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ICM - Infectious Disease > Streptococcal Pharyngitis or Tonsillitis and Its Complications > Flashcards

Streptococcal Pharyngitis or Tonsillitis and Its Complications Flashcards

1
Q

Define Streptococcal pharyngitis/tonsillitis

A

An infection of the pharynx or tonsils with Group A beta hemolytic streprococci (GABHS, Strep. pyogenes)

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2
Q

Common age for Streptococcal pharyngitis/tonsillitis?

A

Most common among school aged (5-15 years)

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3
Q

Transmission of Streptococcal pharyngitis/tonsillitis?

A

Direct contact and/or droplet

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4
Q

Time of year for Streptococcal pharyngitis/tonsillitis?

A

Late fall, winter, spring

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5
Q

Incubation period of Streptococcal pharyngitis/tonsillitis

A

2-5 days

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6
Q

Common patient history of Streptococcal pharyngitis/tonsillitis

A 
COntact
Sore throat
Headache
Fever
Adenopathy
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7
Q

Common physical exam of a Streptococcal pharyngitis/tonsillitis

A 
Exudative tonsillitis
Petechiae on palate
Strawberry tongue
Fever
Cervical Adenopathy
Circumoral Pallor
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8
Q

Circumoral Pallor is often confused with..

A

Viral Pharyngitis-tonsillitis
Coxsackie
Herpes

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9
Q

How to do a laboratory diagnosis of Streptococcal pharyngitis/tonsillitis

A

Throat Culture - Rapid Test (strep serology)

Routine Culture – Takes 24 hours

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10
Q

What is the rapid test based on

A

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

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11
Q

Did he ever do that?

Order prescription without seeing patient

A

No. He never did that.

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12
Q

Routine treatment for Streptococcal pharyngitis/tonsillitis?

A

Penicillin V (Amoxicillin can be used)
Benzathine penacillin G
Erythromycin (for penicillin sensitive)
Cephlosporins for 10 days

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13
Q

A carrier state may be found in as high as

A

10-20%

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14
Q

What does bid mean?

A

twice a day

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15
Q

What does tid

A

three times a day

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16
Q

How to treat a Streptococcal pharyngitis/tonsillitis carrier state patient

A

Benzathine penicillin G
Clindamycin, Cephalosporin, or Amoxacillin-Clavulanate (10)
Azithromycin (5 days)
Penicillin and Rifampin, 10 days pen, last 4 add rifampin

17
Q

Etiology of Scarlet Fever

A

Erythrogenic exotoxin in Strep Organism

18
Q

Incubation period for Scarlet Fever

A

1 to 7 days (average 3 days)

19
Q

Signs and Symptoms of Scarlet Fever

A 
Fever
Vomiting
Headache
Pharyngitis-tonsillitis-Strep Type
Chills
Abdominal Pain
Rash
20
Q

Describe the rash of Scarlet Fever

A

Appears first in Axillae, groin, and neck
Generalized in 24 hours
Begins desanguinating after 1 week from head to toe
Some peeling at hands and feet, but the rest of it is kind of granular and just kind of sloughs off

21
Q

Treatment for Scarlet Fever?

A

Penicillin x 10 days

Symptomatic Management

22
Q

Etiology of Rheumatic Fever?

A

Group A beta hemolytic streptococcal pharyngitis - especially M types (1, 3, 5, 6, 18, 19, 24) extracellular toxin

23
Q

Incidence of Rheumatic Fever?

A

As high as 3% of untreated patients infected with Group B beta hemolytic strep

24
Q

How to diagnose Rheumatic Fever?

A

The Jones Criteria

2 major or 1 major, 2 minor

25
Q

What are the components of the Jones Criteria for Rheumatic Fever**

A

Major – Carditis, Polyarthritis, Erythema Marginatum, Chorea, Subcutaneous Nodules

Minor – Fever, Arthralgia, Elevated Acute Phase Reactants, long PR interval on EKG, evidence of preceding Group A streptococcal infection (1-3 weeks prev)

26
Q

Treatment for Rheumatic Fever

A

Treat Strep Infection
Salicyclates (90-120 mgm/kgm per 24) (3-4 weeks)
Corticosteroids (2-3 weeks)
Bed Rest
Treat Chorea - Diazepam (mild), Haloperidol (Severe)
Treat CHF - Bed Rest, Digitalis, Diuretics

27
Q

Ways to prevent progression to Rheumatic Fever?

A

Bicillin by injection 1x month

Oral penicillin daily

28
Q

How long of duration for prevention treatment?

A

RhF without Carditis – 5 years or until age 21 (whichever is longer)
RhF with Caridits (not residual) - 10 years or well into adulthood
RhF with residual – at least 10 years and to age 40

29
Q

Incidence of Streptococcal glomerulonephritis?

A

Rare – Usually after age 3

30
Q

Diagnosis of Streptococcal glomerulonephritis?

A 
Hematuria -- RBC Casts
Malaise
Lethargy
Abdominal or Flank Pain
Fever
31
Q

Why worry about Salicyclates?

A

Reye’s Syndrome

Gotta watch carefully for liver damage

32
Q

Signs of Renal Failure

A 
Edema/Proteinuria
Oliguria
Hypertension
CHF
Encephalopathy
33
Q

Other lab work important for Streptococcal glomerulonephritis diagnosis

A

+ Strep Culture
Serum C3
Antibodies to streptolysin O

34
Q

Treatment for Streptococcal glomerulonephritis

A

Treat for strep (10 days penicillin)

Treat complications

35
Q

Other than problems with scarlet fever, rheumatic fever, and glomerulonephritis, what are a couple other important streptococcal infection complications

A

Peritonsillar abscess

Toxic Shock Syndrome (very rare following GABHS phar/tons)

ICM - Infectious Disease (11 decks)

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