Streptococcal Pharyngitis

Transcription

1 Streptococcal Pharyngitis

2 Issues in Infectious Diseases Vol. 3 Series Editors Heinz Zeichhardt Brian W. J. Mahy Berlin Atlanta, GA

3 Streptococcal Pharyngitis Optimal Management Volume Editors Jean Claude Pechère Edward L. Kaplan Geneva Minneapolis, Minn. 12 figures, 1 in color, and 54 tables, 2004 Basel Freiburg Paris London New York Bangalore Bangkok Singapore Tokyo Sydney

4 Issues in Infectious Diseases Library of Congress Cataloging-in-Publication Data Streptococcal pharyngitis : optimal management / volume editors, Edward L. Kaplan, Jean Claude Pechère. p. cm. (Issues in infectious diseases, ISSN ; v. 3) Includes bibliographical references and index. ISBN (hbk.) 1. Streptococcal infections. 2. Throat Diseases. 3. Pharyngitis. I. Kaplan, Edward L. II. Pechère. J.-C. (Jean Claude) III. Series. RC116.S84S dc Bibliographic Indices. This publication is listed in bibliographic services, including Current and Index Medians. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2004 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISSN ISBN

5 1 Introduction 3 Virulence Factors of Streptococcus pyogenes D.L. Stevens, Boise, Idaho 3 The Pathogen 3 General Characteristics 4 Microbiological Characteristics 4 Virulence Factors 4 Capsule 4 Cell Wall 5 M-Proteins 5 Immunoglobulin Binding Proteins (M-Like Proteins) 6 Fibronectin Binding Protein (Protein F) 6 Protein SIC (Streptococcal Complement Inhibitory Protein) 6 Opacity Factor 6 Streptolysin O 7 Streptolysin S 7 Deoxyribonucleases A, B, C and D 7 Hyaluronidase 7 Nicotine-Adenine-Dinucleotidase (NADase) 8 Streptokinase 8 Pyrogenic Exotoxins 9 General Pathogenic Mechanisms 9 Anti-Phagocytic Properties 9 Cytokine Induction 10 The Pathogenesis of Pharyngitis

6 11 Pathogenic Mechanisms in Acute Rheumatic Fever 12 Post-Streptococcal Glomerulonephritis 12 References 16 Clinical Presentations of Pediatric Streptococcal Pharyngitis in Developed Countries R.R. Tanz, Chicago, Ill. 16 Typical Presentation 18 Scarlet Fever 19 Streptococcal Respiratory Tract Infection in Younger Children 20 Conclusions 21 References 22 Group A Streptococcal Pharyngitis in Adults: Diagnosis and Management G.S. Peter, A.L. Bisno, Miami, Fla. 22 Group A Streptococcal Pharyngitis in Adults: Diagnosis and Management 22 Incidence 23 Diagnosis of Group A Streptococcal Pharyngitis 23 Signs and Symptoms of Streptococcal Pharyngitis 24 Role of Clinical Criteria 28 Laboratory Testing in the Diagnosis of Strep Pharyngitis in Adults 30 Treatment 32 References 36 Practical Experience with Clinical Algorithms for Reducing Unnecessary Antibiotic Use in the Management of Streptococcal Pharyngitis W.J. McIsaac, Toronto, Ont. 36 The Management of Sore Throat by Primary Care Physicians 38 The Role of Clinical Error in Antibiotic Overuse 39 Clinical Algorithms, Prediction Rules and the Reduction of Clinical Error 40 The Sore Throat Score Management Approach 42 Reliability in Different Clinical Settings 44 The Potential Impact of the Score Approach on Unnecessary Antibiotic Prescriptions 45 Limitations of the Score Approach 46 Conclusions 47 References 48 Recommended Reading 49 Epidemiology, Clinical Presentations, and Diagnosis of Streptococcal Pharyngitis in Developing Countries of the World M.C. Steinhoff, A.W. Rimoin, Baltimore, Md. 49 Epidemiology 50 High Income Countries VI

7 50 Low Income Countries 50 Incidence of GABHS Pharyngitis 51 Prevalence in Clinic Settings 53 Carriage Rates 53 Hemolytic Streptococcal Serogroups 53 GABHS Serotypes 55 Serology 56 Risk Factors 56 Age and Sex Distribution 56 Seasonality 57 Pharyngitis vs. Pyoderma 58 Relationship between GABHS and RF 59 Diagnostic Strategies 59 Clinical Prediction Rules 60 Throat cultures 61 Rapid Antigen Tests 62 Conclusions 62 References 66 The Group A Streptococcal Upper Respiratory Carrier. Diagnosis and Management E.L. Kaplan, Minneapolis, Minn. 66 Definitions 68 Pathophysiology of the Upper Respiratory Tract Carrier State 69 Epidemiology of the Group A Streptococcal Upper Respiratory Tract Carrier 69 Clinical Diagnosis of the Group A Streptococcal Upper Respiratory Tract Carrier 71 Do Group A Streptococcal Carriers Require Therapy? 71 Public Health Implications of the Group A Streptococcal Upper Respiratory Tract Carrier State 73 Conclusion 73 References 75 The Laboratory Diagnosis of Streptococcal Pharyngitis. Throat Cultures, Rapid Tests and Streptococcal Antibodies D.R. Martin, Porirua 75 Diagnosis of Streptococcal Pharyngitis 76 Diagnostic Sensitivity of the Throat Swab 77 Laboratory Culture 78 Rapid Streptococcal Detection Tests (RADTs) 80 Identification of Group A Streptococci 80 Streptococcal Antibody Tests 81 Anti-Streptolysin O (ASO) 82 Anti-Deoxyribonuclease B VII

8 82 Other Streptococcal Antibody Tests 82 Anti-Hyaluronidase Titer (AHT) 82 References 85 Diagnosis of Non-Suppurative Complications of Group A Streptococcal Pharyngitis P. Ferrieri, Minneapolis, Minn. 85 Acute Post-Streptococcal Glomerulonephritis 88 Pathogenesis of Acute Post-Streptococcal Glomerulonephritis 89 Acute Rheumatic Fever 90 Epidemiology and Clinical Manifestations of Rheumatic fever 91 Pathogenesis of Rheumatic Fever 92 Post-Streptococcal Reactive Arthritis 93 Pathogenesis of PSRA 93 References 95 Diagnosis and Management of Suppurative Complications of Streptococcal Pharyngitis P. Gehanno, Paris 96 Collection of Pus 96 Peritonsillar Abscess 97 Parapharyngeal Abscesses 97 Abscesses in the Prestyloid Space 97 Abscesses in the Retrostyloid Space 98 Extensive Cervical Cellulitis and Necrotising Fasciitis 99 Constitutional Symptoms 99 Local and Regional Manifestations 99 Physical Findings 100 Investigations 100 Treatment and Course 101 Type of Surgical Drainage 101 Prognosis 102 References 103 Antibiotic Treatment for Streptococcal Pharyngitis. Penicillin First? J.C. Salazar, Hartford, Conn. 103 Historical Perspective 104 Pharmacology 104 Chemical Composition and Mode of Action 105 Pharmacodynamics/Pharmacokinetics 105 Dosage and Route of Administration for GABHS Pharyngitis 106 Side Effects 107 Clinical Efficacy of Penicillin for Treatment of GABHS VIII

9 107 Prevention of Rheumatic Fever 107 Eradication of GABHS 109 Adherence 109 Copathogenicity 110 Antimicrobial Resistance 111 Penicillin Tolerance 111 Conclusions 112 References 115 Antibiotic Treatment for Streptococcal Pharyngitis. What is the Role of Oral Cephalosporins D. Adam, M. Helmerking, Munich 116 Antimicrobial Therapy 117 Other Explanations for Treatment Failure with Penicillin 117 The Role of Oral Cephalosporins 117 Effectiveness of Short Course Therapy 119 Clinical Efficacy 119 Resolution of Clinical Symptoms 119 Recurrence of Tonsillopharyngitis 119 Eradication of GABHS 120 Oral Antibiotics for Short Course Therapy 121 Antibiotic Prescription for Patients with Sore Throat 121 References 124 What is the Current Role of Macrolides and Ketolides in the Treatment of Group A Streptococcal Pharyngitis? A. Bryskier, Romainville; G. Cornaglia, Verona 124 Macrolide Antibiotics 125 Microbiology 125 In vitro Activities Against Susceptible S. pyogenes 125 Impact on Oral Flora 126 Pharmacokinetics 126 Distribution in Tonsillar Tissue 127 Concentrations in Saliva 129 Clinical Efficacy 130 Erythromycin 132 Clarithromycin 133 Azithromycin 133 Roxithromycin 133 Dirithromycin 135 Flurithromycin 135 Spiramycin 135 Josamycin 136 Telithromycin IX

10 137 Conclusion 137 References 143 Mechanisms of Antibiotic Resistance in Streptococcus pyogenes N. Yamanaka, Wakayama 143 Oral Antimicrobial Susceptibilities of Streptococcus pyogenes 144 Mechanisms of Macrolides Resistance in Streptococcus pyogenes 144 rrna Methylases 146 Efflux System 147 Molecular Epidemiology of Erythromycin Resistance Genes in Streptococcus pyogenes 148 Conclusion 148 References 150 Macrolide Resistance of Streptococcus pyogenes G. Cornaglia, Verona; A. Bryskier, Romainville 151 Mode of Action of 14- and 15-Membered Ring Macrolides and Ketolides 152 Molecular Basis of Macrolide Resistance 152 Modification of the Target Site 153 Erythromycin A Efflux 154 Laboratory Detection of Resistance 155 Epidemiology of Erythromycin A Resistance 155 Early Reports 156 The Last Decade and the Spread of Macrolide Resistance in Europe 157 Susceptibility Reports from Asia and Australia 157 Susceptibility Reports from North America and Latin America 158 Present Trends 160 Role of Low-Level Resistance and Clinical Importance of the Different Macrolides 162 References 166 Cost Issues in Streptococcal Pharyngitis J.C. Pechère, Geneva 167 Is Microbiological Diagnosis of Streptococcal Pharyngitis Cost Effective? 167 First Approaches 168 Hypothetical Cohorts and Meta-Analysis 169 Prospective Study in France 170 Cost-Effectiveness of Antibiotic Therapy for Sore Throat 170 The Western World 170 Impact on Symptoms 170 Impact on Complications 170 Side Effects of Antibiotics 171 Third World 172 General Conclusion 172 References X

11 173 Practical Problems Associated with the Prevention of Initial and Recurrent Attacks of Acute Rheumatic Fever in Developing Countries S.R. Zaher, A. Mandil, Alexandria 173 Governmental Involvement 174 Economic Constraints 175 Physicians Attitudes in Management 176 Negligence of Health Education 176 Reluctance in the Laboratory Diagnosis of Group A Streptococcal Pharyngitis 177 Inappropriate Reliance on the Anti-Streptolysin O Antibody Titer as a Diagnostic/Prognostic Test 177 Inappropriate Antibiotic Therapy for Group A Streptococcal Pharyngitis Once Diagnosed 178 Premature Discontinuation of Penicillin Prophylaxis 178 Social and Cultural Constraints 179 Patient Compliance with Treatment Protocols 179 Primary Prevention 179 Secondary Prevention 180 Health Education and Public Involvement 181 Pharmacokinetics of Benzathine Penicillin G 181 Technique of Injection 182 References 184 Streptococcal Pharyngitis: A Continuing Important Public Health Issue Worldwide T.E. Tupasi, Makati 185 Risk Groups for GAS 186 Health and Economic Impact of GAS 188 Public Health Approaches in the Control of Group A Streptococcal Infections 190 References 192 Practical Management of Pharyngitis: The Costa Rica Experience and Its Impacts on Public Health A. Arguedas, E. Mohs, San José 193 The Costa Rican Experience 199 References 202 Vaccine Control Strategies against Group A Streptococcal Infections. Expectations, Hopes and Possible Impact M.F. Good, K.S. Sriprakash, D.J. Kemp, Herston 203 GAS Vaccine Approaches 203 The M Protein XI

12 205 Fibronectin-Binding Proteins (FBPs) 206 C5a Peptidase 206 Spa18, Another Coiled-Coil Protein 207 Toxins 208 Is a Vaccine Against Scabies Possible? 208 The Need for a Scabies Vaccine 208 Evidence for a Role of Immunity in Self-Limiting Normal Scabies 209 Tick Vaccine Studies: Concealed Antigens 210 House Dust Mite Allergens 210 A Vaccine Strategy for Scabies 210 Conclusion 211 References 215 Author Index 216 Subject Index XII