Streptococcal pharyngitis Flashcards
definition of strep
an infection of pharynx or tonsils with GABHS, S. pyogenes
epidemiology
any age
-Most common: 5-15 years
transmission of strep
direct contact and/or droplet
when is strep most common
late fall, winter, spring
incubation period
2-5 days
things to ask for diagnosis
- contact
- sore throat
- headache
- fever
- adenopathy
things to look for on physical exam
exudative tonsillitis petechiae on palate strawberry tongue fever cervical adenopathy circumoral pallor
what can strep be confused with
viral pharyngitis-tonsillitis
coxsackie
herpes
diagnosis of strep
rapid test
routine
what does rapid strep test look for?
based on nitrous acid extraction of Group A carbohydrate antigen from bacteria obtained from the throat
treatment for strep
Penicillin V
-Adolescent and adults take for 10 days
Amoxicillin in appropriate dosage may be used 1-3 times a day for 10 days
Benzathine penicillin G: IM, single dose, long acting
erythromycin for penicillin sensitive person
cephalosporins, may be used up to 10 times a day
how to treat those that are carries or strep
- Benzathine penicillin G
- Clindamycin, Cephalosporins, or Amoxicillin-> Clauvulanate (10days) or Azithromycin (5 days)
- Penicillin and rifampin, 10 days penicillin-> last four days add rifampin
complications of strep
scarlet fever
rheumatic fever
glomerulonephritis
toxin responsible for scarlet fever
erythrogenic exotoxin in strep organism
incubation times for scarlet fever
1-7 days
signs and symptoms of scarlet fever
fever vomiting headache pharyngitis-tonsillitis strep type chills abdominal pain rash
how does the rash present with scarlet fever?
first axillae, groin, neck-> becomes generalized in 24 hours
-begins desquamating after 1 week-> face first, then trunk hands and feet
treatment for scarlet fever
penicillin for 10 days
-symptomatic
what type of strep is the cause of rheumatic fever
GABH streptococcal pharyngitis, especially M types and extracellular toxins
diagnosis of rheumatic fever: Jones criteria
need 2 major or 1 major and 2 minor to make diagnosis plus supporting evidence of preceding strep infection
What are major criteria?
carditis polyarthritis-> migratory: sometimes to point where they can't walk erythema marginatum chorea: movement type disorder subcutaneous nodules
what are minor criteria?
fever
arthralgia
elevated acute phase reactants (ESR, CRP)
prolonged PR interval on EKC
+evidence of preceding strep infection, within last 1-3weeks
treatment for rheumatic fever
treat the strep infection
salicylates
corticosteroids
bed rest
treat chorea with: diazepam (mild) or haloperidol (severe)
congestive heart failure: bed rest, digitalis, diuretics
prevention of rheumatic fever
bicillin by injection once per month
oral penicillin daily
duration for
1.) RhF without carditis: 5 years or until 21
2.) RhF with carditis but no residual-> 10 years or into adulthood
3.) RhF with residual: at least 10 years or till age 40
(residual-> cardiac residual damage)
