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- 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
- Lifestyle and Home Remedies
- Preparing For Your Appointment
Your doctor will conduct a physical exam, look for signs and symptoms of strep throat, and probably order one or more of the following tests: 1. Rapid antigen test.Your doctor may perform a rapid antigen test on a swab sample from your throat. This test can detect strep bacteria in minutes by looking for substances (antigens) in the throat. If the test is negative but your doctor still suspects strep, he or she might do a throat culture. 2. Molecular (polymerase chain reaction, or PCR) test. This test is also done using a swab sample from your throat. 3. Throat culture.A sterile swab is rubbed over the back of the throat and tonsils to get a sample of the secretions. It's not painful, but it may cause gagging. The sample is then cultured in a laboratory for the presence of bacteria, but results can take as long as two days.
Medications are available to cure strep throat, relieve its symptoms, and prevent its complications and spread.
In most cases, antibiotics will quickly wipe out the bacteria causing the infection. In the meantime, try these tips to relieve symptoms of strep throat: 1. Get plenty of rest.Sleep helps your body fight infection. If you have strep throat, stay home from work if you can. If your child is ill, keep him or her at home until there's no sign of fever, and he or she feels better and has taken an antibiotic for at least 24 hours. 2. Drink plenty of water.Keeping a sore throat lubricated and moist eases swallowing and helps prevent dehydration. 3. Eat soothing foods.Easy-to-swallow foods include broths, soups, applesauce, cooked cereal, mashed potatoes, soft fruits, yogurt and soft-cooked eggs. You can puree foods in a blender to make them easier to swallow. Cold foods, such as sherbet, frozen yogurt or frozen fruit pops also may be soothing. Avoid spicy foods or acidic foods such as orange juice. 4. Gargle with warm salt water.For older children and adults, gargling several times a day c...
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of: 1. Symptoms you or your child has, including any that seem unrelated to the reason for your appointment 2. Key personal information, including major stresses, recent life changes, family medical history and possible sources of recent infection 3. All medications,vitamins or other supplementsyou or your child takes, including the doses 4. Questions to...
What to expect from your doctor
Your doctor is likely to ask a number of questions, including: 1. When did the symptoms begin? 2. Have the symptoms changed over time? 3. How severe are the symptoms? 4. Have you or your child been exposed to anyone with strep throat in the last couple of weeks? 5. Does anything seem to make the symptoms better or worse? 6. Have you or your child been diagnosed with strep throat in the past? When? How was it treated? 7. Have you or your child been diagnosed with any other medical conditions?
What you can do in the meantime
If you think you or your child might have a strep infection, take steps to relieve symptoms and avoid spreading infection: 1. Keep your hands clean,cover your mouth when you cough or sneeze, and don't share personal items. 2. Garglewith 1/4 teaspoon (1.5 grams) of table salt in 8 ounces (237 milliliters) of warm water. 3. Rest, drink fluids, eat soft foods and take pain relievers,such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) to help ease symptoms.
Mar 01, 2009 · Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice because of cost, narrow spectrum of activity, and effectiveness. Amoxicillin...DrugClass of antimicrobialRoute of administrationDosagePenicillin V (Veetids; brand no longer ...PenicillinOralChildren: 250 mg two to three times per ...AmoxicillinPenicillin (broad spectrum)OralChildren (mild to moderate GABHS ...Penicillin G benzathine (Bicillin L-A)PenicillinIntramuscularChildren: unitsErythromycin ethylsuccinateMacrolideOralChildren: 30 to 50 mg per kg per day in ...
- Beth A Choby
Jun 29, 2020 · recommend that people with strep throat should stay home until they are fever-free for at least 24 hours and have been taking antibiotics for at least 1 day. People who do not receive treatment can...
- Jennifer Huizen
Jan 12, 2021 · In general, strep throat is a mild infection, but it can be very painful. The most common symptoms of strep throat include: Other symptoms may include a headache, stomach pain, nausea, or vomiting — especially in children. Someone with strep throat may also have a rash known as scarlet fever (also called scarlatina).
Three to six days of oral antibiotics for children with streptococcal throat infection is a safe treatment with a comparable effect to the standard duration of 10 days of penicillin. However, our results must be interpreted with caution in low-income countries where acute rheumatic fever is still a problem.