STREPTOCOCCAL PHARYNGITIS

dr.Erwin

Etiology • • Infection by streptogenes ( group A β- hemolytic streptococcus ) Altough upper respiratory and cutaneous infection with S. pyogenes are common in the pediatric population , infection may also serious invasive disease, such as toxic shock syndrome and necrotizing fascilitis • • S. pyogenes is also common cause bacterial superinfection following acut varicella infection Scarlet fever is an erythemateous rash that may occur in the stting of streptococcal pharyngitis Epidemiology • • • • • • • Cause of acute pharyngitis in 15-20% of children Occurs in all age but predominantly in children 5 – 12 years old Occurs is all genders and ethnicities Colonization is present in as many as 15% of healthy children Person-to-person transmission via respiratory droplets Incubation periode of 2 – 5 days Variable clinical spectrum ranging from subclinical infection with few symptoms ( especially in younger children ) to toxic appearing manifestations • • Fever, HA , malaise, abdominal pain , dysphagia , and vomiting are common Exam may show erythreamatous pharynx exudative tonsillitis , palatal petechiae, uvular edema, strawberry tongue, scarlatina informrash lymphadenopathy • Papular “ sandpaper-like “, diffuse rash begins in the neck and chest area, extending especially to flexor creases ; circumolar pallor , desquamation may occurs over the trunk , hands , and feet after the first week of illness Diferential Dx • Other causes of pharyngitis : – Adenovirus , enterovirus, parainfluenzae, rhinovirus, eipsteinbarr virus – – – – Diphteria Scarlet fever Kawasaki syndrome Drug eruption

Sign / Symptom

resistant Streptococcus has not been seen in clinical practice.– Toxigenic Staphylococuc aureus infection – – Measles Roseola Diagnosis • • • Throat culture is the gold standard for diagnosis ( 90-95% Sensitive when performed correctly ) Rapid strep test via throat swab is cheaper and quicker but less sensitive Spyogenes is less likely as the cause of pharyngitis if hoarseness. acute glomerulonephritis. clinical failures from penicillin therapy may be due to poor compliance Penicillin derivatives (eg. diarhea. cough. conjuctivitis. resistance to macrolide exists Treatment of asymptomatic carriers is controversial . should be considered on a case.cephalosporins ) may be more palatable for young children Clindamycin or macrolide in penicillin alergis patient.by case basis Prognosis / Clinical Course • Sequalae may include parapharyngeal or peritonsillar abcess. and may decrease the duration of acute illness • • • • • • Treatment should be started within 9 days after the onset of acute illness to prevent rheumatic fever Pencillin for 10 days remains the treatment of choce Penicillin. however. retropharngeal abcess . or rhinorhea is present Treatment • Antomicrobial therapy will prevent the development of sequelae. especially rheumatic fever. and acute rheumatic fever • • Appropriate treatment of pharyngitis will prevent the development of rheumatic fever but not acute glomerulonephritis Isolation precautions : Children should be kept from contact with other children until 24 hours after the initiation of therapy .

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