Epidemics are usually caused by strains resistant
to penicillin. The reservoir is man. The incuba-
tion period for most problems is usually from 4
to 10 days. Transmission is usually be direct con-
tact with a person who has a purulent lesion or
is an asymptomatic carrier. The anterior aspect
of the nasal canal is the major site of coloniza-
tion for carriers.
Staphylococcal disease is communicable as
long as purulent lesions are present or the carrier
state continues. Autoinfection can continue
throughout the period of nasal colonization or as
long as a purulent lesion exists.
Preventive measures involve education on per-
sonal hygiene to groups at risk as well as ap-
propriate wound/abscess management and
Isolation of patients is not practical in most
communities. However, patients with infections
should avoid contact with the newborn and
chronically ill, who are most at risk.
When outbreaks occur in homes, offices, or
on ships, etc., an investigation should be done to
look for common sources (index cases).
Streptococcal Disease (Group A Type)
Streptococcal sore throat presents symptoms
of tonsillitis or pharyngitis, fever, and tender
anterior lymph nodes. The pharynx, tonsils, and
soft palate may be red and swollen. Otitis media,
peritonsillar abscesses, glomerulonephritis, and
rheumatic heart disease are complications that
Streptococcal skin infections such as impetigo
may occur. These occur as vesicles, pustules, and
then crusting lesions.
Scarlet fever is a type of streptococcal disease;
it is characterized by a skin rash that occurs when
the invading strain of streptococcus produces a
toxin to which the patient is sensitized. Other
symptoms may include a sore throat, wound or
skin infection, strawberry tongue, and exanthem.
High fever, nausea, and vomiting occur often with
Erysipelas is a form of severe streptococcal
cellulitis that is accompanied by fever. Skin le-
sions are red, tender, swollen, and spreading. The
center point of origin usually clears as the
periphery extends. The periphery of the lesion fre-
quently has a definite raised border.
The diagnosis of streptococcal disease is
established by a culture of organisms from the af-
Streptococcal diseases in the United States may
be endemic or sporatic. Foodborne epidemics oc-
cur in any season. Military and school popula-
tions are frequently affected. The incidence rate
is highest in the 3- to 15-year-old age group.
The reservoir of streptococcal disease is man.
Streptococcal diseases are usually transmitted by
direct contact with a patient or carrier and rarely
through contact with the hands or objects. Strep-
tococcal sore throat may be transmitted by con-
taminated food causing sudden large outbreaks
The incubation period is for 1 to 3 days, occa-
sionally longer. Untreated cases will often resolve
spontaneously after a few weeks. Treatment is
given to reduce communicability and to prevent
The specific antibiotic treatment is penicillin.
For those patients sensitive to penicillin,
erythromycin is the preferred alternative.
Preventive measures include (1) making
laboratory facilities available for the diagnosis of
group A hemolytic streptococcal diseases; (2) en-
suring public education concerning methods of
transmission, seriousness of complications, and
the necessity of taking the full prescribed course
of antibiotic therapy; (3) educating food service
personnel on proper hygiene and food prepara-
tion techniques to prevent contamination with the
bacteria; (4) excluding individuals with respiratory
illness or skin lesions from food handling; and
(5) prescribing long-term antibiotic prophylaxis
with penicillin for those individuals at special risk
(e.g., with a history of recurrent erysipelas or
rheumatic fever). Patients with streptococcal
disease should be educated about proper
During outbreaks of streptococcal disease, in-
vestigations should find the source and method
Tetanus is a serious disease caused by an ex-
otoxin produced by the tetanus bacillus, which
grows under anaerobic conditions in the site of
an injury. Symptoms include painful muscular
contractions, usually of the jaw and neck muscles
and secondarily in the trunk muscles. Commonly
the first symptom is abdominal rigidity and
sometimes rigidity of the muscles in the region of
the wound. Often generalized muscles spasms oc-
cur that are induced by sensory stimuli. The fa-
tality rate will range from 30 to 90 percent.
Laboratory confirmation is of little value because