Clinical presentations of group A streptococcal  infection.

• Pharyngitis: Sorethroat, fever, cervical lymphadenopathy, swollen red tonsils with white or yellow patches

• Rheumatic fever: Auto-immune process. Systemic inflammation affecting Heart, Joints and Skin.

• Acute Glomerulonephritis: Auto-immune process.

• Toxic shock syndrome:  Pyrogenic exotoxins A,B or C. Stimulates T cells to release of Cytokines. Shock and failure of multiple organs. Superantigens

• Scarlet fever is a manifestation of group A streptococcal pharyngitis in which the infecting strain produces a specific virulence factor called erythrogenic toxin, which is coded for by a phage.

  • Production of this toxin is manifested clinically by the appearance of a scarlatinal (bright red) rash beginning on the chest and spreading to the trunk and neck, then to the extremities. The rash is not seen on the face, or the palms or soles. 

  • A "strawberry" tongue is frequently seen with this disease as well. 

  • Rheumatic fever can be a post-streptococcal sequela of scarlet fever just as it may be follow strep throat caused by strains which do not produce erythrogenic toxin. 

• Necrotizing Fascitis: Bacterial infection of fibrous tissue that covers the body beneath the skin. "Flesh eating bacteria" . Significant mortality.