2005 May:33. Pharyngitis: Causes, symptoms, and treatment Cars T, Eriksson I, Granath A, Wettermark B, Hellman J, Norman C, et al. Reportedly, 50 to 75% of all cases of pharyngitis are currently treated with antibiotic therapy, approximately 40% of which use broad-spectrum antibiotics or antibiotics that are not indicated.7,10,14 Spurred by efforts from the Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA), recent guidelines have been established to decrease the frequency of unnecessary antibiotic use, and to concentrate instead on clinical protocol and appropriate laboratory evaluation. However, there are several other bacterial causes, including Group C streptococci, Neisseria gonorrhorea, Corynebacterium diphtheriae, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Arcanobacterium haemolyticus.3 Clinical presentation and associated signs and symptoms are important for differentiating these bacterial infections. Management of adults with acute streptococcal pharyngitis: minimal value for backup strep testing and overuse of antibiotics. Minor criteria include fever, arthralgia, elevated acute phase reactants, and a prolonged PR interval on EKG. Pathophysiology of Pediatric Ear, Nose, and Throat Infections Differences among international pharyngitis guidelines: not just academic. Sadeghirad B, Siemieniuk RAC, Brignardello-Petersen R, Papola D, Lytvyn L, Vandvik PO, et al. Making the diagnosis of GABHS (or any differential diagnosis) is important in the prevention of rheumatic fever and/or other suppurative complications, hastening illness resolution, and preventing transmission. Important historical elements include the onset, duration, progression, and severity of the associated symptoms (e.g., fever, cough, respiratory difficulty, swollen lymph nodes); exposure to infections; and presence of comorbid conditions (e.g., diabetes). The rash is found in the neck, groin, and axillae, and is accentuated in body folds and creases (Pastias lines).1,4,19 The pharynx and tonsils are erythematous and covered with exudates. pharyngitis. Ms. Z is asked to take ibuprofen for pain and to maintain adequate hydration. Under ideal circumstances, and often using two samples, the sensitivity and specificity of such cultures reaches 97% and 99%, respectively.17 In most offices, however, those numbers vary widely, with a sensitivity between 30 and 90% and a specificity from 75 to 99%.8 Some false positive results can be expected with culture results because up to 20% of the US population may be chronic, asymptomatic GABHS carriers. Patients with a positive test result should be treated with appropriate antibiotics, and those with a negative result should receive supportive treatment and follow-up care. Although viral pharyngitis is typically self-limiting with minimal sequelae, bacterial and fungal infections are more severe. Treatment involves GABHS antibiotic coverage for any subsequent pharyngitis attacks and therapy for all clinical manifestations. Rather, they can rule out atypical infections such as non-GAS and fungal pharyngitis that require alternate antimicrobial regimens.22. Pharyngitis ( sore throat) is a common upper respiratory infection that usually goes away after a few days. Pharyngitis is an inflammation of the pharynx that can lead to a sore throat. Symptoms often manifest after an incubation period ranging from 1 to 5 days, and occur most commonly in the winter or early spring. Viral pharyngitis can be caused by numerous viruses. Acute rheumatic fever (ARF), a serious late complication of GAS pharyngitis, can be prevented with antibiotic . She had similar symptoms a few years ago, which were treated with antibiotics. Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction. In a GABHS-dense population, a higher score on a GABHS prediction tool would convey a higher probability of actually having a bacterial infection than in regions where overall prevalence was lower.4. Rapid and simple molecular tests for the detection of respiratory syncytial virus: a review. However, they are not recommended in acute illness, as serologic markers peak 3 to 8 weeks after symptom onset.28,29, Individuals suspected of having EBV infections should receive mononucleosis spot testing. Pharyngitis is the inflammation of the mucous membranes of the oropharynx. These bacteria possess protein M, a potent virulence factor that inhibits bacterial phagocytosis, as well as a hyaluronic acid capsule that enhances its ability to invade tissues. If the diagnosis remains uncertain, the physician should consider a test for IgM antibody to the viral capsid antigen. Quintana EC. There is significant debate surrounding the selection of which laboratory tests are necessary to establish the correct diagnosis and ensure the appropriate treatment course for pharyngitis. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. Sore Throat - PMC Herein, we provide an updated clinical review of pharyngitis for Canadian family physicians. of 1 PATHOPHYSIOLOGY OF PHARYNGITIS BACTERIA VIRUS Invasion of mucosa Local Inflammation Irritation of mucosa by secretions Release of toxins and proteases M-protein fragments of GABHS and sarcolemma antigens of myocardium Antigen-antibodies complex in glomeruli Produce the Signs and Symptoms Younger Child Older Child Fever Fever may reach 40 Gonzalez RM, Varnum SM, Zangar RC. Pharyngitis - PubMed Bacterial pharyngitis, in temperate climates, is more common in winter (or early spring), while enteroviral infection is more common in the summer and fall. Environmental and epidemiologic factors also may need to be assessed. Rheumatic fever tends to affect genetically predisposed individuals after a GABHS infection, and occurs in > 1 in 100,000 cases of GABHS pharyngitis in the United States and other developed countries.12,17 Symptoms may present within weeks and are thought to be caused by cross reactivity between antistreptococcal antibodies and sarcolemmal muscle and kidney antigens. Patients present with hematuria and, frequently, edema in the setting of a recent streptococcal infection with an elevated antistreptolysin-O titer. Schroeder BM. Nonsuppurative complications are reflective of streptococcal toxins, streptolysins, and inflammatory processes involving antibodies targeted at the bacteria. Little P, Hobbs FD, Mant D, McNulty CA, Mullee M, PRISM investigators. Patients with recurrent episodes of streptococcal bacterial tonsillitis (> 7 in the past year, > 5 per year for the past 2 years, or > 3 per year for the past 3 years) can be referred to an otolaryngologyhead and neck surgery specialist for consideration of tonsillectomy.35 Eradication for asymptomatic colonized carriers is currently not indicated.50 However, acute flares should be treated as concurrent infections requiring 10 days of clindamycin or penicillin-rifampin, or 1 dose of benzathine penicillin G and rifampin.5154. One must be suspicious of symptoms that worsen or persist beyond clinical expectations. The https:// ensures that you are connecting to the Tang S, Cowen U, Fader R, Duncan D, Quezada T, Walker K, et al. Federal government websites often end in .gov or .mil. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. A thorough history is key to diagnosing pharyngitis. 18 The optimal approach for differentiating among various causes of pharyngitis requires a problem-focused history, a physical examination, and appropriate laboratory testing. Strep throat pathophysiology - wikidoc This general approach is advocated by a recent evidence-based guideline from the Centers for Disease Control and Prevention that was written by family physicians, general internists, pediatricians, and other experts.28,29. Group A strep pharyngitis is an infection of the oropharynx caused by S. pyogenes. On examination, the typical findings of acute pharyngitis may include an erythematous and swollen pharynx, tonsillar hypertrophy and inflammation (with or without tonsillar exudates), fever, edematous uvula, petechial rash along the palate, and tender anterior cervical lymphadenopathy. PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study. Severely ill patients should be referred immediately to the hospital or urgent care for immediate management and workup. Careers, Unable to load your collection due to an error. They are characterized by the sudden onset of fever, sore throat, and painful swallowing. Minimize the risk of developing rheumatic fever and suppurative complications. Arcanobacterium haemolyticum, formerly known as Corynebacterium haemolyticum, is seen more frequently in teenagers and young adults, and may be accompanied by a scarlatiniform rash. Predictive algorithms have been developed to guide investigation and prevent antibiotic overprescribing by assigning signs and symptoms an aggregated pretest probability for bacterial pharyngitis.17 The modified Centor score (Figure 2) remains the most widely used method to work up streptococcal pharyngitis.18 Those with scores of 1 or less are at very low risk (< 10%), while those with scores of 4 or greater are at high risk (53%) of streptococcal infections. Last, physicians should ensure that patients understand the medical course of their illness, and are satisfied with the assessment and treatment plan. Given Ms Z.s symptoms and probable fever in the absence of cough and rhinorrhea, pharyngitis is suspected. Etiologic agents are passed through person-to-person contact, most likely via droplets of nasal secretions or saliva. Antibiotic stewardship and the low incidence of streptococcal pharyngitis complications suggest that treatments can be largely supportive. Dermatologic features of the disease become apparent within three days of the onset of fever14,18 and include cracked red lips, a generalized polymorphous erythematous rash with edema and erythema of the hands and feet, and periungual desquamation followed by peeling of the palms. Multiple exotoxins and two hemolysins (Streptolysin S and Streptolysin O) further enhance the virulence of GABHS. Jaggi P, Leber A. Molecular testing for group A streptococcal pharyngitis: to test or not to test, that is the question. Rheumatic fever is exceedingly rare in the United States and other developed countries (annual incidence less than one case per 100,000).21 This illness should be suspected in any patient with joint swelling and pain, subcutaneous nodules, erythema marginatum or heart murmur, and a confirmed streptococcal infection during the preceding month. If a patient has GABHS pharyngitis, a full 10-day course of PCN or other appropriate antibiotic must be completed to eradicate the bacteria from the pharynx and prevent rheumatic fever. Pharyngitis is one of the most common conditions encountered by the family physician.15 The optimal approach for differentiating among various causes of pharyngitis requires a problem-focused history, a physical examination, and appropriate laboratory testing. IDSA updates guideline for managing group A streptococcal pharyngitis. Microbial Causes of Acute Pharyngitis. Impact of a stewardship-focused culture follow-up initiative on the treatment of pharyngitis in the emergency department and urgent care settings. Attending Physician, Westside Health, Wilmington, DE. Pharyngitis - StatPearls - NCBI Bookshelf Streptococcus pharyngitis and pharyngeal carriage: a meta-analysis. Pharyngitis can present with sudden onset of sore throat, fever, headache, tender anterior cervical lymphadenopathy or lymphadenitis, and, occasionally, abdominal pain, nausea, vomiting, fatigue, or rash. Additional evaluation is required to investigate for the presence of a foreign body, neoplastic lesions, and other unusual causes of sore throat. government site. It is part of the spectrum of pharyngitis, which ranges from localised tonsillar infection to. The complaint of "sore throat" is a common one in the primary care office, and can be accompanied by other symptoms and signs including throat scratchiness, fever, headache, malaise, rash, joint and muscle pains, and swollen lymph nodes. Sigra S, Hesselmark E, Bejerot S. Treatment of PANDAS and PANS: a systematic review. When the clinical scenario suggests the presence of infectious mononucleosis, the diagnosis may be obtained by the presence of a positive heterophil antibody test (Monospot test) for Epstein-Barr virus. Empirical antibiotic use should be limited to patients who are severely ill, have a high risk of complications, or show no signs of improvement within 5 days of presentation. Inclusion in an NLM database does not imply endorsement of, or agreement with, Yoon YK, Park CS, Kim JW, Hwang K, Lee SY, Kim TH, et al. Voyez ", Sore throat and pharyngitis represent more than 2% and 5% of all outpatient primary care visits for adult and pediatric populations, respectively. Diagnostic performance of influenza viruses and RSV rapid antigen detection tests in children in tertiary care. Major criteria include carditis, migratory polyarthritis, Sydenham's chorea, subcutaneous nodules, and erythema marginatum. A cost-effective analysis. The patients' clinical history and physical examination findings can help distinguish among the several viral, bacterial, and other causes of pharyngitis. Pharyngitis is inflammation of the pharyngeal tissues, and is usually associated with pain. Symptoms may include sore throat, odynophagia, cervical lymphadenopathy, and fever. Pharyngitis is the inflammation of the mucous membranes of the oropharynx. The Centor Criteria is an effective clinical tool that may help guide this decision. Ressel G. Principles of Appropriate Antibiotic Use: Part I V. Acute Pharyngitis. Pankhurst CL. Oral corticosteroids for 1 to 2 days have been shown to reduce odynophagia (number needed to treat of 4) but they have no effect on the clinical course.6,42 Lozenges and benzocaine or lidocaine mouth rinses also provide mild pain relief by numbing the oropharynx.10 Nonsteroidal antiinflammatory drugs such as ibuprofen, along with acetaminophen, can be used to reduce pain and fever in adults and children.43 Acetylsalicylic acid is contraindicated in pediatric patients owing to the risk of Reye syndrome.10 Patients suspected of EBV infections should be advised to refrain from contact sports owing to the increased risk of splenic rupture secondary to EBV. Pharyngitis caused by Streptococcus pyogenes is among the most concerning owing to its associated severe complications such as acute rheumatic fever and glomerulonephritis. All Rights Reserved. Otherwise, supportive treatment options are indicated for sore throat symptoms. Currently, they have been designed to rule in streptococcal infections, respiratory syncytial virus, and influenza.2325 The specificity and sensitivity of RADT vary widely from 54% to 100% and 38% to 100%, respectively.2,23,2527 Although results are immediate, each kit is pathogen-specific and cannot broadly differentiate between viral and bacterial pharyngitis. Pharyngitis - an overview | ScienceDirect Topics Drs Sykes and Wu contributed equally to the literature review and its interpretation. First-year resident, Department of OtolaryngologyHead and Neck Surgery at the University of Toronto in Ontario. Penicillin V and rifampin for the treatment of group A streptococcal pharyngitis: a randomized trial of 10 days penicillin vs 10 days penicillin with rifampin during the final 4 days of therapy. National Library of Medicine Alternatively, RADT technology is specific but equally should not guide management in isolation, as its sensitivity can be variable and RADT lacks high-quality evidence in the pediatric population.23 Negative RADT results in patients aged 5 to 15 should be verified with a throat culture.34 Moreover, children younger than 3 should not be tested unless there is a high chance of GAS exposure, as incidence within this population is less than 14% and infection rarely causes acute rheumatic fever.35, Approximately 7% of pediatric and 20% of adult patients are asymptomatic and noninfectious carriers of GAS.36 Superfluous antibiotic use can lead to unnecessary side effects and increase health care costs. Symptoms of strep throat may include pharyngeal erythema and swelling, tonsillar exudate, edematous uvula, palatine petechiae, and anterior cervical lymphadenopathy. Pathophysiology of Allergic and Nonallergic Rhinitis Betul Sin1 and Alkis Togias2 1Ankara University, School of Medicine, Ankara, Turkey; and2National Institute of Allergy and Infectious Diseases, Bethesda, Maryland Allergic and nonallergic rhinitis affect approximately 30% of the U.S.population. The role of Chlamydia pneumoniae and Mycoplasma pneumoniae as causes of acute pharyngitis, particularly in the absence of lower respiratory tract disease, remains somewhat uncertain.18 There is no evidence that testing for atypical bacteria or treatment in the primary care setting improves clinical outcomes in patients with pharyngitis.18, Diphtheria is an acute upper respiratory tract illness that is characterized by sore throat, low-grade fever, and an adherent grayish membrane with surrounding inflammation of the tonsils, pharynx, or nasal passages.16,22 In diphtheria, the throat is moderately sore, with tender cervical adenopathy. of group A strep pharyngitis is approximately 2 to 5 days. Careers, Unable to load your collection due to an error. Whether or not a second RAD or throat culture is to be used as back up to initial testing should depend on the level of clinical suspicion and prevalence of GABHS in the region. Acute inflammation of the tonsils and pharynx. Pharyngitis is inflammation of the mucous membranes that line the back of the throat, or pharynx. Other less common causes of pharyngitis include allergies, trauma, cancer, reflux, and certain toxins. Sore throat, odynophagia, and fever are all common features. In recent years, fear of GABHS infection and its possible complications, and growing expectation of antibiotic prescriptions by patients has resulted in overuse of antibiotics for treatment of acute pharyngitis. The relative importance of each of these agents varies greatly depending on a number of epidemiologic factors, including age of the patient, season of the year, and geographic locale.VirusesMost cases of acute pharyngitis are viral in etiology and involve the pharynx as well as other portions of the respiratory . Before The .gov means its official. Pharyngitis is defined as an infection or irritation of the pharynx or tonsils (see the image below). Kocoglu E, Karabay O, Yilmaz F, Ekerbicer H. The impact of incubating the throat culture for 72 h on the diagnosis of group A beta-hemolytic streptococci. Cultures effectively identify pathogens but should not delay or guide initial treatment in atypical presentations, as results have a 5- to 10-day latency and fail to distinguish those with acute infections from carriers. The CDC, the AAP, and the IDSA all agree that penicillin is the first-line agent to treat GABHS in children and adults.4,10,16 Treatment should continue for 10 days to eradicate the bacteria from the pharynx (dosing regimens are indicated in Table 2.2). Group A strep pharyngitis can occur in people of all ages. The most concerning are. Kawasaki disease is most common in children younger than 3 years of age, and is defined by a number of well-documented features, including pharyngeal erythema, strawberry tongue, nonpurulent conjunctivitis, fever, cervical lymphaden-opathy, cracked red lips, and erythema and swelling of the hands and feet with desquamation of periungual regions several days after symptom onset. Values from McIsaac et al.18. Reported cases of Corynebacterium diphtheriae are very rare because of childhood vaccinations, but patients with this variety of pharyngitis will frequently complain of hoarseness and stridor caused by circulation of the diphtheria exotoxin, and may also experience cervical adenitis and edema. Viral features and testing for streptococcal pharyngitis. The https:// ensures that you are connecting to the For patients with acute pharyngitis, complications can develop when a bacterial source of infection is not managed properly. Guidelines for the antibiotic use in adults with acute upper respiratory tract infections. Kawasaki Disease, Sore Throat, Rheumatic Fever, Scarlet Fever, Throat Culture. Occasionally, a scarlatiniform rash may be present, often seen in association with a GABHS infection. Sore throat (acute): antimicrobial prescribing. Russell BL, Steele JC., Jr. Infectious mononucleosis testing at the point-of-care. Objective To provide family physicians with an updated approach to diagnosis and treatment of pharyngitis, detailing key symptoms, methods of investigation, and a summary of common causes. GABHS is also linked to scarlet fever, myositis, impetigo, erysipelas or cellulitis, necrotizing fasciitis, and streptococcal toxic shock syndrome. Assistant Professor and Research Director in the Department of Otolaryngology at Queens University and Adjunct Scientist with ICES Queens. and transmitted securely. Acute pharyngitis - Etiology | BMJ Best Practice US Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Group A streptococcus (GAS) is the main bacterial cause, and mainly affects children aged 3 to 14 years. Antistreptolysin O titre tests are used for patients with suspected suppurative complications of GAS. Thus, pharyngitis is a symptom, rather than a condition. Persistent Sore Throat (Chronic Pharyngitis): Treatment & Symptoms Biomarker methods in drug discovery and development. The entire range of supportive therapies, including analgesic and antipyretic medicines, oral hydration, and rest, should be considered for every patient whose symptoms warrant them. The most concerning are S pyogenes infections, which can lead to suppurative and nonsuppurative complications. Some physicians will begin antibiotic therapy presumptively for patients with severe symptoms who meet three or four of the Centor criteria, and may not send a diagnostic test in addition to testing. government site. Patients will have an elevated antistreptolysin-O titer and erthrocyte sedimentation rate. What clinical features are useful in diagnosing strep throat? Useful, well-validated clinical decision rules are available to help family physicians care for patients who present with pharyngitis. It also is important to assess the patient for fever, rash, cervical adenopathy, and coryza. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. One of the most common chief complaints in a primary care physician's office is sore throat. Etiologic agents are passed through person-to-person contact, most likely via droplets of nasal secretions or saliva. Role of the microbiology laboratory in diagnosis and management of pharyngitis. Serum titers of deoxyribonuclease B, hyaluronidase, strep-tokinase, nicotinic acid, and antistreptolysin O (ASO) may rise quickly during acute streptococcal infection (a positive ASO result reflects a fourfold increase), and will peak within 2 to 3 weeks. Clinical differentiation of viral, bacterial, and fungal pharyngitis is challenging owing to similarities in presentation. Acute pharyngitis | MSF Medical Guidelines Another class of available tests are the rapid antigen detection (RAD) tests, which use enzyme or acid extraction from throat swabs, followed by latex agglutination, coagglutination, or enzyme-linked immunoabsorbent assay (ELISA) procedures to isolate GABHS antigenantibody complexes.3 Although older models were not as reliable and variation still exists, newer techniques show a sensitivity ranging from 76 to 97% and a specificity > 95%.8,17 Most modern RAD tests produce results within 10 minutes or less. Identifying the cause of pharyngitis, especially group A beta-hemolytic streptococcus (GABHS), is important to prevent potential life-threatening complications.6. Hogan CA, Caya C, Papenburg J. Third, the patient's symptoms should be alleviated. The differential diagnosis for sore throat symptoms is extensive. Upper Respiratory Infections - PMC For GABHS, the above supportive measures should be combined with antibiotic therapy. Empirical validation of guidelines for the management of pharyngitis in children and adults. However, clinical impression is only moderately accurate in diagnosing peritonsillar abscess (78 percent sensitivity and 50 percent specificity in one series of 14 patients).20 Intraoral ultrasound examination is an accurate diagnostic test if abscess is suspected. Neoplastic processes can be more subtle, but may have accompanying weight loss, night sweats, fatigue, or dysphagia. Physicians should exercise restraint in antibiotic initiation for pharyngitis, as restraint does not delay recovery or increase the risk of S pyogenes infections. ESCMID Sore Throat Guideline Group. Ms Z.s lack of cough and rhinorrhea help to rule out sinusitis and postnasal drip. Delayed prescriptions with instructions to use if symptoms do not improve within 3 to 5 days are advised for patients with intermediate risk of GAS.38. Posterior cervical lymphadenopathy is common in patients with infectious mononucleosis, and its absence makes the diagnosis much less likely. Preventing complications requires antimicrobial treatment, but growing antibiotic resistance has placed emphasis on minimizing antibiotic use.7 Unfortunately, differentiating bacterial pharyngitis from other infections is difficult. The Infectious Diseases Society of America 2012 guidelines suggest that the modified Centor score could guide laboratory testing and antimicrobial therapy.10,34 Symptomatic treatment is recommended for scores of 1 while antimicrobial treatment guided by RADT or culture is advised for scores of 2 to 3 (Figure 2).18 Unfortunately, this tool has a 54% specificity in patients aged 3 to 14.37 Clinicians should exercise caution when applying this schema within this population owing to limited diagnostic accuracy.12,37, The National Institute for Health and Care Excellence endorses a combination of the modified Centor and FeverPAIN scores to guide follow-up and initiation of antimicrobial prescriptions (Figure 4).38 Low-risk patients are advised to receive symptomatic treatment with a 1-week follow-up. Federal government websites often end in .gov or .mil. In most cases, it is caused by an infection, either bacterial or viral. Vaginal, cervical, penile, and rectal cultures also should be obtained when gonococcal pharyngitis is suspected.27,33. These symptoms typically peak within 3 to 5 days and resolve by day 10.8 Although some pathogen-specific symptoms have been reported, predictive values have only been formulated for GAS pharyngitis (Table 2).2,3,914. Patients may also have tender, swollen cervical. Diagnosis of chlamydial pharyngitis is difficult, whether by culture or serologically, and neither method is readily available to the clinician. Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study. The gold standard of pharyngitis testing remains the throat culture, collected by swabbing the pharynx and peritonsillar region, and growing the sample on a sheep's blood agar plate. This activity reviews the evaluation and treatment of patients with pharyngitis and highlights . Bourbeau PB. Pathophysiology Pathophysiology of GAS throat infection may be described in the following steps: [1] [2] [3] [4] [5] Transmission Group A strep pharyngitis is most commonly spread through direct person-to-person transmission, typically through saliva or nasal secretions from an infected person. These modalities are inexpensive, easy to use, and provide an appreciable degree of comfort relief. The clinical significance of an A. haemolyticum infection remains uncertain. Pharyngitis is a common concern seen in primary care, caused by viral, bacterial, and fungal agents. She denies having a cough or runny nose but has been febrile with intermittent chills. Scarlet fever presents as a characteristic erythematous, blanchable sandpaper-like rash formed by tiny papules, and is caused by streptococcal pyrogenic exotoxins A, B, and C. Along with typical pharyngitis symptoms, the scarlatiniform rash begins on day 2 or 3 of illness on the trunk and spreads to the extremities, sparing the palms and soles. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Untreated, GABHS infection lasts seven to 10 days.4,13,19 Patients with untreated streptococcal pharyngitis are infectious during the acute phase of the illness and for one additional week.1 Effective antibiotic therapy shortens the infectious period to 24 hours, reduces the duration of symptoms by about one day, and prevents most complications.
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