
2884:
2883:
2879:
2878:
2877:
2874:
2870:
2869:
2865:
2864:
2863:
2861:
2857:
2856:
2854:
2852:
2848:
2840:
2837:
2835:
2832:
2830:
2827:
2826:
2825:
2824:
2820:
2819:
2817:
2815:
2811:
2808:
2806:
2805:
2800:
2797:
2794:
2789:
2785:
2775:
2774:
2770:
2766:
2763:
2762:
2761:
2760:
2755:
2752:
2751:
2749:
2747:
2746:
2741:
2731:
2730:
2725:
2722:
2720:
2717:
2716:
2714:
2712:
2708:
2696:
2693:
2692:
2691:
2690:
2686:
2685:
2683:
2679:
2671:
2668:
2667:
2666:
2665:
2664:S. agalactiae
2660:
2656:
2655:
2653:
2651:
2647:
2639:
2636:
2634:
2631:
2629:
2628:Scarlet fever
2626:
2624:
2621:
2619:
2616:
2615:
2614:
2613:
2609:susceptible:
2608:
2605:
2604:
2602:
2600:
2596:
2593:
2591:
2587:
2577:
2575:
2571:
2569:
2568:
2564:
2562:
2561:
2557:
2555:
2554:
2550:
2548:
2547:
2543:
2541:
2540:
2535:
2532:
2531:
2529:
2525:
2517:
2514:
2513:
2512:
2511:
2510:S. pneumoniae
2507:
2506:
2504:
2501:
2497:
2494:
2492:
2488:
2485:
2483:
2482:
2481:Streptococcus
2477:
2474:
2471:
2466:
2462:
2459:
2457:
2453:
2447:
2443:
2440:
2438:
2434:
2430:
2427:
2426:
2421:
2416:
2414:
2409:
2407:
2402:
2401:
2398:
2392:
2388:
2385:
2383:
2379:
2376:
2375:
2365:
2361:
2360:
2356:
2355:
2352:
2348:
2341:
2337:
2336:
2332:
2328:
2327:
2324:
2319:
2315:
2308:
2302:
2298:
2294:
2293:
2287:
2286:
2282:
2280:
2278:
2274:
2262:
2258:
2254:
2250:
2245:
2240:
2236:
2232:
2228:
2221:
2218:
2213:
2209:
2204:
2199:
2195:
2191:
2187:
2183:
2179:
2172:
2169:
2164:
2160:
2156:
2152:
2148:
2144:
2137:
2135:
2133:
2131:
2127:
2122:
2118:
2114:
2110:
2106:
2102:
2098:
2094:
2087:
2085:
2083:
2081:
2077:
2072:
2068:
2064:
2060:
2056:
2052:
2048:
2044:
2037:
2035:
2031:
2026:
2022:
2018:
2014:
2010:
2004:
2001:
1996:
1992:
1987:
1982:
1978:
1974:
1970:
1966:
1962:
1954:
1951:
1946:
1942:
1938:
1934:
1930:
1926:
1922:
1918:
1910:
1908:
1904:
1900:
1898:9781475711424
1894:
1890:
1886:
1882:
1875:
1873:
1871:
1869:
1867:
1865:
1861:
1856:
1852:
1847:
1842:
1838:
1834:
1830:
1826:
1822:
1818:
1814:
1806:
1804:
1800:
1795:
1791:
1787:
1783:
1779:
1775:
1768:
1765:
1760:
1756:
1751:
1746:
1742:
1738:
1734:
1730:
1726:
1722:
1718:
1711:
1708:
1703:
1699:
1695:
1691:
1686:
1681:
1677:
1673:
1669:
1662:
1659:
1647:
1643:
1636:
1634:
1630:
1625:
1621:
1617:
1613:
1605:
1602:
1597:
1593:
1589:
1585:
1581:
1577:
1569:
1566:
1553:
1549:
1543:
1540:
1535:
1531:
1526:
1521:
1517:
1513:
1509:
1505:
1501:
1494:
1492:
1488:
1475:
1471:
1465:
1463:
1459:
1454:
1448:
1445:
1439:
1434:
1429:
1424:
1420:
1416:
1412:
1405:
1402:
1391:on 2007-12-19
1390:
1386:
1380:
1377:
1374:
1368:
1365:
1354:on 2008-06-25
1350:
1346:
1342:
1339:(4): 354–61.
1338:
1334:
1327:
1320:
1318:
1316:
1312:
1307:
1303:
1298:
1293:
1289:
1285:
1281:
1274:
1271:
1259:
1255:
1248:
1245:
1233:
1229:
1222:
1219:
1214:
1210:
1205:
1200:
1195:
1190:
1186:
1182:
1178:
1171:
1168:
1155:
1151:
1145:
1142:
1130:
1124:
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818:
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809:
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798:streptococcal
795:
794:tic disorders
791:
784:
782:
780:
773:
771:
769:
765:
760:
758:
753:
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746:
744:
740:
735:
733:
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725:
721:
717:
712:
710:
706:
702:
698:
697:polyarthritis
694:
690:
685:
681:
679:
672:
668:
665:
663:
662:Scarlet fever
660:
658:
655:
653:
650:
648:
645:
644:
641:Complications
640:
638:
635:
630:
626:
617:
615:
611:
609:
605:
600:
596:
593:
589:
585:
580:
578:
574:
570:
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549:
545:
538:
536:
534:
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522:
518:
517:Streptococcus
512:
505:
503:
500:
496:
495:Health Canada
492:
491:Public health
488:
486:
480:
478:
474:
470:
466:
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443:
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377:
370:
366:
363:
361:
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354:
352:
348:
345:
342:
338:
335:
333:
329:
328:osteomyelitis
326:
324:
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298:
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293:
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242:
238:
234:
230:
226:
222:
216:
214:
213:Scarlet fever
210:
206:
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193:
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187:
182:
179:
175:
171:
167:
163:
154:
152:
150:
146:
142:
138:
137:
132:
131:
127:
123:
122:
121:Streptococcus
116:
114:
110:
105:
102:
99:
95:
91:
87:
86:
81:
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3179:
3172:
3158:
3125:
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3095:
3080:
3060:Gas gangrene
3052:
3044:
3025:
3011:
3003:
2987:
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2922:
2908:
2898:
2880:
2875:
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2858:
2821:
2802:
2771:
2757:
2745:Enterococcus
2743:
2727:
2687:
2662:
2617:
2610:
2598:
2574:S. anginosus
2573:
2565:
2560:S. sanguinis
2558:
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2544:
2537:
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2329:
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2234:
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2016:
2003:
1968:
1964:
1953:
1920:
1916:
1880:
1820:
1816:
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1777:
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1767:
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1649:. Retrieved
1645:
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1579:
1575:
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1552:the original
1542:
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1473:
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1389:the original
1379:
1367:
1356:. Retrieved
1349:the original
1336:
1332:
1287:
1283:
1273:
1261:. Retrieved
1257:
1247:
1235:. Retrieved
1231:
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1180:
1170:
1160:November 21,
1158:. Retrieved
1154:the original
1144:
1132:. Retrieved
1123:
1111:. Retrieved
1107:the original
1057:
1054:Cell Reports
1053:
1043:
1031:. Retrieved
1026:
1017:
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955:
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866:. Retrieved
862:the original
830:
820:
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777:
761:
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747:
739:mitral valve
736:
732:pericarditis
713:
701:subcutaneous
695:, migratory
686:
682:
676:
621:
618:Epidemiology
612:
603:
601:
597:
581:
569:erythromycin
561:
551:
547:
543:
542:
526:
520:
516:
489:
481:
473:blood counts
458:
446:chemotherapy
422:burn victims
391:
379:
375:
373:
307:Less common:
306:
305:
297:strep throat
258:Most common:
257:
256:
245:
217:
201:strep throat
194:
183:
158:
134:
128:
124:, including
119:
117:
106:
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75:
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3214:Erysipeloid
2989:Clostridium
2959:Listeriosis
2862:susceptible
2612:S. pyogenes
2567:S. sobrinus
2502:susceptible
1134:21 November
1113:21 November
1033:21 November
926:24 December
693:pancarditis
625:serological
610:is common.
604:S. pyogenes
592:clindamycin
552:S. pyogenes
548:S. pyogenes
544:S. pyogenes
205:pharyngitis
113:antibiotics
94:S. pyogenes
3142:Mollicutes
3116:Finegoldia
3045:nonmotile:
2979:Clostridia
2860:novobiocin
2788:Bacillales
2633:Erysipelas
2607:bacitracin
2145:(Review).
2095:(Review).
2045:(Review).
1651:7 December
1618:(5): 839.
1480:7 December
1395:2007-12-11
1358:2008-05-09
812:References
728:arthralgia
573:macrolides
539:Prevention
533:blood agar
529:Gram stain
483:increased
477:urinalysis
426:cellulitis
414:chickenpox
410:fat tissue
347:meningitis
313:bacteremia
272:erysipelas
268:cellulitis
241:bacteremia
188:or in the
170:epigenetic
166:phenotypic
149:hemolysins
80:infections
3089:-forming)
2996:-forming)
2823:S. aureus
2681:ungrouped
2659:CAMP test
2553:S. oralis
2546:S. mutans
2429:Bacillota
2359:eMedicine
2237:: 51–65.
2099:: 39–44.
1937:1058-4838
1837:1058-4838
1774:J Pediatr
1741:1058-4838
1694:1198-743X
703:nodules,
558:Treatment
506:Diagnosis
365:pneumonia
356:sinusitis
337:vaginitis
237:pneumonia
145:M protein
55:Specialty
3235:Category
3019:Botulism
2943:Listeria
2900:Bacillus
2539:S. mitis
2500:optochin
2301:26866208
2261:40827012
2253:29309797
2212:30996598
2163:29398245
2121:13681480
2113:29689421
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2063:28915150
2025:28379675
1995:34348475
1945:17806049
1855:27105747
1759:29788397
1702:14759242
1646:Medscape
1624:14784714
1596:18674472
1534:23863455
1345:15786581
1263:July 19,
1237:July 12,
1213:36881216
1084:31801066
1009:16253886
974:17806050
921:31506299
634:sequelae
571:, other
430:diabetes
394:bacteria
351:meninges
264:impetigo
231:(STSS),
209:impetigo
3033:Tetanus
3004:motile:
2916:Anthrax
2456:Bacilli
2203:6462125
1986:8475057
1846:5776658
1794:3903089
1750:6186853
1558:15 June
1525:3981849
1474:CDC.gov
1438:4474978
1306:9195067
1204:9989989
1075:6951797
912:6802508
442:steroid
404:, deep
360:sinuses
301:pharynx
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716:DNAase
707:, and
575:, and
521:Strep.
467:, and
438:cancer
406:muscle
341:vagina
323:joints
292:muscle
288:fascia
270:, and
239:, and
235:(NF),
225:organs
190:throat
133:, and
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3087:spore
2994:spore
2576:group
2431:(low-
2340:B95.0
2257:S2CID
2117:S2CID
2067:S2CID
1476:. CDC
1352:(PDF)
1329:(PDF)
590:, or
469:death
461:shock
436:, or
402:lungs
398:blood
332:bones
221:blood
109:mucus
82:with
2839:MRSA
2793:Cat+
2470:Cat-
2297:PMID
2249:PMID
2208:PMID
2159:PMID
2109:PMID
2059:PMID
2021:PMID
1991:PMID
1941:PMID
1933:ISSN
1893:ISBN
1851:PMID
1833:ISSN
1790:PMID
1755:PMID
1737:ISSN
1698:PMID
1690:ISSN
1653:2014
1620:PMID
1592:PMID
1560:2012
1530:PMID
1482:2014
1341:PMID
1302:PMID
1265:2012
1239:2012
1209:PMID
1162:2012
1136:2012
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1080:PMID
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806:PANS
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2190:doi
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1981:PMC
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