Streptococcal Pharyngitis

Streptococcal Pharyngitis

📌 Definition

Streptococcal pharyngitis is an acute infection of the pharynx and tonsils caused primarily by Streptococcus pyogenes (Group A β-hemolytic streptococcus). It is one of the most common bacterial causes of sore throat, especially in children and adolescents.

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📊 Epidemiology

• Most common in children aged 5 to 15 years.

• Transmitted via respiratory droplets (coughing, sneezing).

• More frequent in winter and early spring.

• Incubation period: 2–5 days.

• Rare in children under 3 years and adults over 40.

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🧬 Pathogenesis

1. Bacterial entry through the upper respiratory tract.

2. Colonization of the pharyngeal mucosa.

3. Production of toxins and enzymes leading to:

• acute inflammation,

• redness,

• tonsillar exudate.

4. Without treatment → risk of suppurative and non-suppurative complications.

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⚠️ Causes and Risk Factors

Causes:

• Streptococcus pyogenes (most common).

• Other Group A β-hemolytic streptococci (less common).

Risk Factors:

• School-age children

• Crowded environments (schools, barracks)

• Contact with infected individuals

• Weakened immune system

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🩺 Diagnosis

History and symptoms:

• Sudden onset of sore throat

• Fever (>38°C / 100.4°F)

• Pain when swallowing

• Red, swollen tonsils with white exudate

• Enlarged and tender anterior cervical lymph nodes

• Absence of cough (important for differentiating from viral infections)

Diagnostic tests:

• Rapid antigen detection test (throat swab): quick, but less sensitive.

• Throat culture: more accurate, takes 24–48 hours.

• Blood tests: elevated ESR, CRP (non-specific).

• If complications are suspected: urinalysis (for glomerulonephritis), neck ultrasound.

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💊 Medical Therapy

Antibiotics (mandatory for Group A Strep infection):

• Penicillin V (for 10 days)

• Alternatives:

• Amoxicillin

• In case of allergy: Erythromycin, Clarithromycin, or Clindamycin

Symptomatic treatment:

• Antipyretics (Paracetamol/Acetaminophen, Ibuprofen)

• Antiseptic gargles

• Adequate hydration and rest

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🩺 Nursing Care

• Monitoring temperature and vital signs

• Ensuring correct and timely administration of antibiotics

• Patient education on the importance of completing the full antibiotic course

• Providing comfort measures: warm fluids, humidifier use

• Observation for possible complications (breathing difficulties, chest pain, dark urine)

• Precautionary isolation if indicated (first 24 hours of antibiotics)

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🛡️ Prevention and Nursing Advice

• Frequent hand washing

• Avoid sharing cups or utensils

• Avoid contact with infected individuals

• Health education in schools and households

• Covering mouth and nose when coughing/sneezing

• Return to school/work only after 24 hours of antibiotic treatment

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⚠️ Complications (if untreated)

Suppurative:

• Peritonsillar abscess

• Otitis media

• Sinusitis

Non-suppurative:

• Rheumatic fever

• Post-streptococcal glomerulonephritis

• Reactive arthritis.