Tasty Morsels of EM 101 – #FRCEM Post strep complications

1 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here

Group A strep (or strep pyogenes) causes all kinds of interesting infections with some even more interesting and weird post infectious complications.

What Types of infection does GAS cause?

  • Invasive
    • toxic shock (can be strep or staph)
    • necrotising fasciits
    • pneumonia
    • osteo
    • bacteraemia
  • Non invasive

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describe some Post strep issues?

  • erythema nodosum
    • strep
    • mycoplasma
    • sarcoid
    • TB
    • inflammatory bowel disease
    • OCP and even NSAIDS
  • rheumatic fever
  • glomerulonephritis
    • coke urine
    • +ve BLD/PROT on dipstick
    • hypertension
  • the funny neuro one – PANDAS (though there’s some controversy there)

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what is rheumatic fever and how is it treated?

of note we covered this before… were you not paying attention…

  • migratory polyarthritis
  • Jones Criteria
    • evidence of prior strep (basically an ASOT but can be clinical)
    • plus 2 major or 1 major and 2 minor
      • Major
      • Minor
        • raised inflammatory markers
        • arthralgia
        • fever
        • 1 degree block
  • Give penicillin (GAS has never been able to form resistance)
  • Of note penicillin for strep infections can prevent rheumatic fever but none of the other post strep diseases

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