GABHS are responsible for the majority of bacterial
pharyngitis. The profile of pharyngeal disease these
organisms can cause ranges from asymptomatic colonization
of the pharynx to a severe pharyngotonsillitis. The
symptoms and signs are as discussed above.

A scarlatiniform rash can accompany the
throat and systemic symptoms.
GABHS infections need systemic antibiotics as serious
complications can ensue from the infection.

These include
rheumatic fever, scarlet fever, toxic shock syndrome,
necrotizing fasciitis, and septicaemia.

Antibiotics do not
prevent poststreptococcal glomerulonephritis.

Scarlet fever is a very uncommon presentation these days,
and most cases are less severe than in the past. There are
characteristic findings in the oral cavity and oropharynx that
may be encountered in otolaryngological practice. These
include palatal petechiae and a strawberry tongue (white fur
on the surface through which red papillae appear) initially.
The white fur on the tongue later peels off leaving red papillae
(raspberry tongue).

The skin shows symmetrical, punctate,
diffuse, blanching rash in the neck, axillae, and groin, usually
on the second day of the infection.

This rash resolves over 3 weeks and skin
peeling occurs over the extremities.
Several clinical scoring systems have been developed to
help diagnose GABHS infection to start prompt antibiotic
treatment. None have demonstrated high diagnostic efficacy.
The streptococcal rapid antigen test is a rapid immuno assay
that looks for specific group A streptococcal carbohydrate
antigen from a throat swab, with the results being available in
a few minutes. This has been demon strated to have a high
specificity and negative predictive value.

The antibiotic of choice is penicillin, with erythromycin for
individuals allergic to penicillin. Analgesia and supportive
care are essential.

However, aspirin should be avoided in
children under 16 years due to the risk of Reye’s syndrome.



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