Streptococcal pharyngitis


Streptococcal pharyngitis

Infobox_Disease
Name = PAGENAME



Caption =
DiseasesDB = 12507
ICD10 = ICD10|J|02|0|j|00
ICD9 = ICD9|034.0
ICDO =
OMIM =
MedlinePlus = 000639
eMedicineSubj = med
eMedicineTopic = 1811
MeshID =

Streptococcal pharyngitis or streptococcal sore throat (Strep throat AmE) is a form of group A streptococcal infection [DorlandsDict|nine/100014400|streptococcal pharyngitis] that affects the pharynx and possibly the larynx and tonsils.

igns and symptoms

Streptococcal pharyngitis usually appears suddenly with a severe sore throat that may make talking or swallowing painful. In severe cases, breathing may be impaired.

Symptoms may include:
*Sudden and severe sore throat
*Red and enlarged tonsils
*Yellow and white patches in the throat
*Difficulty swallowing
*Tender cervical lymphadenopathy
*Fever
*General discomfort, feeling ill or uneasy
*Halitosis
*Abdominal pain, nausea and vomiting
*Rash [ [http://www.kidshealth.org/parent/infections/lung/strep_throat.html Kids Health] ]
*Hives
*Chills

Diagnosis

There are several causes for pharyngitis, not just streptococcus bacteria. Productive coughing, nasal discharge, and red, irritated eyes in addition to fever and sore throat are more indicative of a viral sore throat than of strep throat, though a co-infection with a virus is possible and may explain the presence of these additional symptoms. A Rapid Strep Test or a throat culture may be undertaken to help clarify diagnosis.

The presence of marked lymph node enlargement along with sore throat, fever and tonsillar enlargement may also occur in infectious mononucleosis (glandular fever).cite journal |author=Ebell MH |title=Epstein-Barr virus infectious mononucleosis |journal=Am Fam Physician |volume=70 |issue=7 |pages=1279–87 |year=2004 |pmid=15508538 |doi= |url=http://www.aafp.org/afp/20041001/1279.html]

A study of 729 patients with pharyngitis, in which 17% had a positive throat culture for group A streptococcus, identified the following four best predictors of streptococcus, also called the Centor criteria:cite journal |author=Centor RM, Dalton HP, Campbell MS, Lynch MR, Watlington AT, Garner BK |title=Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients |journal=J Gen Intern Med |volume=1 |issue=4 |pages=248–51 |year=1986 |pmid=3534175|doi=10.1007/BF02596194]
*Lack of cough
*Swollen and tender anterior cervical lymph nodes
*(Marked) tonsillar exudatescite journal |author=Komaroff AL, Pass TM, Aronson MD, "et al" |title=The prediction of streptococcal pharyngitis in adults |journal=J Gen Intern Med |volume=1 |issue=1 |pages=1–7 |year=1986 |pmid=3534166|doi=10.1007/BF02596317]
*Fever:

Another study on 621 patients, assigned one point for each of the following symptoms:cite journal |author=McIsaac WJ, Goel V, To T, Low DE |title=The validity of a sore throat score in family practice |journal=CMAJ |volume=163 |issue=7 |pages=811–5 |year=2000 |pmid=11033707 |doi= |url=http://www.cmaj.ca/cgi/content/full/163/7/811]
*Temperature greater than 38 C
*Absence of cough
*Tender anterior cervical adenopathy
*Tonsillar swelling or exudate
*Age younger than 15
*Subtracting a point for age older than 45.:

Finally, patients usually experience swelling of the tonsils and lymph nodes in the neck, but swelling can also be located in the soft palate in the top of the mouth. The absence of tender anterior cervical lymph nodes, tonsillar enlargement, and tonsillar or pharyngeal exudates has been suggested as being the most useful finding in ruling out strep throat, with a negative likelihood of 0.74.cite journal |author=Eaton CA |title=What clinical features are useful in diagnosing strep throat? |journal=J Fam Pract |volume=50 |issue=3 |pages=201 |year=2001 |pmid=11252201 |doi= |url=http://www.jfponline.com/Pages.asp?AID=2184]

Transmission

Strep throat is caused by Group A streptococcal infection (GAS),cite journal |author=Merrill B, Kelsberg G, Jankowski TA, Danis P |title=Clinical inquiries. What is the most effective diagnostic evaluation of streptococcal pharyngitis? |journal=J Fam Pract |volume=53 |issue=9 |pages=734, 737–8, 740 |year=2004 |pmid=15353164 |doi= |url=http://www.jfponline.com/Pages.asp?AID=1774] cite journal |author=Centor RM, Meier FA, Dalton HP |title=Throat cultures and rapid tests for diagnosis of group A streptococcal pharyngitis |journal=Ann. Intern. Med. |volume=105 |issue=6 |pages=892–9 |year=1986 |pmid=3535604 |doi=] cite journal |author=Falck G, Kjellander J, Schwan A |title=Recurrence rate of streptococcal pharyngitis related to hygienic measures |journal=Scand J Prim Health Care |volume=16 |issue=1 |pages=8–12 |year=1998 |pmid=9612872 |doi=10.1080/028134398750003331] cite journal |author=Kieserman SP, Williams J, Linstrom C |title=Streptococcal pharyngitis: alternative treatments |journal=Ear Nose Throat J |volume=74 |issue=11 |pages=777–80 |year=1995 |pmid=8536567 |doi=] specifically the bacterium "Streptococcus pyogenes".cite journal |author=Opdyke JA, Scott JR, Moran CP |title=A secondary RNA polymerase sigma factor from Streptococcus pyogenes |journal=Mol. Microbiol. |volume=42 |issue=2 |pages=495–502 |year=2001 |pmid=11703670|doi=10.1046/j.1365-2958.2001.02657.x] cite journal |author=Gieseker KE, Roe MH, MacKenzie T, Todd JK |title=Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing |journal=Pediatrics |volume=111 |issue=6 Pt 1 |pages=e666–70 |year=2003 |pmid=12777583 |doi=10.1542/peds.111.6.e666|url=http://pediatrics.aappublications.org/cgi/content/full/111/6/e666] cite journal |author=Nandi S, Chakraborti A, Bakshi DK, Rani A, Kumar R, Ganguly NK |title=Association of pyrogenic exotoxin genes with pharyngitis and rheumatic fever/rheumatic heart disease among Indian isolates of Streptococcus pyogenes |journal=Lett. Appl. Microbiol. |volume=35 |issue=3 |pages=237–41 |year=2002 |pmid=12180948|doi=10.1046/j.1472-765X.2002.01176.x] cite journal |author=Brandt CM, Allerberger F, Spellerberg B, Holland R, Lütticken R, Haase G |title=Characterization of consecutive Streptococcus pyogenes isolates from patients with pharyngitis and bacteriological treatment failure: special reference to prtF1 and sic / drs |journal=J. Infect. Dis. |volume=183 |issue=4 |pages=670–4 |year=2001 |pmid=11170997 |doi=10.1086/318542|url=http://www.journals.uchicago.edu/doi/full/10.1086/318542?cookieSet=1] It is spread by direct, close contact with an infected person via air-based germs.cite journal |author=Lindbaek M, Høiby EA, Lermark G, Steinsholt IM, Hjortdahl P |title=Predictors for spread of clinical group A streptococcal tonsillitis within the household |journal=Scand J Prim Health Care |volume=22 |issue=4 |pages=239–43 |year=2004 |pmid=15765640 |doi=10.1080/02813430410006729 ] In addition, it may be spread through contamination of pillow cases, toys, toothbrushes and other often-used materials.cite journal |author=Falck G, Kjellander J, Schwan A |title=Recurrence rate of streptococcal pharyngitis related to hygienic measures |journal=Scand J Prim Health Care |volume=16 |issue=1 |pages=8–12 |year=1998 |pmid=9612872 |doi=10.1080/028134398750003331] Rarely, contaminated food, especially milk and milk products, can result in outbreaks.cite journal |author=Asteberg I, Andersson Y, Dotevall L, "et al" |title=A food-borne streptococcal sore throat outbreak in a small community |journal=Scand. J. Infect. Dis. |volume=38 |issue=11-12 |pages=988–94 |year=2006 |pmid=17148066 |doi=10.1080/00365540600868370]

The incubation period for strep throat is thought to be between two to five days, but has been reported as long as eight days.cite journal |author=Sarvghad MR, Naderi HR, Naderi-Nassab M, "et al" |title=An outbreak of food-borne group A Streptococcus (GAS) tonsillopharyngitis among residents of a dormitory |journal=Scand. J. Infect. Dis. |volume=37 |issue=9 |pages=647–50 |year=2005 |pmid=16126564 |doi=10.1080/00365540510044085]

Treatment

ymptomatic therapies

Nonprescription over the counter drugs of ibuprofen and paracetamol (acetaminophen) both help relieve throat pain and reduce fever by an average of 2.2˚F or 2.3˚F in children.cite journal |author=Figueras Nadal C, García de Miguel MJ, Gómez Campderá A, Pou Fernández J, Alvarez Calatayud G, Sánchez Bayle M |title=Effectiveness and tolerability of ibuprofen-arginine versus paracetamol in children with fever of likely infectious origin |journal=Acta Paediatr. |volume=91 |issue=4 |pages=383–90 |year=2002 |pmid=12061352 |doi=] Aspirin is not recommended for children due to the small risk of Reye's syndrome. In adults aspirin, paracetamol, or ibuprofen help reduce back pain by 48% and sore throat by 31%. [Farhan, M., Leparc, J.M., Moore, N., Pelen, F., Vanganse, E., Verriere, F., & Wall, R. (1999). The pain study: Paracetamol, aspirin and ibuprofen new tolerability study: A large-scale, randomized clinical trial comparing the tolerability of aspirin, ibuprofen and paracetamol for short-term analgesia. Clinical Dug Investigation, 18(2), 89-98. Retrieved on December 9, 2007.]

Antibiotics

Antibiotics will reduce symptoms slightly, as was the case in one study of 11 adult patients with sore throat and confirmed GAS infection. They were evaluated daily after the start of antibiotic treatment to register symptoms and signs and to measure body temperature. The mean reduction rate was great, but the greatest reduction was after 3 days. Out of all symptoms, reduction scores for muscle or joint pain was the most at 86%, and the lowest for sore throat at 67%.cite journal |author=Melbye H, Bjørkheim MK, Leinan T |title=Daily reduction in C-reactive protein values, symptoms, signs and temperature in group-A streptococcal pharyngitis treated with antibiotics |journal=Scand. J. Clin. Lab. Invest. |volume=62 |issue=7 |pages=521–5 |year=2002 |pmid=12512742|doi=10.1080/003655102321004530] Treatment, which consists of penicillin (orally for 10 days or a single intramuscular injection of penicillin G), will also minimize transmission. This is why GAS positive children should not go back to school or day care until they have taken antibiotics for at least 48 hours. In one study the potential risk of transmission to close school contact was assessed by taking 47 children with positive throat cultures and randomly selecting them to receive penicillin V, penicillin G, or erythromycin. Throat cultures were then taken 24 hours after start of antibiotics and 17 (36.2%) had positive throat cultures and 39 (83%) of the patients became culture negative.cite journal |author=Snellman LW, Stang HJ, Stang JM, Johnson DR, Kaplan EL |title=Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy |journal=Pediatrics |volume=91 |issue=6 |pages=1166–70 |year=1993 |pmid=8502522 |doi=]

Cephalosporins (such as cefazoline, cefuroxime, and ceftriaxone) are recommended for penicillin-allergic patients. In another study, 41 patients with confirmed penicillin allergy were evaluated with cefazoline, cefuroxime, and ceftriaxone—all cephalosporins—to see the allergic reaction. Skin tests with cephalosporins were clearly negative in 39 patients and all 41 patients tolerated the three cephalosporins administered.cite journal |author=Novalbos A, Sastre J, Cuesta J, "et al" |title=Lack of allergic cross-reactivity to cephalosporins among patients allergic to penicillins |journal=Clin. Exp. Allergy |volume=31 |issue=3 |pages=438–43 |year=2001 |pmid=11260156|doi=10.1046/j.1365-2222.2001.00992.x] cite journal |author=Pichichero ME |title=A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients |journal=Pediatrics |volume=115 |issue=4 |pages=1048–57 |year=2005 |pmid=15805383 |doi=10.1542/peds.2004-1276 |url=http://pediatrics.aappublications.org/cgi/content/full/115/4/1048] Second-line antibiotics included amoxicillin,cite journal |author=Feder HM, Gerber MA, Randolph MF, Stelmach PS, Kaplan EL |title=Once-daily therapy for streptococcal pharyngitis with amoxicillin |journal=Pediatrics |volume=103 |issue=1 |pages=47–51 |year=1999 |pmid=9917438|doi=10.1542/peds.103.1.47] clindamycin,cite journal |author=Martin JM, Green M, Barbadora KA, Wald ER |title=Group A streptococci among school-aged children: clinical characteristics and the carrier state |journal=Pediatrics |volume=114 |issue=5 |pages=1212–9 |year=2004 |pmid=15520098 |doi=10.1542/peds.2004-0133 |url=http://pediatrics.aappublications.org/cgi/content/full/114/5/1212] and oral cephalosporins which have a significantly better cure rate than penicillin.cite journal |author=Casey JR, Pichichero ME |title=Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children |journal=Pediatrics |volume=113 |issue=4 |pages=866–82 |year=2004 |pmid=15060239 |doi=10.1542/peds.113.4.866|url=http://pediatrics.aappublications.org/cgi/content/full/113/4/866]

Studies have also shown that the broader-spectrum of antibiotics offer effective short treatment courses than the traditional 10 days of Penicillin V,cite journal |author=Adam D, Scholz H, Helmerking M |title=Short-course antibiotic treatment of 4782 culture-proven cases of group A streptococcal tonsillopharyngitis and incidence of poststreptococcal sequelae |journal=J. Infect. Dis. |volume=182 |issue=2 |pages=509–16 |year=2000 |pmid=10915082|doi=10.1086/315709] but noted that "widespread use of broad-spectrum agents for a common infection is a significant concern in an age of increasing bacterial antibiotic resistance".cite journal |author=Lord RW |title=Is a 5-day course of antibiotics as effective as a 10-day course for the treatment of streptococcal pharyngitis and the prevention of poststreptococcal sequelae? |journal=J Fam Pract |volume=49 |issue=12 |pages=1147 |year=2000 |pmid=11132064 |doi= |url=http://www.jfponline.com/Pages.asp?AID=2674] It is important to complete the full course of antibiotics to prevent rheumatic fever or an abscess on the tonsils. In one report of 500 patients, 30% had group A beta-hemolytic streptococcal pharyngitis, 0.2% had rheumatic fever and 0.2% had peritonsillar abscess (an abscess on the tonsils).

Other

A 2003 study found extract of Pelargonium sidoides was superior compared to placebo for the treatment of acute non-GABHS tonsillopharyngitis in children. Treatment with these drugs reduced the severity of symptoms and shortened the duration of illness by at least two days.cite journal |author=Bereznoy VV, Riley DS, Wassmer G, Heger M |title=Efficacy of extract of Pelargonium sidoides in children with acute non-group A beta-hemolytic streptococcus tonsillopharyngitis: a randomized, double-blind, placebo-controlled trial |journal=Altern Ther Health Med |volume=9 |issue=5 |pages=68–79 |year=2003 |pmid=14526713 |doi=]

Complications

The symptoms of strep throat usually improve even without treatment in five days, but the patient is contagious for several weeks. Lack of treatment or incomplete treatment of strep throat can lead to various complications. Some of them may pose serious health risks. Therefore, streptococcal tonsillitis is important to recognize and treat early. The patient is considered to be contagious up to three days after being treated with antibiotics. cite book |author=Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson |title=Robbins Basic Pathology: With STUDENT CONSULT Online Access |publisher=Saunders |location=Philadelphia |year= |edith=8th edition |pages=p537 |isbn=1-4160-2973-7 |oclc= |doi=]

List of Complications arising from disseminated Streptococcal infection (originating in the throat) [{http://www.utdol.com/online/content/topic.do?topicKey=upp_resp/4610#3}]
*Scarlet Fever : a red, raised skin rash caused by toxins released by the bacteria
*Acute Rheumatic Fever : sore joints, heart disease, involuntary movements and skin manifestations may occur
*Streptococcal Toxic shock syndrome : septic shock and multi-organ failure
*Glomerulonephritis : a form of kidney failure in which antibodies directed against the Streptococcus bacteria become lodged in the kidney, causing damage to the kidney itself
*PANDAS Syndrome : a neurological disorder which can result in permanent injury. Symptoms include Obsessive-Compulsive Type disorders and involuntary movements
*Herpes may be aggravated post-infection

A skin disease known as necrotizing fasciitis may occur if Streptococcus bacteria infect a wound on the body, but this is not a complication of Strep Throat per se.

ee also

*PANDAS - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections
*Tonsillitis
*Pharyngitis
*Psoriasis
*Herpes
*Sepsis Infection of the blood.

References

External links

* [http://www.niaid.nih.gov/factsheets/strep.htm Group A Streptococcal Infections] - National Institute of Allergy and Infectious Diseases.
* [http://www.mayoclinic.com/health/post-infectious-glomerulonephritis/AN00629 Post-infectious glomerulonephritis] - mayoclinic.com.


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