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Jan 12, 2021 · Strep throat is more common in children than adults. It is most common in children 5 through 15 years old. It is rare in children younger than 3 years old. Adults who are at increased risk for strep throat include:
- Clinical Features
- Risk Factors
- Diagnosis and Testing
- Special Considerations
- Prognosis and Complications
Group A strep pharyngitis is an infection of the oropharynx caused by S. pyogenes. S. pyogenes are gram-positive cocci that grow in chains (see figure 1). They exhibit β-hemolysis (complete hemolysis) when grown on blood agar plates. They belong to group A in the Lancefield classification system for β-hemolytic Streptococcus, and thus are called group A streptococci.
Group A strep pharyngitis is an acute pharyngitis that commonly presents with 1. Sudden-onset of sore throat 2. Odynophagia 3. Fever Other symptoms may include headache, abdominal pain, nausea, and vomiting — especially among children. Patients with group A strep pharyngitis typically do not typically have cough, rhinorrhea, hoarseness, oral ulcers, or conjunctivitis. These symptoms strongly suggest a viral etiology. On clinical examination, patients with group A strep pharyngitis usually have 1. Pharyngeal and tonsillar erythema 2. Tonsillar hypertrophy with or without exudates 3. Palatal petechiae 4. Anterior cervical lymphadenopathy Patients with group A strep pharyngitis may also present with a scarlatiniform rash. The resulting syndrome is called scarlet feveror scarlatina. Respiratory disease caused by group A strep infection in children younger than 3 years old rarely manifests as acute pharyngitis. These children usually have mucopurulent rhinitis followed by fever, irritabi...
Group A strep pharyngitis is most commonly spread through direct person-to-person transmission. Typically transmission occurs through saliva or nasal secretions from an infected person. People with group A strep pharyngitis are much more likely to transmit the bacteria to others than asymptomatic pharyngeal carriers. Crowded conditions — such as those in schools, daycare centers, or military training facilities — facilitate transmission. Although rare, spread of group A strep infections may also occur via food. Foodborne outbreaks of pharyngitis have occurred due to improper food handling. Fomites, such as household items like plates or toys, are very unlikely to spread these bacteria. Humans are the primary reservoir for group A strep. There is no evidence to indicate that pets can transmit the bacteria to humans. Treatment with an appropriate antibiotic for 12 hours or longer generally eliminates a person’s ability to transmit group A strep. People with group A strep pharyngitis o...
Group A strep pharyngitis can occur in people of all ages. It is most common among children 5 through 15 years of age. It is rare in children younger than 3 years of age. The most common risk factor is close contact with another person with group A strep pharyngitis. Adults at increased risk for group A strep pharyngitis include: 1. Parents of school-aged children 2. Adults who are often in contact with children Crowding, such as found in schools, military barracks, and daycare centers, increases the risk of disease spread.
The differential diagnosis of acute pharyngitis includes multiple viral and bacterial pathogens. Viruses are the most common cause of pharyngitis in all age groups. Experts estimate that group A strep, the most common bacterial cause, causes 20% to 30% of pharyngitis episodes in children. In comparison, experts estimate it causes approximately 5% to 15% of pharyngitis infections in adults. History and clinical examination can be used to diagnose viral pharyngitis when clear viral symptoms are present. Viral symptoms include: 1. Cough 2. Rhinorrhea 3. Hoarseness 4. Oral ulcers 5. Conjunctivitis Patients with clear viral symptoms do not need testing for group A strep. However, clinicians cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms. Clinicians need to use either a rapid antigen detection test (RADT) or throat culture to confirm group A strep pharyngitis. RADTs have high specificity for group A strep but varying s...
Clinicians should confirm group A strep pharyngitis in children older than 3 years of age to appropriately guide treatment decisions. Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing sequela (acute rheumatic fever). Testing for group A strep pharyngitis is not routinely indicated for: 1. Children younger than 3 years of age 2. Adults Acute rheumatic fever is very rare in those age groups. Clinicians can use a positive RADT as confirmation of group A strep pharyngitis in children. However, clinicians should follow up a negative RADT in a child with symptoms of pharyngitis with a throat culture. Clinicians should have a mechanism to contact the family and initiate antibiotics if the back-up throat culture is positive.
The use of a recommended antibiotic regimen to treat group A strep pharyngitis: 1. Shortens the duration of symptoms 2. Reduces the likelihood of transmission to family members, classmates, and other close contacts 3. Prevents the development of complications, including acute rheumatic fever When left untreated, the symptoms of group A strep pharyngitis are usually self-limited. However, acute rheumatic fever and suppurative complications (e.g., peritonsillar abscess, mastoiditis) are more likely to occur after an untreated infection. Patients, regardless of age, who have a positive RADT or throat culture need antibiotics. Clinicians should not treat viral pharyngitis with antibiotics. Penicillin or amoxicillin is the antibiotic of choice to treat group A strep pharyngitis. There has never been a report of a clinical isolate of group A strep that is resistant to penicillin. However, resistance to azithromycin and clarithromycin is common in some communities. For patients with a peni...
Asymptomatic group A strep carriers usually do not require treatment. Carriers have positive throat cultures or are RADT positive, but do not have clinical symptoms or an immunologic response to group A strep antigens on laboratory testing. Compared to people with symptomatic pharyngitis, carriers are much less likely to transmit group A strep to others. Carriers are also very unlikely to develop suppurative or nonsuppurative complications. Some people with recurrent episodes of acute pharyngitis with evidence of group A strep by RADT or throat culture actually have recurrent episodes of viral pharyngitis with concurrent streptococcal carriage. Repeated use of antibiotics among this subset of patients is unnecessary. However, identifying carriers clinically or by laboratory methods can be very difficult. The Infectious Diseases Society of America guidelines and Red Book address determining someone if is a carrier and their management.1, 2
Rarely, suppurative and nonsuppurative complications can occur after group A strep pharyngitis. Suppurative complications result from the spread of group A strep from the pharynx to adjacent structures. They can include: 1. Peritonsillar abscess 2. Retropharyngeal abscess 3. Cervical lymphadenitis 4. Mastoiditis Other focal infections or sepsis are even less common. Acute rheumatic fever is a nonsuppurative sequelae of group A strep pharyngitis. Post-streptococcal glomerulonephritisis a nonsuppurative sequelae of group A strep pharyngitis or skin infections. These complications occur after the original infection resolves and involve sites distant to the initial group A strep infection site. They are thought to be the result of the immune response and not of direct group A strep infection.
Good hand hygiene and respiratory etiquette can reduce the spread of all types of group A strep infection. Hand hygiene is especially important after coughing and sneezing and before preparing foods or eating. Good respiratory etiquette involves covering your cough or sneeze. Treating an infected person with an antibiotic for at least 12 hours reduces their ability to transmit the bacteria. Per the American Academy of Pediatrics Red Book 2018, people with group A strep pharyngitis should stay home from work, school, or daycare until: 1. They are afebrile AND 2. At least 12 hours after starting appropriate antibiotic therapy
Jan 07, 2020 · Strep throat is a common respiratory disease that tends to affect more children than adults, but it can affect anyone at any age. And while it tends to be somewhat more prevalent in the winter...
- Elaine K. Howley
- Risk Factors
Strep throat is a bacterial infection that can make your throat feel sore and scratchy. Strep throat accounts for only a small portion of sore throats. If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a specific type of rash, or heart valve damage. Strep throat is most common in children, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt testing and treatment.
Signs and symptoms of strep throat can include: 1. Throat pain that usually comes on quickly 2. Painful swallowing 3. Red and swollen tonsils, sometimes with white patches or streaks of pus 4. Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate) 5. Swollen, tender lymph nodes in your neck 6. Fever 7. Headache 8. Rash 9. Nausea or vomiting, especially in younger children 10. Body aches It's possible for you or your child to have many of these signs and symptoms but not have strep throat. The cause of these signs and symptoms could be a viral infection or some other illness. That's why your doctor generally tests specifically for strep throat. It's also possible for you to be exposed to a person who carries strep but shows no symptoms.
Strep throat is caused by infection with a bacterium known as Streptococcus pyogenes, also called group A streptococcus. Streptococcal bacteria are contagious. They can spread through droplets when someone with the infection coughs or sneezes, or through shared food or drinks. You can also pick up the bacteria from a doorknob or other surface and transfer them to your nose, mouth or eyes.
Several factors can increase your risk of strep throat infection: 1. Young age.Strep throat occurs most commonly in children. 2. Time of year.Although strep throat can occur anytime, it tends to circulate in winter and early spring. Strep bacteria flourish wherever groups of people are in close contact.
To prevent strep infection: 1. Wash your hands.Proper hand-washing is the best way to prevent all kinds of infections. That's why it's important to wash your own hands regularly with soap and water for at least 20 seconds. Teach your children how to wash their hands properly using soap and water or to use an alcohol-based hand sanitizer if there is no soap and water available. 2. Cover your mouth.Teach your children to cover their mouths with an elbow or tissue when they cough or sneeze. 3. Don't share personal items.Don't share drinking glasses or eating utensils. Wash dishes in hot, soapy water or in a dishwasher.
Strep throat in seniors Many older adults have a weakened immune system, which is a consequence of the natural aging process. Not only does this increase the likelihood that a senior will get sick, but it also makes it more difficult for him or her to recover.
Aug 30, 2019 · Strep throat is a bacterial infection that causes inflammation and pain in the throat. This common condition is caused by group A Streptococcus bacteria. Strep throat can affect children and adults...
- Valencia Higuera
Sep 01, 2019 · Of the remaining infections, however, strep throat is most common. It is responsible for 15 to 30 percent of cases in children and 5 to 10 percent in adults. 1 While streptococcus infection is the definitive cause of strep throat, there are several factors that can make someone more susceptible to the disease.
Jul 06, 2018 · Strep throat is a bacterial infection of the tonsils that is relatively common. It’s contagious and can lead to a very sore throat, so the earlier it’s treated, the better. Emergency physician Dr. Troy Madsen discusses four tell-tale signs you should be looking for to determine if you have strep throat and how to treat it.
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