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strep throat

 
Medical Encyclopedia: Strep Throat
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Definition

Streptococcal sore throat, or strep throat as it is more commonly called, is an infection of the mucous membranes lining the pharynx. Sometimes the tonsils are also infected (tonsillitis). The disease is caused by group A Streptococcus bacteria. Untreated strep throat may develop into rheumatic fever or other serious conditions.

Description

Strep throat accounts for between 5–10% of all sore throats. Although anyone can get strep throat, it is most common in school-age children. People who smoke, who are fatigued, run down, or who live in damp, crowded conditions are also more likely to become infected. Children under age two and adults who are not around children are less likely to get the disease.

Strep throat occurs most frequently from November to April. The disease passes directly from person to person by coughing, sneezing, and close contact. Very occasionally the disease is passed through food, when a food handler infected with strep throat accidentally contaminates food by coughing or sneezing. Statistically, if someone in the household is infected, one out of every four other household members may get strep throat within two to seven days.

— Tish Davidson


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Dictionary: strep throat
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n.
An infection of the throat, often epidemic, caused by hemolytic streptococci and characterized by fever and inflammation of the tonsils.


Dental Dictionary: strep throat
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n

An infection of the oral pharynx and tonsils caused by hemolytic species of Streptococcus. The infection is characterized by sore throat, chills, fever, swollen lymph nodes in the neck, and sometimes nausea and vomiting.

Alternative Medicine Encyclopedia: Strep Throat
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Definition

Strep throat is a contagious infection caused by the bacterium Streptococcus pyogenes.

Description

Strep throat primarily affects children, especially those between the ages of five and 15. Adults whose immune systems have been weakened by stress or other infections are also at risk. Most sore throats are associated with viral infections such as the common cold or the flu. Strep throat is responsible in only about 10%–15% of cases. Many people carry Streptococcus pyogenes in their systems without even knowing it. It can survive in the lining of the throat or nose for years without producing symptoms. Almost 20% of people in general good health may be harboring this bacterium unsuspectingly, according to one statistic.

Strep throat is often mistaken for a cold or the flu. It is important, however, to identify strep throat because if left untreated it can lead to serious health problems. In rare cases, untreated strep throat may increase the risk of developing scarlet or rheumatic fever. Rheumatic fever, in turn, is associated with meningitis and diseases affecting the heart, skin, kidneys, and joints. Strep throat may return repeatedly if not treated effectively the first time.

Another reason for getting treatment for strep throat is that Streptococcus pyogenes belongs to a group of diseasecausing bacteria that produce superantigens. Superantigens are a group of toxins that have the ability to trigger excessive and abnormal activation of the body's T cells. T cells are produced in the thymus gland and regulate the human immune system's response to infection. Superantigens are being studied intensively for their roles in causing disease. Streptococcus pyogenes and Staphylococcus aureus together produce 19 different superantigens.

Causes & Symptoms

Most people develop strep throat through close contact with someone who has an untreated strep infection. Infected mucus from the nose or throat is often spread via sneezing or coughing. Carriers of Streptococcus pyogenes who do not show symptoms of strep throat are less likely to infect others, as are people with strep throat who have received antibiotic therapy for 24 hours or more. Strep throat is not usually transmitted through casual contact. In rare cases, strep can develop after exposure to infected food, dairy products, or water.

People with weakened immune systems are more likely to become infected with strep throat. This infection can occur when the body is battling a cold or the flu. Stress or physical exhaustion can also weaken the immune system and increase the risk of bacterial infection. Strep throat usually strikes during the winter months. Symptoms develop two to four days after being infected.

While cold or flu symptoms often develop gradually over a period of several days, the symptoms associated with strep throat occur with little warning. Classic symptoms of strep include sore throat and fever. Other tell-tale signs may include swollen and tender lymph glands in the neck, redness on the inside of the throat, inflamed tonsils or gray/white patches on the tonsils, and headache. Trouble swallowing can also occur, and red specks may be visible on the roof of the mouth. Nausea and stomach pain are more likely in children infected with strep. Unlike a cold or the flu, strep throat does not usually produce cough or a stuffy, runny nose.

Diagnosis

Most doctors who suspect strep throat recommend a rapid strep test to confirm the diagnosis. This painless test involves using a swab to remove a specimen from the throat of the infected person. The results of the test are available in 10–20 minutes. In addition, the doctor may send a similar specimen to a laboratory to have a throat culture performed, which takes a day or two to complete. A negative strep test or culture usually indicates that the cause is viral in nature, in which case antibiotics are of no help.

Treatment

Conventional medicine is very successful in treating strep throat. However, several alternative therapies may help to resolve the disease or relieve symptoms. Herbal remedies such as echinacea (Echinacea spp.), goldenseal (Hydrastis canadensis), and garlic (Allium sativum) are believed to strengthen the immune system and combat bacterial infections.

Goldenseal

One of its active agents is a chemical called berberine. This alkaloid is believed to have antibiotic effects against streptococci bacteria. It may also help to prevent Streptococcus pyogenes from attaching itself to the throat lining, according to a study published in the journal Antimicrobial Agents and Chemotherapy in 1988. Goldenseal is also believed to increase the activity of disease-fighting white blood cells.

Echinacea

This popular herb fights viral and bacterial infections by boosting the immune system, according to herbalists. Echinacea may also combat strep throat by interfering with the production of hyaluronidase, an enzyme that helps the offending bacterium to grow and spread.

Garlic

The focus of hundreds of medical studies and papers, garlic is believed to be an antibiotic as well as an antiviral. As an added benefit, garlic may also prevent atherosclerosis, lower cholesterol levels, and act as an antioxidant.

Zinc and ginger (Zingiber officinale) are sometimes recommended to help treat symptoms of sore throat. In addition to strengthening the immune system, zinc may reduce throat inflammation and pain regardless of the cause. Ginger may have analgesic properties and ease throat irritation.

In the practice of homeopathy, belladonna, lachesis, and mercurius are usually the remedies of choice for strep throat and other causes of throat irritation. Which remedy to use depends on the exact nature of the symptoms. These homeopathic treatments are not recommended for more than a few days or symptoms may actually return.

Vitamin C may also help to boost the immune system. In some studies, it has been shown to shorten the duration of colds.

Allopathic Treatment

Antibiotics, the conventional treatment of choice, are very effective in curing strep throat. They also ease symptoms and are generally believed to reduce the risk of serious complications such as rheumatic fever. Ten days of oral penicillin is a typical course of therapy. People allergic to this drug usually take erythromycin instead. In some cases, a single injection of antibiotics may be preferred. It is important to complete the full course of antibiotic therapy (even if symptoms begin to subside earlier) in order to resolve the disease and prevent the development of complications. To further alleviate symptoms, acetaminophen or ibuprofen may also be used.

Studies of bacterial resistance to various drugs indicate that the strains of S. pyogenes found most commonly in the United States have developed some resistance to erythromycin as of 2002. As a result, doctors are more likely to prescribe antibiotics that belong to a newer group of drugs called quinolones. It is important to take quinolone antibiotics exactly as directed, as they have a number of side effects.

Expected Results

The symptoms associated with strep throat usually begin to disappear within several days even without treatment. When antibiotics are used, fever may subside within 24 hours, and the course of the illness may be shortened by two days.

People who use alternative remedies in the absence of antibiotics should consult a doctor if symptoms do not subside within a week. In these cases, the use of antibiotics is strongly recommended.

Prevention

Washing the hands frequently can help to prevent strep throat. Exposure to infected people should also be avoided. In order to prevent transmission of the disease within households, consult a doctor if any family member suddenly develops a sore throat (especially if it is accompanied by fever).

Boosting the immune system is also important to help prevent the development of strep throat. Vitamin C and zinc are often recommended for this purpose, as are goldenseal, echinacea, and garlic. Reducing stress and getting proper sleep can also strengthen the body's defenses against infection.

Resources

Books

Bennett, Claude J., and Fred Plum. Cecil Textbook of Medicine. Philadelphia, PA: W.B. Saunders Company, 1996.

Murray, Michael T., and Joseph Pizzorno. Encyclopedia of Natural Medicine. Rocklin, CA: Prima Publishing, 1998.

Periodicals

Barros, M.G. "Soothing Sore Throats Gingerly." Cortlandt Forum 67 (1995): 86-16.

Critchley, I. A., D. F. Sahm, C. Thornsberry et al. "Antimicrobial Susceptibilities of Streptococcus pyogenes Isolated from Respiratory and Skin and Soft Tissue Infections: United States LIBRA Surveillance Data from 1999." Diagnostic Microbiology and Infectious Disease 42 (February 2002): 129-135.

Llewelyn, M., and J. Cohen. "Superantigens: Microbial Agents That Corrupt Immunity." Lancet Infectious Diseases 2 (March 2002): 156-162.

Sun, D., H.S. Courtney, and E.H Beachey. "Berberine sulfate blocks adherence of Streptococcus pyogenes to epithelial cells, fibronectin, and hexadecane." Antimicrob Agents Chemother 32, no. 9 (1988): 1370-4.

Organizations

National Institute of Allergy and Infectious Disease. 31 Center Drive MSC 2520, Building 31, Room 7A-50, Bethesda, MD 20892-2520.

Other

Discovery Health. http://www.discoveryhealth.com.

National Institute of Allergy and Infectious Disease. http://www.niaid.nih.gov.

[Article by: Greg Annussek; Rebecca J. Frey, PhD]

Children's Health Encyclopedia: Strep Throat
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Definition

Streptococcal sore throat, or strep throat, as it is more commonly called, is a bacterial infection of the mucous membranes lining the throat or pharynx.

Description

Strep throat is caused by a type of bacteria called group A streptococci. The tonsils may also become infected (tonsillitis). Left untreated, strep throat may develop into rheumatic fever or other serious conditions.

Demographics

Strep throat accounts for between 5 and 10 percent of all sore throats. Although anyone can get strep throat, it is most common in school-age children. People who smoke, who are fatigued, run down, or who live in damp, crowded conditions are also more likely to become infected. Children under age two and adults who are not around children are less likely to get the disease.

Strep throat occurs most frequently between November to April. The disease passes directly from person to person by coughing, sneezing, and close contact. On rare occasions, the disease is passed through food, when a food handler infected with strep throat accidentally contaminates food by coughing or sneezing. Statistically, if someone in the household is infected, one out of every four other household members may get strep throat within two to seven days.

Causes and Symptoms

A person with strep throat suddenly develops a painful sore throat one to five days after being exposed to the streptococcus bacteria. The pain is indistinguishable from sore throats caused by other diseases.

The infected person usually feels tired and has a fever, sometimes accompanied by chills, headache, muscle aches, swollen lymph glands, and nausea. Young children may complain of abdominal pain. The tonsils look swollen and are bright red, with white or yellow patches of pus on them. Sometimes the roof of the mouth is red or has small red spots. Often a person with strep throat has bad breath.

Despite these common symptoms, strep throat can be deceptive. It is possible to have the disease and not show any of these symptoms. Many young children complain only of a headache and stomachache, without the characteristic sore throat.

Occasionally, within a few days of developing the sore throat, an individual may develop a fine, rough, sunburn-like rash over the face and upper body and have a fever of 101–104°F (38.3–40°C). The tongue becomes bright red, with a flecked, strawberry-like appearance. When a rash develops, this form of strep throat is called scarlet fever. The rash is a reaction to toxins released by the streptococcus bacteria. Scarlet fever is no more dangerous than strep throat and is treated the same way. The rash disappears in about five days. One to three weeks later, patches of skin may peel off, as might occur with a sunburn, especially on the fingers and toes.

Untreated strep throat can cause rheumatic fever. This is a serious illness, although it occurs rarely. One outbreak appeared in the United States in the mid-1980s. Rheumatic fever occurs most often in children between the ages of five and 15 and may have a genetic component, since it seems to run in families. Although the strep throat that causes rheumatic fever is contagious, rheumatic fever itself is not.

Rheumatic fever begins one to six weeks after an untreated streptococcal infection. The joints, especially the wrists, elbows, knees, and ankles become red, sore, and swollen. The infected person develops a high fever and possibly a rapid heartbeat when lying down, paleness, shortness of breath, and fluid retention. A red rash over the trunk may come and go for weeks or months. An acute attack of rheumatic fever lasts about three months.

Rheumatic fever can cause permanent damage to the heart and heart valves. It can be prevented by promptly treating streptococcal infections with antibiotics. It does not occur if all the streptococcus bacteria are killed within the first ten to 12 days after infection.

In the 1990s, outbreaks of a virulent strain of group A streptococcus were reported to cause a toxic-shock-like illness and a severe invasive infection called necrotizing fasciitis, which destroys skin and muscle tissue. Although these diseases are caused by group A streptococci, they rarely begin with strep throat. Usually the streptococcus bacteria enters the body through a skin wound. These complications are rare. However, since the death rate in necrotizing fasciitis is 30 to 50 percent, it is wise to seek prompt treatment for any streptococcal infection.

Diagnosis

Diagnosis of a strep throat by a doctor begins with a physical examination of the throat and chest. The doctor will also look for signs of other illness, such as a sinus infection or bronchitis, and seek information about whether the patient has been around other people with strep throat. If it appears that the patient may have strep throat, the doctor will do laboratory tests.

There are two types of tests to determine if a person has strep throat. A rapid strep test can only determine the presence of streptococcal bacteria but will not tell if the sore throat is caused by another kind of bacteria. To perform a rapid strep test or a throat culture, a nurse will use a sterile swab to reach down into the throat and obtain a sample of material from the sore area. The procedure takes only a few seconds but may cause gagging. The results are available in about 20 minutes. The advantage of this test is the speed with which a diagnosis can be made.

The rapid strep test has a false negative rate of about 20 percent. In other words, in about 20 percent of cases where no strep is detected by the rapid strep test, the patient actually does have strep throat. Because of this margin of error, when a rapid strep test is negative, the doctor often does a throat culture.

For a throat culture a sample of swabbed material is cultured, or grown, in the laboratory on a medium that allows technicians to determine what kind of bacteria are present. Results take 24 to 48 hours. The test is very accurate and will show the presence of other kinds of bacteria besides streptococci. It is important not to take any leftover antibiotics before visiting the doctor and having a throat culture. Even small amounts of antibiotics can suppress the bacteria and mask its presence in the throat culture.

In the event that rheumatic fever is suspected, the doctor does a blood test. Results of this test, called an antistreptolysin-O test, tell the doctor whether the person has recently been infected with strep bacteria. This information helps the doctor distinguish between rheumatic fever and rheumatoid arthritis.

Treatment

Strep throat is treated with antibiotics. Penicillin is the preferred medication. Oral penicillin must be taken for 10 days. Patients need to take the entire amount of antibiotic prescribed and not discontinue taking the medication when they feel better. Stopping the antibiotic early can lead to a return of the strep infection. Occasionally, a single injection of long-acting penicillin (Bicillin) is given instead of ten days of oral treatment.

About 10 percent of the time, penicillin is not effective against the strep bacteria. When this happens a doctor may prescribe other antibiotics such as amoxicillin (Amoxil, Pentamox, Sumox, Trimox), clindamycin (Cleocin), or a cephalosporin (Keflex, Durocef, Ceclor). Erythromycin (Eryzole, Pediazole, Ilosone), another inexpensive antibiotic, is given to people who are allergic to penicillin. Scarlet fever is treated with the same antibiotics as strep throat.

Without treatment, the symptoms of strep throat begin subsiding in four or five days. However, because of the possibility of getting rheumatic fever, it is important to treat strep throat promptly with antibiotics. If rheumatic fever does occur, it is also treated with antibiotics. Anti-inflammatory drugs, such as steroids, are used to treat joint swelling. Diuretics are used to reduce water retention. Once the rheumatic fever becomes inactive, children may continue on low doses of antibiotics to prevent a reoccurrence. Necrotizing fasciitis is treated with intravenous antibiotics.

Prognosis

Patients with strep throat begin feeling better about 24 hours after starting antibiotics. Symptoms rarely last longer than five days.

People remain contagious until after they have been taking antibiotics for 24 hours. Children should not return to school or childcare until they are no longer contagious. Food handlers should not work for the first 24 hours after antibiotic treatment, because strep infections are occasionally passed through contaminated food. People who are not treated with antibiotics can continue to spread strep bacteria for several months.

About 10 percent of strep throat cases do not respond to penicillin. People who have even a mild sore throat after a 10-day treatment with antibiotic should return to their doctor. An explanation for this problem may be that the person is just a carrier of strep and that something else is causing the sore throat.

Taking antibiotics within the first week of a strep infection will prevent rheumatic fever and other complications. If rheumatic fever does occur, the outcomes vary considerably. Some cases may be cured. In others there may be permanent damage to the heart and heart valves. In rare cases, rheumatic fever can be fatal.

Necrotizing fasciitis has a death rate of 30 to 50 percent. Patients who survive often suffer a great deal of tissue and muscle loss. Fortunately, this complication of a streptococcus infection is very rare.

Prevention

There is no way to prevent getting a strep throat. However, the risk of getting one or passing one on to another person can be minimized by the following precautions:

  • washing hands well and frequently, especially after nose blowing or sneezing and before food handling
  • disposing of used tissues properly
  • avoiding close contact with someone who has a strep throat
  • not sharing food and eating utensils with anyone
  • not smoking

Parental Concerns

Children who have strep throat should be kept out of daycare, school, activities, and other public places until they have been taking their antibiotic for a full 24 hours. This will help decrease the likelihood of passing on the infection to others.

Parents who are caring for a child with strep will want to take the following steps:

  • Give the child acetaminophen or ibuprofen for pain. Aspirin should not be given to children because of its association with Reye's syndrome, a serious disease.
  • Encourage the child to gargle with warm double strength tea or warm salt water, made by adding one teaspoon of salt to eight ounces of water, to relieve sore throat pain.
  • Make sure that the child drinks plenty of fluids but avoids acidic juices like orange juice because they irritate the throat.
  • Offer the child soft, nutritious foods like noodle soup and avoid spicy foods.
  • Help the child avoid exposure to people who are smoking.
  • Encourage the child to rest until the fever is gone, then allow him or her to gradually resume activities.
  • Use a room humidifier, as it may make sore throat sufferers more comfortable.
  • Be aware that antiseptic lozenges and sprays may aggravate the sore throat rather than improve it.

Resources

Books

Gerber, Michael A. "Group A Streptococcus." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

Periodicals

Ebell, M. H. "Strep Throat." American Family Physician 68 (September 1, 2000): 937–8.

[Article by: Tish Davidson, A.M. Rosalyn Carson-DeWitt, MD]


Health Dictionary: strep throat
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A severe sore throat caused by a kind of streptococcus. Strep throat can be treated with antibiotics.

Wikipedia: Streptococcal pharyngitis
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Streptococcal pharyngitis
Classification and external resources
ICD-10 J02.0
ICD-9 034.0
DiseasesDB 12507
MedlinePlus 000639
eMedicine med/1811

Streptococcal pharyngitis or streptococcal sore throat (strep throat AmE) is a form of group A streptococcal infection[1] that affects the pharynx and possibly the larynx and tonsils.

Contents

Signs and symptoms

Streptococcal pharyngitis usually appears suddenly with a severe sore throat that may make talking or swallowing painful.

Signs and symptoms may include

Additional symptoms such as sinusitis, vaginitis, or impetigo may be present if the strep bacteria infects both the throat and a secondary location. For additional information on non-pharynx symptoms, see Group A Streptococcal (GAS) Infection.

Diagnosis

There are several causes for pharyngitis, not just streptococcus bacteria. Productive coughing, nasal discharge, and red, irritated eyes in addition to fever and sore throat are more indicative of a viral sore throat than of strep throat, though a co-infection with a virus is possible and may explain the presence of these additional symptoms. A rapid strep test (also called rapid antigen detection testing or RADT) or a throat culture may be undertaken to clarify diagnosis. The rapid strep test is quicker but less sensitive and specific than a throat culture developed on a blood agar plate.[4] Positive tests in association with symptoms establish a positive diagnosis, which can be treated with antibiotics.[4] Asymptomatic patients should not be routinely tested with a throat culture because a certain percentage of the population persistently "carries" strep throat.[4]

The presence of marked lymph node enlargement along with sore throat, fever and tonsillar enlargement may also occur in infectious mononucleosis (glandular fever).[5]

A study of 729 patients with pharyngitis, in which 17% had a positive throat culture for group A streptococcus, identified the following four best predictors of streptococcus, also called the Centor criteria:[6]

Number of symptoms Probability of Strep
0 2.5%
1 6.0 - 6.9%
2 14.1 – 16.6%
3 30.1 – 34.1%
4 55.7%

Another study on 621 patients, assigned one point for each of the following symptoms:[8]

  • Temperature greater than 38°C (100.4°F)
  • Absence of cough
  • Tender anterior cervical adenopathy
  • Tonsillar swelling or exudate
  • Age younger than 15
  • Subtracting a point for age older than 45.
Points Probability of Strep Management
1 or less 0% Negative: No antibiotic
2 17% Indeterminate: antibiotic based on throat culture
3 35%
4 or 5 51% Positive: for throat culture and antibiotics

Finally, patients usually experience swelling of the tonsils and lymph nodes in the neck, but swelling can also be located in the soft palate in the top of the mouth. The absence of tender anterior cervical lymph nodes, tonsillar enlargement, and tonsillar or pharyngeal exudates has been suggested as being the most useful finding in ruling out strep throat, with a negative likelihood of 0.74.[9]

Transmission

Strep throat is caused by Group A streptococcal infection (GAS),[10] specifically the bacterium Streptococcus pyogenes.[11] It is spread by direct, close contact with an infected person.[12] It has been found that dried bacteria in dust are not infectious. Although moist bacteria on toothbrushes or similar items, which can persist for up to fifteen days,[13] might theoretically spread it, a decreased rate of recurrence in families following hygienic measures has not been shown rigorously.[10] Rarely, contaminated food, especially milk and milk products, can result in outbreaks.[14]

The incubation period for strep throat is thought to be between two to five days, but has been reported as long as eight days.[15][16]

Treatment

Symptomatic therapies

Nonprescription over the counter drugs of ibuprofen and paracetamol (acetaminophen) both help relieve throat pain and reduce fever by an average of 2.2˚F or 2.3˚F in children.[17] Aspirin is not recommended for children due to the risk of Reye's syndrome. In adults aspirin, paracetamol, or ibuprofen help reduce back pain by 48% and sore throat by 31%.[18]

Antibiotics

Antibiotics decrease the duration of symptoms (which last about 3–5 days[4]) by 1 or 2 days and reduce contagiousness. They are also prescribed out of a motivation to reduce rare complications such as acute rheumatic fever, acute glomerulonephritis (incidence of glumerulonephritis is not reduced by antibiotic therapy), and suppurative complications such as peritonsillar abscess.[19] The use of antibiotics should be balanced by the consideration of side-effects,[13] and it is reasonable to suggest no antimicrobial treatment in healthy adults who are averse to medication.[19] Antibiotics are prescribed for strep throat at a higher rate than would be expected from its prevalence.[20]

In one clinical trial, the greatest reduction in symptoms after antibiotic treatment occurred after 3 days. Out of all symptoms, reduction scores for muscle or joint pain was the most at 86%, and the lowest for sore throat at 67%.[21] Another clinical trial found that only (17%) of 42 children had positive throat cultures a day after antibiotic treatment.[22] Sometimes penicillin fails to completely treat the infection.[23]

Cephalosporins (such as cefazoline, cefuroxime, and ceftriaxone) are recommended for penicillin-allergic patients. In another study, 41 patients with confirmed penicillin allergy were evaluated with cefazoline, cefuroxime, and ceftriaxone—all cephalosporins—to see the allergic reaction. Skin tests with cephalosporins were clearly negative in 39 patients and all 41 patients tolerated the three cephalosporins administered.[24][25] Second-line antibiotics included amoxicillin,[26] clindamycin,[27] and oral cephalosporins which have a significantly better cure rate than penicillin.[28]

Studies have also shown that the broader-spectrum of antibiotics offer more effective short treatment courses than the traditional 10 days of Penicillin V,[29] but noted that "widespread use of broad-spectrum agents for a common infection is a significant concern in an age of increasing bacterial antibiotic resistance".[30] It is important to complete the full course of antibiotics to prevent rheumatic fever or an abscess on the tonsils. In one report of 500 patients, 30% had group A beta-hemolytic streptococcal pharyngitis, 0.2% had rheumatic fever and 0.2% had peritonsillar abscess (an abscess on the tonsils).[5]

Azithromycin and other macrolides have been used to treat strep throat in penicillin-sensitive patients, however macrolide resistant strains of GAS are not uncommon. In these strains, cross-resistance to macrolides, lincosamides, and streptogramins is possible. Some of the initial motivation for using antibiotics to treat all strep throat with antibiotics came from early studies showing that it reduced acute rheumatic fever at a military base, but it's difficult to generalize these findings to the current population.[31]

Complications

The symptoms of strep throat usually improve even without treatment in three to five days,[4] but without treatment the patient remains contagious for several weeks. Lack of treatment or incomplete treatment of strep throat can lead to various complications. Some of them may pose serious health risks. Therefore, streptococcal tonsillitis is important to recognize and treat early. The patient is considered to be contagious up to three days after being treated with antibiotics.[32]

List of complications arising from disseminated streptococcal infection (originating in the throat)[33]

See also

References

  1. ^ streptococcal pharyngitis at Dorland's Medical Dictionary
  2. ^ Xu J, Schwartz K, Monsur J, Northrup J, Neale AV (December 2004). "Patient-clinician agreement on signs and symptoms of 'strep throat': a MetroNet study". Fam Pract 21 (6): 599–604. doi:10.1093/fampra/cmh604. PMID 15528291. http://fampra.oxfordjournals.org/cgi/content/full/21/6/599. 
  3. ^ Kids Health
  4. ^ a b c d e Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Schwartz RH (July 2002). "Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America". Clin. Infect. Dis. 35 (2): 113–25. doi:10.1086/340949. PMID 12087516. http://www.journals.uchicago.edu/doi/abs/10.1086/340949. 
  5. ^ a b Ebell MH (2004). "Epstein-Barr virus infectious mononucleosis". Am Fam Physician 70 (7): 1279–87. PMID 15508538. http://www.aafp.org/afp/20041001/1279.html. 
  6. ^ Centor RM, Dalton HP, Campbell MS, Lynch MR, Watlington AT, Garner BK (1986). "Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients". J Gen Intern Med 1 (4): 248–51. doi:10.1007/BF02596194. PMID 3534175. 
  7. ^ Komaroff AL, Pass TM, Aronson MD, et al. (1986). "The prediction of streptococcal pharyngitis in adults". J Gen Intern Med 1 (1): 1–7. doi:10.1007/BF02596317. PMID 3534166. 
  8. ^ McIsaac WJ, Goel V, To T, Low DE (2000). "The validity of a sore throat score in family practice". CMAJ 163 (7): 811–5. PMID 11033707. http://www.cmaj.ca/cgi/content/full/163/7/811. 
  9. ^ Eaton CA (2001). "What clinical features are useful in diagnosing strep throat?". J Fam Pract 50 (3): 201. PMID 11252201. http://www.jfponline.com/Pages.asp?AID=2184. 
  10. ^ a b Falck G, Kjellander J, Schwan A (1998). "Recurrence rate of streptococcal pharyngitis related to hygienic measures". Scand J Prim Health Care 16 (1): 8–12. doi:10.1080/028134398750003331. PMID 9612872. 
  11. ^ Gieseker KE, Roe MH, MacKenzie T, Todd JK (2003). "Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing". Pediatrics 111 (6 Pt 1): e666–70. doi:10.1542/peds.111.6.e666. PMID 12777583. http://pediatrics.aappublications.org/cgi/content/full/111/6/e666. 
  12. ^ Lindbaek M, Høiby EA, Lermark G, Steinsholt IM, Hjortdahl P (2004). "Predictors for spread of clinical group A streptococcal tonsillitis within the household". Scand J Prim Health Care 22 (4): 239–43. doi:10.1080/02813430410006729. PMID 15765640. 
  13. ^ a b Hayes CS, Williamson H (April 2001). "Management of Group A beta-hemolytic streptococcal pharyngitis". Am Fam Physician 63 (8): 1557–64. PMID 11327431. http://www.aafp.org/afp/20010415/1557.html. 
  14. ^ Asteberg I, Andersson Y, Dotevall L, et al. (2006). "A food-borne streptococcal sore throat outbreak in a small community". Scand. J. Infect. Dis. 38 (11-12): 988–94. doi:10.1080/00365540600868370. PMID 17148066. 
  15. ^ Sarvghad MR, Naderi HR, Naderi-Nassab M, et al. (2005). "An outbreak of food-borne group A Streptococcus (GAS) tonsillopharyngitis among residents of a dormitory". Scand. J. Infect. Dis. 37 (9): 647–50. doi:10.1080/00365540510044085. PMID 16126564. 
  16. ^ Coburn, A.F.; Pauli, R.H. (1941), "The interaction of host and bacterium in the development of communicability by Streptococcus haemolyticus", The Journal of Experimental Medicine 73: 551–570 
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