Streptococcal Pharyngitis or Tonsillitis and Its Complications Flashcards
Define Streptococcal pharyngitis/tonsillitis
An infection of the pharynx or tonsils with Group A beta hemolytic streprococci (GABHS, Strep. pyogenes)
Common age for Streptococcal pharyngitis/tonsillitis?
Most common among school aged (5-15 years)
Transmission of Streptococcal pharyngitis/tonsillitis?
Direct contact and/or droplet
Time of year for Streptococcal pharyngitis/tonsillitis?
Late fall, winter, spring
Incubation period of Streptococcal pharyngitis/tonsillitis
2-5 days
Common patient history of Streptococcal pharyngitis/tonsillitis
COntact Sore throat Headache Fever Adenopathy
Common physical exam of a Streptococcal pharyngitis/tonsillitis
Exudative tonsillitis Petechiae on palate Strawberry tongue Fever Cervical Adenopathy Circumoral Pallor
Circumoral Pallor is often confused with..
Viral Pharyngitis-tonsillitis
Coxsackie
Herpes
How to do a laboratory diagnosis of Streptococcal pharyngitis/tonsillitis
Throat Culture - Rapid Test (strep serology)
Routine Culture – Takes 24 hours
What is the rapid test based on
Basd on nitrous acid extraction of Group A carbohydrate antigen from bacteria obtained from the throat
Did he ever do that?
Order prescription without seeing patient
No. He never did that.
Routine treatment for Streptococcal pharyngitis/tonsillitis?
Penicillin V (Amoxicillin can be used)
Benzathine penacillin G
Erythromycin (for penicillin sensitive)
Cephlosporins for 10 days
A carrier state may be found in as high as
10-20%
What does bid mean?
twice a day
What does tid
three times a day
How to treat a Streptococcal pharyngitis/tonsillitis carrier state patient
Benzathine penicillin G
Clindamycin, Cephalosporin, or Amoxacillin-Clavulanate (10)
Azithromycin (5 days)
Penicillin and Rifampin, 10 days pen, last 4 add rifampin
Etiology of Scarlet Fever
Erythrogenic exotoxin in Strep Organism
Incubation period for Scarlet Fever
1 to 7 days (average 3 days)
Signs and Symptoms of Scarlet Fever
Fever Vomiting Headache Pharyngitis-tonsillitis-Strep Type Chills Abdominal Pain Rash
Describe the rash of Scarlet Fever
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
Treatment for Scarlet Fever?
Penicillin x 10 days
Symptomatic Management
Etiology of Rheumatic Fever?
Group A beta hemolytic streptococcal pharyngitis - especially M types (1, 3, 5, 6, 18, 19, 24) extracellular toxin
Incidence of Rheumatic Fever?
As high as 3% of untreated patients infected with Group B beta hemolytic strep
How to diagnose Rheumatic Fever?
The Jones Criteria
2 major or 1 major, 2 minor
What are the components of the Jones Criteria for Rheumatic Fever**
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)
Treatment for Rheumatic Fever
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
Ways to prevent progression to Rheumatic Fever?
Bicillin by injection 1x month
Oral penicillin daily
How long of duration for prevention treatment?
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
Incidence of Streptococcal glomerulonephritis?
Rare – Usually after age 3
Diagnosis of Streptococcal glomerulonephritis?
Hematuria -- RBC Casts Malaise Lethargy Abdominal or Flank Pain Fever
Why worry about Salicyclates?
Reye’s Syndrome
Gotta watch carefully for liver damage
Signs of Renal Failure
Edema/Proteinuria Oliguria Hypertension CHF Encephalopathy
Other lab work important for Streptococcal glomerulonephritis diagnosis
+ Strep Culture
Serum C3
Antibodies to streptolysin O
Treatment for Streptococcal glomerulonephritis
Treat for strep (10 days penicillin)
Treat complications
Other than problems with scarlet fever, rheumatic fever, and glomerulonephritis, what are a couple other important streptococcal infection complications
Peritonsillar abscess
Toxic Shock Syndrome (very rare following GABHS phar/tons)
