1. References
    1. Carrillo-Marquez, M. A., (2016). Bacterial Pharyngitis. Medscape. Retrieved from: http://emedicine.medscape.com/article/225243-overview#a5.
    2. Kalra, M. G., Higgins, K. E., & Perez, E. D. (2016). Common Questions about Streptococcal Pharyngitis. American Family Physician, 94(1), 24-31, Retrieved from: http://web.a.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?sid=2d6fdc37-8945-4684-ab25-9f74045c6e73%40sessionmgr4008&vid=14&hid=4209
    3. Valentine, W. (2013). Streptococcal Pharyngitis. XMind. Retrieved from: http://www.xmind.net/m/YHes.
    4. Zimbron, J. (2008). Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD) [PDF]. Retrieved from http://MedMaps.co.uk
  2. Signs and Symptoms
    1. - Fever over 103.3 F
    2. - Headache
    3. - Chills
    4. - Abdominal Pain
    5. - Nausea and Vomiting
    6. - Sore throat with pain
    7. - Tonsils +4 with erythema (redness) and exudate (drainage or white spots)
    8. - Difficulty swallowing with anterior cervical node tenderness
  3. Tool to Diagnosis
    1. Points
      1. Fever 1
      2. Absence of cough 1
      3. Tonsillar exudates 1
      4. Swollen, Tender Anterior Lymph Nodes 1
      5. Age between 3-14 1
    2. Low Risk = 1-2 points
    3. Medium Risk = 3-4 points Perform RADT
    4. High Risk = 5 points Perform RADT/ Start Antibiotics
  4. Pathophysiology
    1. - Group A Streptococcus prevalence in children is 20-30% with pharyngitis. In adults only 5 to 15%.
    2. - Gram positive streptococci pair up with catalase –negative cocci to conlonlise the upper respiratory tract. S. pyogenes rapidly spreads as it overtakes defense systems of the tonsils
    3. - As the bacterium escapes the phagocytosis through the neutrophils or macrophages it is able to colonize through the body resulting in complications
  5. Complications
    1. !!Rheumatic fever!!
    2. !Poststreptococcal glomerulonephritis!
  6. High Risk Factors
    1.  Other people in home sick
    2.  School aged children
    3.  Children 5 -15 and under 25 at highest risk
    4.  More common in the north is winter and early
  7. Treatment
    1. Perform Rapid Stress test to confirm diagnosis
    2. *** Antibiotics (must emphasizing completing course even if symptoms get better) ***
    3. - Amoxicillin or Penicillin = 10 days 250mg – twice daily in children. Adults may take 500mg once daily or 250mg twice daily for 10 days
    4. - IM injection once – 1.2 million units of Penicillin G Benzithine (child must be over 27kg) or 600,000 units Penicillin G Benzithine (for a child under 27kg)
    5. - If Allergic to “–cillins” other antibiotics can be used. See following list: Azithromycin, clarithromycin, cephalosporins.