Allen James, Munoz Christine, Byakova Alla, Pachulski Roman
Internal Medicine, St. John's Episcopal Hospital, New York, USA.
Cardiology, St. John's Episcopal Hospital, New York, USA.
Cureus. 2022 Jul 26;14(7):e27282. doi: 10.7759/cureus.27282. eCollection 2022 Jul.
Group A beta-hemolytic streptococcus (GAS) is a gram-positive bacteria found in the upper respiratory tract that can cause disease with a wide gamut of symptoms ranging from pharyngitis to peritonsillar abscess, pneumonia, meningitis, and acute rheumatic fever (ARF). The primary goal of antibiotic therapy is to prevent complications of the primary infection such as ARF. ARF is defined by the revised Jones criteria. The Jones criteria have been modified to account for the moderate- to high-risk populations. The mechanism of the development of ARF from pharyngitis is not well understood, but the leading theory is molecular mimicry. The host's own immune system that responds to bacterial virulence factors develops autoantibodies that attack the host tissue. ARF typically develops two to four weeks post pharyngitis. Markers such as antistreptolysin O rise by week 2-3. The rapid streptococcal antigen is often negative by the time ARF develops. We present a case of a 23-year-old male with no past medical history who presented with a chief complaint of fever and sore throat for one week associated with new-onset chest pain. The patient had a fever with normal blood pressure. Labs showed mild leukocytosis, elevated troponin I, and positive Group A strep polymerase chain reaction (PCR). He was initially treated with aspirin 81 mg, antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs) in the emergency room. The patient was subsequently started on prednisone 60 mg as he showed no clinical improvement. His initial echocardiography (ECHO) showed a left ventricular ejection fraction (LVEF) of 55%. Repeat ECHO showed LVEF of 45% with regional wall motion abnormalities (RWMA). His cardiac troponin continued to rise with EKG changes on day 7. With the addition of steroids, the patient's clinical symptoms, as well as EKG and ECHO findings, improved. The patient was discharged with penicillin benzathine for 12 weeks. Case reports of acute carditis presenting concomitantly with pharyngitis are limited. The diagnosis of post-streptococcus complications relies on antistreptolysin O titer (ASOT) serology. With the increased availability of more acute diagnostic markers such as PCR, troponin, and ECHO, GAS confirmation can potentially be obtained within one hour and maybe in the future in the diagnosis of early-onset ARF.
A组β溶血性链球菌（GAS）是一种在上呼吸道发现的革兰氏阳性细菌，可引发一系列症状的疾病，从咽炎到扁桃体周围脓肿、肺炎、脑膜炎和急性风湿热（ARF）。抗生素治疗的主要目标是预防原发性感染的并发症，如ARF。ARF由修订后的琼斯标准定义。琼斯标准已被修改以适用于中高风险人群。咽炎发展为ARF的机制尚不完全清楚，但主要理论是分子模拟。宿主自身对细菌毒力因子作出反应的免疫系统会产生攻击宿主组织的自身抗体。ARF通常在咽炎后两到四周出现。抗链球菌溶血素O等标志物在第2 - 3周时升高。当ARF出现时，快速链球菌抗原检测通常为阴性。我们报告一例23岁男性病例，既往无病史，主要症状为发热、咽痛一周，伴有新发胸痛。患者发热，血压正常。实验室检查显示轻度白细胞增多、肌钙蛋白I升高，A组链球菌聚合酶链反应（PCR）呈阳性。他在急诊室最初接受了81毫克阿司匹林、抗生素和非甾体抗炎药（NSAIDs）治疗。由于患者没有临床改善，随后开始使用60毫克泼尼松。他最初的超声心动图（ECHO）显示左心室射血分数（LVEF）为55%。复查ECHO显示LVEF为45%，伴有局部室壁运动异常（RWMA）。第7天，他的心肌肌钙蛋白持续升高，伴有心电图变化。加用类固醇后，患者的临床症状以及心电图和ECHO检查结果均有所改善。患者出院时接受苄星青霉素治疗12周。咽炎同时并发急性心肌炎的病例报告有限。链球菌感染后并发症的诊断依赖于抗链球菌溶血素O滴度（ASOT）血清学检查。随着PCR、肌钙蛋白和ECHO等更快速诊断标志物的可用性增加，GAS的确诊可能在一小时内完成，也许在未来可用于早期ARF的诊断。
