Streptococcal Pharyngitis or Tonsillitis and Its Complications

Question 1

Define Streptococcal pharyngitis/tonsillitis

Answer 1

An infection of the pharynx or tonsils with Group A beta hemolytic streprococci (GABHS, Strep. pyogenes)

Question 2

Common age for Streptococcal pharyngitis/tonsillitis?

Answer 2

Most common among school aged (5-15 years)

Question 3

Transmission of Streptococcal pharyngitis/tonsillitis?

Answer 3

Direct contact and/or droplet

Question 4

Time of year for Streptococcal pharyngitis/tonsillitis?

Answer 4

Late fall, winter, spring

Question 5

Incubation period of Streptococcal pharyngitis/tonsillitis

Answer 5

2-5 days

Question 6

Common patient history of Streptococcal pharyngitis/tonsillitis

Answer 6

COntact
Sore throat
Headache
Fever
Adenopathy

Question 7

Common physical exam of a Streptococcal pharyngitis/tonsillitis

Answer 7

Exudative tonsillitis
Petechiae on palate
Strawberry tongue
Fever
Cervical Adenopathy
Circumoral Pallor

Question 8

Circumoral Pallor is often confused with..

Answer 8

Viral Pharyngitis-tonsillitis
Coxsackie
Herpes

Question 9

How to do a laboratory diagnosis of Streptococcal pharyngitis/tonsillitis

Answer 9

Throat Culture - Rapid Test (strep serology)

Routine Culture – Takes 24 hours

Question 10

What is the rapid test based on

Answer 10

Basd on nitrous acid extraction of Group A carbohydrate antigen from bacteria obtained from the throat

Question 11

Did he ever do that?

Order prescription without seeing patient

Answer 11

No. He never did that.

Question 12

Routine treatment for Streptococcal pharyngitis/tonsillitis?

Answer 12

Penicillin V (Amoxicillin can be used)
Benzathine penacillin G
Erythromycin (for penicillin sensitive)
Cephlosporins for 10 days

Question 13

A carrier state may be found in as high as

Answer 13

10-20%

Question 14

What does bid mean?

Answer 14

twice a day

Question 15

What does tid

Answer 15

three times a day

Question 16

How to treat a Streptococcal pharyngitis/tonsillitis carrier state patient

Answer 16

Benzathine penicillin G
Clindamycin, Cephalosporin, or Amoxacillin-Clavulanate (10)
Azithromycin (5 days)
Penicillin and Rifampin, 10 days pen, last 4 add rifampin

Question 17

Etiology of Scarlet Fever

Answer 17

Erythrogenic exotoxin in Strep Organism

Question 18

Incubation period for Scarlet Fever

Answer 18

1 to 7 days (average 3 days)

Question 19

Signs and Symptoms of Scarlet Fever

Answer 19

Fever
Vomiting
Headache
Pharyngitis-tonsillitis-Strep Type
Chills
Abdominal Pain
Rash

Question 20

Describe the rash of Scarlet Fever

Answer 20

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

Question 21

Treatment for Scarlet Fever?

Answer 21

Penicillin x 10 days

Symptomatic Management

Question 22

Etiology of Rheumatic Fever?

Answer 22

Group A beta hemolytic streptococcal pharyngitis - especially M types (1, 3, 5, 6, 18, 19, 24) extracellular toxin

Question 23

Incidence of Rheumatic Fever?

Answer 23

As high as 3% of untreated patients infected with Group B beta hemolytic strep

Question 24

How to diagnose Rheumatic Fever?

Answer 24

The Jones Criteria

2 major or 1 major, 2 minor

Question 25

What are the components of the Jones Criteria for Rheumatic Fever**

Answer 25

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)

Question 26

Treatment for Rheumatic Fever

Answer 26

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

Question 27

Ways to prevent progression to Rheumatic Fever?

Answer 27

Bicillin by injection 1x month | Oral penicillin daily

Question 28

How long of duration for prevention treatment?

Answer 28

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

Question 29

Incidence of Streptococcal glomerulonephritis?

Answer 29

Rare -- Usually after age 3

Question 30

Diagnosis of Streptococcal glomerulonephritis?

Answer 30

``` Hematuria -- RBC Casts Malaise Lethargy Abdominal or Flank Pain Fever ```

Question 31

Why worry about Salicyclates?

Answer 31

Reye's Syndrome | Gotta watch carefully for liver damage

Question 32

Signs of Renal Failure

Answer 32

``` Edema/Proteinuria Oliguria Hypertension CHF Encephalopathy ```

Question 33

Other lab work important for Streptococcal glomerulonephritis diagnosis

Answer 33

+ Strep Culture Serum C3 Antibodies to streptolysin O

Question 34

Treatment for Streptococcal glomerulonephritis

Answer 34

Treat for strep (10 days penicillin) | Treat complications

Question 35

Other than problems with scarlet fever, rheumatic fever, and glomerulonephritis, what are a couple other important streptococcal infection complications

Answer 35

Peritonsillar abscess | Toxic Shock Syndrome (very rare following GABHS phar/tons)