Treatment of Strep Throat in Medicine Essay

This paper will discuss the communicable disease, strep throat and the efforts to control it. It will identify the environmental factors related to the disease and explain lifestyle influences, socioeconomic status, and the management of the disease. Any gaps in available resources for strep throat and how to meet the needs of the gaps with recommendations on expanding community programs will also be covered. Information on what the public health department is doing to reduce the threat of strep throat will be provided.

Strep Throat

“Strep throat is a bacterial infection that is caused by streptococcal (strep) bacteria.Treatment of Strep Throat in Medicine Essay.  It is found in the throat and on the tonsils.” (WebMd, 2013) When you have strep throat your throat becomes irritated and inflamed which causes a sudden, severe sore throat. There are many kinds of strep bacteria and some cause a more serious illness than others. It is common for people to think they have strep when they have a sore throat but most sore throats are caused by viral infections.

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However, a sore throat caused by a viral infection can be just as painful as strep throat.

Symptoms of Strep

The most common symptoms of strep throat include a sudden, severe sore throat, a fever over 101 degrees, white or yellow spots on the back of a bright red throat, pain when you swallow, and swollen tonsils and lymph nodes. Some people may also experience a headache and belly pain. Other strep cases my cause a red skin rash, vomiting, body aches, and not feeling hungry but these are less common symptoms.

How is Strep Contracted, Diagnosed, and Treated

Strep throat is a communicable disease that is passed from person to person through particles in the air from breathing, coughing or sneezing into the air while infected. It takes 2 to 5 days before having symptoms after being exposed to strep. Treatment of Strep Throat in Medicine Essay. “Your doctor will do a physical exam, ask you about your symptoms and past health, and do a lab test such as a throat culture or rapid strep test.” (WebMD, 2013) The diagnosis of strep throat is done through a physical examination by a doctor, medical history, and lab testing that includes a throat culture or rapid strep test. The rapid strep test gives the doctor results within 10 minutes but sometimes it is not accurate. If a rapid strep is taken and shows negative with other symptoms of step a culture is sent to a lab for further testing and takes one to two days. If the rapid test shows positive for strep no further testing is required.

Once a strep throat diagnosis is made, the patient is given an antibiotic and it is recommended that they stay away from others for at least 24 hours after starting the antibiotics so they are no longer contagious. Taking an antibiotic will shorten the time a person is able to spread the disease to others and also lowers the risk of spreading it to other parts of the body. A person that has strep may also be advised, by their doctor, to take an over-the-counter medicine such as acetaminophen (Tylenol or Ibuprofen) to help with pain and to reduce your fever.

Prevention of Strep Throat

Hand washing is especially helpful in places where germs are easily spread, such as nursing homes, schools, and hospitals. It is suggested that you wash your hands throughout the day, before, during and after preparing food and before eating. “The best way to keep from getting strep throat is to wash your hands often and avoid sharing eating utensils, like forks and cups.” (Center for Disease Control and Prevention, 2013) You should also wash your hands after changing a diaper and using the bathroom. “If you are sick, wash your hands after sneezing, coughing, or blowing your nose.” (Healthline, 2012)

Environmental Factors Related to Strep Throat

Anyone can contract strep throat but there are some environmental factors that can also cause the bacteria or make it worse. These factors include irritants such as cigarette smoke, chronic postnasal drip and fungi.Treatment of Strep Throat in Medicine Essay.  Although case series and population-based surveillance have identified several possible host risk factors for the development of invasive GAS (group A streptococcal) disease, including age, Native American ethnicity, HIV infection, diabetes mellitus, cardiovascular disease, alcoholism, and other chronic diseases, these studies have not been able to assess household risk factors. (Emerging Infectious Disease, 2003) In previous case studies and noninstitutional surveillance, risk factors in adults age eighteen to forty-four included exposures to one or more children with sore throats, HIV infection, and a history of injecting drug use.

The same case studies and surveillance in adults age 45 and over identified risk factors as the number or persons in the home, diabetes, cardiac disease, cancer, and corticosteroid use. There are no local gaps in the availability of information pertaining to strep throat. The public health department epidemiologist staff works with community health care providers to prevent disease occurrences. They work together to provide public health recommendations for care and diagnosis of the ill and to prevent the spread of diseases by educating the community about disease control methods. In order to help the community stay healthy the county health department provides early detection of disease clusters and outbreaks.

References

1. WebMD (2013). Strep Throat – Topic Overview. Retrieved from: www.webmd.com/oral-health/tc/strep-throat-topic-overview
2. Center for Disease Control and Prevention (2013). Is it Strep Throat? Retrieved from: www.cdc.gov/features/strepthroat/
3. Emerging Infectious Disease (2003). Invasive Group A Streptococcal Disease: Risk Factors forAdults. Retrieved from: www.ncbi.nlm.nih.gov/pmc/articles/PMC3020599/#!po=3.12500

Streptococcal pharyngitis is the inflammation of the pharynx and presentation of white pus spots on the throat caused by the bacterium streptococcus pyogenes. Streptococcus pyogenes is a gram-positive cocci shaped bacterium that arranges in chains. Gram-positive cocci contain a thick peptidoglycan wall that encloses the inner plasma membrane and sits between the membrane and capsule. Unlike gram-negative bacteria, gram-positive bacteria do not contain more than one cell membrane. Streptococcus pyogenes are facultative anaerobes, which allows the bacteria to grow in anaerobic conditions. Facultative anaerobes are able to use oxygen when present to grow rapidly, which explains how S. pyogenes grows so effectively in the throat where oxygen is readily available. Treatment of Strep Throat in Medicine Essay.

B: History

The organism Streptococci was first founded in 1874 by Theodor Billroth. He discovered this organism through cases of wound infections and erysipelas. Louis Pasteur was the first to introduce this organism into history in 1879 through his discovery of isolating the microorganisms from the uterus and blood of women with puerperal fever. Friedrich Rosenbach received credit for naming the organism Streptococcus Pyogenes in 1884. One of the treatments called Penicillin was not established to be an effective treatment until 1940. In 1928 Alexander Fleming was the first person to be credited with the discovery of Penicillin through his founding of Penicillium fungus. However, Penicillin was not actually isolated to where it could be used as an effective treatment for diseases until 1939 by Howard Florey and Ernst Chain. Throughout decades this treatment continues to be the best option to treat streptococcal pharyngitis. With newer advances in technology led to more knowledge of the disease and the best treatment options to cure this disease.

C: Epidemiology

Streptococcal pharyngitis is prevalent worldwide. Although, there are more cases of strep throat found in low income regions. There are thousands of people worldwide who are currently infected with strep throat. Colder temperatures can tend to influence the outbreak of the disease. This is why strep throat is a very common disease to be infected with during this time of year. Based on the CDC there are 11,000 to 13,000 cases of streptococcal pharyngitis that arise every year in the United States alone (Centers for Disease Control and Prevention 2018).Treatment of Strep Throat in Medicine Essay.  Each year 20-30% of strep throat cases are found in children and 5-15% of cases are found in adults (Centers for Disease Control and Prevention 2018). There are more than 18 million cases of streptococcal pharyngitis found worldwide each year (World Health Organization 2009). According to the CDC the mortality rate for strep throat is approximately 1,100 to 1,600 people die each year in the U.S. (Centers for Disease Control and Prevention 2018). Globally the mortality rate is approximately 500,000 people die each year (World Health Organization 2009).

This disease is transmitted through direct contact with an infected person’s saliva or nasal fluids. These fluids are transmitted through airborne droplets by the infected person sneezing or coughing. It can also be transmitted by an infected person touching an item that will be touched by several people such as a doorknob. A person will then be able to pick up the disease by touching the doorknob and transmitting it to either there mouth, nose, or eyes. Strep throat tends to spread more rapidly in crowded areas such as schools, dorms, daycare centers, military training facilities, and workplaces. Humans are the main reservoir of the disease. Asymptomatic Group A Streptococcus carriers are another reservoir of this disease. Children are most commonly infected with the disease.

D. Pathology

Streptococcus pyogenes can affect multiple systems, although in the case of pharyngitis S. pyogenes invades the epithelial cells of the pharynx and tonsils causing inflammation. Due to the body fighting off the infection, the tonsils and surrounding lymph nodes become swollen and white pus spots appear on the tonsils, back of the throat, and tongue. The accumulation of pus in the throat can cause a foul-smell to patients’ breath signaling there is an infection.

S. Pyogenes contains many virulence factors to aid in their invasion including: M proteins, exotoxins, hydrolytic enzymes, and a capsule around the cell wall. M proteins embedded in the cell wall aid the pathogen in adhering to host cells upon entry. Along with the M proteins, a hyaluronic capsule surrounds the microbe which also aids in adherence and prevents phagocytosis from the immune system. The capsule appears sticky causing incoming macrophages be unable to properly engulf the bacteria. The major cause of damage occurs from enzymes and exotoxins released from the pathogen. Streptococcus pyogenes releases an exotoxin that degrades surrounding tissue and causes an excess release of cytokines from surrounding T cells. This excess of cytokines, or a superantigen, causes an increase in inflammation around the infected area.Treatment of Strep Throat in Medicine Essay.  Hydrolytic enzymes are another mechanism that S. pyogenes uses to damage host cells. These enzymes include C5a peptidase, streptolysin, and streptokinase. C5a peptidase is an enzyme that blocks the immune system’s complement cascade by cleaving C5 rendering it useless. Streptolysins O & S cause surrounding host cells and red blood cells to lyse and kill phagocytes. Lastly, the enzyme streptokinase is used to lyse blood clots which aid in the spread of bacteria to other tissue in the host.

When a host is infected with streptococcus pyogenes, the host will not exhibit symptoms for 2-5 days while the pathogen incubates. After 2 or so days, the rapid onset of a sore throat, swollen lymph nodes, fever, and malaise will set in. Vomiting in young children is common, although not as common in adults. When showing signs of the infection, the patient should consult a doctor to start treatment and take proper precautions to prevent transmission to others. If the infection is treated, symptoms will resolve within 7-10 days. Although if left untreated, S. pyogenes can cause two major immune-mediated sequelae.

A sequelae is a condition that presents after a previous disease has subsided. Streptococcal pharyngitis, if untreated, can lead to acute rheumatic fever and scarlet fever. Acute rheumatic fever appears within 2-4 weeks after the initial sore throat and is caused by a cross-reaction between the pathogen’s M proteins and the host’s heart muscle. This immunological cross-reaction causes the host to exhibit a fever, painful joints, and unregulated body movements. S. pyogenes’ other sequelae is scarlet fever. Scarlet fever occurs when streptococcus pyogenes has been infected with a phage. When a phage infects S. pyogenes, it begins to produce a erythrogenic toxin that causes a sandpaper-like rash to develop on the cheeks and chest along with a high fever. Treatment of Strep Throat in Medicine Essay.

E. Response and Treatment

The immune system takes action when fighting off strep throat. Inflammation of the throat and fever are key factors. CD4 T cells are directed against the M proteins of the streptococcus pyogenes bacteria. The body’s T cells secrete cytokines to guide that class switch recombination. Th17 cells protect against the GAS bacteria. IgG1 and IgG3 are responsible for the body’s humoral response and are developed over time, therefore adults are much less susceptible to this infection than children. Once exposed to the GAS bacteria, the body produces antibodies which have a protective capacity against infection. The B memory cells developed within the body help to fight of future infection of the same strain of bacteria. Vaccine development is currently focusing on antibody development more than the T cell immunity to encompass more the one strain.

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Treatment of the disease will shorten the duration of symptoms, reduce the chance of transmission between people in close contact, and prevent further complications. Clinicians should treat patients who test positive for streptococcus pyogenes (Strep Group A) through a throat culture test or rapid diagnostic throat test, in order to reduce the risk of serious sequelae. Penicillin is the first choice of treatment for the bacteria, however cephalexin and vancomycin can be used if the patient is allergic to the penicillin family. Both of these antibiotics are taken for a span of 10 days to completely eradicate the bacteria. The body could potentially fight off the infection without treatment, however antibiotic treatment is important to prevent possible life-threatening sequelae.

In order to prevent the spread of the infection, proper hygiene and respiratory etiquette should be practiced. Washing hands after coughing or sneezing and before handling food will help stop the spread of bacteria.  Respiratory etiquette means covering your nose or mouth when coughing or sneezing and not coming into close-contact with sick individuals. Normally, after twenty-four hours of antibiotic therapy, the individual is no longer at risk of transmitting the bacteria. They should stay at home for one entire day after starting the medication and until their fever is gone to further limit other’s exposure to possible illness. Treatment of Strep Throat in Medicine Essay.