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strep throat

 
American Heritage 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.


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Gale Encyclopedia of Children's Health:

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]


Dictionary of Cultural Literacy: Health:

strep throat

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

Mosby's 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.

Random House Word Menu:

categories related to 'strep throat'

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Wikipedia on Answers.com:

Streptococcal pharyngitis

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Streptococcal pharyngitis
Classification and external resources
A set of large tonsils in the back of the throat covered in white exudate
A culture positive case of streptococcal pharyngitis with typical tonsillar exudate in a 16 year old.
ICD-10 J02.0
ICD-9 034.0
DiseasesDB 12507
MedlinePlus 000639
eMedicine med/1811

Streptococcal pharyngitis, streptococcal tonsillitis, or streptococcal sore throat (known colloquially as strep throat) is a type of pharyngitis caused by a group A streptococcal infection.[1] It affects the pharynx including the tonsils and possibly the larynx. Common symptoms include fever, sore throat, and enlarged lymph nodes. It is the cause of 37% of sore throats among children.[2]

Strep throat is a contagious infection, spread through close contact with an infected individual. A definitive diagnosis is made based on the results of a throat culture. However, 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.[3]

Contents

Signs and symptoms

The typical symptoms of streptococcal pharyngitis are a sore throat, fever of greater than 38 °C (100 °F), tonsillar exudates (pus on the tonsils), and large cervical lymph nodes.[3]

Other symptoms include:

The incubation period and thus the start of symptoms for strep throat is between one to three days post contact.[3]

Mouth wide open showing the throat
A throat infection which on culture tested positive for group A streptococcus. Note the large tonsils with white exudate.  
Mouth wide open showing the throat
Note the petechiae, or small red spots, on the soft palate. This is an uncommon but highly specific finding in streptococcal pharyngitis.[3]  
A set of large tonsils in the back of the throat covered in white exudate.
A culture positive case of streptococcal pharyngitis with typical tonsillar exudate in an 8 year old.  

Cause

Strep throat is caused by group A beta-hemolytic streptococcus (GAS).[6] Other bacteria such as non–group A beta-hemolytic streptococci and fusobacterium may also cause pharyngitis.[3][5] 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.[5][7] 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.[5] Rarely, contaminated food can result in outbreaks.[5] Of children with no signs or symptoms 12% carry GAS in their pharynx.[2]

Diagnosis

Modified Centor score
Points Probability of Strep Management
1 or less <10% No antibiotic or culture needed
2 11–17% Antibiotic based on culture or RADT
3 28–35%
4 or 5 52% Empiric antibiotics

The modified Centor score is used to determine the management of people with pharyngitis. Based on 5 clinical criteria, it indicates the probability of a streptococcal infection.[3]

One point is given for each of the criteria:[3]

  • Absence of a cough
  • Swollen and tender cervical lymph nodes
  • Temperature >38 °C (100 °F)
  • Tonsillar exudate or swelling
  • Age less than 15 (a point is subtracted if age >44)

Laboratory testing

A throat culture is the gold standard[8] for the diagnosis of streptococcal pharyngitis with a sensitivity of 90–95%.[3] 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.[3]

A positive throat culture or RADT in association with symptoms establishes a positive diagnosis in those in which the diagnosis is in doubt.[9] 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.[9]

Differential diagnosis

See also: Acute pharyngitis

As the symptoms of streptococcal pharyngitis overlap with other conditions it can be difficult to make the diagnosis clinically.[3] 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.[3] The presence of marked lymph node enlargement along with sore throat, fever and tonsillar enlargement may also occur in infectious mononucleosis.[10]

Prevention

Tonsillectomy may be a reasonable preventive measure in those with frequent throat infections.[11][12] Three or more a year was seen as sufficient in 2003.[13] Watchful waiting is also appropriate.[11]

Treatment

Untreated streptococcal pharyngitis usually resolves within a few days.[3] Treatment with antibiotics shortens the duration of the acute illness by about 16 hours.[3] The primary reason for treatment with antibiotics is to reduce the risk of complications such as rheumatic fever and retropharyngeal abscesses[3] and they are effective if given within 9 days of the onset of symptoms.[6]

Analgesics

Analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) help significantly in the management of pain associated with strep throat.[14] Steroids are also useful in this respect[6][15] as is viscous lidocaine.[16] Aspirin may be used in adults but is not recommended in children due to the risk of Reye's syndrome.[6]

Antibiotics

The antibiotic of choice in the United States for streptococcal pharyngitis is penicillin V due to safety, cost, and effectiveness.[3] Amoxicillin is preferred in Europe.[17] In India, where the risk of rheumatic fever is higher, intramuscular benzathine penicillin G is the first choice for treatment.[6] Appropriate antibiotics decrease the average 3–5 day duration of symptoms by about one day, and also reduce contagiousness.[9] They are primarily prescribed out of a motivation to reduce rare complications such as acute rheumatic fever and peritonsillar abscess.[18] The arguments in favour of antibiotic treatment should be balanced by the consideration of possible side effects,[5] and it is reasonable to suggest that no antimicrobial treatment be given to healthy adults who have adverse reactions to medication.[18] Antibiotics are prescribed for strep throat at a higher rate than would be expected from its prevalence.[19] Erythromycin and other macrolides are recommended for people with severe penicillin allergies.[3] First, general cephalosporins may be used in those with less severe allergies.[3] Streptococcal infections may also lead to acute glomerulonephritis, however the incidence of this side effect is not reduced by the use of antibiotics.[6]

Prognosis

The symptoms of strep throat usually improve irrespective of treatment within three to five days.[9] Treatment with antibiotics reduces the risk of complications and transmission; children may return to school 24 hours after antibiotics are administered.[3]

Complications arising from streptococcal throat infections include:

Epidemiology

Pharyngitis, the broader category into which Streptococcal pharyngitis falls, is diagnosed in 11 million people annually in the United States.[3] Although most cases are viral, group A beta-hemolytic streptococcus is the cause in 15–30% of the pharyngitis cases in children and 5–20% in adults.[3] Cases usually occur in late winter and early spring.[3]

References

  1. ^ "streptococcal pharyngitis" at Dorland's Medical Dictionary
  2. ^ a b Shaikh N, Leonard E, Martin JM (September 2010). "Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis". Pediatrics 126 (3): e557–64. doi:10.1542/peds.2009-2648. PMID 20696723. 
  3. ^ a b c d e f g h i j k l m n o p q r s t u v Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician 79 (5): 383–90. PMID 19275067. http://www.aafp.org/afp/2009/0301/p383.html. 
  4. ^ a b c d Brook I, Dohar JE (December 2006). "Management of group A beta-hemolytic streptococcal pharyngotonsillitis in children". J Fam Pract 55 (12): S1–11; quiz S12. PMID 17137534. 
  5. ^ a b c d e f 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. 
  6. ^ a b c d e f Baltimore RS (February 2010). "Re-evaluation of antibiotic treatment of streptococcal pharyngitis". Curr. Opin. Pediatr. 22 (1): 77–82. doi:10.1097/MOP.0b013e32833502e7. PMID 19996970. 
  7. ^ 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. 
  8. ^ Smith, Ellen Reid; Kahan, Scott; Miller, Redonda G. (2008). In A Page Signs & Symptoms. In a Page Series. Hagerstown, Maryland: Lippincott Williams & Wilkins. pp. 312. ISBN 0-7817-7043-2. 
  9. ^ a b c d 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. 
  10. ^ 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. 
  11. ^ a b Paradise JL, Bluestone CD, Bachman RZ, et al. (March 1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642. 
  12. ^ Alho OP, Koivunen P, Penna T, Teppo H, Koskela M, Luotonen J (May 2007). "Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial". BMJ 334 (7600): 939. doi:10.1136/bmj.39140.632604.55. PMC 1865439. PMID 17347187. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1865439. 
  13. ^ Johnson BC, Alvi A (March 2003). "Cost-effective workup for tonsillitis. Testing, treatment, and potential complications". Postgrad Med 113 (3): 115–8, 121. PMID 12647478. 
  14. ^ Thomas M, Del Mar C, Glasziou P (October 2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract 50 (459): 817–20. PMC 1313826. PMID 11127175. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1313826. 
  15. ^ "Effectiveness of Corticosteroid Treatment in Acute Pharyngitis: A Systematic Review of the Literature.". Andrew Wing. 2010; Academic Emergency Medicine. http://www3.interscience.wiley.com/journal/123372200/abstract. 
  16. ^ "Generic Name: Lidocaine Viscous (Xylocaine Viscous) side effects, medical uses, and drug interactions". MedicineNet.com. http://www.medicinenet.com/lidocaine_viscous/article.htm. Retrieved 2010-05-07. 
  17. ^ Bonsignori F, Chiappini E, De Martino M (2010). "The infections of the upper respiratory tract in children". Int J Immunopathol Pharmacol 23 (1 Suppl): 16–9. PMID 20152073. 
  18. ^ a b Snow V, Mottur-Pilson C, Cooper RJ, Hoffman JR (March 2001). "Principles of appropriate antibiotic use for acute pharyngitis in adults". Ann Intern Med 134 (6): 506–8. PMID 11255529. http://www.annals.org/cgi/reprint/134/6/506.pdf. 
  19. ^ Linder JA, Bates DW, Lee GM, Finkelstein JA (November 2005). "Antibiotic treatment of children with sore throat". J Am Med Assoc 294 (18): 2315–22. doi:10.1001/jama.294.18.2315. PMID 16278359. http://jama.ama-assn.org/cgi/content/full/294/18/2315. 
  20. ^ a b "UpToDate Inc.". http://www.utdol.com/online/content/topic.do?topicKey=upp_resp/4610. 
  21. ^ Stevens DL, Tanner MH, Winship J, et al. (July 1989). "Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A". N. Engl. J. Med. 321 (1): 1–7. doi:10.1056/NEJM198907063210101. PMID 2659990. 
  22. ^ a b Hahn RG, Knox LM, Forman TA (May 2005). "Evaluation of poststreptococcal illness". Am Fam Physician 71 (10): 1949–54. PMID 15926411. 
Bacilli
A, bacitracin susceptible: S. pyogenes (Scarlet fever, Erysipelas, Rheumatic fever, Streptococcal pharyngitis)
B, bacitracin resistant, CAMP test+: S. agalactiae
Clostridia
Clostridium (spore-forming)
Peptostreptococcus (non-spore forming)
Mollicutes

M: BAC

drug(J1p, w, n, m, vacc)

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American Heritage Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.  Read more
$copyright.smallImage.alttext Gale Encyclopedia of Children's Health. © 2006 by The Gale Group, Inc. All rights reserved.  Read more
Dictionary of Cultural Literacy: Health. The New Dictionary of Cultural Literacy, Third Edition Edited by E.D. Hirsch, Jr., Joseph F. Kett, and James Trefil. Copyright © 2002 by Houghton Mifflin Company. Published by Houghton Mifflin. All rights reserved.  Read more
Mosby's Dental Dictionary. Mosby's Dental Dictionary. Copyright © 2004 by Elsevier, Inc. All rights reserved.  Read more
Random House Word Menu. © 2010 Write Brothers Inc. Word Menu is a registered trademark of the Estate of Stephen Glazier. Write Brothers Inc. All rights reserved.  Read more
Wikipedia on Answers.com. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article Streptococcal pharyngitis.  Read more

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