Nejm 1970;282:23; 1977;297:365

Cause:Streptococcus pyogenes(rarely Staph. aureus, which causes no sore throat)

Pathophys:Erythrogenic toxin produced by bacteria lysogenized by a specific phage, which causes bacterial capsular dilatation, rupture, and toxin release

Respiratory droplets and wound infections. Occurs in children only, since adults usually already immune

Sx:Sore throat, fever, rash

Si:Rash, trunkal, esp in creases (Pastia's lines), palpable, viral-like. Spots on soft palate. "Strawberry" tongue. Circumoral pallor

• Acute glomerular nephritis
• Rheumatic fever, in old days 3% in epidemic and 0.5% in endemic type if no rx; now <1/10 000 without rx, and <1/100 000 with rx in adults
• Peritonsillar abscess (Quincy abscess), and tonsillar vein phlebitis leading to pulmonary emboli, rx with tonsillectomy
• Toxic shock syndrome (Toxic Shock Syndrome), which may just be the extreme variant (Nejm 1991;325:783)

r/o other childhood exanthems: roseola, rubeola, rubella, erythema infectiosum (5th disease)

Lab:

Sore throat workup protocol (Ann IM 1980;93:244)

Bact:Throat culture, single swab positive in 75%, 2 swabs in 85% ß-hemolysis on culture plates. Positive culture may still be just a carrier. Rapid office tests but may still have to culture if negative (J Peds 1987;111:80)

Hem:Eosinophils increased often

Rx:Penicillin, erythromycin. If sick, treatment speeds healing (Jama 1975;227:1278)