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Streptococcal pharyngitis in Child
See also in: Oral Mucosal Lesion
Other Resources UpToDate PubMed

Streptococcal pharyngitis in Child

See also in: Oral Mucosal Lesion
Contributors: Anand N. Bosmia MD, James H. Willig MD, MSPH
Other Resources UpToDate PubMed

Synopsis

Streptococcal pharyngitis, or strep throat, is an acute infection and inflammation of the pharynx that affects both children and adults. The most common bacterial etiology of pharyngitis is group A beta-hemolytic Streptococcus (GABHS, or Streptococcus pyogenes). The infection is transmitted via respiratory secretions.

Demographics:
  • Responsible for 5% to 20% of cases of pharyngitis in adults.
  • Responsible for 15% to 30% of cases of pharyngitis in children.
  • Most commonly occurs in children between 5 and 15 years of age.
Symptoms (Often Abrupt Onset):
Typical
  • Pain or difficulty swallowing
  • Fever
  • Chills
  • Malaise
  • Headache – Frequently frontal in location
Variants
  • Younger children – Abdominal pain, nausea, and vomiting
  • Severe unilateral throat pain should raise concern for a peritonsillar or retropharyngeal abscess, especially if this symptom arises or progresses several days after onset of symptoms. Inability to swallow, or odynophagia, should raise concern for a peritonsillar or retropharyngeal abscess.
Signs:
Typical
  • Pharyngeal erythema
  • Exudate (gray-white), tonsillar pillars or posterior pharynx; occasional palatine petechiae, erythema and edema of the uvula
  • Anterior cervical lymphadenopathy (classic angle of jaw)
Variants
  • Scarlet fever – Usually face sparing, punctate, erythematous, blanchable, sandpaper-like exanthem that may be accentuated in skin folds and creases (Pastia's lines) and may desquamate during convalescence; bright red tongue with inflamed papillae (strawberry tongue); erythematous pharynx and tonsils covered with exudate.
  • Children less than 3 years of age – Coryza, purulent nasal discharge, excoriated nares (streptococcosis), and generalized adenopathy.
Risk Factors:
  • Exposure to a person with known streptococcal pharyngitis.
  • History of acute rheumatic fever or rheumatic heart disease.
Timeline:
  • The incubation period is 24-72 hours.
  • In most people, fever resolves within 3-5 days, and throat pain resolves within 1 week, even without specific treatment.
  • Patients with untreated GABHS pharyngitis are infectious during the acute phase and for 1 week after.
  • Late winter and early spring are peak GABHS seasons.
Complications of GABHS Illness:
Suppurative
  • Bacteremia
  • Cervical lymphadenitis
  • Endocarditis
  • Fasciitis/myositis
  • Mastoiditis
  • Meningitis
  • Otitis media
  • Perianal dermatitis in children
  • Peritonsillar/retropharyngeal abscess (quinsy) – Patient has toxic appearance, "hot potato voice," fluctuant peritonsillar mass, and asymmetric deviation of the uvula.
  • Pneumonia
  • Sinusitis
  • Toxic shock
Nonsuppurative
  • Post-streptococcal glomerulonephritis – Hematuria and edema with history of a recent streptococcal infection (elevated anti-streptolysin O titer).
  • Acute rheumatic fever – Major (carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules) and minor (arthralgias, fever, elevated acute-phase reactants, prolonged PR interval).
  • Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection.
  • Post-streptococcal autoimmune dystonia secondary to striatal necrosis.
  • Post-streptococcal reactive arthritis.
  • Sydenham's chorea and other autoimmune movement disorders.

Codes

ICD10CM:
J02.0 – Streptococcal pharyngitis

SNOMEDCT:
43878008 – Streptococcal sore throat

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Last Updated:05/08/2013
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Streptococcal pharyngitis in Child
See also in: Oral Mucosal Lesion
A medical illustration showing key findings of Streptococcal pharyngitis : Abdominal pain, Cervical lymphadenopathy, Chills, Fever, Headache, Nausea/vomiting, Oral petechiae, Tonsillar exudates, Dysphagia, Oropharyngeal erythema, Pharyngitis
Clinical image of Streptococcal pharyngitis - imageId=5246650. Click to open in gallery.  caption: 'A "cobblestone throat" caused by patchy lymphoid tissue hypertrophy and exudates and erythema of the uvula and tonsillar fauces.'
A "cobblestone throat" caused by patchy lymphoid tissue hypertrophy and exudates and erythema of the uvula and tonsillar fauces.
Copyright © 2024 VisualDx®. All rights reserved.