Case of group A streptococcus infection showing“Doughnut” Lesions

Dr Akira Kobayashi, M.D. at Nanmei-kai Miyagami Hospital, Kagoshima, Japan and colleagues have reported a rare case of Doughnut” Lesions due to group A streptococcus infection. The case has appeared in the NEJM.

Infection with Streptococcus pyogenes, a beta-hemolytic bacterium that belongs to Lancefield serogroup A, also known as the group A streptococci (GAS), causes a wide variety of diseases in humans. Along with Staphylococcus aureus, group A streptococcus is one of the most common pathogens responsible for cellulitis. Infection with this pathogen is also causally linked to 2 potentially serious nonsuppurative complications: acute rheumatic fever (ARF) and acute glomerulonephritis. In addition to this, infection with S pyogenes has reemerged as an important cause of toxic shock syndrome (TSS) and of life-threatening skin and soft-tissue infections, especially necrotizing fasciitis

In the instant case, an otherwise healthy 9-year-old girl presented to the primary care clinic with a sore throat and fever. Her temperature was 38.5°C. Physical examination revealed swollen and tender cervical lymph nodes, an inflamed uvula, enlarged tonsils, and “doughnut” lesions on both the hard and soft palates.

A rapid antigen detection test for group A streptococcus was positive. Throat culture confirmed group A beta-hemolytic streptococcus. “Doughnut” lesions are erythematous papules with a pale centre that may be present on both the soft and hard palates.

The presence of these lesions is a clinical sign that has historically been associated with group A Streptococcus pharyngitis. The patient was treated with a 10-day course of oral amoxicillin and recovered without complication.

The fastest cure for strep is with the antibiotics penicillin or amoxicillin, according to the CDC. It is important to get treated because in the unlikely event strep spreads, one can experience ear and sinus infections or even more serious conditions like rheumatic fever and rheumatic heart disease.

For more details click on the link: DOI: 10.1056/NEJMicm1810556