Streptococcal pharyngitis , also known as sore throat , is an infection of the back of the throat including the tonsils caused by group A streptococcus (GAS). Common symptoms include fever, sore throat, red tonsils, and enlarged lymph nodes in the neck. Headaches, and nausea or vomiting can also occur. Some develop rashes such as sandpaper, known as dengue fever. Symptoms usually begin one to three days after exposure and the last seven to ten days.
Strep throat is spread by respiratory droplets from an infected person. It can spread directly or by touching something that has droplets on it and then touching the mouth, nose, or eyes. Some people may carry asymptomatic bacteria. It can also be spread by infected skin with group A streptococcal. Diagnosis is made based on the results of rapid antigen detection or throat culture tests in those who have symptoms.
Prevention is by washing hands and not sharing cutlery. There is no vaccine for this disease. Treatment with antibiotics is recommended only in those with confirmed diagnoses. Those infected should stay away from others for at least 24 hours after starting treatment. Pain can be treated with paracetamol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
Strep throat is a common bacterial infection in children. This is the cause of 15-40% sore throat among children and 5-15% among adults. Cases are more common in late winter and early spring. Potential complications include rheumatic fever and peritonsillar abscess.
Video Streptococcal pharyngitis
Signs and symptoms
The typical signs and symptoms of streptococcal pharyngitis are sore throat, fever over 38 ° C (100 ° F), tonsils exudate (pus in the tonsils), and large cervical lymph nodes.
Other symptoms include: headache, nausea and vomiting, abdominal pain, muscle pain, or a scarlatiniform or palatal petechiae rash, the latter being a rare but very specific finding.
Symptoms usually begin one to three days after exposure and the last seven to ten days.
Sore throat is not possible when one of the symptoms of red eyes, hoarseness, runny nose, or mouth ulcers is present. Also not possible when there is no fever.
Maps Streptococcal pharyngitis
Cause
Strep throat is caused by group A beta-hemolytic streptococcus (GAS or S. pyogenes). Other bacteria such as non-group A and fusobacterium beta-hemolytic streptococci may also cause pharyngitis. It is spread by direct and close contact with an infected person; so the crowd, as can be found in the military and schools, increases the rate of transmission. Dry bacteria in the dust is not contagious, although damp bacteria on toothbrushes or similar articles can last up to fifteen days. Contaminated food can cause an outbreak, but this is rare. Of children without signs or symptoms, 12% carry GAS in their pharynx, and, after treatment, about 15% of them remain positive, and are a true "carrier".
Diagnosis
A number of assessment systems exist to aid the diagnosis; however, their use is controversial due to inadequate accuracy. Modified Centor Criteria is a set of five criteria; the total score indicates a possible streptococcal infection.
One point is given for each of the criteria:
- Lack of cough
- cervical lymph nodes are swollen and soft
- Temperature & gt; 38.0Ã, Â ° C (100,4Ã, Â ° F)
- Exudate or swelling of the tonsils
- Age less than 15 (one point minus if age & gt; 44)
A single score may indicate no care or culture is required, or it may indicate the need to conduct further testing if there are other high risk factors, such as family members who have the disease.
The Infectious Disease Society of America recommends against empirical treatment and considers antibiotics only appropriate when given after a positive test. Tests are not required in children younger than three years because streptococcal fever and group rheumatic fever are rare, unless a child has siblings with the disease.
Laboratory testing
Throat culture is the gold standard for the diagnosis of streptococcal pharyngitis, with a 90-95% sensitivity. Rapid strep tests (also called rapid antigen detection testing or RADT) can also be used. While rapid strep test is faster, it has a lower sensitivity (70%) and the same specificity is statistically (98%) as a culture of the throat. In areas of the world where rheumatic fever is rare, rapid strep tests are negative enough to exclude disease.
A positive throat culture or RADT in relation to symptoms establishes a positive diagnosis in those whose diagnosis is questionable. In adults, negative RADT is enough to rule out the diagnosis. However, in children the culture of the throat is recommended to confirm the outcome. Asymptomatic individuals do not have to be routinely tested with a throat culture or RADT because a certain percentage of the population constantly "carries" streptococcal bacteria in their throats without harmful results.
Differential diagnosis
Because the symptoms of streptococcal pharyngitis overlap with other conditions, clinical diagnosis is difficult to make. Cough, nasal congestion, diarrhea, and red, irritated eyes other than fever and sore throat show more sore throat due to virus than sore throat. The presence of enlarged lymph nodes marked together with sore throat, fever, and tonsil enlargement can also occur in infectious mononucleosis.
Prevention
Tonsillectomy may be a reasonable precaution for those who have frequent throat infections (more than three years). However, the benefits are small and the episodes are usually reduced in time regardless of the action taken. Recurrent pharyngitis episodes proven positive for GAS may also represent a person who is a chronic GAS carrier who gets recurrent viral infections. Treating people who are exposed but without symptoms is not recommended. Treating people who are carriers of GAS is not recommended because the risk of spreading and complications is low.
Treatment
Untreated streptococcal pharyngitis usually disappears within a few days. Treatment with antibiotics shortens the duration of acute illness by about 16 hours. The main reason for treatment with antibiotics is to reduce the risk of complications such as rheumatic fever and retropharyngeal abscess. Antibiotics prevent acute rheumatic fever if given within 9 days of onset of symptoms.
Pain medication
Pain medications such as NSAIDs and paracetamol (acetaminophen) help in pain management associated with strep throat. Lidocaine can also be useful. While steroids can help with pain, they are not recommended routinely. Aspirin can be used in adults but is not recommended in children because of the risk of Reye's syndrome.
Antibiotics
The antibiotic choice in the United States for streptococcal pharyngitis is penicillin V, because of its safety, cost, and effectiveness. Amoxicillin is preferred in Europe. In India, where the risk of rheumatic fever is higher, intramuscular penicillin benicathin is the first choice for treatment.
Proper antibiotics reduce the average duration of symptoms 3-5 days about a day, and also reduce transmission. They are primarily prescribed to reduce rare complications such as rheumatic fever and peritonsillar abscess. Arguments that support antibiotic treatment should be offset by consideration of possible side effects, and it is reasonable to suggest that no antimicrobial treatment is given to healthy adults who have adverse reactions to drugs or those with low-risk complications. Antibiotics are prescribed for sore throat at a higher rate than expected from how common it is.
Erythromycin and other macrolides or clindamycin are recommended for people with severe penicillin allergies. First-generation cephalosporins may be used in those with less severe allergies and some evidence to favor cephalosporins that are superior to penicillin. Streptococcal infection may also cause acute glomerulonephritis; However, the incidence of these side-effects is not reduced by antibiotic use.
Prognosis
The symptoms of sore throat usually improve within three to five days, regardless of treatment. Treatment with antibiotics reduces the risk of complications and transmission; children can return to school 24 hours after antibiotics are given. The risk of complications in adults is low. In children, acute rheumatic fever is rare in most developed countries. However, this is a major cause of heart disease acquired in India, sub-Saharan Africa and parts of Australia.
Complications arising from strep throat infection include:
The economic cost of illness in the United States in children is about $ 350 million per year.
Epidemiology
Pharyngitis, a broader category in which streptococcal pharyngitis falls, is diagnosed in 11 million people each year in the United States. This is the cause of 15-40% sore throat among children and 5-15% in adults. Cases usually occur in late winter and early spring.
References
External links
Source of the article : Wikipedia
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