Purulent tonsillitis or tonsil inflammation (tonsillitis) is caused by a bacterium called group A beta-hemolytic streptococcus. It is transmitted via respiratory droplets, dirty hands or shared objects children use or play with.
Causes and transmission of purulent tonsillitis
The first symptoms appear after the incubation period (1 – 3 days) and include headache, fever, nausea and general malaise. Stomach pain may also occur. Swollen tonsils are visible in the throat and soon become covered in white streaks of pus. The entire throat is dark red, with spots of blood sometimes visible on the palate. The tongue also becomes red and its papillae enlarged, making it look like a raspberry (raspberry tongue). The lymph nodes in the neck become enlarged and painful.
Symptoms of scarlet fever
• The beta-hemolytic streptococcus bacteria release toxins, causing fatigue and nausea.
• These toxins trigger a fine-grained rash, especially in pressure-prone areas such as:
- Armpits
- Upper arms
- Underwear-covered areas (especially the lower back)
• Some patients experience joint pain and swelling.
• Skin peeling on the palms and soles may appear later. The cheeks become red, while the area around the mouth is pale.
What You Need to Know About Scarlet Fever
• Scarlet fever is caused by a streptococcal throat infection, with visible skin symptoms.
• Adults rarely develop a rash, but children commonly do.
• Treatment: Antibiotics are required to clear the infection.
• No lasting immunity – It is possible to get scarlet fever multiple times.
How long is scarlet fever contagious?
• After 48 hours of antibiotics, patients are no longer contagious.
• However, untreated strep infections can lead to rheumatic fever, a serious complication affecting the heart and joints.
Complications of streptococcal infections
Streptococcus bacteria can interfere with the immune system, causing serious complications. The immune system is designed to protect the body by recognizing and eliminating foreign threats. However, in some cases, streptococcal infections confuse the immune system, leading it to attack the body’s own tissues.
Potential complications include:
• Joint inflammation (arthritis-like symptoms)
• Heart issues, including damage to heart valves (rheumatic fever)
• Kidney problems (post-streptococcal glomerulonephritis)
• Neurological effects (such as Sydenham’s chorea, affecting movement and coordination)
• Skin disorders due to immune overreaction
To detect complications early, doctors often recommend blood tests, urine tests, and ECG (electrocardiogram) screenings after a streptococcal infection.
Possible complications of streptococcal infections
Proper hygiene is crucial in preventing the recurrence of streptococcal infections. One of the most overlooked steps is changing the toothbrush—this should be done five days after starting antibiotics to prevent reinfection. Additionally, pacifiers, bottle teats, and toys should be boiled and disinfected to eliminate lingering bacteria.
Streptococcus carriers. Are they contagious?
In some cases, Group A beta-hemolytic streptococcus (Streptococcus pyogenes) can be found in a throat swab, even if the person shows no symptoms of illness. This means they are a carrier, but not contagious. Carriers can safely attend daycare or kindergarten, and treatment with antibiotics is not necessary, as it is often ineffective.
However, beta-hemolytic streptococcus is sometimes confused with Streptococcus pneumoniae (pneumococcus), which is commonly found in the noses of preschool children. Pneumococcus does not cause tonsillitis, but it often leads to long-lasting, milky-white nasal discharge. This is a sign of bacterial colonization of the upper airways rather than an active infection.
Important: This condition does not require antibiotics. Instead, parents should focus on frequent nasal irrigation with a physiological solution to keep the airways clear.
When streptococcus becomes dangerous
While some strains are harmless, certain types of streptococcus can be highly aggressive. These strains easily enter the respiratory tract and can cause severe infections, including:
• Meningitis (brain membrane inflammation)
• Sepsis (a life-threatening blood infection)
• Purulent ear infections
• Severe pneumonia
Vaccination provides effective protection against these dangerous strains. Since streptococcus quickly develops antibiotic resistance, it is essential to follow proper medical guidelines.
When streptococcus becomes dangerous
• Antibiotic nasal drops: These do not fully penetrate the complex nasal cavity, allowing bacteria to survive and develop resistance.
Recent trends
There has been a notable rise in Group A beta-hemolytic streptococcus infections in recent years. This highlights the importance of proper hygiene, timely vaccination, and medical supervision to prevent complications.
Rising trends in streptococcal infections
The phenomenon has been identified in the majority of European countries: in some regions, the frequency is five times greater than usual, which is a record level for the past 50 years. Unfortunately, the causes of this phenomenon remain unknown.
Most recent laboratory reports on the bacteria have not identified any changes in their structure or level of contagiousness, so other (external?) factors that may enable the spread of the infection are being examined. Prevention (increased hygiene) is key in situations like this, along with regular reports on streptococcal infections and cooperation with epidemiologists working to fight epidemics in kindergartens and schools.
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