Group A streptococci have surface molecules of lipoteichoic acid and protein F which aid in the adhesion to host cells. Once adhered, it releases streptolysin and hyaluronidase to further degrade host tissues, enabling a deeper colonization. In addition to attachment and dissemination factors, Group A streptococci are also encapsulated and have other varying protein factors that defend it from host immunity. Mechanism
The most common symptom associated with streptococcal associated intertrigo is erysipelas, an infection of the upper or superficial layers of the skin. This infection is mostly associated with group A beta-hemolytic streptococcal bacteria (GABHS) since they are normally found in the skin flora. This group of bacteria typically invades and affects the lymphatic vessels, often leading to a localized inflammation. The infection can be recognized by tongue-like or irregular extensions of the rash, accompanied by systemic symptoms such as fever, chills, or a general feeling of discomfort. Once in the lymphatic system of the host, GABHS can easily disseminate systemically to produce effects. Risk Factors
Streptococcal intertrigo occurs when bacteria penetrates the skin. Having an increased amount of skin folds can increase the risk of skin abrasion and erosion, leading to inflammation. Therefore, individuals with obesity, infants, and other factors that increase ones own skin-to-skin contact have an increased risk of intertrigo. Immunocompromised individuals are also at a greater risk for intertrigo since they are more susceptible to infection from any foreign pathogen. Environmental factors also play a role in increasing the risk of this condition.
The folds of the neck are most commonly affected, but other areas with skin folds are also susceptible, including the armpits, groin, and anus. Complications
Progression of intertrigo is dependent on the strain of streptococcus responsible for the symptoms. Streptococcal intertrigo can lead to complications if not appropriately diagnosed and treated in a timely manner. It has been reported that bacteremia, or a bacterial infection of the circulating blood, can occur which may require intravenous antibiotic therapy. Streptococcus pyogenes is also known to cause other serious diseases such as meningitis, necrotizing fasciitis, toxic shock syndrome, and osteomyelitis. Skin infections caused by Group A Beta-hemolytic streptococci (GABHS) can also be associated with acute glomerulonephritis, furthering the need for prompt diagnosis and treatment. Cause
Intertrigo is a skin condition often associated with rashes in deep skin folds with increased friction and moisture exposure. There are various causes that can lead to intertrigo including fungal and viral, although the agent would depend on the nature of the infection whether it be candidal or bacterial. In the case of bacterial infections, the main etiological agents are either group A beta hemolytic streptococci or Staphylococcus aureus. Group A streptococci (GAS) are ubiquitous microorganisms found in the surrounding environment and in the normal skin microbiota. Although there are different severities of infections Group A streptococci can affect individuals, broken skin and wounds allow easier access for colonization by the bacteria. The streptococci family has its own factors that aid in its promotion of infection and severity.