• Like
Streptococcal pharyngitis
Upcoming SlideShare
Loading in...5
×

Streptococcal pharyngitis

  • 2,975 views
Uploaded on

Streptococcal pharyngitis

Streptococcal pharyngitis

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
No Downloads

Views

Total Views
2,975
On Slideshare
0
From Embeds
0
Number of Embeds
1

Actions

Shares
Downloads
125
Comments
4
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. STREPTOCOCCAL PHARYNGITIS COMPLICATIONS, DIAGNOSIS, PREVENTION Dr.T.V.Rao MDDR.T.V.RAO MD 1
  • 2. GROUP A STREPTOCOCCAL INFECTION AND HEALTH CARE- TRIBUTE TO IGNAZ SEMMELWEIS Ignaz Philipp Semmelweis (1818-1865) All students or doctors who enter the wards for the purpose of making an examination must wash their hands thoroughly in a solution of chlorinated lime which will be placed in convenient basins near the entrance of the wards. This disinfection will be considered sufficient for this visit. Between examinations the hands must be washed in soap and water. 1847
  • 3. DEFINITIONSPharyngitis refers to inflammation of the structures of the pharynx.- The tonsils are most often affected.- The term pharyngitis, tonsillitis, tonsillopharyngitis and pharyngotonsillitis are interchangeable and do not imply an etiology.DR.T.V.RAO MD 3
  • 4. STREPTOCOCCUS PYOGENES:MICROSCOPIC APPEARANCE & COLONIAL MORPHOLOGY
  • 5. INFECTIONS CAUSED BYSTREPTOCOCCUS PYOGENES (GAS) • Superficial diseases pharyngitis, skin & soft tissue inf n, erysipelas, impetigo, vaginitis, post-partum infn • Deep infections bacteraemia, necrotising fasciitis, deep soft tissue infn, cellulitis, myositis, puerperal sepsis, pericarditis, meningitis, pneumonia, septic arthritis • Toxin-mediated scarletina, toxic shock-like syndrome • Immunologically mediated rheumatic fever, post-streptococcal GN, reactive arthritis
  • 6. GROUP A STREPTOCOCCAL INFECTION OVERALL DISEASE BURDENEach year• 1.8 million new cases ofserious infection• at least 500,000 deaths• 110 million cases of soft tissueinfection• 610 million cases ofpharyngitisAt least 18 million people sufferthe consequences of seriousGAS diseases
  • 7. DEFINITIONS• Pharyngitis • predominantly inflammation of the oropharynx, but not the tonsils.• Tonsillitis • when the tonsils are particularly affected.• Laryngitis • few signs of infection visible but the patient complains of soreness lower down the throat often with a hoarse voice.DR.T.V.RAO MD 7
  • 8. STREP THROAT• Strep throat is caused by Group A Streptococcus bacteria. It is the most common bacterial infection of the throat Streptococcal pharyngitis, streptococcal tonsillitis, or streptococcal sore throat (known colloquially as strep throat) is a type of pharyngitis caused by a group A streptococcal infection It affects the pharynx including the tonsils and possibly the larynx. Common symptoms include fever, sore throat, and enlarged lymph nodes. It is the cause of 37% of sore throats among childrenDR.T.V.RAO MD 8
  • 9. HOW THE GROUP A STREPTOCOCCI SPREAD1. Which factors lead to the spread of GAS pharyngitis? Droplets, Not Fomites, Overcrowding, Possibly families with young children, Proven family contacts, and the effects of povertyDR.T.V.RAO MD 9
  • 10. ETIOLOGY• 30%-65%: idiopathic• 30%-60%: viral• 5%-10%: bacterial• Group A beta-hemolytic: most common bacterial pathogen • 15%-36%: pediatric cases • 5%-10% : adult pharyngitis • Disease of childrenDR.T.V.RAO MD 10
  • 11. PROGRESS OF EVENTS IN GROUP A STREPTOCOCCAL INFECTIONDR.T.V.RAO MD 11
  • 12. WHICH CLINICAL SIGNS AND SYMPTOMS BEST CORRELATE WITH GROUP A STREPTOCOCCAL (GAS) PHARYNGITIS INFECTION IN ADULTS AND CHILDREN?1. Temperature > 38 C2. Sudden onset3. Coryza4. Diarrhoea5. Macular rash6. Age 3 -14 yrs7. Conjunctivitis8. Early winter or spring presentation9. Exudate on tonsils10. History of exposure to GAS11. Palpable cervical lymph nodes12. Cough13. Myalgia14. Prolonged sore throat15. Fatigue16. No cough17. Sandpaper-like rash18. Nausea19. Loss of appetite DR.T.V.RAO MD 12
  • 13. DIAGNOSISDR.T.V.RAO MD 13
  • 14. COLLECTING A APPROPRIATE SPECIMEN IS HIGHLY ESSENTIALDR.T.V.RAO MD 14
  • 15. COLLECTING PHARYNGEAL SPECIMEN• AVOID TOUCHING THE TONGUE AND LIPS.• SWAB FROM EXUDATE AND BOTH TONSILS.• ALSO POST PHARYNGEAL WALL – BEHIND THE UVULA AND BETWEEN THE TONSILS.DR.T.V.RAO MD 15
  • 16. THROAT CULTURE: GOLD STANDARD• Throat culture: gold standard for treating • Sensitivity 90%, specificity 99% • American Academy of Pediatrics, US Centers for Disease Control and Prevention and Infectious Diseases Society of America- GABHS test prior to treating children with suspected strep pharyngitis • For adult patients to confirm clinical diagnosisDR.T.V.RAO MD 16
  • 17. UNDERSTANDING THE IMPORTANCE OF THROAT CULTURING• A throat culture is the gold standard for the diagnosis of streptococcal pharyngitis with a sensitivity of 90–95%.] A rapid strep test (also called rapid antigen detection testing or RADT) may also be used. While the rapid strep test is quicker, it has a lower sensitivity (70%) and statistically equal specificity (98%) as throat culture.• A positive throat culture or RADT in association with symptoms establishes a positive diagnosis in those in which the diagnosis is in doubt.[ Asymptomatic individuals should not be routinely tested with a throat culture or RADT because a certain percentage of the population persistently "carries" the streptococcal bacteria in their throat without any harmful results.[DR.T.V.RAO MD 17
  • 18. OBSERVATION OF STREPTOCOCCUS GROUP A ON SHEEP BLOOD AGAR PLATESDR.T.V.RAO MD 18
  • 19. LIMITATIONS IN DIAGNOSIS• Throat swabs cannot differentiate between "infection" and "carriage", are poorly sensitive, and are therefore of limited value. Results take up to 24 - 48 hours to be reported, and the test is relatively expensive.• Rapid antigen tests to detect streptococcal antigen on a throat swab are not easily available.• Anti-streptolysin O (ASO) titres can help to identify whether a patient has recently been infected with streptococcus, and may be useful for patients who remain unwell or develop complications.DR.T.V.RAO MD 19
  • 20. DIFFERENTIAL DIAGNOSIS• Infectious mononucleosis (glandular fever)• Epiglottitis (requires urgent admission)• Gonococcal pharyngitis (rare)• Diphtheria (very rare in developed countries )• Neutropenia (e.g. ensure patient not on carbimazole)DR.T.V.RAO MD 20
  • 21. STREPTOCOCCUS GROUP A INFECTIONS CAN BE SELF LIMITING• Group A strep pharyngitis naturally self-limiting• Resolve spontaneously in 3-4 days w/ or w/o antibiotics• Rapid test or throat culture: reduces unnecessary antibiotic use by identifying those whom antibiotic therapy is justified• Viral etiology do not need antibiotic treatmentDR.T.V.RAO MD 21
  • 22. COMPLICATIONS OF STREPTOCOCCAL INFECTION• Otitis media• Sinusitis• Peritonsillar abscess (quinsy)• Suppurative cervical adenopathy• Rheumatic fever• Post streptococcal glomerulonephritisDR.T.V.RAO MD 22
  • 23. COMPLICATION OF STREPTOCOCCAL INFECTIONS• Complications arising from streptococcal throat infections include:• Acute rheumatic fever• Scarlet fever• Streptococcal toxic shock syndrome]• Glomerulonephritis ]• PANDAS syndrome]DR.T.V.RAO MD 23
  • 24. WHAT IS PANDAS• PANDAS is an acronym for Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. This term describes a hypothesis that a set of children develop rapid onset of obsessive-compulsive disorder (OCD) and/or tic disorders following group A beta-haemolytic streptococcal (GABHS) infections such as "strep throat" and scarlet fever. The proposed link between infection and these disorders is an autoimmune reaction, where antibodies produced to the infection interfere with neuronal cells.DR.T.V.RAO MD 24
  • 25. STREPTOCOCCAL GROUP A INFECTIONS CAN PRODUCE RHEUMATIC HEAR DISEASE AND GLUMORELONEPHRITSDR.T.V.RAO MD 25
  • 26. MANAGEMENT• If an antibiotic is necessary • Penicillin is the treatment of choice, with erythromycin in patients with penicillin allergy. 10 days treatment is recommended in order to eradicate possible streptococcus infection. [DTB 1995]• Tonsillectomy is occasionally recommended for recurrent attacks of tonsillitis. Consider only if seven documented throat infections in the preceding year, or three in each of three successive years.DR.T.V.RAO MD 26
  • 27. ERADICATIONS OF STREPTOCOCCUS WILL REDUCE THE COMPLICATIONS• Eradication of GABHS to provide primary prevention against suppurative and nonsuppurative complications• Abating clinical signs and symptoms• Reducing bacterial transmission to close contacts• Minimizing adverse effects of therapy• Early abx tx: shortens clinical courseDR.T.V.RAO MD 27
  • 28. PREVENTION• Most people with strep are contagious until they have been on antibiotics 24 - 48 hours. They should stay home from school, day-care, or work until they have been on antibiotics for at least a day.• Get a new toothbrush after you are no longer contagious, but before finishing the antibiotics. Otherwise the bacteria can live in the toothbrush and re-infect you when the antibiotics are done. Also, keep your familys toothbrushes and utensils separate, unless they have been washed.• If repeated cases of strep still occur in a family, you might check to see if someone is a strep carrier. Carriers have strep in their throats, but the bacteria do not make them sick. Sometimes, treating them can prevent others from getting strep throat.DR.T.V.RAO MD 28
  • 29. FOLLOW ME FOR MORE ARTICLES OF INTEREST ON ISSUES OF INFECTIONSDR.T.V.RAO MD 29
  • 30. • Programme created by Dr.T.V.Rao MD for Medical and Paramedical students in the developing World • Email • doctortvrao@gmail.comDR.T.V.RAO MD 30