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Streptococcal Infection, Pharyngitis or Tonsillitis

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Pharyngitis or Tonsillitis

Streptococcal infections are very common in childhood, most often located in the upper respiratory tract (tonsillitis / pharyngitis, otitis, sinusitis, scarlet fever), but also on the skin (impetigo), in rare cases, may occur severe infections like pneumonia, meningitis or complications of streptococcal infection: acute articular rheumatism (rheumatic fever) and acute glomerulonephritis (inflammatory kidney damage or disruption of kidney function).

This multitude of manifestations derives from the fact that there are many groups of streptococci, by far, the most common being group A with more than 80 types. The most common is beta hemolytic streptococcus from group A, which can cause infections in the upper respiratory tract, but also in the skin. Group B streptococcus is involved in the occurrence of severe infections in newborns by maternal fetal transmission.

A special category is represented by streptococcus pneumoniae (pneumococcus) that cause severe infections such pneumonia, meningitis, and against whom, respectively, defenses can be made by taking pneumococcal vaccination.

By far, the most common condition is that of pharyngitis / tonsillitis, caused by group A beta-hemolytic streptococci.

What is pharyngitis / tonsillitis?

– Inflammation of the pharynx (throat) and tonsils, often caused by viruses (up to 85%) and less often by bacteria (15-30%), the most common bacteria group A streptococcus is involved but can also be other streptococci and other bacteria: Mycoplasma, Chlamydia (rare).

Red throat

– Tonsils are some structures that are involved in defending the body, made ​​up of lymph tissue and are located above and behind the tongue, on both sides of the neck, which react (increase in size and turn red) when the body comes into contact with various viruses or bacteria. There are children with more episodes of tonsillitis, having enlarged tonsils (beyond infectious episodes) and the so-called chronic tonsillitis, hypertrophic, which sometimes require surgical removal of the tonsils (partial or total).

– Streptococcal infection affects mostly children aged between 5 and 15 years, the infection is rare in the first year of life.

How is it spread?

Given the localization mainly in the nose and throat, it is easily transmitted through sneezing, coughing, runny nose or through contaminated objects (toys, furniture, etc.) so that, in the community, is recorded real epidemic, especially in winter, a child with pharyngitis / strep throat is contagious in the first 24-48 hours of antibiotic treatment.

A special category is represented by healthy carriers of strep, which shows no manifestation, but that can easily transmit the infection.

Symptoms of the virus

There are a number of similarities between pharyngitis / tonsils viral and bacterial ones to confirm with certainty streptococcal infection, thus, requiring further investigations (blood tests, throat secretions).

Onset: – suddenly with:

  • Sometimes high fever (39° C) suggestive of streptococcal;
  • General altered state, malaise, irritability;
  • Refusal of food, vomiting (especially in smaller children);
  • Severe sore throat (dysphagia) that make it impossible to feed;
  • Increasing the size of the nodes (laterocervical and submandibular) with sorrow and sensitivity to touch;
  • Pharyngeal hyperemia (red throat) with the increase in size of the tonsils that sometimes can even unite in the midline; tonsils are heavily congested, and deposits may whitish, yellowish;
  • The lack of dysphonia (hoarseness), cough, rhinorrhea (a runny nose), events that may suggest the involvement of a virus rather than a bacteria.



24-48 hours after the treatment (required antibiotic of choice penicillin) the child is no longer contagious and symptoms improve, however, treatment should be continued 7-10 days, depending on the doctors advice.

It is important to differentiate streptococcal pharyngitis / tonsillitis from viral types, to stop the unnecessary administration of antibiotics. Antibiotics do not decrease the evolution of a viral infection, just as do not prevent bacterial superinfection. Only your family doctor or pediatrician can recommend treatment with antibiotics.

How is it diagnosed?

In general, based on the child’s symptoms and clinical examination (consultation itself), suspicion of streptococcal infection must be confirmed / disproven by performing pharyngeal secretions. Even so, about 30% of those with suspected strep have negative secretion (streptococcus is not confirmed), a variable rate of between 20-40% confirm the streptococcus, although they did not show any manifestation.

In practice, the McIsaac score is used, helping with the etiological classification of tonsillitis.

Thus, for each of the following symptoms are awarded 1 point:

1. Temperature exceeding 38C;
2. Absence of cough;
3. Painful lymphadenopathy (increase in size of lymph)
4. Increase in size of the tonsils congestion (blush) buildup of pus;
5. Ages 3 to 14 years.

A score ranges between 1 and 3 raise the suspicion of streptococcal infection, while a score of 4-5 is almost certainly that a bacterial infection exists, namely streptococcal.

Streptococcal Infection

Besides pharyngeal secretion, is indicated to perform ASO or ASLO = Anti-streptolysin O, which is a response of the organism to infection with streptococcus, in other words, the body produces “soldiers” (antibodies) against streptolysin (an enzyme produced by Streptococcus) which can be determined from blood, and this reflects streptococcal infection. This test is not much used in the diagnosis of the acute phase, being most useful in the dynamic of tracking evolution. Should be noted that ASO increases in the first weeks of the infection, reaching a maximum value in the next 2-4 weeks, after that, within 6-12 months, returns to normal. Therefore, the persistence of high values within a few months, impose a reassessment.

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