Streptococcal angina

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Classification according to ICD-10
J03.0 Streptococcal tonsillitis
ICD-10 online (WHO version 2019)

In the streptococcal pharyngitis is a bacterial infection of the throat by beta-hemolytic group A streptococci ( Streptococcus pyogenes ).

Pathogen

There are over 80 serotypes of Streptococcus pyogenes, which differ in the antigenicity of the surface protein M. If this is not inactivated by antibodies, this protein and also the hyaluronic acid bacterial capsule protect against phagocytosis.

However, extracellular toxins and enzymes also play a role in the development of an infection with Streptococcus pyogenes. Including the pyrogenic exotoxins A, B and C, streptolysin O and S and streptokinase.

The pathogen is mainly transmitted as a droplet infection, especially from symptomatic carriers, as these are more contagious. It can also be transmitted through contaminated food.

Epidemiology

Streptococcus pyogenes occurs worldwide and is obligately pathogenic for humans . Streptococcal angina can occur endemically or sporadically, especially in temperate or cold climates, preferably from January to April. Primarily primary school children often fall ill, 15–20% of these are asymptomatic carriers of the germ. Around 50% of infections are asymptomatic or have only mild symptoms. After the disease one has an immunity against the respective M-type, but not against the other types. However, some people do not produce enough antibodies or produce enough antibodies and thus immunity. You are u. U. affected by recurrent infections.

clinic

After an incubation period of 1 to 4 days, the symptoms begin in various ways. The main symptoms are:

  • acute onset
  • Pain in swallowing
  • Fever> 39 ° C
  • Malaise, chills
  • a headache
  • Nausea, vomiting and abdominal pain especially in children

The clinical examination reveals reddening and swelling of the tonsils with white spots on the surface (follicular tonsillitis). There is also a painful swelling of the mandibular angle glands on both sides. Streptococcal angina also occurs after tonsillectomy, where the throat and tonsil bed are reddened.

Complications

Acute complications are:

Late complications

Diagnosis

The most accurate method is the cultural pathogen detection in the throat swab. So-called rapid test kits can further substantiate the suspicion of streptococcal angina, but have a higher error rate. Serodiagnosis is only possible during the course of the disease, when an increase in antibodies against streptolysin O is detected. The blood count often shows leukocytosis with a shift to the left.

Differential diagnoses

  • Angina due to adenoviruses, Mycoplasma pneumoniae, influenza viruses, parainfluenza viruses
  • Mononucleosis
  • Plaut-Vinzent's angina

therapy

Bed rest should be maintained for quick recovery. Neck wrapping and gargling with chamomile can aid healing. The streptococci must be eliminated with antibiotics, preferably penicillin . Erythromycin is used for penicillin allergies.

swell

  • Piper (2007) Internal Medicine. Springer publishing house