Streptococcal Angina

Symptoms

A typical strep throat starts suddenly with sore throat and swallowing pain and an inflammation of the throat. The tonsils are inflamed, red, swollen, and coated. Further, fever occurs while cough is absent. The cervical lymph nodes are painfully enlarged. Possible accompanying symptoms include headache, muscle aches, abdominal pain, chills, a scarlet-like rash, nausea, and vomiting. However, an atypical course is possible, especially in children. The infection is usually self-limiting and lasts only a few days. Streptococcal angina with a large-area rash and with raspberry tongue is called scarlet fever (see there).

Causes

Angina is caused by gram-positive beta-hemolytic group A streptococci and is transmitted from person to person as a droplet infection via saliva and nasal secretions. The incubation period is short, lasting 24 to 72 hours. In children between 5 and 15 years of age, the main cause of tonsillitis is group A streptococcal infection and is most common in winter and spring. Local outbreaks occur wherever people live closely together, such as in families or schools. Under the age of three, strep throat is uncommon. Adults are also more likely to suffer from viral tonsillitis, but they can be infected by children (parents, teachers).

Complications

A very rare and dangerous complication is acute rheumatic fever, which occurs two to four weeks after the illness. Complaints include high fever, migratory arthritis, carditis, myocarditis, and endocarditis. It is an immunologic cross-reaction between bacterial and human antigens. Other complications, also rare, include glomerulonephritis, sinusitis, mastoiditis, otitis media, bacteremia, meningitis, and pneumonia. Antibiotic therapy aims to prevent these complications, among others.

Diagnosis

Diagnosis is made by medical treatment based on the patient’s history, with physical examination, and with a rapid streptococcal test or culture. A diagnosis based solely on symptoms is not reliable enough because other pathogens cause a similar clinical picture (see under Differential Diagnoses). The following score allows a first estimation. The more of the criteria are met, the more likely it is streptococcal angina:

  • No cough (1 point)
  • Swollen lymph nodes of the neck (1 point)
  • Increased temperature (>38°C) (1 point)
  • Coated or swollen tonsils (1 point).
  • Young age (3 to 14 years) (1 point).
  • Age > 45 years (-1 point)

The complete method can be found in McIsaac et al (1998). The corresponding article is freely available Pubmed.

Differential diagnoses

The cause of sore throat is often a viral infection, such as the common cold. Colds are caused by a number of viruses. Other viruses that cause serious illness must also be ruled out at diagnosis. These include herpes viruses such as Epstein-Barr virus (mononucleosis), herpes simplex virus, and cytomegalovirus. A few days to weeks after infection with the HI virus, sore throats may occur along with other symptoms. Similar symptoms are eventually caused by other bacteria.

Drug treatment

Because an untreated streptococcal infection can rarely lead to serious complications, accurate clarification of the cause and adequate treatment are important. Antibiotics:

  • Oral treatment with an appropriate antibiotic is considered the first-line treatment. Antibiotics relieve symptoms, shorten the duration of the disease, reduce the risk of infection and reduce the incidence of complications.

Symptomatic treatment:

Probiotics lozenges: