Complications of streptococcal tonsillopharyngitis

Pharyngeal infection induced by g. A Streptococcus (GAS) is frequently a self-limited, with Sms usually lasting for 2-5 d.s in untreated ptns.

 

Complications of streptococcal tonsillopharyngitis

 

Pharyngeal infection induced by g. A Streptococcus (GAS) is frequently a self-limited, with Sms usually lasting for 2-5 d.s in untreated ptns. If started within 48 hs of illness, antimicrobial agents decrease the duration & severity of Sms and limit the spreading of infection to ptns’ contacts. The additional vital goal of therapy is to limit the risk of suppurative & nonsuppurative sequelae.  The nonsuppurative sequelae of GAS infection include acute Rhc (rheumatic) fever (ARF), SF (scarlet fever), streptococcal toxic shock syndrome, acute GN (glomerulonephritis), & paediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS).  Acute Rhc fever is a latent sequela of GAS-induced pharyngeal infection. After the initial pharyngitis, there’s a latent interval of 2-3 weeks before the 1^st Sns or Sms of ARF became evident. Clinically, the disease usually presenting with several manifestations including arthritis, carditis, chorea, SC nodules, as well as erythema marginatum.  

  

 

Clinically intense GAS infection with shock & organo-failure have been observed with increasing prevalence mainly in North America & Europe.   Poststreptococcal GN is induced by specific nephritogenic strains of GAS (e.g., type 12 & 49). This can occur in sporadic pattern or with an epidemic spread. Clinically, presentation often vary from asymptomatic, microscopic haematuria to full-blown👉 acute nephritic syndrome, characterizing by:

1)    oedema,

2)    HT (hypertension),  

3)    ARF (acute renal failure).

4)    Red to brown (smoky) urine, &

5)    Proteinuria (could be nephrotic range),

The suppurative sequelae of GAS TP (tonsillopharyngitis) include cellulitis or abscess formation, otitis media, sinusitis, as well as necrotizing fasciitis; streptococcal bacteraemia, meningitis, & brain abscess are rarely seen with GAS infection. Ttt of streptococcal TP with AB therapy is crucial to limit its complications.

 

Scarlet fever (SF): = ("scarlatina") is a diffuse erythematous eruption that is usually observed in combination with pharyngitis. The appearance of scarlet fever rash needs previous exposure to S. pyogenes & appear due to delayed-type skin hypersensitivity to the pyrogenic exotoxin (erythrogenic toxin, types A, B, or C) produced by the pathogen. SF rash is = diffuse erythema that can be blanched by pressure, with many small (1-2 mm) papular elevated lesions, giving a cutaneous👉 "sandpaper" quality. It can be observed in the groin & armpits in addition to circumoral pallor and a strawberry tongue. This rash may expand rapidly to cover most of the trunk then involve the extremities, and, eventually, desquamates; interestingly, palms & soles are commonly spared. Rash is mostly seen in the skin folds of the inguinal, axillary, antecubital, as well as abdominal areas in addition to around pressure points. Moreover, they may exhibit a linear petechial character seen in the antecubital fossae & axillary folds, forming what is known as Pastia's lines.

Dgx is usually depending on the clinical manifestations. Except of rapid strep tests + throat culture, there’s no role for more tests. SF with TP can induce to acute rheumatic fever. Approach of therapy of scarlet fever is the👉 same as that followed in streptococcal TP; no additional therapy is required for the skin rash. Children can be back to school or day care 24 hs after commencing an AB. No more monitoring for such ptns is required.