Among the large family of streptococci, the most dangerous is group A hemolytic streptococcus, formerly known as Streptococcus pyogenes, the pusproducing streptococcus. This is responsible for several diseases that in the past have had great public health importance, and still do in developing countries. Streptococcus pyogenes was the principal cause of puerperal sepsis, or childbed fever, once a leading cause of death in the immediate postpartum period when delivery of the baby introduced virulent pathogenic organisms into the birth canal and uterus. Streptococcal tonsillitis is a precursor of rheumatic fever and acute nephritis when the toxin produced by the invading pathogens provokes an autoimmune response. Streptococcal infection also causes scarlet fever, formerly a common and sometimes deadly infection of early childhood.
All these diseases have become rare since the discovery and development of chemotherapy and antibiotics to which the streptococcus is sensitive. However, streptococcal infection has not become extinct. Erysipelas, a skin infection, remains common; streptococcal septicemia occurs occasionally; and the rare but dramatic streptococcal cellulitis, known as flesh-eating disease, captures headlines when it attacks, disfigures, and sometimes kills a previously healthy young adult. Humans are the main reservoir of infection, which is transmitted person-to-person by direct contact or droplet spread, with a brief incubation period of one to three days.
Outbreaks of all these forms of streptococcal infection occur when social and economic conditions deteriorate, as in post–Soviet Russia and its satellites, and in many of the world's combat zones where hygiene and public health facilities are rudimentary or have deteriorated to the stage of being ineffectual. Treatment of streptococcal infection relies on antibiotics, and prevention requires good hygiene, cleanliness, and education about ways to minimize the risks of transmission of this and other pathogens.
JOHN M. LAST