Streptococcal pharyngitis
| Streptococcal pharyngitis | |
|---|---|
| Specialty | Otorhinolaryngology, infectious diseases  |
See also Pharyngitis.
Strep throat (or "Streptococcal pharyngitis", or "Streptococcal Sore Throat") is a form of Group A streptococcal infection that affects the pharynx.
Symptoms
Sore throat, whitening/reddening of the tonsils, fever, problems swallowing and eating. Other symptoms may include a bad headache, fever, or an upset stomach. Orange juice or other citrus drinks should not be consumed, because the acids in them may irritate the throat.
Transmission
The illness is caused by the bacterium Streptococcus pyogenes and is spread by direct, close contact with an infected person via respiratory droplets (cough or sneezing). Casual contact rarely results in transmission. Rarely, contaminated food, especially milk and milk products, can result in outbreaks. Untreated patients are most infectious for 2-3 weeks after onset of infection. The incubation period, the period after exposure and before symptoms show up, is difficult to establish as some people don't become symptomatic. However, it is thought to be about 1 week.
Treatment
Antibiotic treatment will reduce symptoms slightly, minimize transmission, and reduce the likelihood of complications. Treatment consists of penicillin (orally for 10 days; or a single intramuscular injection of penicillin G). Erythromycin is recommended for penicillin-allergic patients. Second-line antibiotics include amoxicillin, clindamycin, and oral cephalosporins. Although symptoms subside within 4 days even without treatment, it is very important to start treatment within 10 days of onset of symptoms, and to complete the full course of antibiotics to prevent rheumatic fever, a rare but serious complication. Other complications that can occur include an ear infection, sinus infection, acute glomerulonephritis, or an abscess on the tonsils (peritonsillar abscess).
According to a meta-analysis in Pediatrics, the overall summary odds ratio (OR) for the bacteriologic cure rate significantly favored cephalosporins compared with penicillin (OR: 3.02; 95% confidence interval [CI]: 2.49 –3.67, with the individual cephalosporins [cephalexin, cefadroxil, cefuroxime, cefpodoxime, cefprozil, cefixime, ceftibuten, and cefdinir] showing superior bacteriologic cure rates). The overall summary OR for clinical cure rate was 2.33 (95% CI: 1.84 –2.97), significantly favoring cephalosporins. [1]).
Penicillins should be avoided for treatment of a sore throat if bacterial (swab) confirmation has not been obtained since it causes a distinctive rash if the true illness proves to be viral. This rash is harmless but alarming. The most common virus responsible for strep-like symptoms is glandular fever, better known as mononucleosis. Typically, antibiotics such as clindamycin or clarithromycin will be prescribed if there is any doubt as to whether the infection is bacterial as it does not cause a rash in the presence of a virus.
In addition to taking antibiotics, other ways to relieve strep symptoms include taking nonprescription medications (such as ibuprofen and acetaminophen/paracetamol) for throat pain and fever reduction, and getting plenty of rest. Also, gargling with warm saltwater (1/4 teaspoon of table salt in 8 oz. warm water) can help relieve throat pain as well as warm, plain tea.
References
- ^ PMID 15060239
See also
- PANDAS - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections
- Tonsillitis
- Psoriasis