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
