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| | __NOTOC__ |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]].''' |
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| | '''To review wikidoc page on Group A Streptococcal infection, [[Group A streptococcal infection|click here]].''' |
| {{DiseaseDisorder infobox | | | {{DiseaseDisorder infobox | |
| Name = Strep throat | | | Name = Strep throat | |
| ICD10 = {{ICD10|J|02|0|j|00}} |
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| ICD9 = {{ICD9|034.0}}|
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| Image = PHIL_3183_lores.jpg | | | Image = PHIL_3183_lores.jpg | |
| Width = 200 | | | Width = 200 | |
| Caption = Strep throat | | | Caption = Strep throat | |
| }} | | }} |
| {{Search infobox}} | | {{Strep throat}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{AAA}} |
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| | {{SK}} Streptococcal pharyngitis, streptococcal angina, strept throat, septic sore throat |
| | ==[[Strep throat overview|Overview]]== |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
| | ==[[Strep throat historical perspective|Historical Perspective]]== |
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| {{Editor Help}}
| | ==[[Strep throat pathophysiology|Pathophysiology]]== |
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| ==Overview== | | ==[[Strep throat causes|Causes]]== |
| '''Strep throat''' (or "[[Streptococcus|Streptococcal]] [[pharyngitis]]", or "Streptococcal Sore Throat") is a form of [[Group A streptococcal infection]] that affects the [[pharynx]].
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| ==Symptoms== | | ==[[Strep throat differential diagnosis|Differentiating Strep throat from other Diseases]]== |
| *[[Sore throat]]
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| *Red and Black patches in the throat.
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| *Difficulty swallowing
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| *Tender cervical lymphadenopathy
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| *Red and enlarged [[tonsils]]
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| *[[Halitosis]]
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| *[[Fever]] of 101 F/38C or greater
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| *Rash <ref>[http://www.kidshealth.org/parent/infections/lung/strep_throat.html Kids Health]</ref>
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| *Frequent cold chills
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| *Absence of cough
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| *White spots on tonsils
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| *Desquamation (peeling skin on fingertips) a few weeks after treatment
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| ==Diagnosis== | | ==[[Strep throat epidemiology and demographics|Epidemiology & Demographics]]== |
| ===Signs and symptoms===
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| 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<ref name="pmid3534175">Centor RM, Dalton HP, Campbell MS, Lynch MR, Watlington AT, Garner BK. Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients. J Gen Intern Med. 1986 Jul-Aug;1(4):248-51. PMID 3534175</ref>:
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| 1. Lack of cough
| | ==[[Strep throat risk factors|Risk Factors]]== |
| * [[sensitivity (tests)|sensitivity]] = 56%
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| * [[specificity (tests)|specificity]] = 74%
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| 2. Swollen tender anterior cervical nodes
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| 3. (Marked) tonsillar exudates. Although the original study did not specify the degree of exudate, 'marked exudate' may be more accurate. A subsequent study of 693 patients with 9.7% having positive cultures found that 'marked exudates' had a sensitivity and specificity of 21% and 70% while 'pinpoint exudates' were nonspecific with sensitivity and specificity of 22% and 45%<ref name="pmid3534166">Komaroff AL, Pass TM, Aronson MD, Ervin CT, Cretin S, Winickoff RN, Branch WT Jr. The prediction of streptococcal pharyngitis in adults. J Gen Intern Med. 1986 Jan-Feb;1(1):1-7. PMID 3534166</ref>.
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| * [[sensitivity (tests)|sensitivity]] = 65%
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| * [[specificity (tests)|specificity]] = 69%
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| 4. History of fever
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| * [[sensitivity (tests)|sensitivity]] = 78%
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| * [[specificity (tests)|specificity]] = 45%
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| 5.hurts when swallowing.
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| When these findings are counted in a patient, the probabilities of positive cultures in the original study (prevalence=17%) are<ref name="pmid3534175">.</ref>:
| | ==[[Strep throat screening|Screening]]== |
| * 4 findings -> 55.7%
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| * 3 findings -> 30.1 – 34.1%
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| * 2 findings -> 14.1 – 16.6%
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| * 1 findings -> 6.0 - 6.9%
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| * 0 findings -> 2.5%
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| The probabilities can also be computed with the following equation:
| | ==[[Strep throat natural history|Natural History, Complications & Prognosis]]== |
| X = −2.69 + 1.04 (exudtons) + 1 (swolacn) - 0.95 (cough) + 0.89 (fevhist)
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| ===Tests=== | | ==Diagnosis== |
| The throat of the patient is swabbed for culture or for a rapid strep test (5 to 10 min) which can be done in the doctor's office. A rapid test tests for the presence of antibodies against the bacteria. If the rapid test is negative, a follow-up culture (which takes 24 to 48 hours) may be performed. A negative culture suggests a [[virus|viral]] infection, in which case [[antibiotic]] treatment should be withheld or discontinued.
| | [[Strep throat history and symptoms|History & Symptoms]] | [[Strep throat physical examination|Physical Examination]] | [[Strep throat laboratory tests|Lab Tests]] | [[Strep throat x ray|X Ray]] | [[Strep throat echocardiography|Echocardiography]] | [[Strep throat other diagnostic studies|Other Diagnostic Studies]] |
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| A doctor will most likely prescribe [[Amoxicillin|Amoxicilin]] a.k.a Novamoxin.
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| ==Transmission==
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| The illness is caused by the bacterium ''[[Streptococcus pyogenes]]'' and is spread by direct, close contact with an infected person via respiratory droplets ([[cough]] or [[sneeze|sneezing]]). Casual contact rarely results in transmission. Rarely, contaminated food, especially milk and milk products, can result in [[outbreak]]s. Untreated patients are most infectious for 2-3 weeks after onset of infection. The [[incubation period]], the period after exposure and before symptoms show up, is difficult to establish as some people don't become symptomatic. However, it is thought to be between two and five days.
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| Strep is caused by bacteria of a type called group A beta-hemolytic streptococci. Symptoms include sore throat, fever, headache, and in some cases, chills, nausea, and vomiting. The patient usually experiences swelling of the tonsils and lymph nodes in the neck.
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| ==Treatment== | | ==Treatment== |
| Treatment will reduce symptoms slightly, minimize transmission, and reduce the likelihood of complications. Treatment consists of [[penicillin]] (orally for 10 days; or a single intramuscular injection of penicillin G). [[Erythromycin]] is recommended for penicillin-[[allergy|allergic]] patients. Second-line antibiotics include [[amoxicillin]], [[clindamycin]], and oral [[cephalosporin]]s. Although symptoms subside within 4 days even without treatment, it is very important to start treatment within 10 days of onset of symptoms, and to complete the full course of antibiotics to prevent [[rheumatic fever]], a rare but serious complication. Other complications that can occur include an [[ear infection]], [[sinus infection]], acute [[glomerulonephritis]], or an abscess on the tonsils ([[peritonsillar abscess]]).
| | [[Strep throat medical therapy|Medical Therapy]] | [[Strep throat prevention|Prevention]] | [[Strep throat cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Strep throat future or investigational therapies|Future or Investigational Therapies]] |
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| According to a meta-analysis in [[Pediatrics (journal)|Pediatrics]], the overall summary odds ratio (OR) for the bacteriologic cure rate significantly favored cephalosporins compared with penicillin (OR: 3.02; 95% confidence interval [CI]: 2.49 –3.67, with the individual cephalosporins [cephalexin, cefadroxil, cefuroxime, cefpodoxime, cefprozil, cefixime, ceftibuten, and cefdinir] showing superior bacteriologic cure rates). The overall summary OR for clinical cure rate was 2.33 (95% CI: 1.84 –2.97), significantly favoring cephalosporins. <ref> PMID 15060239 </ref>.
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| Penicillins should be avoided for treatment of a sore throat if bacterial (swab) confirmation has not been obtained since it causes a distinctive rash if the true illness proves to be viral. This rash is harmless but alarming. The most common virus illness responsible for strep-like symptoms is [[glandular fever]], also known as [[mononucleosis]]. Typically, antibiotics such as [[clindamycin]] or [[clarithromycin]] will be prescribed if there is any doubt as to whether the infection is bacterial as it does not cause a rash in the presence of a virus.
| | ==Case Studies== |
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| In addition to taking antibiotics, other ways to relieve strep symptoms include taking nonprescription medications (such as [[ibuprofen]] and [[acetaminophen]]/[[paracetamol]]) for throat pain and fever reduction, and getting plenty of rest. Also, gargling with warm saltwater (1/4 teaspoon of table salt in 8 oz. warm water) can help relieve throat pain as well as warm, plain tea. Avoid orange juice or other citrus drinks. The acids in them may irritate the throat.
| | [[Strep throat case study one|Case #1]] |
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| ==Lack of Treatment== | | ==Related Chapters== |
| The symptoms of strep throat usually improve even without treatment in five days, but the patient is 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.
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| '''Infectious complications'''
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| *The active infection may occur in the throat, skin, and in blood.
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| *Skin and soft tissues may become infected, resulting in redness, pain, and swelling. Skin and deep tissues may also become necrotic (rare).
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| *[[Scarlet fever]] is caused by toxins released by the bacteria.
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| *Rarely, some strains may cause a severe illness in which [[blood pressure]] is reduced and lung injury and [[kidney failure]] may occur (toxic shock syndrome).
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| '''Noninfective complications'''
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| *During the infection, [[antibodies]] (disease–fighting chemicals) are produced. *Rare complication can result after the organism is cleared, when these antibodies cause disease in body organs.
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| *[[Rheumatic fever]] is a heart disease in which the [[inflammation]] of heart muscle and scarring of [[heart valves]] can occur.
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| *[[Glomerulonephritis]] is a kidney disease in which the injury may lead to kidney failure.<ref>[http://www.emedicinehealth.com/strep_throat/page10_em.htm EMedicineHealth]</ref>
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| ==See also==
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| *[[PANDAS]] - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections | | *[[PANDAS]] - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections |
| *[[Tonsillitis]] | | *[[Tonsillitis]] |
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| *[[Psoriasis]] | | *[[Psoriasis]] |
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| ==References== | | ==Resources== |
| <references/>
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| world book encyclopedia
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| ==External links==
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| *[http://www.niaid.nih.gov/factsheets/strep.htm Group A Streptococcal Infections] - National Institute of Allergy and Infectious Diseases. | | *[http://www.niaid.nih.gov/factsheets/strep.htm Group A Streptococcal Infections] - National Institute of Allergy and Infectious Diseases. |
| *[http://www.mayoclinic.com/health/post-infectious-glomerulonephritis/AN00629 Post-infectious glomerulonephritis] - mayoclinic.com.
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| {{Respiratory pathology}} | | {{Respiratory pathology}} |
| {{SIB}}
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| [[es:Amigdalitis]] | | [[es:Amigdalitis]] |
| [[yi:סטרעפ טראוט]] | | [[yi:סטרעפ טראוט]] |
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| [[Category:Bacterial diseases]]
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| [[Category:Infectious disease]]
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| [[Category:Otolaryngology]]
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| [[Category:Pulmonology]]
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| [[pl:Angina]] | | [[pl:Angina]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
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| | [[Category:Disease]] |
| | [[Category:Otolaryngology]] |
| | [[Category:Pulmonology]] |
| | [[Category:Bacterial diseases]] |
| | [[Category:Emergency mdicine]] |
| | [[Category:Up-To-Date]] |
| | [[Category:Infectious disease]] |
| | [[Category:Pediatrics]] |