Pharyngitis natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
Symptoms develop after a short incubation period of 24 to 72 hours.<ref name="pmid15053411">Vincent MT, Celestin N, Hussain AN (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15053411 Pharyngitis.] ''Am Fam Physician'' 69 (6):1465-70. PMID: [https://pubmed.gov/15053411 15053411]</ref> Most cases of [[pharyngitis]] go away on their own without [[complications]]. Untreated, GABHS infection lasts seven to 10 days. Patients with untreated streptococcal pharyngitis are infectious during the acute phase of the illness and for one additional week. Effective antibiotic therapy shortens the infectious period to 24 hours, reduces the duration of symptoms by about one day, and prevents most complications.<ref name="pmid15053411" /> | Symptoms develop after a short incubation period of 24 to 72 hours.<ref name="pmid15053411">Vincent MT, Celestin N, Hussain AN (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15053411 Pharyngitis.] ''Am Fam Physician'' 69 (6):1465-70. PMID: [https://pubmed.gov/15053411 15053411]</ref> Most cases of [[pharyngitis]] go away on their own without [[complications]]. Untreated, group A bete hemolytic streptococcus (GABHS) infection lasts seven to 10 days. Patients with untreated streptococcal pharyngitis are infectious during the acute phase of the illness and for one additional week. Effective antibiotic therapy shortens the infectious period to 24 hours, reduces the duration of symptoms by about one day, and prevents most complications.<ref name="pmid15053411" /> | ||
==Complications== | ==Complications== | ||
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*[[Scarlet fever]] | *[[Scarlet fever]] | ||
*Streptococcal toxic shock syndrome<ref name="pmid22338589">{{cite journal| author=Murray RC, Chennupati SK| title=Chronic streptococcal and non-streptococcal pharyngitis. | journal=Infect Disord Drug Targets | year= 2012 | volume= 12 | issue= 4 | pages= 281-5 | pmid=22338589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22338589 }} </ref> | *Streptococcal toxic shock syndrome<ref name="pmid22338589">{{cite journal| author=Murray RC, Chennupati SK| title=Chronic streptococcal and non-streptococcal pharyngitis. | journal=Infect Disord Drug Targets | year= 2012 | volume= 12 | issue= 4 | pages= 281-5 | pmid=22338589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22338589 }} </ref> | ||
*Acute [[glomerulonephritis]] ([[Post-streptococcal glomerulonephritis]]) | *Acute [[glomerulonephritis]] ([[Post-streptococcal glomerulonephritis]])<ref name="pmid15053411" /> | ||
*Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS) | *Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS) | ||
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=== '''Group A Streptococcal Pharyngitis Complications''' === | |||
=== Rheumatic fever === | |||
Rheumatic fever is exceedingly rare in the United States and other developed countries (annual incidence less than one case per 100,000). This illness should be suspected in any patient with joint swelling and pain, subcutaneous nodules, erythema marginatum or heart murmur, and a confirmed streptococcal infection during the preceding month. Patients will have an elevated antistreptolysin- O titer and erthrocyte sedimentation rate.<ref name="pmid15053411" /> | |||
=== Post streptococcal glomerulonephritis === | |||
Post streptococcal glomerulonephritis is another rare complication of GABHS pharyngitis, although treatment with antibiotics does not prevent it. Patients present with hematuria and, frequently, edema in the setting of a recent streptococcal infection with an elevated antistreptolysin-O titer.<ref name="pmid15053411" /> | |||
=== Scarlet fever === | |||
Scarlet fever is associated with GABHS pharyngitis and usually presents as a punctate, erythematous, blanchable, sandpaperlike exanthem. The rash is found in the neck, groin, and axillae, and is accentuated in body folds and creases (Pastia’s lines). The pharynx and tonsils are erythematous and covered with exudates. The tongue may be bright red with a white coating (strawberry tongue). | |||
==Prognosis== | ==Prognosis== | ||
Revision as of 18:20, 19 December 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Natural History
Symptoms develop after a short incubation period of 24 to 72 hours.[1] Most cases of pharyngitis go away on their own without complications. Untreated, group A bete hemolytic streptococcus (GABHS) infection lasts seven to 10 days. Patients with untreated streptococcal pharyngitis are infectious during the acute phase of the illness and for one additional week. Effective antibiotic therapy shortens the infectious period to 24 hours, reduces the duration of symptoms by about one day, and prevents most complications.[1]
Complications
Complications of pharyngitis based on the causing agent include the following: [2] Identifying the cause of pharyngitis, especially group A beta-hemolytic streptococcus (GABHS), is important to prevent potential life-threatening complications.[1]
| Common complications | ||
| Pathogen | Complications | |
|---|---|---|
| Group A Streptococcus |
Suppurative complications
Non suppurative complications
| |
| Influenza |
| |
| Adenovirus |
| |
| Cocksackie A virus |
| |
| Ebstein barr virus |
| |
| Less common complications | ||
| Gonococcus |
| |
| Diphtheria |
| |
| Heamophilis influenza | ||
| Fusobacterium necrophorum | ||
| Parainfluenza virus |
| |
Group A Streptococcal Pharyngitis Complications
Rheumatic fever
Rheumatic fever is exceedingly rare in the United States and other developed countries (annual incidence less than one case per 100,000). This illness should be suspected in any patient with joint swelling and pain, subcutaneous nodules, erythema marginatum or heart murmur, and a confirmed streptococcal infection during the preceding month. Patients will have an elevated antistreptolysin- O titer and erthrocyte sedimentation rate.[1]
Post streptococcal glomerulonephritis
Post streptococcal glomerulonephritis is another rare complication of GABHS pharyngitis, although treatment with antibiotics does not prevent it. Patients present with hematuria and, frequently, edema in the setting of a recent streptococcal infection with an elevated antistreptolysin-O titer.[1]
Scarlet fever
Scarlet fever is associated with GABHS pharyngitis and usually presents as a punctate, erythematous, blanchable, sandpaperlike exanthem. The rash is found in the neck, groin, and axillae, and is accentuated in body folds and creases (Pastia’s lines). The pharynx and tonsils are erythematous and covered with exudates. The tongue may be bright red with a white coating (strawberry tongue).
Prognosis
Most cases of pharyngitis go away on their own without complications.