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Key Features

  • Non-group A hemolytic streptococci (eg, groups B, C, and G) produce a spectrum of disease similar to that of group A β-hemolytic streptococci

  • Viridans streptococci are part of the normal oral flora but may produce focal pyogenic infection

Clinical Findings

  • Group B streptococci

    • An important cause of sepsis, bacteremia, and meningitis in the neonate

    • Antepartum screening vaginal cultures are recommended to identify carrier mothers

    • May cause septic abortion, endometritis, or peripartum infections in women and, less commonly, cellulitis, bacteremia, and endocarditis in adults

  • Group D streptococci

    • Include Streptococcus bovis and the enterococci

    • S bovis is a cause of endocarditis in association with colorectal cancer or cirrhosis

  • Viridans streptococci

    • Nonhemolytic or α-hemolytic (ie, producing a green zone of hemolysis on blood agar)

    • Leading cause of native valve endocarditis

Diagnosis

  • Culture of affected site or blood

Treatment

  • Non-group A hemolytic streptococci (eg, groups B, C, and G

    • Give penicillin G aqueous, 4 million units every 4 hours intravenously

    • Vancomycin, 1 g intravenously every 12 hours, is recommended for persons allergic to penicillin

  • Group B streptococci

    • Addition of low-dose gentamicin, 1 mg/kg every 8 hours is recommended by some experts because of in vitro synergism

    • Peripartum antimicrobial prophylaxis is recommended

  • Viridans streptococci

    • Give penicillin with or without addition of gentamicin

    • Alternatives are cephalosporin and vancomycin

  • S bovis infection treated like viridans streptococci

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