Epidemics are usually caused by strains resistant to penicillin. The reservoir is man. The incubation period for most problems is usually from 4 to 10 days. Transmission is usually be direct contact 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 colonization 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 personal hygiene to groups at risk as well as appropriate wound/abscess management and antibiotics.
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 may follow.
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 severe cases.
Erysipelas is a form of severe streptococcal cellulitis that is accompanied by fever. Skin lesions are red, tender, swollen, and spreading. The center point of origin usually clears as the periphery extends. The periphery of the lesion frequently has a definite raised border.
The diagnosis of streptococcal disease is established by a culture of organisms from the affected tissue.
Streptococcal diseases in the United States may be endemic or sporatic. Foodborne epidemics occur in any season. Military and school populations 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. Streptococcal sore throat may be transmitted by contaminated food causing sudden large outbreaks of cases.
The incubation period is for 1 to 3 days, occasionally longer. Untreated cases will often resolve spontaneously after a few weeks. Treatment is given to reduce communicability and to prevent serious complications.
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) ensuring 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 preparation 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 throat/wound hygiene.
During outbreaks of streptococcal disease, investigations should find the source and method of spread.
Tetanus (Lockjaw)
Tetanus is a serious disease caused by an exotoxin 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 occur that are induced by sensory stimuli. The fatality rate will range from 30 to 90 percent. Laboratory confirmation is of little value because