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If they are not cleared by normal defense mechanisms, their capacity to cause an intense inflammatory reaction leads to disease.

Remote infection may result from bacteremia during infection of the respiratory tract.

Infrequently, colonizing pneumococci may invade mucous membranes directly, making their way directly to lymphatics or to the blood stream and causing infection in the CNS or at other sites in the body.

Pathogen recognition receptors on the surface of mammalian phagocytic cells play a major role in innate immunity.

Peptidoglycan and lipoteichoic acid interact with cluster of differentiation (CD)14, stimulating toll-like receptor (TLR) 2. Pneumolysin interacts with TLR4 to induce nuclear

factor

All pneumococci produce pneumolysin, a thiol-activated toxin that inserts into the lipid bilayer of cell membranes via its interaction with cholesterol.

Pneumolysin is cytotoxic for phagocytic and respiratory epithelial cells and causes inflammation by activating complement and inducing the production of TNF-alpha and interleukin-1. Injection of pneumolysin into rat lung causes all the histologic findings of pneumonia, and immunization of mice with this substance before pneumococcal infection or challenge with genetically engineered pneumococci that do not produce it is associated with a significant reduction in virulence.

Proteins on the pneumococcal surface that bind to choline residues may mediate attachment to and penetration of mammalian cells, particularly if these cells have been upregulated by prior cytokine exposure.

Pneumococcal surface protein A is present on the surface of nearly all pneumococci and exerts an antiphagocytic force, perhaps by blocking deposition of complement. Despite some antigenic variability, antibody raised against pneumococcal surface protein A protects experimental animals to a greater or lesser extent against challenge with the same or different strain, and genetically engineered mutants that lack it have reduced virulence for mice.

Human antibody to this protein protects mice against pneumococcal infection and may protect humans against pneumococcal colonization. This substance is a major constituent of a vaccine that is currently in development (see vaccination).

In addition to pneumococcal surface adhesin A, a surface-expressed permease, neuraminidase and autolysin are also thought to contribute to pathogenesis. Copyright © 2017, 2013 Decision Support in Medicine, LLC. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM. Strep throat is a bacterial infection in the throat and the tonsils . The throat gets irritated and inflamed , causing a sudden, severe sore throat. Strep throat is caused by streptococcal (strep) bacteria. Although some people are quick to think that any painful sore throat is strep, sore throats are usually caused by a viral infection and not strep bacteria.

A sore throat caused by a virus can be just as painful as strep throat. But if you have cold symptoms such as coughing, sneezing, or a runny or stuffy nose, you probably do not have strep throat. The most common symptoms of strep throat are: A sudden, severe sore throat. White or yellow spots on the back of a bright red throat.

Less common symptoms are a red skin rash , vomiting, not feeling hungry, and body aches.

When a person who has strep throat breathes, coughs, or sneezes, tiny droplets with the strep bacteria go into the air.

If you come into contact with strep, it will take 2 to 5 days before you start to have symptoms.

Your doctor

will

To do a throat culture, the doctor will swab a sample of cells from the back of your throat. The sample will go into a special cup (culture) where the strep bacteria can grow over time.

If strep bacteria grow, the doctor knows that you have strep. If the doctor does a rapid test and the test says that you don't have strep (the

test

This is because rapid strep tests are not always accurate. If the rapid strep test is positive and says that you do have strep, there's no need to do the throat culture.

Doctors usually treat strep throat with antibiotics.

Antibiotics shorten the time you are able to spread the disease to others (are contagious) and lower the risk of spreading the infection to other parts of your body. Most people stop being contagious 24 hours after they start antibiotics. If you don't take antibiotics, you may be contagious for 2 to 3 weeks, even if your symptoms go away.

Your doctor may also advise you to take an over-the-counter medicine like acetaminophen (such as Tylenol) or ibuprofen (such as Advil or Motrin) to help with pain and lower your fever.

Acetaminophen and ibuprofen are different products with different dosing recommendations.

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen.

When you switch between two medicines, there is a chance your child will get too much medicine. Studies have not shown any added benefit from alternating these medicines.

It has been linked to Reye syndrome, a serious illness.

To avoid getting strep throat, it is a good idea to avoid contact with anyone who has a strep infection.

If you are around someone who has strep, wash your hands often. Don't drink from the same glass or use the same eating utensils.

Bacteria can live for a short time on doorknobs, water faucets, and other objects.

If you have a strep infection, there are things you can do to avoid spreading it to others.

Use tissues you can throw away instead of handkerchiefs, wash your hands often, and do not sneeze or cough on others. Antibiotics can shorten the time that you are contagious.

It is a good idea to stay home from work or school until 24 hours after you have started antibiotics. Health Tools help you make wise health decisions or take action to improve your health. Strep throat is caused by streptococcal (strep) bacteria, most often by group A beta-hemolytic streptococcus (GABS). Other types of strep that can sometimes infect the throat are groups C and G strep bacteria. A strep infection causes the throat (pharynx) and the tonsils or adenoids to become irritated, inflamed , and painful.

Sore throats are most commonly caused by viral infections or other irritants such as smoke, allergies, dry air, or a throat injury, and not by a strep infection.

When a person infected with strep throat breathes, coughs, or sneezes, tiny droplets containing the strep bacteria are released into

the

Common symptoms of strep throat in children and adults include: Severe and sudden sore throat without coughing, sneezing, or other cold symptoms.

Lower fevers may point to a viral infection and not strep.

White or yellow spots or coating on the throat and tonsils. Bright red throat or dark red spots on the roof of the mouth at the back near the throat.

Swollen tonsils, although this symptom may also be caused by a viral infection.

In teenagers, mononucleosis can cause a severe sore throat that looks like and has symptoms similar to those of strep throat. For more information, see the topic Mononucleosis (Mono).

It is easy to tell when you have a sore throat or a cold. Typically, sore throats are caused by a viral infection and not strep bacteria.

Strep throat usually does not occur with cold symptoms such as coughing, sneezing, or a runny or stuffy nose. The more cold symptoms you have, the less likely it is that your sore throat is a strep infection. In some cases of strep infection, a skin rash develops and spreads over the neck and chest and eventually over the whole body.

Symptoms of strep throat usually begin within 2 to 5 days after you come in contact with someone who has a strep infection.

Strep throat usually goes away in 3 to 7 days with or without antibiotic treatment. In contrast, if allergies or irritants are the cause of your sore throat, it will usually last longer unless the cause is eliminated.

If strep throat isn't treated with antibiotics, you will continue to be contagious for 2 to 3 weeks even if your symptoms go away. You are much less contagious within 24 hours after you start antibiotics and are less likely to develop complications of the strep infection.

Complications of strep throat are rare but can occur, especially if your throat infection isn't properly treated with antibiotics. Complications can occur when the strep infection spreads to other parts of the body and causes other infections, such as an ear or sinus infection or an abscess near the tonsils ( peritonsillar abscess ).

Complications can also result in your immune system attacking itself and causing serious conditions

such

The size of a child's tonsils isn't a risk factor for throat infections. Children or adults who have had their tonsils removed can still get strep throat. Call your doctor today if you have: A red rash that feels like sandpaper.

Difficulty sleeping because your throat is blocked by swollen tonsils or adenoids . Call a doctor if the following symptoms develop 1 to 2 weeks or longer after a strep throat infection. Weakness Shortness of breath Joint pain Raised red rash or lumps under the skin Uncontrolled, jerking movements of the arms or legs.

Call your doctor if your symptoms do not improve after 2 days of treatment with an antibiotic.

Watchful waiting is appropriate if your sore throat occurs with symptoms like those of a cold, such as sneezing, coughing, and a runny or stuffy nose. In general, the more of these symptoms you have, the less likely it is that your sore throat is caused by a strep infection.

You can try home treatment if your sore throat is not severe and you have other symptoms of a cold. For more information on what to do if you have sore throat symptoms, see the topic Sore Throat and Other Throat Problems.

Your family doctor or general practitioner can evaluate a sore

throat

If surgery to remove chronically enlarged or infected tonsils or adenoids is suggested, you may be referred to an otolaryngologist.

Strep throat is diagnosed from your medical history, a physical examination of your throat, and a lab test, such as a throat culture. Sometimes a rapid strep test is used to check for strep.

Your doctor may confirm the results of the rapid strep test with a throat culture. Current treatment guidelines recommend that your doctor confirm strep throat with a lab test, such as a throat culture, and not just diagnose strep throat from your symptoms. But your doctor may begin treatment for strep throat before the result of your throat culture is back if you have three or four of the following symptoms: A recent fever of 38.3°C (101°F) or higher White or yellow spots or coating on the throat or tonsils Swollen or tender lymph nodes on the neck Absence of signs of a cold or upper respiratory infection , such as coughing or sneezing.

One or both of the following tests are used to confirm that you have strep throat.

Throat culture is a test to find germs (such as strep bacteria) that can cause an infection. A sample of cells from the back of your throat is added to a substance that promotes the growth of bacteria.

Rapid strep test analyzes the bacteria in your throat to see if strep is the cause of

your

The doctor uses a cotton swab to gather cells from the back of your throat for testing. The rapid strep test is not used in many parts of Canada. If symptoms of strep throat are present, it is important to be tested for strep infection.

Prompt treatment will reduce the spread of strep throat and may reduce the risk of complications, such as the infection spreading to other parts of your body causing ear or sinus infections or an abscess behind or around your tonsils ( peritonsillar abscess ). The rapid strep test is not used in many parts of Canada.

If you need to be tested for strep throat and the rapid strep test is available, it may help to discuss with your doctor the advantages and disadvantages of each test.

For instance, results from a rapid strep test are available within 10 to 15 minutes, and results from a throat culture may take 1 to 2 days.

A negative rapid strep

test