I.

ACUTE GLOMERULONEPHRITIS
This sometimes develops 3 weeks after streptococcal infection,
particularly with M types 12, 4, 2, and 49. Glomerulonephritis may be
initiated by antigen-antibody complexes on the glomerular basement
membrane. The most important antigen is probably in the
streptococcal protoplast membrane.
II. CAUSATIVE ORGANISM
STREPTOCOCCUS
PYOGENES
(GABS):
-hemolytic
colonies,
Bacitracin sensitive, PYR (+) hydrolysis of L-pyrrolidonyl-2naphthylamide) and contain the group A antigen
-

Serotype 12 - Poststreptococcal nephritis due to an upper

respiratory infection, occurring primarily in the winter months
Serotype 49 - Poststreptococcal nephritis due to a skin infection,
usually observed in the summer and fall

III. MANNER OF TRANSMISSION

It spread by respiratory droplets or by direct contact.
IV. PROMINENT AND IMPORTANT CLINICAL MANIFESTATION
Acute glomerulonephritis may include pink or cola-colored urine
from red blood cells in your urine (hematuria), foamy urine due to
excess protein (proteinuria), high blood pressure (hypertension), fluid
retention (edema) with swelling evident in your face, hands, feet and
abdomen, fatigue from anemia or kidney failure
V. PATHOGENESIS AND PATHOLOGY
Hyaluronic acid capsule (a polysaccharide) is non-immunogenic;
inhibits phagocytic uptake and the the M-protein which is a virulence
factor, antiphagocytic, used to type group A strep; M12 strains
associated with acute glomerulonephritis. Its spreading factors include
the Streptokinase that breaks down fibrin clot, the Streptococcal DNAse
which liquefies pus and extension of lesion and hyaluronidase that
hydrolyzes the ground substances of connective tissues which is also
important to spread in cellulitis.
VI. PROCEDURE NEEDED FOR DIAGNOSIS
a. SPECIMEN NEEDED
- throat swab, pus, or blood is obtained for culture
- Serum is obtained for antibody determinations
b. LABORATORY TECHNIQUES OR METHODS NEEDED FOR DIAGNOSIS
1. Smears from pus often show single cocci or pairs rather than
definite chains.

2. Culture on blood agar

3. Antigen Detection Tests
4. Kidney Biopsy
c. EXPECTED POSITIVE RESULTS
1. If smears of pus show streptococci but cultures fail to grow,
anaerobic organisms must be suspected
2. Oxygen inactivates streptolysin O. Blood cultures will grow
hemolytic group A streptococci. Group A streptococci can be
rapidly identified by a fluorescent antibody test, the PYR test, and
by rapid tests specific for the presence of the group A-specific
antigen. Streptococci belonging to group A may be presumptively
identified by inhibition of growth by bacitracin
3. Antigen Detection Tests use enzymatic or chemical methods to
extract the antigen from the swab, then use EIA or agglutination
tests to demonstrate the presence of the antigen
d. LIMITATION OF THE PROCEDURE
The resistance to streptococcal diseases is type specific. M
protein interferes with phagocytosis, but in the presence of typespecific antibody to M protein, streptococci are killed by human
leukocytes.