June 21, 2024

Streptococcus pyogenes also known as group A streptococcus (GAS), is the most common cause of bacterial inflammation of the tonsils (tonsillitis) and/or the pharynx in acute pharyngitis and tonsillopharyngitis. It accounts for 15 to 30 percent of cases in children and five to 10 percent of cases in adults.
Tonsillitis causes sore throat that is worsened by swallowing. There may also be associated pain in the ears, reduced appetite, fever, body pains or body malaise, headache, and vomiting.
On examination, the tonsils are swollen and reddish. Some pus or a thin whitish membrane may be seen. A throat swab may be done, culture of which may yield the causative bacteria.
Extension of infection beyond the throat may lead to ear infection (otitis media), abs-cess formation around the tonsils, sinusitis, meningitis, bacteria in the blood stream or bacteremia, and necrotizing fasciitis. Cellulitis or abscess around the tonsils is more common among young adults. There is severe pain on swallowing and opening the mouth is difficult because of spasm of the muscles used in chewing.
Infection with GAS can also trigger the formation of antibodies that, instead of being directed against the bacteria, can cause inflammation and damage to the heart, leading to acute rheumatic fever and rheumatic heart disease. The antibodies can also cause inflammation of the kidneys as seen in poststreptococcal glomerulonephritis, and the joints in reactive arthritis.
GAS can spread at a rate of five to 50 percent among close contacts of an infected person, whether a symptomatic or an asymptomatic carrier. This leads to clusters of infected cases and recurrent infections in households. Data show that when the infection is not treated, about half of cases with streptococcal pharyngitis continue to harbor the bacteria three to four weeks after the onset of symptoms.
Immediate and complete treatment with the appropriate antibiotic under the supervision of a physician can eradicate the bacteria and help prevent transmission and complications.
Antibiotic therapy has been shown to eliminate bacteria from the oropharynx in about 80 to 90 percent of cases after one day of therapy.
Inflammation of the tonsils and pharyngeal area can also be caused by viral infection.The diagnosis may be difficult based on symptoms alone.
Should you also get a swab test for Covid-19?
Yes, because the treatments differ. Viral infections are not treated with antibiotics unless there is superimposed bacterial infection.