Alpha-hemolytic strep: therapy and trigger

The Bottom Line: The exact mechanism(s) where AHS bacteremia leads to septic shock, pneumonia and acute respiratory distress in neutropenic patients is unclear, but it seemingly differs from Gram-negative septic shock. . Predisposing factors to AHS among patients with cancer include mucositis, profound neutropenia, high intensity chemotherapy and, at for patients under 10, acute monocytic leukemia. It is not clear why infection by these organisms appears to have increased recently, but this may reflect changes in cancer management rather than changes in the microbe. There is evidence early administration of vancomycin may provide a survival advantage in AHS. AHS patients that received empiric vancomycin had a significantly improved outcome over patients whose vancomycin was delayed until microbial identification.

Bruckner. Alpha-hemolytic streptococcal infections among immunocompromised hosts: increasing incidence, severity and antibiotic resistance. The Pediatric infectious disease journal 2002 vol:21 iss:4 pg:343 -345

Summary: Alpha-hemolytic streptococci are a diverse group of strep. It is present in human oral flora and can be part of the normal bacterial flora of the GI tract. AHS is not typically virulent, it typically causes infection only when normal immune mechanisms are compromised.

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