Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 33-01: Streptococcal Infections + Key Features Download Section PDF Listen +++ ++ Arthritis, pneumonia, empyema, endocarditis, and necrotizing fasciitis are relatively uncommon infections that may be caused by group A beta-hemolytic streptococci + Clinical Findings Download Section PDF Listen +++ ++ Arthritis generally occurs in association with cellulitis Pneumonia and empyema often are characterized by Extensive tissue destruction Aggressive, rapidly progressive clinical course Endocarditis (rare) Should be suspected when bacteremia accompanies pneumonia, particularly if the patient uses injection drugs Tricuspid valve is most commonly involved Necrotizing fasciitis Rapidly spreading infection involving the fascia of deep muscle Clinical findings at presentation range from severe cellulitis to systemic toxicity and severe pain Any streptococcal infection, especially necrotizing fasciitis, can be associated with streptococcal toxic shock syndrome, characterized by invasion of skin or soft tissues, acute respiratory distress syndrome, and kidney failure + Diagnosis Download Section PDF Listen +++ ++ Culture of affected site or blood + Treatment Download Section PDF Listen +++ ++ Arthritis Penicillin G aqueous, 2 million units every 4 hours intravenously Frequent percutaneous needle aspiration Pneumonia/empyema Penicillin G aqueous, 4 million units every 4 hours intravenously Chest tube drainage for treatment of the empyema Endocarditis Penicillin G aqueous, 4 million units every 4 hours intravenously for 4 weeks Vancomycin, 1 g intravenously every 12 hours, is recommended for persons allergic to penicillin Necrotizing fasciitis: early, extensive débridement is essential for survival Toxic shock syndrome Penicillin G aqueous 4 million units every 4 hours intravenously Consider the addition of clindamycin, 600 mg every 8 hours intravenously, to halt toxin production, and intravenous immune globulin, 0.5 g/kg once daily for 5–6 days or a single dose of 2 g/kg with a repeat dose at 48 hours if the patient remains unstable