• The cause is usually due to a virus or bacterial infection.
• It is more common in older children and is unusual in infants.
• It is spread by close contact such as in daycare centers and school

Cause:

• The most common cause is viral infections that require NO ANTIBIOTIC TREATMENT
• Of the bacterial causes, only Group A Strep. REQUIRES ANTIBIOTIC TREATMENT

Features of Strep Throat:

• Most cases are in the 5 to 15 years age group and account for 15% to 20% of the cases of sore throat in this age group. It is very rare under 2 years of age.
• Sudden onset, sore throat, headache, nausea and vomiting and abdominal pain. After 24 to 48 hours enlarged  and sometimes tender lumps under the jaw near the angle of the jaw and a  characteristic rash of  scarlet fever (salmon colored sandpaper feeling rash usually most dense under arms, upper chest and lower abdomen) may appear.
• Can occur any time throughout the year, but is most common in winter and early spring.

Features of a viral illness:

• The child is more likely to have a runny nose, cough, hoarseness, redness of eyes (conjunctivitis), ulcers in the mouth and throat and gastrointestinal symptoms such as diarrhea.
• Some viral infections cause easily identifiable syndromes:
  • Hand-foot-mouth disease (coxsackie virus): ulcers in the mouth and on the hands and feet
  • Pharyngoconjunctival fever (adenovirus): red watery eyes and sore throat.
  • Herpangina: Ulcers on the tonsillar pillars (common in infants and young children).
• Herpes simplex (fever blister virus): Initial infection has multiple ulcers in the mouth, red swollen gums and fever.
  Infectious mononucleosis: Usually asymptomatic or only mild symptomatic in infant to 5 year old age group.

Other Causes:

• Foreign body such as a fish bone embedded in the back of the throat.
• Kawasaki disease causes sore throat as well as other symptoms such as high fever with at least 4 of the 5 following findings: red eyes (conjunctivitis), inflammation of the lining of the mouth and lips, swelling and redness of the extremities, rash on the trunk and enlarged nodes (lumps) in the neck.
• Ingestions of caustic home products particularly caustic cleaning products.
• Referred pain from tonsillar abscesses, dental disease, ear infection, etc.

Diagnosis:

• Most cases can be diagnosed after taking the history and doing a physical exam.
• If a strep Infection is suspected, a Quick Strep test is done and if positive the diagnosis is made, but if it is negative a throat culture is done to make sure the initial test was not a false negative.
• Your doctor may at times order a complete blood count as part of the diagnostic workup.

Treatment:

Viral Illness:

• Antibiotics are not indicated during the initial phase of the illness. When symptoms last longer than 7 to 10 days a secondary bacterial infection is a consideration and antibiotic treatment might be necessary at that time.
• Fever medicine such as Ibuprofin (Motrin/Advil) or acetomeniphen (Tylenol) should be used when temperatures are high or child is uncomfortable. There is no need to try to keep the temperature at normal. Fever is part of the body’s defense systems.
• It is important that the child receives adequate fluid intake. Dehydration makes secretions more difficult to clear.
• Saline nose drops or irrigation of the nose with saline helps with breathing.
• Saline or other gargles are not appropriate or are difficult to use in this age group.

Group A Streptococcal infections:

• Penicillin is still the treatment of choice for this infection. Amoxicillin is also an excellent choice and tastes better than the liquid penicillin preparations.
• If the child is allergic to these medications, Erythromycin or Zithromax or a cephalosporin can be used.
• REGARDLESS OF THE MEDICATION, THE CHILD MUST RECEIVE 10 FULL DAYS OF TREATMENT TO PREVENT DELAYED COMPLICATIONS OF GROUP A STREPTOCOCCAL INFECTIONS SUCH AS RHEUMATIC FEVER.
• If there is a chance of inadequate compliance with a 10 day oral therapy regimen, a single injection of Bicillin in the non-penicillin allergic patient will provided more than adequate duration of therapy.        

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