2: strep pharyngitis or tonsilitis + complications Flashcards
most common age for strep
any but most common among school age - 5-15y/o
when is strep most common?
late fall, winter, spring
incubation period for strep
2-5d
history w/ strep
- contact
- sore throat
- headache
- fever
- adenopathy
physical exam for strep
- exudative tonsillitis
- petechiae on palate
- strawberry tongue
- fever
- cervical adenopathy
- circumoral pallor
other options for strep ddx
- viral pharyngitis - tonsillitis (more common)
- coxsackie
- herpes
how do you make the diagnosis for strep?
throat culture
-routine (takes 24h)
also -rapid test (strep serology or strep Ag)
describe the rapid strep test
based on nitrous acid extraction of Group A carbohydrate Ag’s from bacteria obtained from the throat
routine treatment
- pen V (250mgm BID or TID for kids under 60lb; 500 mgm BID or TID for kids over 60lb); adolescents/YA for 10d
- amoxicillin in appropriate dosage may be used 1-3x/d for 10d
- benzathine pen G - IM, single dose long-acting
- erythromycin for penicillin sensitive persons x 10d
- cephalosporins may be used x 10d
treatment for carrier state
- benzathine pen G
- clindamycin, cephalosporins, or amoxicillin-clavulanate 10d or azithromycin 5d
- penicillin and rifampin, 10d pen + last 4d add Rifampin
list complications of strep
- scarlet fever
- rheumatic fever
- glomerulonephritis
- peritonsillar abscess
- toxic shock syndrome (very rare)
etiology of scarlet fever
erythrogenic exotoxin
incubation of scarlet fever
1-7d (average 3d)
signs and symptoms of scarlet fever
- fever
- vomit
- headache
- pharyngitis-tonsillitis-strep type
- chills
- abdominal pain
- rash
- strawberry tongue
describe rash of scarlet fever
first appears in axilla, groin, neck -> becomes generalized in 24h -> begins desquamating at 1w- face first, then trunk, hands, and feet
treatment for scarlet fever
penicillin x 10d
symptomatic treatment
etiology of rheumatic fever
GABHS pharyngitis - especially M types (1,3,5,6,18,19, and 24) extracellular toxin
incidence of rheumatic fever
as high as 3% of untreated patients infects w/ Group B beta hemolytic strep
diagnosis of rheumatic fever
- 2 major or 1 major + 2 minor symptoms of Jones criteria for diagnosis
- supporting evidence of preceding strep infection 1-3w prior
describe major and minor Jones criteria
Major:
- carditis
- polyarthritis-migratory
- erythema marginatum (frequently missed)
- chorea (involuntary movements)
- subQ nodules (medial aspect of elbow usually)
Minor:
- fever
- arthralgia
- elevated APR (ESR, CRP)
- prolonged PR interval on EKG
treatment of rheumatic fever
- treat strep infection
- salicylates (90-120mgm/kgm/24h x 3-4w) -but Reye’s syndrome
- corticosteroids (2-3w)
- bed rest
- treat chorea w:
- diazepam (mild) or haloperidol (severe)
- treat CHF w:
- bed rest, digitalis, diuretics
prevention of rheumatic fever
- bicillin injected 1/mo
- daily oral pen
duration of treatment for prevention of rheumatic fever
- RhF w/o carditis: 5y or until age 21 (whichever is longer)
- RhF w/ carditis, but no residual: 10y or well into adulthood (whichever is longer)
- RhF w/ residual: at least 10y and at least to age 40
etiology of PSGN
GABHS strep throat or skin infection 1-2w prior
- throat serotypes 1,6,12
- skin serotypes 49,55,57,59
incidence of PSGN
-rare
usually after age 3
how do you make the diagnosis of PSGN
- hematuria (RBC casts)
- malaise
- lethargy
- abdominal or flank pain
- fever
signs of renal failure with PSGN
- edema (may have proteinuria)
- oliguria
- HTN
- CHF
- encephalopathy
other labs to look at for PSGN
- positive Strep culture
- serum C3
- Ab’s to streotolysin O
treatment for PSGN
- treat for strep (pen x 10d)
- treat complications
how does peritonsillar abscess present?
- drooling child - means throat is so swollen and painful that they can’t swallow their own saliva
- on throat inspection: bulging abscess on one side
- needs to be seen in ER now b/c don’t want abscess to rupture (they could aspirate that shit, then get pneumonia)
what can erythema marginatum be confused with?
if you can see it in the scarlet fever patient, it looks similar to spread out target lesions (similar to RMSF)
