An infection of the throat, often epidemic, caused by hemolytic streptococci
and characterized by fever and inflammation of the tonsils.
The group A streptococcus bacterium (Streptococcus pyogenes) is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. Other types (B, C, D, and G) may also cause infection. Group B streptococci cause most streptococcal infections in newborns and maternal post-labor/delivery infections.
Signs and Symptoms
The signs and symptoms of strep throat are red, sore throat with white patches on tonsils, swollen lymph nodes in neck, fever, and headache. Nausea, vomiting, and abdominal pain are more common in children. The patient will usually not have a cough, unlike in a viral infection or coldlike symptoms including stuffy noses and sneezing.
Transmission
The illness is caused by the bacterium Streptococcus pyogenes and is spread by direct, close contact with patients via respiratory droplets (coughing 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. Incubation period, the period after exposure and before symptoms show up, is 2-4 days. Patient is no longer infectious within 24 hours of commencing treatment.
Diagnosis
The throat of the patient is swabbed for culture or for a rapid strep test (5 to 10 min) which can be done in the doctor's office. If the rapid test is negative, a follow-up culture (which takes 24 to 48 h) may be performed. A negative culture suggests a viral infection, in which case antibiotic treatment should be withheld or discontinued.
In the UK, rapid strep testing is not available to general practitioners and a clinical decision must be made whether to treat, whilst awaiting upto 7 days for a swab result to be reported. This is criticized for encouraging overuse of antibiotics (see antibiotic resistance).
Treatment
Antibiotic treatment will reduce symptoms, minimize transmission, and reduce the likelihood of complications. Treatment consists of penicillin (oral drug for 10 days; or 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 complete the full course of antibiotics to prevent complications.
Amoxicillin should be avoided for treatment of a sore throat if bacterial (swab)confirmation has not been obtained as it causes a distinctive rash should the true illness prove to be Glandular fever.
Scarlet fever/Scarlatina
Scarlet fever is a streptococcal infection that occurs most often in association with a sore throat and rarely with impetigo or other streptococcal infections. It is characterized by sore throat, fever and a rash over the upper body that may spread to cover almost the entire body.
Signs and Symptoms: Persons with scarlet fever have a characteristic rash that is fine, red, rough-textured and blanches upon pressure. Scarlet fever also produces a bright red tongue with "strawberry" appearance. The skin often "desquamates," or peels, after recovery, usually on tips of fingers and toes.
Common Respiratory Tract Infections
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