Complications of streptococcal tonsillopharyngitis
- Michael E Pichichero, MD
Michael E Pichichero, MD
- Director, Research Institute
- Rochester General Hospital
- Section Editors
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Pharyngitis caused by infection with Streptococcus pyogenes (also known as group A Streptococcus [GAS]) is usually a self-limited condition; symptoms in untreated patients typically last two to five days. Antimicrobial therapy reduces the duration and severity of symptoms by one to two days (when begun within 48 hours of illness) and prevents spread of infection [1-3]. (See "Treatment and prevention of streptococcal tonsillopharyngitis".)
The other major goal of therapy is to reduce the risk of suppurative and nonsuppurative complications. The potential complications of GAS tonsillopharyngitis will be briefly reviewed here.
The nonsuppurative complications of group A streptococcal (GAS) tonsillopharyngitis include:
●Acute rheumatic fever (ARF)
- Randolph MF, Gerber MA, DeMeo KK, Wright L. Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis. J Pediatr 1985; 106:870.
- Pichichero ME, Disney FA, Talpey WB, et al. Adverse and beneficial effects of immediate treatment of Group A beta-hemolytic streptococcal pharyngitis with penicillin. Pediatr Infect Dis J 1987; 6:635.
- Krober MS, Bass JW, Michels GN. Streptococcal pharyngitis. Placebo-controlled double-blind evaluation of clinical response to penicillin therapy. JAMA 1985; 253:1271.
- Rammelkamp CH Jr, Stolzer BL. The latent period before the onset of acute rheumatic fever. Yale J Biol Med 1961; 34:386.
- Denny FW Jr. A 45-year perspective on the streptococcus and rheumatic fever: the Edward H. Kass Lecture in infectious disease history. Clin Infect Dis 1994; 19:1110.
- Stollerman GH. Changing streptococci and prospects for the global eradication of rheumatic fever. Perspect Biol Med 1997; 40:165.
- Stollerman GH. Rheumatic fever. Lancet 1997; 349:935.
- North DA, Heynes RA, Lennon DR, Neutze J. Analysis of costs of acute rheumatic fever and rheumatic heart disease in Auckland. N Z Med J 1993; 106:400.
- Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis 1992; 14:2.
- Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med 1996; 334:240.
- Begovac J, Kuzmanović N, Bejuk D. Comparison of clinical characteristics of group A streptococcal bacteremia in children and adults. Clin Infect Dis 1996; 23:97.
- Stevens DL, Tanner MH, Winship J, et al. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med 1989; 321:1.
- Stetson CA, Rammelkamp CH Jr, Krause RM, et al. Epidemic acute nephritis: studies on etiology, natural history and prevention. Medicine (Baltimore) 1955; 34:431.
- Anthony BF, Kaplan EL, Wannamaker LW, et al. Attack rates of acute nephritis after type 49 streptococcal infection of the skin and of the respiratory tract. J Clin Invest 1969; 48:1697.
- Rodríguez-Iturbe B. Epidemic poststreptococcal glomerulonephritis. Kidney Int 1984; 25:129.
- Tejani A, Ingulli E. Poststreptococcal glomerulonephritis. Current clinical and pathologic concepts. Nephron 1990; 55:1.
- Lewy JE, Salinas-Madrigal L, Herdson PB, et al. Clinico-pathologic correlations in acute poststreptococcal glomerulonephritis. A correlation between renal functions, morphologic damage and clinical course of 46 children with acute poststreptococcal glomerulonephritis. Medicine (Baltimore) 1971; 50:453.
- Sagel I, Treser G, Ty A, et al. Occurrence and nature of glomerular lesions after group A streptococci infections in children. Ann Intern Med 1973; 79:492.
- Bisno AL, Stevens DL. Streptococcus pyogenes. In: Principles and Practice of Infectious Diseases, 6th ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia, PA 2005. p.2362.
- Shoemaker M, Lampe RM, Weir MR. Peritonsillitis: abscess or cellulitis? Pediatr Infect Dis 1986; 5:435.
- Pichichero ME. Therapeutic considerations for management of otitis media, sinusitis and tonsillopharyngitis. Pediatr Allergy Immunol 1992; 6:167.
- Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989; 160:83.
- Schwartz B, Elliott JA, Butler JC, et al. Clusters of invasive group A streptococcal infections in family, hospital, and nursing home settings. Clin Infect Dis 1992; 15:277.
- Stevens DL. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerg Infect Dis 1995; 1:69.
- Asteberg I, Andersson Y, Dotevall L, et al. A food-borne streptococcal sore throat outbreak in a small community. Scand J Infect Dis 2006; 38:988.
- Kemble SK, Westbrook A, Lynfield R, et al. Foodborne outbreak of group a streptococcus pharyngitis associated with a high school dance team banquet--Minnesota, 2012. Clin Infect Dis 2013; 57:648.
- Stamm WE, Feeley JC, Facklam RR. Wound infections due to group A streptococcus traced to a vaginal carrier. J Infect Dis 1978; 138:287.
- Chandler RE, Lee LE, Townes JM, Taplitz RA. Transmission of group A Streptococcus limited to healthcare workers with exposure in the operating room. Infect Control Hosp Epidemiol 2006; 27:1159.
- Del Mar C. Managing sore throat: a literature review. II. Do antibiotics confer benefit? Med J Aust 1992; 156:644.
- NONSUPPURATIVE COMPLICATIONS
- Acute rheumatic fever
- Scarlet fever
- Streptococcal toxic shock syndrome
- Acute glomerulonephritis
- PANDAS syndrome
- SUPPURATIVE COMPLICATIONS
- Tonsillopharyngeal cellulitis or abscess
- Otitis media
- Necrotizing fasciitis
- Other complications
- PREVENTING COMPLICATIONS
- INFORMATION FOR PATIENTS