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Group A Beta-hemolytic Streptococcal Pharyngitis

Pharyngitis Due to Group a Beta Hemolytic Streptococcus


Presentation

  • METHODS: Patients aged 6 months to 18 years presenting to a pediatric ED with suspected GABHS pharyngitis were prospectively enrolled in the study.[ncbi.nlm.nih.gov]
  • OBJECTIVES: To assess the performance of a clinical scoring system and to determine whether RADT spectrum bias is present among children who are evaluated for GABHS pharyngitis.[ncbi.nlm.nih.gov]
  • A total of 578 children aged between 1 and 15 years with a mean of 6.3 or- 3.7 years, presenting with sore throat were enrolled in the study.[popline.org]
  • Abstract The classic triad of fever, pharyngeal exudate and tender anterior cervical adenopathy is present in only 15 percent of cases of group A beta-hemolytic streptococcal pharyngitis.[ncbi.nlm.nih.gov]
  • Additionally, you may go back to previous EM:RAP episodes and redeem CME (any episode Jan 2015 to the present, 6 hours per month). On EM:RAP we try to make make the process simple and the question sets are quite reasonable.[emrap.org]
Cervical Lymphadenopathy
  • Patients were stratified according to the number of clinical features present by using modified Centor criteria, ie, history of fever, absence of cough, presence of pharyngeal exudates, and cervical lymphadenopathy.[ncbi.nlm.nih.gov]
  • Description of prediction guide During the clinical evaluation, the examining physician recorded 4 variables from the tested model: cervical lymphadenopathy, tonsillar swelling (2-category severity scale: absent or mild and moderate or severe), coryza[acpjc.org]
  • On clinical examination, patients with group A strep pharyngitis usually have Pharyngeal and tonsillar erythema Tonsillar hypertrophy with or without exudates Palatal petechiae Anterior cervical lymphadenopathy Patients with group A strep pharyngitis[cdc.gov]
Lymph Node Tenderness
  • Using data from all 453 patients, the groups did not differ for adverse effects, lymph node tenderness, abdominal pain, or recurrence.[acpjc.acponline.org]
Fever
  • No patient developed rheumatic fever or nephritis. Treatment-related adverse events were similar between the two groups; mild vomiting (2%) was most frequently reported.[ncbi.nlm.nih.gov]
  • Outbreak of acute rheumatic fever in northeast Ohio. J Pediatr 1987;111:176-9. [20.] Acute rheumatic fever among Army trainees. MMWR Morb Mortal Wkly Rep 1988;37:519-22. [21.][drplace.com]
  • The results suggest that T4 may be associated with a high incidence of scarlet fever. Serotyping should be performed to identify disease carriers and patterns of GABHS infection.[ncbi.nlm.nih.gov]
  • Early antibiotic therapy reduces the duration of pharyngitis, minimizes transmission and lessens complications such as acute rheumatic fever and abscess.[ncbi.nlm.nih.gov]
  • Penicillin was shown to reduce fever and relieve sore throat, dysphagia, headache, abdominal pain, lethargy and anorexia significantly beyond that achieved with aspirin or acetaminophen alone. Penicillin had no effect on culture-negative cases.[ncbi.nlm.nih.gov]
Chills
  • Besides getting a fever, chills, and a throat that really hurts, people can develop some pretty nasty-looking white stuff at the very back of the throat where the bacteria have settled in.[study.com]
  • Symptoms include extreme tiredness, weakness, fever, chills, night sweats, and weight loss. The infection can progress, resulting in problems with heart function in some cases.[humanillnesses.com]
  • Symptoms of group A streptococcal infection Streptococcal sore throat (pharyngitis) Typical symptoms include of streptococcal sore throat include: a sore, red throat with thick pus-like fluid around the tonsils fever and chills enlarged and tender lymph[betterhealth.vic.gov.au]
  • Typical symptoms include fever (usually greater than 101.3 F), red throat, sore throat, headache, stomach ache, nausea, chills, malaise, loss of appetite, abnormal taste, swollen lymph nodes in the neck, and difficulty swallowing.[3,5] While a sore throat[austincc.edu]
  • Constitutional symptoms include fever and chills, myalgias, headaches and nausea. Physical findings may include petechiae of the palate, pharyngeal and tonsillar erythema and exudates, and anterior cervical adenopathy.[aafp.org]
Infectious Mononucleosis
  • Sensitive and specificity not high enough to make the diagnosis without culture confirmation Differential Diagnosis of “Sore Throat” Group A beta-hemolytic Streptococcus Infectious Mononucleosis (EBV) Other bacterial and viral pharyngitis etiologies ([pedclerk.bsd.uchicago.edu]
  • Differential Diagnosis See Pharyngitis Causes Common other causes Infectious Mononucleosis Posterior cervical adenopathy, Fatigue and prolonged Pharyngitis Hand, foot and mouth disease Oral Lesion s, hand and foot skin lesions VIII.[fpnotebook.com]
  • Infectious mononucleosis. Consultant . 2000;40:134–136. Google Scholar 18. Breese BB. A simple scorecard for the tentative diagnosis of streptococcal pharyngitis. Am J Dis Child . 1977;131:514–517. PubMed Google Scholar 19.[link.springer.com]
Malaise
  • In older children several nonspecific signs and symptoms can be associated with the disease, including headache, nausea, abdominal pain, malaise and vomiting (especially in older children).[news-medical.net]
  • The first symptoms appear after the incubation period (1 – 3 days) and include headache, fever, nausea and general malaise. Stomach pain may also occur. Swollen tonsils are visible in the throat and soon become covered in white streaks of pus.[littledotapp.com]
  • Typical symptoms include fever (usually greater than 101.3 F), red throat, sore throat, headache, stomach ache, nausea, chills, malaise, loss of appetite, abnormal taste, swollen lymph nodes in the neck, and difficulty swallowing.[3,5] While a sore throat[austincc.edu]
Constitutional Symptom
  • Constitutional symptoms include fever and chills, myalgias, headaches and nausea. Physical findings may include petechiae of the palate, pharyngeal and tonsillar erythema and exudates, and anterior cervical adenopathy.[aafp.org]
Vomiting
  • Treatment-related adverse events were similar between the two groups; mild vomiting (2%) was most frequently reported.[ncbi.nlm.nih.gov]
  • Significant predictors of GABHS pharyngitis were: age 10-15 years, the presence of dysphagia, vomiting, pharyngeal exudate, and scarlatiniform rash.[popline.org]
  • […] infection Streptococcal sore throat (pharyngitis) Typical symptoms include of streptococcal sore throat include: a sore, red throat with thick pus-like fluid around the tonsils fever and chills enlarged and tender lymph nodes in and around the neck vomiting[betterhealth.vic.gov.au]
  • Abdominal pain, nausea and vomiting may occur, although these symptoms are more characteristic of GABHS infection in children than in adults. Headache may be present, but cough, rhinorrhea and hoarseness are generally absent.[drplace.com]
  • In older children several nonspecific signs and symptoms can be associated with the disease, including headache, nausea, abdominal pain, malaise and vomiting (especially in older children).[news-medical.net]
Nausea
  • Leukopenia and nausea, the most common side effects observed, were more common in the cefprozil-treated group.[ncbi.nlm.nih.gov]
  • The beta-hemolytic streptococcus produces several poisons (toxins) which cause debility and nausea.[littledotapp.com]
  • Abdominal pain, nausea and vomiting may occur, although these symptoms are more characteristic of GABHS infection in children than in adults. Headache may be present, but cough, rhinorrhea and hoarseness are generally absent.[drplace.com]
  • In older children several nonspecific signs and symptoms can be associated with the disease, including headache, nausea, abdominal pain, malaise and vomiting (especially in older children).[news-medical.net]
  • Typical symptoms include fever (usually greater than 101.3 F), red throat, sore throat, headache, stomach ache, nausea, chills, malaise, loss of appetite, abnormal taste, swollen lymph nodes in the neck, and difficulty swallowing.[3,5] While a sore throat[austincc.edu]
Abdominal Pain
  • Penicillin was shown to reduce fever and relieve sore throat, dysphagia, headache, abdominal pain, lethargy and anorexia significantly beyond that achieved with aspirin or acetaminophen alone. Penicillin had no effect on culture-negative cases.[ncbi.nlm.nih.gov]
  • Using data from all 453 patients, the groups did not differ for adverse effects, lymph node tenderness, abdominal pain, or recurrence.[acpjc.acponline.org]
  • Strep symptoms include sore throat, fever, ear pain, abdominal pain, and headache. There may be swollen and perhaps tender lymph nodes in the neck, bright red tonsils, and dark red hemorrhagic petechiae on the soft palate and uvula.[drhull.com]
  • Abdominal pain, nausea and vomiting may occur, although these symptoms are more characteristic of GABHS infection in children than in adults. Headache may be present, but cough, rhinorrhea and hoarseness are generally absent.[drplace.com]
  • In older children several nonspecific signs and symptoms can be associated with the disease, including headache, nausea, abdominal pain, malaise and vomiting (especially in older children).[news-medical.net]
Odynophagia
  • Management: Acute Episode Sore Throat symptomatic management Prescribe medications in liquid form if odynophagia Antibiotic Course Penicillin use requires 10 day course Five days of alternative antibiotics effective Amoxicillin Clavulanate ( Augmentin[fpnotebook.com]
  • Clinical Features Group A strep pharyngitis is an acute pharyngitis that commonly presents with Sudden-onset of sore throat Odynophagia Fever Figure 1. Streptococcus pyogenes (group A Streptococcus ) on Gram stain.[cdc.gov]
  • ., sudden onset of sore throat, fever, odynophagia, tonsillar erythema, exudates, cervical lymphadenitis, or history of streptococcal exposure) History and physical examination to establish risk Diagnostic testing RADT with Centor score of 2 or 3 only[aafp.org]
Strawberry Tongue
  • Pus on the tonsils was less common and strawberry tongue more common in patients with eruptions than in those without. Skin eruptions were much more common in the patients infected with T4 than with other T types (p 0.001).[ncbi.nlm.nih.gov]
  • The rash may feel like sandpaper when touched a bright red tongue (known as ‘strawberry tongue’) paleness around the mouth. Impetigo blisters, typically around the nose and mouth and the legs fever and swollen lymph nodes in severe cases.[betterhealth.vic.gov.au]
  • Tonsils (if present) are usually enlarged and erythematous with patchy exudates on their surfaces, while the tongue is red and swollen (often designated “strawberry tongue” for that reason). Lymph nodes of the neck can be enlarged and tender.[news-medical.net]
  • There is circum- oral pallor and a strawberry tongue. There may be Pasita lines (petechiae) in the antecubital fossa area. May be accentuated in the underpants area. Can be pruritic and will often peel at the end of the illness.[pedclerk.bsd.uchicago.edu]
Palatal Petechiae
  • Physical examination may reveal erythema and swelling of the pharynx, enlarged and erythematous tonsils, tonsillar exudate and palatal petechiae.[drplace.com]
  • On clinical examination, patients with group A strep pharyngitis usually have Pharyngeal and tonsillar erythema Tonsillar hypertrophy with or without exudates Palatal petechiae Anterior cervical lymphadenopathy Patients with group A strep pharyngitis[cdc.gov]
  • Palatal petechiae and scarlatiniform rash are highly specific but uncommon; a swollen uvula is sometimes noted. Cough, coryza, conjunctivitis, and diarrhea are more common with viral pharyngitis.[aafp.org]
Tonsillar Exudate
  • Physical examination may reveal erythema and swelling of the pharynx, enlarged and erythematous tonsils, tonsillar exudate and palatal petechiae.[drplace.com]
  • Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.4 F (38 C), tonsillar exudates, and cervical adenopathy. Cough, coryza, and diarrhea are more common with viral pharyngitis.[aafp.org]
Exudative Pharyngitis
  • The triad of fever, pharyngeal exudate and anterior cervical adenopathy is present in only 15 percent of cases.[7] Exudate occurs in fewer than 50 percent of patients with GABHS pharyngitis; culture of an exudative pharyngitis leads to a diagnosis of[drplace.com]
Circumoral Pallor
  • The rash of scarlet fever, which is characterized by a fine, blanching appearance, sandpaper texture, circumoral pallor and hyperpigmentation in the skin creases, is highly suggestive of GABHS infection.[drplace.com]
Headache
  • Penicillin was shown to reduce fever and relieve sore throat, dysphagia, headache, abdominal pain, lethargy and anorexia significantly beyond that achieved with aspirin or acetaminophen alone. Penicillin had no effect on culture-negative cases.[ncbi.nlm.nih.gov]
  • Major end points were sore throat, pharyngeal erythema or exudate, lymph node tenderness, fever, abdominal pain, headache, drug side effects, and bacteriologic cure.[acpjc.acponline.org]
  • Hepatitis Chronic Obstructive Pulmonary Disease Chronic Pancreatitis Chronic Pelvic Pain Syndrome (in men) Chronic Prostatitis Cigarette Addiction Cigarette Smokers, Nutrition Cirrhosis of the Liver Classic Migraine Climacteric Clinical Depression Cluster Headache[therapy.epnet.com]
  • Classic streptococcal tonsillopharyngitis has an acute onset; produces concurrent headache, stomach ache, and dysphagia; and upon examination is characterized by intense tonsillopharyngeal erythema, yellow exudate, and tender/enlarged anterior cervical[ncbi.nlm.nih.gov]
  • Strep symptoms include sore throat, fever, ear pain, abdominal pain, and headache. There may be swollen and perhaps tender lymph nodes in the neck, bright red tonsils, and dark red hemorrhagic petechiae on the soft palate and uvula.[drhull.com]

Workup

Positive Throat Culture
  • Twelve demographic and clinical features of patients with positive throat cultures were compared with the features of patients with negative throat cultures.[ncbi.nlm.nih.gov]
  • The sensitivity of the RADT was defined as the number of patients with positive RADT results divided by the number of patients with either positive RADT results or negative RADT results but positive throat culture results.[ncbi.nlm.nih.gov]
  • Furthermore, the physician made a subjective probability estimate for a GABHS-positive throat culture result (11-point scale: 0 most unlikely and 10 extremely likely).[acpjc.org]
  • Unfortunately, the study fails to make clear which patients, if any, with positive throat cultures after treatment were symptomatic.[acpjc.acponline.org]
  • Also, are patients that have persistent positive throat cultures following adequate treatment with antibiotics. The patient is clinically well. These patients are not contagious and are not at increased risk for Acute Rheumatic Fever.[pedclerk.bsd.uchicago.edu]
Gram-Positive Bacteria
  • Group A beta-hemolytic streptococci (GABHS) are gram-positive bacteria that grow in culture as pairs or chains of variable length.[pedsinreview.aappublications.org]
  • However, S. dysgalactiae can also be group A. [1] S. pyogenes is a beta-hemolytic species of Gram positive bacteria that is responsible for a wide range of both invasive and noninvasive infections. [2] Infection of GAS may spread through direct contact[en.wikipedia.org]
Gram-Positive Coccus
  • Crowding increases transmission as evidenced by common outbreaks in institutional settings, the military, school, etc.[5] Reservoirs: The human throat and skin are the reservoirs for S. pyogenes .[2] Specific Microbial Characteristics: S. pyogenes is a gram-positive[austincc.edu]

Treatment

  • Cefprozil appears to be an appropriate alternative to cefaclor for the treatment of acute group A beta-hemolytic streptococcal pharyngitis.[ncbi.nlm.nih.gov]
  • Delay in penicillin treatment did not increase GABHS intrafamilial spread. Symptoms of both groups were assessed for 2 days following the initiation of treatment.[ncbi.nlm.nih.gov]
  • Treatment-related adverse events were similar between the two groups; mild vomiting (2%) was most frequently reported.[ncbi.nlm.nih.gov]
  • There may be clinical circumstances in which treatment of Group A beta-hemolytic streptococcal pharyngitis with cephalosporins is indicated.[ncbi.nlm.nih.gov]
  • Clarithromycin vs penicillin in the treatment of streptococcal pharyngitis. J Fam Pract. 1992 Dec;35:622-6.[acpjc.acponline.org]

Prognosis

  • The Infectious Diseases Society of America guidelines and Red Book address determining someone if is a carrier and their management. 1, 2 Prognosis and Complications Rarely, suppurative and nonsuppurative complications can occur after group A strep pharyngitis[cdc.gov]

Etiology

  • Related Editorial Bacteria are responsible for approximately 5 to 10 percent of pharyngitis cases, with group A beta-hemolytic streptococci being the most common bacterial etiology.[aafp.org]
  • Most children and adolescents who develop a sore throat do not have GABHS as the cause; their infection is viral in etiology.[ncbi.nlm.nih.gov]
  • Acute Pharyngitis: Etiology and Diagnosis Schwartz B et al. Pharyngitis - Principles of Judicious Use of Antimicrobial Agents. Pediatrics. 1998; 101(1 Suppl.):171-174.[pedclerk.bsd.uchicago.edu]
  • Etiology: Streptococcus Pyogenes V. Symptoms Stretococcal exposure in last 2 weeks ( Test Sensitivity 19%, Test Specificity 91%) Pharyngitis Fever ( Temperature 100.9) Cough absent Headache Myalgia VII.[fpnotebook.com]
  • Numerous studies have shown that experienced medical personnel are correct in only 50 to 75 percent of cases when they make a decision about the etiology of pharyngitis based on clinical criteria alone.[drplace.com]

Epidemiology

  • PATIENTS AND METHODS: Residents of Rochester, Minn (age, 4-15 years), who had 3 or more GABHS pharyngitis episodes In 1 year, at least 1 month apart, between January 1, 1996, and December 31, 1998, were Identified using the resources of the Rochester Epidemiology[ncbi.nlm.nih.gov]
  • 130 Clarithromycin 132 Azithromycin 133 Flurithromycin 135 Telithromycin 136 Conclusion 137 Mechanisms of Antibiotic Resistance in Streptococcus pyogenes 143 Mechanisms of Macrolides Resistance in Streptococcus pyogenes 144 Efflux System 146 Molecular Epidemiology[books.google.com]
  • Epidemiological analysis of group A streptococci recovered from patients in China. J Med Microbiol 2006;55:1101-7. [Table 1], [Table 2][jlponline.org]
  • GABHS pharyngitis, acute rheumatic fever may develop in up to 3 percent of untreated patients; in endemic infections, fewer cases probably occur.[13] While the pathogenetic mechanisms responsible for the development of acute rheumatic fever are unclear, epidemiologic[drplace.com]
  • Epidemiology of streptococcal pharyngitis Beta-hemolytic group A streptococcus is easily transmitted by inhalation of organisms in large droplets or by direct contact with respiratory secretions.[news-medical.net]
Sex distribution
Age distribution

Prevention

  • Antibacterial therapy is appropriate for GAS pharyngitis and may help prevent complications.[ncbi.nlm.nih.gov]
  • In addition, these antigen detection tests can provide a rapid exclusion of group A beta-hemolytic streptococcal pharyngitis and thereby prevent the initiation of unnecessary antibiotics in patients with nonstreptococcal pharyngitis.[ncbi.nlm.nih.gov]
  • 167 Hypothetical Cohorts and MetaAnalysis 168 Prospective Study in France 169 CostEffectiveness of Antibiotic Therapy for Sore Throat 170 Third World 171 General Conclusion 172 Practical Problems Associated with the Prevention of Initial and Recurrent[books.google.com]
  • Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals.[aafp.org]
  • Commentary Pharyngitis caused by group A β-hemolytic streptococci is treated to prevent rheumatic fever and suppurative complications such as sinusitis and otitis media.[acpjc.acponline.org]

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