Strep throat

Other Names:
Streptococcal pharyngitis, streptococcal tonsillitis, or streptococcal sore throat

Definition:
Strep throat is a disease that causes a sore throat (pharyngitis). It is an infection with a germ called Group A Streptococcus bacteria.  Only a small portion of sore throats are the result of strep throat.

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It  is a contagious infection, spread through close contact with an infected individual.  this is not always needed as treatment may be decided based on symptoms. In highly likely or confirmed cases, antibiotics are useful to both prevent complications and speed recovery.

It’s important to identify strep throat for a number of reasons. If untreated, strep throat can sometimes cause complications such as kidney inflammation and rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a rash and even damage to heart valves.

Strep throat is most common between the ages of 5 and 15, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt treatment.

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Symptoms:
Symptoms may be mild or severe.One will often start to feel sick about 2 to 5 days after he or she  come in contact with the strep germ.

Fever may begin suddenly and is often highest on the second day. You may have chills.

You can have a red sore throat, sometimes with white patches. It may hurt to swallow. You may feel swollen, tender glands in your neck.

Other symptoms may include:
*General ill feeling, a loss of appetite and abnormal taste & Fever
*Headache
*Nausea
*Throat pain
*Difficulty swallowing
*Red and swollen tonsils, sometimes with white patches or streaks of pus
*Tiny red spots on the soft or hard palate — the area at the back of the roof of the mouth
*Swollen, tender lymph glands (nodes) in your neck
*Headache
*Rash
*Stomachache and sometimes vomiting, especially in younger children
*Fatigue

It’s possible for you or your child to have many of these signs and symptoms, but not have strep throat. The cause of these signs and symptoms could be a viral infection or some other kind of illness. That’s why your doctor generally tests specifically for strep throat.

It’s also possible to have the bacteria that can cause strep in your throat without having a sore throat. Some people are carriers of strep, which means they can pass the bacteria on to others, but the bacteria are not currently making them sick.

Some strains of strep throat can lead to a scarlet fever-like rash. The rash first appears on the neck and chest. Then it spreads over the body. It may feel like sandpaper.

Causes:
Strep throat is caused by group A beta-hemolytic streptococcus (GAS). Other bacteria such as non–group A beta-hemolytic streptococci and fusobacterium may also cause pharyngitis. It is spread by direct, close contact with an infected person and thus crowding as may be found in the military and schools increases the rate of transmission. It has been found that dried bacteria in dust are not infectious, although moist bacteria on toothbrushes or similar items can persist for up to fifteen days. Rarely, contaminated food can result in outbreaks. Of children with no signs or symptoms 12% carry GAS in their pharynx and after treatment approximately 15% remain carriers.

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Diagnosis:
The modified Centor criteria maybe used to determine the management of people with pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.

One point is given for each of the criteria:

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*Absence of a cough
*Swollen and tender cervical lymph nodes
*Temperature >38.0 °C (100.4 °F)
*Tonsillar exudate or swelling
*Age less than 15 (a point is subtracted if age >44)

The Infectious Disease Society of America however recommends against empirical treatment and considers antibiotics only appropriate following positive testing. Testing is not needed in children under three as both group A strep and rheumatic fever are rare, except if they have a sibling with the disease.

Laboratory testing:
A throat culture is the gold standard for the diagnosis of streptococcal pharyngitis with a sensitivity of 90–95%. A rapid strep test (also called rapid antigen detection testing or RADT) may also be used. While the rapid strep test is quicker, it has a lower sensitivity (70%) and statistically equal specificity (98%) as throat culture.

A positive throat culture or RADT in association with symptoms establishes a positive diagnosis in those in which the diagnosis is in doubt. In adults a negative RADT is sufficient to rule out the diagnosis however in children a throat culture is recommended to confirm the result. Asymptomatic individuals should not be routinely tested with a throat culture or RADT because a certain percentage of the population persistently “carries” the streptococcal bacteria in their throat without any harmful results.

Differential diagnosis:
As the symptoms of streptococcal pharyngitis overlap with other conditions it can be difficult to make the diagnosis clinically. Coughing, nasal discharge, diarrhea, and red, irritated eyes in addition to fever and sore throat are more indicative of a viral sore throat than of strep throat. The presence of marked lymph node enlargement along with sore throat, fever and tonsillar enlargement may also occur in infectious mononucleosis.

Possible Complications & Risk Factors:

*Acute rheumatic fever….click to see
*Scarlet fever
*Streptococcal toxic shock syndrome
*Glomerulonephritis
*Ear infection
*Glomerulonephritis
*Guttate psoriasis
*Mastoiditis
*Peritonsillar abscess
*Sinusitis

Treatment:
A number of medications are available to cure strep throat, relieve its symptoms and prevent its spread.

Antibiotics:
If you or your child has strep throat, your doctor will likely prescribe an oral antibiotic such as:
Penicillin. This drug may be given by injection in some cases — such as if you have a young child who is having a hard time swallowing or is vomiting.
Amoxicillin. This drug is in the same family as penicillin, but is often a preferred option for children because it tastes better and is available as a chewable tablet.

If you or your child is allergic to penicillin, your doctor likely may prescribe:
A cephalosporin such as cephalexin (Keflex)
Clarithromycin (Biaxin)
Azithromycin (Zithromax, Zmax)
Clindamycin

These antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to classmates or family members.

Once treatment begins, you or your child should start feeling better in just a day or two. Call your doctor if you or your child doesn’t feel better after taking antibiotics for 48 hours.

If children taking antibiotic therapy feel well and don’t have a fever, they often can return to school or child care when they’re no longer contagious — usually 24 hours after beginning treatment. But be sure to finish the entire course of medicine. Stopping medication early may lead to recurrences and serious complications, such as rheumatic fever or kidney inflammation.

Untreated streptococcal pharyngitis usually resolves within a few days. Treatment with antibiotics shortens the duration of the acute illness by about 16 hours. The primary reason for treatment with antibiotics is to reduce the risk of complications such as rheumatic fever and retropharyngeal abscesses and they are effective if given within 9 days of the onset of symptoms

Analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) help significantly in the management of pain associated with strep throat. Viscous lidocaine may also be useful. While steroids may help with the pain they are not routinely recommended. Aspirin may be used in adults but is not recommended in children due to the risk of Reye’s syndrome.

Prognosis:
The symptoms of strep throat usually improve irrespective of treatment within three to five days. Treatment with antibiotics reduces the risk of complications and transmission; children may return to school 24 hours after antibiotics are administered. The risk of complications in adults is low. In children acute rheumatic fever is rare in most of the developed world. It is however the leading cause of acquired heart disease in India, sub-Saharan Africa and some parts of Australia.

Prevention:
Tonsillectomy may be a reasonable preventive measure in those with frequent throat infections (more than three a year). The benefits are however small and episodes typically lessen in time regardless of measures taken. Recurrent episodes of pharyngitis which test positive for GAS may also represent a person who is a chronic carrier of GAS who is getting recurrent viral infections. Treating people who have been exposed but who are without symptoms is not recommended. Treating people who are carriers of GAS is not recommended as the risk of spread and complications is low.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Streptococcal_pharyngitis
http://www.nlm.nih.gov/medlineplus/ency/article/000639.htm
http://ww.mayoclinic.com/health/strep-throat/DS00260

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