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| {{Infobox_Disease
| | #redirect:[[Pharyngitis]] |
| | Name = {{PAGENAME}}
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| | Image = PHIL_3183_lores.jpg
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| | Caption =
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| | DiseasesDB = 12507
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| | ICD10 = {{ICD10|J|02|0|j|00}}
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| | ICD9 = {{ICD9|034.0}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus = 000639
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| | eMedicineSubj = med
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| | eMedicineTopic = 1811
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| | MeshID =
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| }}
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| {{SI}}
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| ==Overview==
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| '''Streptococcal pharyngitis''' or '''streptococcal sore throat''' ('''Strep throat''' [[American English|AmE]]), is a form of [[group A streptococcal infection]] that affects the [[pharynx]], and possibly the [[larynx]] and [[tonsils]].
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| ===Signs and symptoms===
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| Streptococcal pharyngitis usually appears suddenly with a severe sore throat that may make talking or swallowing painful. In severe cases, breathing may be impaired.
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| Symptoms may include:
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| *Sudden and severe [[sore throat]]
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| *Red and enlarged [[tonsils]]
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| *Yellow and white patches in the throat.
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| *Difficulty swallowing ([[dysphagia]])
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| *Tender [[Cervical lymph nodes|cervical]] [[lymphadenopathy]]
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| *[[Fever]] of 38°C (101°F) or greater.
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| *General discomfort, feeling ill or uneasy
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| *Cough or dry cough
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| *[[Halitosis]]
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| *Abdominal pain, nausea and vomiting
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| *[[Rash]]<ref>[http://www.kidshealth.org/parent/infections/lung/strep_throat.html Kids Health]</ref>
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| *[[Urticaria|Hives]]
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| ==Diagnosis==
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| There are several causes for [[pharyngitis]], not just streptococcus bacteria. Productive coughing, nasal discharge, and red, irriated 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]] or a throat culture may be undertaken to help clarify diagnosis.
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| The presence of marked lymph node enlargement along with sore throat, fever and tonsillar enlargement may also occur in [[infectious mononucleosis]] (glandular fever).<ref name="pmid15508538">{{cite journal |author=Ebell MH |title=Epstein-Barr virus infectious mononucleosis |journal=Am Fam Physician |volume=70 |issue=7 |pages=1279-87 |year=2004 |pmid=15508538 |doi= |url=http://www.aafp.org/afp/20041001/1279.html}}</ref>
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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">{{cite journal |author=Centor RM, Dalton HP, Campbell MS, Lynch MR, Watlington AT, Garner BK |title=Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients |journal=J Gen Intern Med |volume=1 |issue=4 |pages=248-51 |year=1986 |pmid=3534175 |doi= |doi=10.1007/BF02596194}}</ref>
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| *Lack of cough
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| *Swollen and tender anterior [[cervical lymph nodes]]
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| *(Marked) tonsillar [[exudate]]s<ref name="pmid3534166">{{cite journal |author=Komaroff AL, Pass TM, Aronson MD, ''et al'' |title=The prediction of streptococcal pharyngitis in adults |journal=J Gen Intern Med |volume=1 |issue=1 |pages=1–7 |year=1986 |pmid=3534166 |doi= |doi=10.1007/BF02596317}}</ref>
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| *Fever
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| :{| class="wikitable"
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| !Number of symptoms!!Probability of GAS
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| |-
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| |0||2.5%
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| |-
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| |1||6.0 - 6.9%
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| |-
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| |2||14.1 – 16.6%
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| |-
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| |3||30.1 – 34.1%
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| |-
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| |4||55.7%
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| |}
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| Another study on 621 patients, assigned one point for each of the following symptoms:<ref name="pmid11033707">{{cite journal |author=McIsaac WJ, Goel V, To T, Low DE |title=The validity of a sore throat score in family practice |journal=CMAJ |volume=163 |issue=7 |pages=811-5 |year=2000 |pmid=11033707 |doi= |url=http://www.cmaj.ca/cgi/content/full/163/7/811}}</ref>
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| *Temperature greater than 38 C
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| *Absence of cough
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| *Tender anterior cervical adenopathy
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| *Tonsillar swelling or exudate
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| *Age younger than 15
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| *Subtracting a point for age older than 45.
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| :{| class="wikitable"
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| !Points!!Probability of GAS || Management
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| |-
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| | 1 or less || 0% || Negative: No antibiotic
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| |-
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| | 2 || 17% || rowspan="2" | Indeterminate: antibiotic based on throat culture
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| |-
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| | 3 || 35%
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| |-
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| | 4 or 5 || 51% || Positive: for throat culture and antibiotics
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| |}
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| 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.<ref name="pmid11252201">{{cite journal |author=Eaton CA |title=What clinical features are useful in diagnosing strep throat? |journal=J Fam Pract |volume=50 |issue=3 |pages=201 |year=2001 |pmid=11252201 |doi= |url=http://www.jfponline.com/Pages.asp?AID=2184}}</ref>
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| ==Transmission==
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| Strep throat is caused by [[Group A streptococcal infection]] (GAS),<ref name="pmid15353164">{{cite journal |author=Merrill B, Kelsberg G, Jankowski TA, Danis P |title=Clinical inquiries. What is the most effective diagnostic evaluation of streptococcal pharyngitis? |journal=J Fam Pract |volume=53 |issue=9 |pages=734, 737-8, 740 |year=2004 |pmid=15353164 |doi= |url=http://www.jfponline.com/Pages.asp?AID=1774}}</ref><ref name="pmid3535604">{{cite journal |author=Centor RM, Meier FA, Dalton HP |title=Throat cultures and rapid tests for diagnosis of group A streptococcal pharyngitis |journal=Ann. Intern. Med. |volume=105 |issue=6 |pages=892-9 |year=1986 |pmid=3535604 |doi=}}</ref><ref name="pmid9612872">{{cite journal |author=Falck G, Kjellander J, Schwan A |title=Recurrence rate of streptococcal pharyngitis related to hygienic measures |journal=Scand J Prim Health Care |volume=16 |issue=1 |pages=8-12 |year=1998 |pmid=9612872 |doi= |doi=10.1080/028134398750003331 |doi=10.1080/028134398750003331}}</ref><ref name="pmid8536567">{{cite journal |author=Kieserman SP, Williams J, Linstrom C |title=Streptococcal pharyngitis: alternative treatments |journal=Ear Nose Throat J |volume=74 |issue=11 |pages=777-80 |year=1995 |pmid=8536567 |doi=}}</ref> specifically the bacterium ''[[Streptococcus pyogenes]]''.<ref name="pmid11703670">{{cite journal |author=Opdyke JA, Scott JR, Moran CP |title=A secondary RNA polymerase sigma factor from Streptococcus pyogenes |journal=Mol. Microbiol. |volume=42 |issue=2 |pages=495-502 |year=2001 |pmid=11703670 |doi= |doi=10.1046/j.1365-2958.2001.02657.x}}</ref><ref name="pmid12777583">{{cite journal |author=Gieseker KE, Roe MH, MacKenzie T, Todd JK |title=Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing |journal=Pediatrics |volume=111 |issue=6 Pt 1 |pages=e666-70 |year=2003 |pmid=12777583 |doi= |url=http://pediatrics.aappublications.org/cgi/content/full/111/6/e666 |doi=10.1542/peds.111.6.e666}}</ref><ref name="pmid12180948">{{cite journal |author=Nandi S, Chakraborti A, Bakshi DK, Rani A, Kumar R, Ganguly NK |title=Association of pyrogenic exotoxin genes with pharyngitis and rheumatic fever/rheumatic heart disease among Indian isolates of Streptococcus pyogenes |journal=Lett. Appl. Microbiol. |volume=35 |issue=3 |pages=237-41 |year=2002 |pmid=12180948 |doi= |doi=10.1046/j.1472-765X.2002.01176.x}}</ref><ref name="pmid11170997">{{cite journal |author=Brandt CM, Allerberger F, Spellerberg B, Holland R, Lütticken R, Haase G |title=Characterization of consecutive Streptococcus pyogenes isolates from patients with pharyngitis and bacteriological treatment failure: special reference to prtF1 and sic / drs |journal=J. Infect. Dis. |volume=183 |issue=4 |pages=670-4 |year=2001 |pmid=11170997 |doi= |url=http://www.journals.uchicago.edu/doi/full/10.1086/318542?cookieSet=1 |doi=10.1086/318542}}</ref> It is spread by direct, close contact with an infected person via air-based germs.<ref name="pmid15765640">{{cite journal |author=Lindbaek M, Høiby EA, Lermark G, Steinsholt IM, Hjortdahl P |title=Predictors for spread of clinical group A streptococcal tonsillitis within the household |journal=Scand J Prim Health Care |volume=22 |issue=4 |pages=239-43 |year=2004 |pmid=15765640 |doi=}}</ref> In addition it may be spread through contamination of pillow cases, toys, tooth brushes, and other often-used materials.<ref name="pmid9612872">{{cite journal |author=Falck G, Kjellander J, Schwan A |title=Recurrence rate of streptococcal pharyngitis related to hygienic measures |journal=Scand J Prim Health Care |volume=16 |issue=1 |pages=8-12 |year=1998 |pmid=9612872 |doi= |doi=10.1080/028134398750003331 |doi=10.1080/028134398750003331}}</ref> Rarely, contaminated food, especially milk and milk products, can result in outbreaks.<ref name="pmid17148066">{{cite journal |author=Asteberg I, Andersson Y, Dotevall L, ''et al'' |title=A food-borne streptococcal sore throat outbreak in a small community |journal=Scand. J. Infect. Dis. |volume=38 |issue=11-12 |pages=988-94 |year=2006 |pmid=17148066 |doi=10.1080/00365540600868370}}</ref>
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| The [[Incubation_period|incubation period]] for strep throat is thought to be between two to five days, but has been reported as long as eight days.<ref name="pmid16126564">{{cite journal |author=Sarvghad MR, Naderi HR, Naderi-Nassab M, ''et al'' |title=An outbreak of food-borne group A Streptococcus (GAS) tonsillopharyngitis among residents of a dormitory |journal=Scand. J. Infect. Dis. |volume=37 |issue=9 |pages=647-50 |year=2005 |pmid=16126564 |doi=10.1080/00365540510044085}}</ref>
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| ==Treatment==
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| ===Symptomatic therapies===
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| Nonprescription [[over the counter drug]]s 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.<ref name="pmid12061352">{{cite journal |author=Figueras Nadal C, García de Miguel MJ, Gómez Campderá A, Pou Fernández J, Alvarez Calatayud G, Sánchez Bayle M |title=Effectiveness and tolerability of ibuprofen-arginine versus paracetamol in children with fever of likely infectious origin |journal=Acta Paediatr. |volume=91 |issue=4 |pages=383-90 |year=2002 |pmid=12061352 |doi=}}</ref> Aspirin is not recommended for children due to the small but fatal risk of [[Reye's syndrome]]. In adults aspirin, paracetamol, or ibuprofen help reduce back pain by 48% and sore throat by 31%.<ref>Farhan, M., Leparc, J.M., Moore, N., Pelen, F., Vanganse, E., Verriere, F., & Wall, R. (1999). The pain study: Paracetamol, aspirin and ibuprofen new tolerability study: A large-scale, randomized clinical trial comparing the tolerability of aspirin, ibuprofen and paracetamol for short-term analgesia. Clinical Dug Investigation, 18(2), 89-98. Retrieved on December 9, 2007.</ref>
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| ===Antibiotics===
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| Antibiotics will reduce symptoms slightly, as was the case in one study of 11 adult patients with sore throat and confirmed GAS infection. They were evaluated daily after the start of antibiotic treatment to register symptoms and signs and to measure body temperature. The mean reduction rate was great, but it was the greatest reduction after 2 days. Out of all symptoms scores was for muscle or joint pain, 86%, and the lowest for sore throat, 67%.<ref name="pmid12512742">{{cite journal |author=Melbye H, Bjørkheim MK, Leinan T |title=Daily reduction in C-reactive protein values, symptoms, signs and temperature in group-A streptococcal pharyngitis treated with antibiotics |journal=Scand. J. Clin. Lab. Invest. |volume=62 |issue=7 |pages=521-5 |year=2002 |pmid=12512742 |doi= |doi=10.1080/003655102321004530}}</ref> Treatment, which consists of penicillin (orally for 10 days or a single intramuscular injection of penicillin G), will also minimize transmission. This is why GAS positive children should not go back to school or day care until they have taken antibiotics for at least 24 hours. In one study, they assessed the potential risk of transmission to close school contact by taking 47 children with positive throat cultures and randomly selecting them to receive penicillin V, penicillin G, or erythromycin. Throat cultures were then taken 24 hours after start of antibiotics and 17 (36.2%) had positive throat cultures and 39 (83%) of the patients became culture negative.<ref name="pmid8502522">{{cite journal |author=Snellman LW, Stang HJ, Stang JM, Johnson DR, Kaplan EL |title=Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy |journal=Pediatrics |volume=91 |issue=6 |pages=1166-70 |year=1993 |pmid=8502522 |doi=}}</ref>
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| [[Cephalosporin| Cephalosporins]], such as cefazoline, cefuroxime, and ceftriaxone, are recommended for penicillin-allergic patients. In a 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.<ref name="pmid11260156">{{cite journal |author=Novalbos A, Sastre J, Cuesta J, ''et al'' |title=Lack of allergic cross-reactivity to cephalosporins among patients allergic to penicillins |journal=Clin. Exp. Allergy |volume=31 |issue=3 |pages=438-43 |year=2001 |pmid=11260156 |doi= |doi=10.1046/j.1365-2222.2001.00992.x}}</ref><ref name="pmid15805383">{{cite journal |author=Pichichero ME |title=A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients |journal=Pediatrics |volume=115 |issue=4 |pages=1048-57 |year=2005 |pmid=15805383 |doi=10.1542/peds.2004-1276 |url=http://pediatrics.aappublications.org/cgi/content/full/115/4/1048}}</ref>
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| Second-line antibiotics include amoxicillin,<ref name="pmid9917438">{{cite journal |author=Feder HM, Gerber MA, Randolph MF, Stelmach PS, Kaplan EL |title=Once-daily therapy for streptococcal pharyngitis with amoxicillin |journal=Pediatrics |volume=103 |issue=1 |pages=47-51 |year=1999 |pmid=9917438 |doi= |doi=10.1542/peds.103.1.47}}</ref> clindamycin,<ref name="pmid15520098">{{cite journal |author=Martin JM, Green M, Barbadora KA, Wald ER |title=Group A streptococci among school-aged children: clinical characteristics and the carrier state |journal=Pediatrics |volume=114 |issue=5 |pages=1212-9 |year=2004 |pmid=15520098 |doi=10.1542/peds.2004-0133 |url=http://pediatrics.aappublications.org/cgi/content/full/114/5/1212}}</ref> and oral cephalosporins which have a significantly better cure rate than penicillin.<ref name="pmid15060239">{{cite journal |author=Casey JR, Pichichero ME |title=Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children |journal=Pediatrics |volume=113 |issue=4 |pages=866-82 |year=2004 |pmid=15060239 |doi= |url=http://pediatrics.aappublications.org/cgi/content/full/113/4/866 |doi=10.1542/peds.113.4.866}}</ref>
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| Studies have also shown that the broader-spectrum of antibiotics offer effective short treatment courses that the traditional 10 days of Penicillin V,<ref name="pmid10915082">{{cite journal |author=Adam D, Scholz H, Helmerking M |title=Short-course antibiotic treatment of 4782 culture-proven cases of group A streptococcal tonsillopharyngitis and incidence of poststreptococcal sequelae |journal=J. Infect. Dis. |volume=182 |issue=2 |pages=509-16 |year=2000 |pmid=10915082 |doi= |doi=10.1086/315709}}</ref> 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".<ref name="pmid11132064">{{cite journal |author=Lord RW |title=Is a 5-day course of antibiotics as effective as a 10-day course for the treatment of streptococcal pharyngitis and the prevention of poststreptococcal sequelae? |journal=J Fam Pract |volume=49 |issue=12 |pages=1147 |year=2000 |pmid=11132064 |doi= |url=http://www.jfponline.com/Pages.asp?AID=2674}}</ref>
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| 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).<ref name="pmid15508538"/>
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| ===Other===
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| A 2003 study found extract of [[Pelargonium sidoides]] was superior compared to placebo for the treatment of acute non-GABHS tonsillopharyngitis in children. Treatment with EPs 7630 reduced the severity of symptoms and shortened the duration of illness by at least 2 days.<ref name="pmid14526713">{{cite journal |author=Bereznoy VV, Riley DS, Wassmer G, Heger M |title=Efficacy of extract of Pelargonium sidoides in children with acute non-group A beta-hemolytic streptococcus tonsillopharyngitis: a randomized, double-blind, placebo-controlled trial |journal=Altern Ther Health Med |volume=9 |issue=5 |pages=68-79 |year=2003 |pmid=14526713 |doi=}}</ref>
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| ==Complications==
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| 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. Therefore, streptococcal tonsillitis is important to recognize and treat early. <ref name=Kumar537> {{cite book |author=Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson |title=Robbins Basic Pathology: With STUDENT CONSULT Online Access |publisher=Saunders |location=Philadelphia |year= |edith=8th edition |pages=p537 |isbn=1-4160-2973-7 |oclc= |doi=}}</ref>
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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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| *Herpes
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| *[[Scarlet fever]] is caused by toxins released by the bacteria.
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| *Rarely, some [[Strain (biology)|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, sometimes causing a rare complication that 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 which 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
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| *[[Tonsillitis]]
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| *[[Pharyngitis]]
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| *[[Psoriasis]]
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| *[[Herpes]], as the symptoms of these two ailments are very similar, do not mistake one for the other.
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| ==References==
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| {{reflist|2}}
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| ==External links==
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| *[http://www.naidd.nih.gov/factsheets/strep.htm Group A Streptococcal Infections] - National Institute of Allergy and Infectious Diseases.
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| *[http://www.mayoclinic.com/health/post-infectious-glomerulonephritis/AN00629 Post-infectious glomerulonephritis] - mayoclinic.com.
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| {{Respiratory pathology}}
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| {{Common Cold}}
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| [[Category:Bacterial diseases]]
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| [[Category:Human throat]]
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| [[es:Amigdalitis]]
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| [[pl:Angina]]
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| [[pt:Faringite estreptocócica]]
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| [[ru:Ангина]]
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| [[yi:סטרעפ טראוט]]
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| {{WH}}
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| {{WS}}
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