Signs and symptoms

Symptoms may include:

• Sudden and severe sore throat
• Red and enlarged tonsils
• Yellow and white patches in the throat.
• Difficulty swallowing
• Tender cervical lymphadenopathy
• Fever of 38°C (101°F) or greater.
• General discomfort, feeling ill or uneasy
• Cough or dry cough
• Halitosis
• Abdominal pain, nausea and vomiting
• Rash
• Hives

Diagnosis

The presence of marked lymph node enlargement along with sore throat, fever and tonsillar enlargement may also occur in infectious mononucleosis (glandular fever).

A study of 729 patients with pharyngitis, in which 17% had a positive throat culture for group A streptococcus, identified the following four best predictors of streptococcus:

• Lack of cough
• Swollen and tender anterior cervical lymph nodes
• (Marked) tonsillar exudates
• Fever

Number of symptoms	Probability of GAS
0	2.5%
1	6.0 - 6.9%
2	14.1 – 16.6%
3	30.1 – 34.1%
4	55.7%

Another study on 621 patients, assigned one point for each of the following symptoms:

• Temperature greater than 38 C
• Absence of cough
• Tender anterior cervical adenopathy
• Tonsillar swelling or exudate
• Age younger than 15
• Subtracting a point for age older than 45.

Points	Probability of GAS	Management
1 or less	0%	Negative: No antibiotic
2	17%	Indeterminate: antibiotic based on throat culture
3	35%
4 or 5	51%	Positive: for throat culture and antibiotics

Finally, patients usually experience swelling of the tonsils and lymph nodes in the neck, but swelling can also be located in the soft palate in the top of the mouth. The absence of tender anterior cervical lymph nodes, tonsillar enlargement, and tonsillar or pharyngeal exudates has been suggested as being the most useful finding in ruling out strep throat, with a negative likelihood of 0.74.

Transmission

Strep throat is caused by Group A streptococcal infection (GAS), specifically the bacterium Streptococcus pyogenes. It is spread by direct, close contact with an infected person via air-based germs. In addition, it may be spread through contamination of pillow cases, toys, toothbrushes and other often-used materials. Rarely, contaminated food, especially milk and milk products, can result in outbreaks.

The incubation period for strep throat is thought to be between two to five days, but has been reported as long as eight days.

Treatment

Symptomatic therapies

Nonprescription over the counter drugs of ibuprofen and paracetamol (acetaminophen) both help relieve throat pain and reduce fever by an average of 2.2˚F or 2.3˚F in children. Aspirin is not recommended for children due to the small risk of Reye's syndrome. In adults aspirin, paracetamol, or ibuprofen help reduce back pain by 48% and sore throat by 31%.

Antibiotics

Antibiotics will reduce symptoms slightly, as was the case in one study of 11 adult patients with sore throat and confirmed GAS infection. They were evaluated daily after the start of antibiotic treatment to register symptoms and signs and to measure body temperature. The mean reduction rate was great, but the greatest reduction was after 3 days. Out of all symptoms, reduction scores for muscle or joint pain was the most at 86%, and the lowest for sore throat at 67%. Treatment, which consists of penicillin (orally for 10 days or a single intramuscular injection of penicillin G), will also minimize transmission. This is why GAS positive children should not go back to school or day care until they have taken antibiotics for at least 48 hours. In one study the potential risk of transmission to close school contact was assessed by taking 47 children with positive throat cultures and randomly selecting them to receive penicillin V, penicillin G, or erythromycin. Throat cultures were then taken 24 hours after start of antibiotics and 17 (36.2%) had positive throat cultures and 39 (83%) of the patients became culture negative.

Cephalosporins (such as cefazoline, cefuroxime, and ceftriaxone) are recommended for penicillin-allergic patients. In another study, 41 patients with confirmed penicillin allergy were evaluated with cefazoline, cefuroxime, and ceftriaxone—all cephalosporins—to see the allergic reaction. Skin tests with cephalosporins were clearly negative in 39 patients and all 41 patients tolerated the three cephalosporins administered. Second-line antibiotics included amoxicillin, clindamycin, and oral cephalosporins which have a significantly better cure rate than penicillin.

Studies have also shown that the broader-spectrum of antibiotics offer effective short treatment courses than the traditional 10 days of Penicillin V, but noted that "widespread use of broad-spectrum agents for a common infection is a significant concern in an age of increasing bacterial antibiotic resistance". It is important to complete the full course of antibiotics to prevent rheumatic fever or an abscess on the tonsils. In one report of 500 patients, 30% had group A beta-hemolytic streptococcal pharyngitis, 0.2% had rheumatic fever and 0.2% had peritonsillar abscess (an abscess on the tonsils).

Other

A 2003 study found extract of Pelargonium sidoides was superior compared to placebo for the treatment of acute non-GABHS tonsillopharyngitis in children. Treatment with these drugs reduced the severity of symptoms and shortened the duration of illness by at least two days.

Complications

The symptoms of strep throat usually improve even without treatment in five days, but the patient is contagious for several weeks. Lack of treatment or incomplete treatment of strep throat can lead to various complications. Some of them may pose serious health risks. Therefore, streptococcal tonsillitis is important to recognize and treat early.the patient is contagious three days after being treated with antibiotics.

Infectious complications

• The active infection may occur in the throat, skin, and in blood.
• Skin and soft tissues may become infected, resulting in redness, pain, and swelling. Skin and deep tissues may also become necrotic (rare).
• Herpes may be aggravated.
• Scarlet fever is caused by toxins released by the bacteria.
• Rarely, some strains may cause a severe illness in which blood pressure is reduced and lung injury and kidney failure may occur (toxic shock syndrome).

Noninfective complications

• During the infection antibodies (disease–fighting chemicals) are produced, sometimes causing a rare complication that can result after the organism is cleared when these antibodies cause disease in body organs.
• Rheumatic fever is a heart disease (in which the inflammation of heart muscle causes scarring of heart valves) can occur.
• Glomerulonephritis is a kidney disease which may lead to kidney failure.

See also

• PANDAS - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections
• Tonsillitis
• Pharyngitis
• Psoriasis
• Herpes, as the symptoms of these two ailments are very similar, do not mistake one for the other.
• Sepsis Infection of the blood.

References

External links

• Group A Streptococcal Infections - National Institute of Allergy and Infectious Diseases.
• Post-infectious glomerulonephritis - mayoclinic.com.