Streptococcus Pyogenes 263 



Pathogenesis. The streptococcus has been found in 

 erysipelas, ulcerative endocarditis, periostitis, otitis, men- 

 ingitis, emphysema, pneumonia, lymphangitis, phlegmons, 

 sepsis, puerperal endometritis, and many other forms of 

 inflammation and septic infection. In man, it is usually 

 associated with active forms of suppuration and sepsis. 



The relation of the streptococcus to diphtheria is of 

 interest, for, though in all probability the great majority of 

 cases of pseudomembranous angina are caused by the 

 Klebs-Loffler bacillus, yet a number are met with in which, 

 as in Prudden's twenty-four cases, no diphtheria bacilli can 

 be found, but which seem to be caused by the streptococcus. 



There is no clinical difference between the throat-lesions 

 produced by the two organisms, and the only positive 

 method of differentiating the one from the other is by means 

 of a careful bacteriologic examination. Such an examina- 

 tion should always be made, as it has much weight in con- 

 nection with the treatment; in streptococcus angina no 

 benefit can be expected from the administration of diphtheria 

 antitoxic serum. 



Hirsh* has shown that streptococci are by no means rare 

 in the intestines of infants, where they may occasion enter- 

 itis. In such cases the organisms are found in large num- 

 bers in the stomach and in the stools, and late in the course 

 of the disease in the blood and urine of the child. They 

 also occur in all of the internal organs of the cadaver. 



Libmanf has reported two carefully studied cases of 

 streptococcic enteritis. 



Flexner,J in a large series of autopsies, found the bodies 

 invaded by numerous micro-organisms, causing what he has 

 called "terminal infections," and hastening the fatal issue. 

 Of 793 autopsies at the Johns Hopkins Hospital, 255 upon 

 cases dying of chronic heart or kidney diseases, or both, were 

 sufficiently well studied, bacteriologically, to meet the re- 

 quirements of a statistical inquiry. Tuberculous infections 

 were not included. Of the 255 cases, 213 gave positive 

 bacteriologic results. "The micro-organisms causing the in- 

 fections, 38 in all, were Streptococcus pyogenes, 16 cases; 

 Staphylococcus pyogenes aureus, 4 cases; Micrococcus lan- 



* "Centralbl. f. Bakt. u. Parasitenk.," Bd. xxn, Nos. 14 and 15, 

 p. 369. 



^ Ibid., Bd. xxii, Nos. 14 and 15, p. 376. 



J "Journal of Experimental Medicine," vol. i, No. 3, 1896. 



