Answer
Rheumatic fever is most frequently observed in the age group most susceptible to group A streptococcal infections (ie, children aged 5-15 y). The attack rate following upper respiratory tract infection is approximately 3% in individuals with untreated or inadequately treated infection.
ARF is commonly seen in young adults or children aged 4-9 years, while PSGN is more common in persons older than 60 years and in children younger than 15 years.
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Media Gallery
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Invasive soft tissue infection due to Streptococcus pyogenes. This child developed fever and soft-tissue swelling on the fifth day of a varicella-zoster infection. Leading edge aspirate of cellulitis grew S pyogenes. Although the patient responded to intravenous penicillin and clindamycin, operative débridement was necessary because of clinical suspicion of early necrotizing fasciitis.
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Streptococcus group A infections. Beta hemolysis is demonstrated on blood agar media.
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Streptococcus group A infections. M protein.
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Streptococcus group A infections. Erysipelas is a group A streptococcal infection of skin and subcutaneous tissue.
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Streptococcus group A infections. White strawberry tongue observed in streptococcal pharyngitis. Image courtesy of J. Bashera.
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Streptococcus group A infections. Streptococcal rash. Image courtesy of J. Bashera.
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Group A Streptococcus on Gram stain of blood isolated from a patient who developed toxic shock syndrome.
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Streptococcus group A infections. Necrotizing fasciitis of the left hand in a patient who had severe pain in the affected area.
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Streptococcus group A infections. Patient who had had necrotizing fasciitis of the left hand and severe pain in the affected area (from Image 8). This photo was taken at a later date, and the wound is healing. The patient required skin grafting.
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Streptococcus group A infections. Gangrenous streptococcal cellulitis in a patient with diabetes.
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Erythema secondary to group A streptococcal cellulitis.
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Invasive soft tissue infection due to Streptococcus pyogenes. This child developed fever and soft-tissue swelling on the fifth day of a varicella-zoster infection. Leading edge aspirate of cellulitis grew S pyogenes. Although the patient responded to intravenous penicillin and clindamycin, operative débridement was necessary because of clinical suspicion of early necrotizing fasciitis.
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Streptococcus group A infections. Necrotizing fasciitis rapidly progresses from erythema to bullae formation and necrosis of skin and subcutaneous tissue.
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Throat swab. Video courtesy of Therese Canares, MD; Marleny Franco, MD; and Jonathan Valente, MD (Rhode Island Hospital, Brown University).
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