Dp Throat

Dp Throat

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Many viruses and bacteria can cause acute pharyngitis. Streptococcus pyogenes , which are also called group A Streptococcus (group A strep), cause acute pharyngitis known as strep throat.
Group A strep pharyngitis is an infection of the oropharynx caused by S. pyogenes . S. pyogenes are gram-positive cocci that grow in chains ( see figure 1 ). They exhibit β -hemolysis (complete hemolysis) when grown on blood agar plates. They belong to group A in the Lancefield classification system for β-hemolytic Streptococcus , and thus are called group A streptococci.
Group A strep pharyngitis is an acute pharyngitis that commonly presents with
Other symptoms may include headache, abdominal pain, nausea, and vomiting — especially among children. Patients with group A strep pharyngitis typically do not have cough, rhinorrhea, hoarseness, oral ulcers, or conjunctivitis. These symptoms strongly suggest a viral etiology.
On clinical examination, patients with group A strep pharyngitis usually have
Figure 1. Streptococcus pyogenes (group A Streptococcus ) on Gram stain. Source: Public Health Image Library, CDC
Patients with group A strep pharyngitis may also present with a scarlatiniform rash. The resulting syndrome is called scarlet fever or scarlatina.
Respiratory disease caused by group A strep infection in children younger than 3 years old rarely manifests as acute pharyngitis. These children usually have mucopurulent rhinitis followed by fever, irritability, and anorexia (called “streptococcal fever” or “streptococcosis”). In contrast to typical acute group A strep pharyngitis, this presentation in young children is subacute and high fever is rare.
Group A strep pharyngitis is most commonly spread through direct person-to-person transmission. Typically, transmission occurs through respiratory droplets but can also occur through contact with secretions, such as saliva, wound discharge, or nasal secretions, from an infected person. People with group A strep pharyngitis are much more likely to transmit the bacteria to others than asymptomatic pharyngeal carriers. Crowded conditions — such as those in schools, daycare centers, or military training facilities — facilitate transmission. Although rare, spread of group A strep infections may also occur via food. Foodborne outbreaks of pharyngitis have occurred due to improper food handling. Environmental transmission via surfaces and fomites was historically not thought to occur. However, evidence from outbreak investigations indicate that environmental transmission of GAS may be possible, although it is likely a less common route of transmission.
Humans are the primary reservoir for group A strep. There is no evidence to indicate that pets can transmit the bacteria to humans.
Treatment with an appropriate antibiotic for 12 hours or longer generally eliminates a person’s ability to transmit group A strep. People with group A strep pharyngitis or scarlet fever should stay home from work, school, or daycare until:
The incubation period of group A strep pharyngitis is approximately 2 to 5 days.
Group A strep pharyngitis can occur in people of all ages. It is most common among children 5 through 15 years of age. It is rare in children younger than 3 years of age.
The most common risk factor is close contact with another person with group A strep pharyngitis. Adults at increased risk for group A strep pharyngitis include:
Crowding, such as found in schools, military training facilities, and daycare centers, increases the risk of disease spread.
The differential diagnosis of acute pharyngitis includes multiple viral and bacterial pathogens. Viruses are the most common cause of pharyngitis in all age groups. Experts estimate that group A strep, the most common bacterial cause, causes 20% to 30% of pharyngitis episodes in children. In comparison, experts estimate it causes approximately 5% to 15% of pharyngitis infections in adults.
History and clinical examination can be used to diagnose viral pharyngitis when clear viral symptoms are present. Viral symptoms include:
Patients with clear viral symptoms do not need testing for group A strep. However, clinicians cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms.
Clinicians need to use either a rapid antigen detection test (RADT) or throat culture to confirm group A strep pharyngitis. RADTs have high specificity for group A strep but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic test.
See the resources section for specific diagnosis guidelines for adult and pediatric patients 1,2,3 .
Clinicians should confirm group A strep pharyngitis in children older than 3 years of age to appropriately guide treatment decisions. Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing sequela (acute rheumatic fever). Testing for group A strep pharyngitis is not routinely indicated for:
Acute rheumatic fever is very rare in those age groups.
Clinicians can use a positive RADT as confirmation of group A strep pharyngitis in children. However, clinicians should follow up a negative RADT in a child with symptoms of pharyngitis with a throat culture. Clinicians should have a mechanism to contact the family and initiate antibiotics if the back-up throat culture is positive.
The use of a recommended antibiotic regimen to treat group A strep pharyngitis:
When left untreated, the symptoms of group A strep pharyngitis are usually self-limited. However, acute rheumatic fever and suppurative complications (e.g., peritonsillar abscess, mastoiditis) are more likely to occur after an untreated infection. Patients, regardless of age, who have a positive RADT or throat culture need antibiotics. Clinicians should not treat viral pharyngitis with antibiotics.
Penicillin or amoxicillin is the antibiotic of choice to treat group A strep pharyngitis. There has never been a report of a clinical isolate of group A strep that is resistant to penicillin. However, resistance to azithromycin and clarithromycin is common in some communities. For patients with a penicillin allergy, recommended regimens include narrow-spectrum cephalosporins (cephalexin, cefadroxil), clindamycin, azithromycin, and clarithromycin.
See the resources section for specific treatment guidelines for adult and pediatric patients 1,2,3 .
Abbreviation: Max, maximum.
a Avoid in individuals with immediate type hypersensitivity to penicillin.
b Resistance of group A strep to these agents is well-known and varies geographically and temporally.
From: Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America . Clin Infect Dis . 2012;55(10):e86–e102, Table 2 (adapted) and it’s erratum ( Clin Infect Dis . 2014;58(10):1496).
Note: If you are interested in reusing this table, first obtain permission from the journal; request by emailing journals.permissions@oup.com .
Asymptomatic group A strep carriers usually do not require treatment. Carriers have positive throat cultures or are RADT positive, but do not have clinical symptoms or an immunologic response to group A strep antigens on laboratory testing. Compared to people with symptomatic pharyngitis, carriers are much less likely to transmit group A strep to others. Carriers are also very unlikely to develop suppurative or nonsuppurative complications.
Some people with recurrent episodes of acute pharyngitis with evidence of group A strep by RADT or throat culture actually have recurrent episodes of viral pharyngitis with concurrent streptococcal carriage. Repeated use of antibiotics among this subset of patients is unnecessary. However, identifying carriers clinically or by laboratory methods can be very difficult. The Infectious Diseases Society of America guidelines and Red Book address determining someone if is a carrier and their management. 1, 2
Rarely, suppurative and nonsuppurative complications can occur after group A strep pharyngitis. Suppurative complications result from the spread of group A strep from the pharynx to adjacent structures. They can include:
Other focal infections or sepsis are even less common.
Acute rheumatic fever is a nonsuppurative sequelae of group A strep pharyngitis. Post-streptococcal glomerulonephritis is a nonsuppurative sequelae of group A strep pharyngitis or skin infections. These complications occur after the original infection resolves and involve sites distant to the initial group A strep infection site. They are thought to be the result of the immune response and not of direct group A strep infection.
Good hand hygiene and respiratory etiquette can reduce the spread of all types of group A strep infection. Hand hygiene is especially important after coughing and sneezing and before preparing foods or eating. Good respiratory etiquette involves covering your cough or sneeze. Treating an infected person with an antibiotic for 12 hours or longer generally eliminates their ability to transmit the bacteria. Thus, people with group A strep pharyngitis should stay home from work, school, or daycare until:
Humans are the only reservoir for group A strep. It is most common among children 5 through 15 years of age. It is rare in children younger than 3 years of age. In the United States, group A strep pharyngitis is most common during the winter and spring.
CDC does not track the incidence of group A strep pharyngitis or other non-invasive group A strep infections. CDC tracks invasive group A strep infections through the Active Bacterial Core surveillance (ABCs) program. For information on the incidence of invasive group A strep infections, please visit the ABCs Surveillance Reports website .
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Children: 250 mg twice daily or 3 times daily; adolescents and adults: 250 mg 4 times daily or 500 mg twice daily
50 mg/kg once daily (max = 1000 mg); alternate:
25 mg/kg (max = 500 mg) twice daily
<27 kg: 600 000 U; ≥27 kg: 1 200 000 U
20 mg/kg/dose twice daily (max = 500 mg/dose)
7 mg/kg/dose 3 times daily (max = 300 mg/dose)
12 mg/kg once (max = 500 mg), then 6 mg/kg (max=250 mg) once daily for the next 4 days
7.5 mg/kg/dose twice daily (max = 250 mg/dose)

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Sore throats. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/sore-throats. Accessed Feb. 18, 2019.
Sore throat. Merck Manual Professional Version. http://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/approach-to-the-patient-with-nasal-and-pharyngeal-symptoms/sore-throat. Accessed Feb. 18, 2019.
Seven tips to help you prevent a sore throat. American Academy of Otolaryngology — Head and Neck Surgery. https://www.enthealth.org/be_ent_smart/seven-tips-to-help-you-prevent-a-sore-throat/. Accessed Feb. 18, 2019.
Sore throat. Centers for Disease Control and Prevention. http://www.cdc.gov/getsmart/community/for-patients/common-illnesses/sore-throat.html. Accessed Feb. 9, 2021.
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Your or your child's doctor may review the symptoms and medical history. He or she may conduct a physical exam that includes:
In many cases, doctors use a simple test to detect streptococcal bacteria, the cause of strep throat. The doctor rubs a sterile swab over the back of the throat to get a sample of secretions and sends the sample to a lab for testing. Many clinics are equipped with a lab that can get a test result for a rapid antigen test within a few minutes. However, a second, often more reliable test, called a throat culture, is sometimes sent to a lab that returns results within 24 to 48 hours.
Rapid antigen tests aren't as sensitive, although they can detect strep bacteria quickly. Because of this, the doctor may send a throat culture to a lab to test for strep throat if the antigen test comes back negative.
In some cases, doctors may use a molecular test to detect streptococcal bacteria. In this test, a doctor swipes a sterile swab over the back of the throat to get a sample of secretions. The sample is tested in a lab. Your or your child's doctor may have accurate results within a few minutes.
A sore throat caused by a viral infection usually lasts five to seven days and doesn't usually require medical treatment. Antibiotics don't help treat a viral infection.
To ease pain and fever, many people turn to acetaminophen (Tylenol, others) or other mild pain relievers.
Consider giving your child over-the-counter pain medications designed for infants or children, such as acetaminophen (Children's Tylenol, FeverAll, others) or ibuprofen (Children's Advil, Children's Motrin, others), to ease symptoms.
Never give aspirin to children or teenagers because it has been linked to Reye's syndrome, a rare but potentially life-threatening condition that causes swelling in the liver and brain.
If your or your child's sore throat is caused by a bacterial infection, your doctor or pediatrician will prescribe antibiotics.
You or your child must take the full course of antibiotics as prescribed even if the symptoms are gone. Failure to take all of the medication as directed can result in the infection worsening or spreading to other parts of the body.
Not completing the full course of antibiotics to treat strep throat can increase a child's risk of rheumatic fever or serious kidney inflammation.
Talk to your doctor or pharmacist about what to do if you forget a dose.
If a sore throat is a symptom of a condition other than a viral or bacterial infection, other treatments will likely be considered depending on the diagnosis.
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