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ICM lectures > Streptococcal pharyngitis > Flashcards

Streptococcal pharyngitis Flashcards

1
Q

definition of strep

A

an infection of pharynx or tonsils with GABHS, S. pyogenes

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2
Q

epidemiology

A

any age

-Most common: 5-15 years

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3
Q

transmission of strep

A

direct contact and/or droplet

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4
Q

when is strep most common

A

late fall, winter, spring

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5
Q

incubation period

A

2-5 days

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6
Q

things to ask for diagnosis

A
  1. contact
  2. sore throat
  3. headache
  4. fever
  5. adenopathy
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7
Q

things to look for on physical exam

A 
exudative tonsillitis
petechiae on palate
strawberry tongue
fever
cervical adenopathy
circumoral pallor
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8
Q

what can strep be confused with

A

viral pharyngitis-tonsillitis
coxsackie
herpes

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9
Q

diagnosis of strep

A

rapid test

routine

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10
Q

what does rapid strep test look for?

A

based on nitrous acid extraction of Group A carbohydrate antigen from bacteria obtained from the throat

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11
Q

treatment for strep

A

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

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12
Q

how to treat those that are carries or strep

A
  • Benzathine penicillin G
  • Clindamycin, Cephalosporins, or Amoxicillin-> Clauvulanate (10days) or Azithromycin (5 days)
  • Penicillin and rifampin, 10 days penicillin-> last four days add rifampin
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13
Q

complications of strep

A

scarlet fever
rheumatic fever
glomerulonephritis

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14
Q

toxin responsible for scarlet fever

A

erythrogenic exotoxin in strep organism

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15
Q

incubation times for scarlet fever

A

1-7 days

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16
Q

signs and symptoms of scarlet fever

A 
fever
vomiting
headache
pharyngitis-tonsillitis strep type
chills
abdominal pain
rash
17
Q

how does the rash present with scarlet fever?

A

first axillae, groin, neck-> becomes generalized in 24 hours

-begins desquamating after 1 week-> face first, then trunk hands and feet

18
Q

treatment for scarlet fever

A

penicillin for 10 days

-symptomatic

19
Q

what type of strep is the cause of rheumatic fever

A

GABH streptococcal pharyngitis, especially M types and extracellular toxins

20
Q

diagnosis of rheumatic fever: Jones criteria

A

need 2 major or 1 major and 2 minor to make diagnosis plus supporting evidence of preceding strep infection

21
Q

What are major criteria?

A 
carditis
polyarthritis-> migratory: sometimes to point where they can't walk 
erythema marginatum
chorea: movement type disorder
subcutaneous nodules
22
Q

what are minor criteria?

A

fever
arthralgia
elevated acute phase reactants (ESR, CRP)
prolonged PR interval on EKC
+evidence of preceding strep infection, within last 1-3weeks

23
Q

treatment for rheumatic fever

A

treat the strep infection
salicylates
corticosteroids
bed rest
treat chorea with: diazepam (mild) or haloperidol (severe)
congestive heart failure: bed rest, digitalis, diuretics

24
Q

prevention of rheumatic fever

A

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)

25
Q

glomerulonephritis etiology

A

GABHS throat or skin infection

-1-2 weeks preceding development

26
Q

incidence of glomerulonephritis

A

usually after 3

but rare

27
Q

diagnosis of glomerulonephritis

A 
hematuria-> RBC casts
malaise
lethargy
abdominal or flank pain
fever
28
Q

what are some signs of renal failure in glomerulonephritis

A 
edema-> may have proteinuria
oliguria
hypertension
congestive heart failure
encephalopathy
29
Q

labs to test for glomerulonephritis

A

+ strep culture
decreased serum of C3
antibodies to streptolysin O

30
Q

treatment for glomerulonephritis

A

treat for strep-> penicillin for 10 days

treat complications

31
Q

other complications from strep

A

peritonsillar abscess

TSS-> rare following GABHS pharyngitis or tonsillitis

ICM lectures (9 decks)

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