From the American Academy of Pediatrics website - excuse me, but this is progress? Really? This website is where AAP physicians go to look up symptoms, how to treat, etc. See the part in all caps about 3/4 of the way through CLINICAL MANIFESTATIONS The most common group A streptococcal (GAS) infection is acute pharyngotonsillitis, which may present with a strawberry tongue, which occurs following peeling of a white coating, leaving a red glistening tongue with prominent papillae. Purulent complications of pharyngotonsillitis, including otitis media, sinusitis, peritonsillar and retropharyngeal abscesses, and suppurative cervical adenitis, develop in some patients, usually those who are untreated. Nonsuppurative sequelae include acute rheumatic fever (ARF) and acute glomerulonephritis. The goals of antimicrobial therapy for GAS upper respiratory tract disease are to reduce acute morbidity, nonsuppurative sequelae (acute rheumatic fever and acute glomerulonephritis), and transmission to close contacts. Scarlet fever occurs most often in association with pharyngitis and, rarely, with pyoderma or an infected wound. Scarlet fever has a characteristic confluent erythematous sandpaper-like rash that is caused by one or more of several erythrogenic exotoxins produced by group A streptococci. Severe scarlet fever occurs rarely. Other than occurrence of rash, the epidemiologic features, symptoms, signs, sequelae, and treatment of scarlet fever are the same as those of streptococcal pharyngitis. Toddlers (1 through 3 years of age) with GAS respiratory tract infection initially can have serous rhinitis and then develop a protracted illness with moderate fever, irritability, and anorexia (streptococcal fever or streptococcosis). Acute pharyngotonsillitis is uncommon in children younger than 3 years of age. The second most common site of GAS infection is skin. Streptococcal skin infections (ie, pyoderma or impetigo) can result in acute glomerulonephritis, which occasionally occurs in epidemics. ARF is not a sequela of GAS skin infection. Other manifestations of GAS infections include erysipelas, perianal cellulitis, vaginitis, bacteremia, pneumonia, endocarditis, pericarditis, septic arthritis, cellulitis, necrotizing fasciitis, purpura fulminans, osteomyelitis, myositis, puerperal sepsis, surgical wound infection, acute otitis media, sinusitis, retropharyngeal abscess, peritonsillar abscess, mastoiditis, and neonatal omphalitis. Invasive GAS infections can be severe, may or may not be associated with an identified focus of local infection, and can be associated with streptococcal toxic shock syndrome (STSS) or necrotizing fasciitis. Severe infection can follow minor or unrecognized trauma. AN ASSOCIATION BETWEEN GAS INFECTION AND SUDDEN ONSET OF OBSESSIVE-COMPULSIVE OR TIC DISORDERS - PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTIONS (PANDAS) - HAS BEEN PROPOSED BUT IS UNPROVEN. STSS is caused by toxin-producing GAS strains and typically manifests as an acute illness characterized by fever, generalized erythroderma, rapid-onset hypotension, and signs of multiorgan involvement, including rapidly progressive renal failure (see Table 3.66). Evidence of local soft tissue infection (eg, cellulitis, myositis, or necrotizing fasciitis) associated with severe, rapidly increasing pain is common, but STSS can occur without an identifiable focus of infection. STSS also can be associated with invasive infections, such as bacteremia, pneumonia, pleural empyema, osteomyelitis, pyarthrosis, or endocarditis.
Posted on: Sat, 30 Aug 2014 04:08:06 +0000
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