STREP THROAT

1. STREP THROAT Streptococcus pyogenEs

2. WHAT IS STREP THROAT? • A contagious disease caused by infection with streptococcal bacteria • Specific bacteria= Group A Streptococcus (GAS) bacteria: streptococcus pyogenes • This bacteria are often found in the throat or on the skin and are responsible for other illnesses as well as impetigo (skin infection)

3. WHAT IS STREP THROAT (cont’d) • It is the most common cause of sore throat in school aged children and teens • Causes inflammation and swelling of the mucus membranes lining the back of the throat and tonsils • Some individuals may carry Group A Streptococcus in the throat or on the skin and not have any signs or symptoms

4. SIGNS AND SYMPTOMS: • Throat pain that usually comes on quickly • Painful swallowing • Red and swollen tonsils sometimes with white patches or streaks of pus • Tiny red spots on the soft or hard palate of the mouth • Swollen, tender lymph nodes • Fever, headache, rash • Nausea or vomiting • Body aches

5. VIRAL OR STREP? Many of these signs and symptoms could be a viral infection or other illness.

6. VIRAL OR STREP? VIRAL STREP Sore throat is more severe and persists Painful inflammation or infection of the tonsils, the tissue masses located at the back of the throat Treated with antibiotics • Sore throat is often the first sign of a cold • Sore throat from a cold often gets better or goes away within 1-2 days • Accompanied by congestion, runny nose, red or watery eyes, cough and sneezing • Other causes of sore throat are irritants in the air, allergies or dry air • Antibiotics are not effective in treating viral illness

7. WHEN TO SEE A DOCTOR: • A sore throat that is accompanied by tender, swollen lymph glands • A sore throat that lasts longer than 48hrs • A fever higher than 101F (38.3 C) in older children or fever that lasts longer than 48hrs • Sore throat with a rash • Problems breathing or swallowing

8. HOW DO YOU GET IT? • Streptococcal bacteria are highly contagious • It spreads through airborne droplets (coughing, sneezes, shared food/drinks) • It also spreads through infected surfaces (door knobs, tables) and transfer them to your nose/mouth/eyes • Spreads when groups of people are in close contact • Tends to circulate in the late fall and early spring

9. CONTAGIOUS PERIOD: • Contagious for about 2-3 weeks in people that do not take antibiotics • Spreads via -direct contact (person-person)- mucus droplets -indirect contact (kissing, sharing utensils and drinking cups) • Incubation period: 1-5 days after exposure to the bacteria • No longer contagious 24 hours after antibiotics have been started

10. DIAGNOSIS: • Physical exam looking for signs and symptoms of strep throat • Rapid Antigen Test • Throat Culture

11. RAPID ANTIGEN TEST: • Throat swab that can detect strep bacteria in minutes by looking for substances (antigens) in the throat • A positive test response occurs when a reaction occurs between a protein on the surface of the strep bacteria and chemicals in the test material • Either living or dead strep bacteria will produce a positive reaction • Most rapid tests have a sensitivity of 95% • 98% of positive tests correctly indicate the presence specifically of Group A Streptococcus bacteria • 2% false positive = similarity between surface proteins found on strep bacteria

12. THROAT CULTURE: • The most traditional test • Sterile swab rubbed over back of throat and tonsils to get a sample of secretions • Sample is cultured in a lab looking for presence of the bacteria

13. LIMITATIONS: Rapid Antigen Test Throat Swab Can take as long as 2 days to get culture results= possible delay in starting antibiotics Access to a lab • 5/100 people with strep throat will be missed, therefore all negative swab specimens should be sent for culture to confirm the absence of strep bacteria • Responds only to the presence of the streptococcal bacteria (Group A) responsible for strep throat- other bacteria and viral causes are not detected • Cost of test kit • Accessibility

14. TREATMENT: ANTIBIOTICS (Penicillin, Amoxicillin, Cephalexin) • Reduce the duration and severity of symptoms • Reduce the risk of complication and reduce spread of infection • Improvement seen in 1-2 days • An individual is no longer contagious after 24 hours after beginning antibiotics • Entire dose of antibiotics must be completed • Antibiotics will not help if a sore throat is caused by a virus

15. COMPLICATIONS: • Strep bacteria may spread causing infections in: • Tonsils • Sinuses • Skin • Blood • Middle ear (Otitis media) • Kidneys (Glomerulonephritis) • Brain (meningitis)

16. SCARLET FEVER: • Bacterial illness that develops is some people who have strep throat • Features a bright red rash that covers most of the body • If left untreated can result in more serious conditions that affect the heart, kidneys and other parts of the body SYMPTOMS: • Red rash: looks like a sunburn and feels like sandpaper • Red lines: folds of skin around the groin, armpits, elbows, knees and neck become a deeper red than the rash • Flushed face: • Strawberry tongue: looks red and bumpy and often covered with a white coating early in the disease

17. RHEUMATIC FEVER: • A serious complication of strep throat if left untreated or inadequately treated by antibiotics • Causes a persistent immune response from the body that triggers the immune system to mistakenly attack other organs in the body including the joints and heart vales causing arthritis and potential heart failure

18. POST-STREPTOCOCCAL GLOMEULPNEPHRITIS (PSGN) • Characterized by the sudden appearance of hematuria, proteinuria and red blood cell casts in the urine, edema and hypertension with or without oliguria • Develops 10-14 days after strep throat infection • Children less than 7 years old are at increased risk of developing PSGN after an episode of strep throat • Typically resolves spontaneously after a few weeks and usually does not lead to permanent kidney damage

19. SELF MANAGEMENT: • Get plenty of rest - sleep helps the body fight infection • Drink plenty of water - keeping a sore throat lubricated and moist eases swallowing and helps prevent dehydration • Eat soft and cold foods: easy-to-swallow foods are more soothing (broths, applesauce, popsicles, smoothies) • Gargle with warm salt water: ¼ teaspoon salt to 8ozs of warm water- helps relieve throat pain

20. SELF MANAGEMENT: • Use a humidifier: cool mist moisture eases discomfort • Avoid irritants: cigarette smoke, fumes (paint, cleaning products) • Throat losenges: provides temporary relief of sore throat (not recommended for young children) • Over-the-counter (OTC) pain medications: Tylenol and advil- reduce fever and provide pain control

21. PREVENTION: • Hand hygiene is the best way to prevent spread of infection • Do not share personal items (drinking glasses, utensils) • Cover your mouth • Clean surfaces

22. QUESTIONS TO DISCUSS: • If awaiting throat culture results, would you immediately start antibiotics based on physical examination or after getting a positive throat culture result?