Clinical Feature of Bacterial APT

5-15 years old

High Grade Fever
Intense inflammation of the pharynx and tonsils: pain, edema, and exudate
Presence of painful and enlarged anterior cervical lymph nodes (>1.0cm)
Absence of signs and symptoms suggesting a viral cause: conjunctivitis,
hoarseness, diarrhea and coryza
History of exposure to a patient with streptococcal disease or onset of the
condition at the end of winter and at the beginning of spring

GHABS

Inhaled
droplet

Attach to pharyngeal
mucosa via Protein F,
Lipotechoic Acid, M
protein

Grow and secrete

toxins

Damage surrounding
mucosa

Stimulates
production of
protective
antibodies

Elicit
inflammatory
response

Influx of WBC, fluid

leakage and pus
formation

Streptococcus
Pharyngitis

Diagnosis
Gold Standard: isolation of the
organism on culture of pharyngeal
tonsils and posterior oropharyngeal
wall secretions in blood agar dish
with goat blood at 5%.
90% sensitivity
24-48 hours

Diagnosis
Quick Antigenic Tests
80-95% sensitivity; 90% specificity
Few minutes

Treatment
Most resolves spontaneously, however
antibiotic therapy hastens clinical
recovery by 12-24 hrs.
Primary benefit of Tx: reduce the
possibility of suppurative and nonsuppurative complications associated
with GHABS
Secondary benefit: Reduce
transmission in the community

Antibiotic Therapy
Can be started immediately without culture in:

Children with symptomatic pharyngitis

Positive rapid streptococcal antigen test
Clinical diagnosis of scarlet fever
Household contact with documented
Streptococcal pharyngitis
Past history of acute RF
Recent history of acute RF in a family
member

Antibiotic Therapy

PENICILLIN V BID or TID for 10 days

Children: 250mg/dose
Larger children and adults: 500mg/dose

ORAL AMOXICILLIN preferred for children

750mg fixed dose or 50mg/kg max of 1g orally for
10days

BENZATHINE PENICILLIN
Children <27kg/60lbs: 600,000 U
Larger children and adults: 1.2 million U

If allergic to penicillin
ERYTHROMYCIN (max 1g/24 hrs)
Erythromycin ethyl succinate
40mg/kg/day for 10 days

Erythromycin estolate
20-40mg/kg/day for 10 days

Symptomatic Therapy
Oral antipyretic/analgesic:
Acetaminophen or ibuprofen
For fever and sore throat

Gargling with warm salt

Anesthetic spray or lozenges

Tonsillectomy
Tonsillar Hyperplasia with Upper
Airway Obstruction
Dysphagia
Speech Impairment or Halitosis
Recurrent or Chronic Tonsillitis
Peritonsillar abscess occurring in the
background of chronic tonsillitis

Complications
Suppurative
Parapharyngeal abscess

Non-suppurative
Acute Rheumatic Fever
Acute Post infectious Glomerulonephritis

Parapharyngeal Abscess

Mx: fever, dysphagia

PE: prominent bulge on the lateral pharyngeal
wall with medial displacement of the tonsils
Definitive Dx: incision for drainage and culture
of an abscessed node; CT can be helpful.
Polymicrobial
Tx: IV antibiotics w/ or w/o surgical drainage
3rd gen cephalosporin + AmpiSul OR clindamycin for
anaerobic coverage

Acute Rheumatic Fever

CYTOTOXICITY THEORY:
IMMUNOLOGIC THEORY:
The antigenicity of GABHS products
and
MAMMALIAN
GABHS
O
CELLS
constituentSTREPTOLYSIN
of immunologic
cross
reactivity between GABHS and
mammalian tissue

Acute Post Infectious GN

Gross hematuria, edema, hypertension and renal
insufficiency
One of the most common glomerular causes of
gross hematuria and major cause of morbidity in
GABHS infection
5-12 yrs old; develop 1-2wks after strep
pharyngitis / 3-6wks after strep pyoderma
Enlarged Kidneys
Immunofluorescence: lumpy bumpy deposits
Electron Microscopy: Humps