Although flu season is ending, the rise in illness will continue. Strep season emerges during the winter months and early springtime, so the time to prepare with support in clinical facilities is now. Streptococcus pyogenes, also known as group A Streptococcus (GAS) is one of the primary pathogens that cause throat and skin infections, hence the cause of strep throat.
Risk Factors of Strep Throat
Common risk factors pertaining to strep throat include early age and time of year. As previously mentioned, strep throat circulates during the winter and early spring. Characteristic of many illnesses, strep throat blooms when people are in close contact with each other. Proximity to other individuals in daycare centers, schools, military facilities, and other common meeting areas brings on illness. There are even individuals who present with asymptomatic illness, which composes 15-20% of cases. If gone untreated or in severe cases, the infection can spread to the tonsils, sinuses, skin, blood, and middle ear. The most common transmission is through saliva (even droplets), or nasal secretions.
Recurrent Strep Tonsillitis
Tonsillitis is among the most common infections in children and adolescents. Studies show that 30% of tonsillitis cases start as strep throat, which is caused by GAS. Children who suffer from recurrent tonsillitis are likely to undergo surgery to remove the tonsils, which will resolve the issue.
A study done by La Jolla Institute for Immunology used samples from 66 children who had their tonsils removed because of recurrent tonsillitis and 80 children who had their tonsils removed for other medical reasons. T follicular helper cells (TFH) are immune cells whose normal function is to aid in B cells, another form of immune cell, to produce protective antibodies against bacteria and viruses.
The study shows that TFH were present in high numbers for children who had recurrent tonsillitis compared to their counterparts. These same children also had fewer B cells in their tonsils.
Naïve B cells work with TFH in the germinal centers within the tonsils. This cell-to-cell interaction allows them to become antibody-producing B cells as opposed to the original naïve B cells. When TFH are present in higher quantities than B cells, the excess cells not performing an interaction do not have the potential to become antibody-producing cells. This allows the illness to persist for longer and develop into streptococcus tonsillitis.
Antibiotic Treatment and Resistance
In cases of strep throat and streptococcal tonsillitis, antibiotic treatment is preferred and highly recommended. Antibiotic treatment shortens the duration of symptoms and reduces their intensity. The transmission rate of the illness is also decreased with the use of antibiotics as it prevents the development of nonsuppurative sequelae, which is important in lowering the risk of poststreptococcal rheumatic fever. Penicillin V is the most common antibiotic used to treat strep throat and streptococcal tonsillitis.
For antibiotic therapies to reach maximum effectiveness and not cause issues of resistance, they need to be taken as directed by the clinician who prescribed the medication. A major contributor to the cause of antibiotic resistance is when patients take it upon themselves to decide when to take their medication and when to stop. The antibiotic treatment should be taken for the full course and should not be stopped simply because an individual "feels better." This can cause the illness to come back and be more difficult to cure. When antibiotics are stopped prematurely, the remaining bacteria learns how to remain functional in the body and strengthen itself.
Antibiotic resistance is when bacteria have taken a new property which protects them from the antibiotic. Some bacteria even produce a secondary substance which hinders the medication's effectiveness as it creates another layer to be penetrated by the antibiotic drug. It is incredibly important that clinicians explain the risks of antibiotic resistance to their patients so that they are well informed. High rates of morbidity and mortality are a global challenge with respect to antibiotic resistance as well as a shortage of effective therapies. The stronger the resistance, the harder it is to find a treatment that will fight the bacteria.
Prescribing only when necessary is another key factor in preventing antibiotic resistance. As medication is prescribed more frequently, the room for user error increases. This is why it is vital to visit a clinician when experiencing symptoms of strep throat as all the signs need to be evaluated. Strep throat testing can be performed when visiting a clinician to be sure of the diagnosis. This will confirm whether antibiotics are needed and allow for prevention of resistance.
Strep Throat Diagnosis
The use of strep throat diagnostics is imperative during this season. Status Strep A Flip Cassette is a CLIA-waived, rapid immunochromatographic assay for the detection of group A streptococcal (GAS) antigen directly from throat swab specimens. Results are available within 5 minutes, providing 96% sensitivity and 99% specificity rates.
Status Strep A Strip Test is another CLIA-waived rapid immunochromatographic assay for the detection of GAS. This test has a "dip and read" procedure, detecting strep easily by using a throat swab to the back of the throat. Rapid results are available within 5-10 minutes. The sensitivity of this test is 96.2% with a specificity of 98.7%.
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