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Streptococcal pharyngitis

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Streptococcal pharyngitis
Streptococcal pharyngitisA culture positive case of streptococcal pharyngitis with typical tonsillar exudate in a 16 year old.
Streptococcal pharyngitisA culture positive case of streptococcal pharyngitis with typical tonsillar exudate in a 16 year old.
A culture positive case of streptococcal pharyngitis with typical tonsillar exudate in a 16 year old.
Ìpínsọ́wọ̀ àti àwọn òkunfà ìta
ICD/CIM-10J02.0 J02.0
ICD/CIM-9034.0 034.0
DiseasesDB12507
MedlinePlus000639

Ọna-ọfun to ndun ni eyiti kokoro ti a ko le f’oju lasan ri nfa(Strep throat)jẹ aisan ti awọn kokoro to nfa arun ti a npe ni “ẹgbẹ bakiteria streptokokal ti A” nfa.[1] Ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa maa nyọ ọna-ọfun, awọn belubelu (awọn gilandi ribiti meji ti o wa ni ọna-ọfun, ni ẹyin ẹnu), ati bi o ba ṣee ṣe apoti ohùn (larynx)lẹnu. Awọn aami aisan ti o wọpọ ní ninu ibà, ọna-ọfun ti o ndun ni(ti a tun npe ni ọọfun to ndun ni, ati awọn nodu ẹjẹ funfun ti o wu (lymph nodes) ni ọrùn. Ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa maa nfa ida mẹtadinlogoji ninu ọgọrun (37%) ọna-ọfun ti o ndun ni laarin awọn ọmọde.[2]

Ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa maa ntan nipasẹ ifarakora pẹkipẹki pẹlu alaisan kan. Lati rii daju wipe eniyan kan ni ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa eyiti o ndun ni, ayẹwo kan ti a npe ni mimu awọn nkan ẹlẹmi dagba lori nkan amu nkan ẹlẹmi dagba l’ode ara lati inu ọna-ọfun (throat culture)fun iwadi ṣe pataki. Lai ṣe ayẹwo yii papa ẹwẹ, a le mọ nipa ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan nfa nipasẹ awọn aami aisan. Ni eyiti o jọ bẹẹ tabi ti a mọ daju, awọn apakokoro(antibiotics)(awọn oogun ti o npa bakiteria) le dẹkun aisan naa lati ma l’ewu gan-an ati lati mu ara pada bọ s’ipo ni kiakia.[3]

Aami aisan ti o wọpọ fun ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa ni ọna-ọfun ti o ndun ni, ibà ti o ju 38°C (100.4°F) lọ, ọyún (olomi yẹlo tabi alawọ-ewé) lori belubelu, ati awọn gilandi ti o wu ninu ọrùn.[3]

Awọn aami aisan miiran tun le wa:

  • Ori ti o ndun ni (ẹfọri)[4]
  • Èébì bíbì tabi èébì ti o ngbe ni[4]
  • Inu ti o ndun ni(Inu riro)[4]
  • Iṣan ti o ndun ni[5]
  • Èélá (awọn wiwu diẹ ti o pọn) ni ara tabi ninu ẹnu tabi ni ọna-ọfun (eyiti kò wọpọ ṣugbọn aami aisan ti o daju ni pato) [3]

Ẹni ti o ba ni ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa yoo fi awọn aami aisan han laarin ọjọ kinni si ikẹta lẹyin ti o ni ifarakora pẹlu alaisan kan.[3] Àdàkọ:Gallery

Awọn kokoro to nfa arun(tabi bakiteria)ti a npe ni ẹgbẹ streptokokus ti bita A (A beta-hemolytic streptococcus) (GAS)lo nse okunfa ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa.[6] Awọn kokoro miiran to nfa arun tun le fa ọna-ọfun ti o ndun ni.[3][5] Ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa maa ntan nipasẹ ifarakora pẹkipẹki ni taara pẹlu alaisan kan. Ợpọ̀ eniyan, bii awọn ti o wa ni ọmọ-ogun tabi awọn ile-iwe maa mu bi aisan naa ti ntan kaakiri lati pọ sii.[5][7] Awọn kokoro to nfa arun ti a ko le f’oju ri ti wọn ti gbẹ tan ti a si ri ninu erupẹ ko le sọ eniyan di aláàárẹ̀. Awọn kokoro to nfa arun ti ko tii gbẹ, bii eyiti a ri lori pako-oyinbo (burọṣi), le jẹ ki eniyan ṣe àárẹ̀fun bi ọjọ mẹẹdoogun (15 days).[5] Ko wọpọ ki awọn kokoro to nfa arun ti a ko f’oju ri yii lati gbe ninu ounjẹ ki wọn si mu awọn ti wọn jẹ ounjẹ naa ṣe àárẹ̀.[5] Ida mejila ninu ọgọrun awọn ọmọde ti ko ni awọn aami aisan kan fun ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa ngbe GAS awọn kokoro ti o nfa arun kaakiri ninu ọfun wọn.[2]

Fifi idi ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa mulẹ

[àtúnṣe | àtúnṣe àmìọ̀rọ̀]
Modified Centor score
Points Ṣiṣe e ṣe kokoro to nfa ọna-ọfun to ndun ni Abojuto
1 tabi eyiti ti o kere si eyi <10% Ko nilo oogun apakokoro tabi ayẹwo kokoro to nfaa ni kankan
2 11–17% Oogun apakokoro ti o dale lori mimu nkan ẹlẹmi ti a mu dagba lori nkan amu ẹlẹmi dagba l’ode ara lati ọna-ọfun tabi RADT
3 28–35%
4 tabi 5 52% Oogun apakokoro ti o daju nipa iriri

Akojọ abuda ti a npe ni iye Sẹntọr ti atunṣe (modified Centor score)ni a nlo lati mọ bi a ti nṣe abojutọ awọn eniyan ti wọn ni ọna-ọfun ti o ndun ni. Eyi dale lori abuda ọna ayẹwo ti iwadi nipa imọ ijinlẹ ti oyinbo marun, iye Sẹntọ naa nṣe itọkasi bi ọna-ọfun ti o ndun ni ṣe le waye si.[3]

Aami kan ni a fun ọkọọkan awọn abuda wọnyii:[3]

  • Ko si ikọ kankan
  • Awọn gilandi ti o wu ti o si rọ̀ ninu ọrùn
  • Iwọn gbigbona ti o ju 38°C (100.4°F)lọ
  • Ọyún tabi wiwu awọn gilandi ninu ọrùn (belubelu)
  • Ọjọ ori ti o kere si mẹẹdogun (15) (aami kan ni a yọ kuro fun ọjọ ori ti o ju ẹẹrinlel’ogoji (44) lọ)

Ayẹwo Iṣẹ iwadi nipa imọ ijinlẹ

[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Ayẹwo kan ti a npe ni mimu nkan ẹlẹmi ti a mu dagba lori nkan amu ẹlẹmi dagba l’ode ara lati ọna-ọfun (throat culture)ni ọna ti o ṣe koko ju lọ.[8] lati mọ boya eniyan kan ni ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju ri. Ayẹwo yii maa nmọ ni ọna ti o daniloju ida 90 si 95 ninu awọn ti o ṣe aisan ti a yẹwo.[3] Ayẹwo kan ti a npe ni ayẹwo kokoro to nfaa ni kankan (eyiti a tun npe ni ayewo mimọ antigini ni kankan (rapid antigen detection testing), tabi RADT) tun ṣe e lo. Ayẹwo kokoro to nfaa ni kankan yara ju mimu nkan ẹlẹmi ti a mu dagba lori nkan amu ẹlẹmi dagba l’ode ara lati ọna-ọfun lo sugbọn o maa nmọ aisan daju ninu ida aadọrin ninu ọgọrun (70 percent) awọn eniyan ti ayẹwo. Awọn ayẹwo mejeeji le mọ ni ọgbọọgba nigbati eniyan ko ba ni ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju ri nfa (ni ida mejidinlọgọrun awọn eniyan ti a yẹwo (98 percent)).[3]

Ayẹwo nkan ẹlẹmi ti a mu dagba lori nkan amu ẹlẹmi dagba l’ode ara lati ọna-ọfun ti o ri bẹẹ (ni ọrọ miiran, eyiti o mo wipe eniyan ṣe aisan) tabi ayẹwo kokoro to nfaa ni kankan, pẹlu awọn aami aisan ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju ri nfa, nfidi wiwa aisan naa mulẹ.[9] A ko gbọdọ maa ṣe ayẹwo nkan ẹlẹmi ti a mu dagba lori nkan amu ẹlẹmi dagba l’ode ara lati ọna-ọfun tabi ayẹwo kokoro to nfaa ni kankan loorekoore fun awọn eniyan ti ko ni aami aisan. Ida awọn eniyan kan l’awujo ni kokoro aifoju lasan ri streptokokal bakiteria naa ninu ọfun wọn lai si abajade ewu kankan.[9]

Awọn aisan miiran ti a tun le si mu fun ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa

[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Àdàkọ:Tun wo Awọn aami aisan ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa fi ara jọ awọn aami aisan miiran. Fun idi eyi, mimọ ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri mọ lai lo nkan ẹlẹmi ti a mu dagba lori nkan amu ẹlẹmi dagba l’ode ara lati ọna-ọfun tabi ayẹwo kokoro to nfa ni kankan le soro.[3] Ikọ́ wiwu, fi fun ikun-imu, igbẹ-ọrin ati oju pipọn ti o nta ni ni afikun pẹlu ibà ati ọna-ọfun to ndun ni le fẹẹ jẹ ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri ti fairọsi (virus)fa ju ki o jẹ ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa lọ.[3] Wiwa awọn gilandi ti o wu (lymph nodes) ninu ọrun pẹlu ọna-ọfun ti o ndun ni, iba ati awọn gilandi ti o tobi (awọn belubelu) ninu ọrùn le tun waye ninu awọn aisan miiran ti a npe ni infectious mononucleosis.[10]

Yiyọ awọn belubelu kuro le jẹ ọna ti o loye lati dẹkun ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa ninu awọn eniyan to maa nsaba ni aisan naa.[11][12] Ṣiṣe aisan pẹlu ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri fun igba mẹta tabi ju bẹẹ lọ ninu ọdun kan ni a ri bii idi lati yọ awọn belubelu kuro, ni titi di ọdun 2003.[13] Kikiyesara nigbati eniyan nduro naa tun tọna.[11]

Ọna-ọfun to ndun ni ti kokoro ti a ko le f’ju ri nfa eyiti a ko tọju maa nsaba yanju ara rẹ laarin ọjọ melo kan.[3] Itọju pẹlu oogun (awọn apakokoro) maa ndin pipẹ awọn aami aisan ku fun bii wakati mẹrindinlogun (16 hours).[3] Idi akọkọ fun titọju pẹlu awọn apakokoro ni lati din ewu nini aisan ti o l’ewu gan-an, bii ibà ti o l’ewu (ti a mọ ni ibà rọọgun-rọọgun)tabi akojọ ọyún ninu ọfun (ti a mọ si retropharyngeal abscesses) ku[3]. Awọn oogun wọnyii munadoko bi a ba lòó laarin ọjọ mẹsan (9 days)ti awọn aami aisan bẹrẹ.[6]

Oogun lati din irora ku, bii oogun ti o ndin wiwu ku (non-steroidal anti-inflammatory drugs, tabi NSAIDs) tabi ogun ti o ndin ibà ku(parasitamọ, tabi asẹtaminofeni), le ranilọwọ lati ṣakoso irora ti o ni asopọmọ ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa.[14] Awọn sitẹriọdu naa tun wulo [6][15], gẹgẹ bii kirimu tabi olomi ti a npe ni lidokaini.[16] A le lo asipirini fun awọn agbalagba ṣugbọn a ko gbani nimọran rẹ fun awọn ọmọde nitori o nmu ewu nini aisan ti o mu ewu ba ẹmi ẹni ti a npe ni akojọ aisan Reye (Reye's syndrome)gberu.[6]

Oogun apakokoro (Antibiotics)

[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

Oogun apakokoro ààyò ni orilẹ-ede Amẹrika fun titọju ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa ni pẹnisilini V. Oogun yii gbayi nitori ailewu rẹ, owo rẹ ti ko wọn ati mimunadoko rẹ.[3] Oogun ti a npe ni amosilini ni wọn yan ni Europe.[17] Ni India, ni ibiti ewu nini ibà rọọgun-rọọgun ti ga gan-an, oogun alabẹrẹ ti a npe ni bẹnsatini pẹnisilini G ni ààyò akọkọ fun abojuto.[6] Oogun apakokoro ti o tọna maa ndin iye igba aami aisan ku (eyiti o jẹ ọjọ mẹta si marun)fun bi ọjọ kan. Awọn oogun wọnyii tun maa ndin titan kaaakiri aisan naa ku.[9] A ma a kọ awọn oogun naa fun lilo lọpolọpọ igba lati gbiyanju lati din awọn ewu ti ko wọpọ bii ibà ti o le gan-an,ara to njanijẹ, tabi awọn arun ku.[18] Awọn anfani ṣiṣe abojuto ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri pẹlu oogun apakokoro ni a gbọdọ mu dọgba pẹlu awọn ewu ti o le waye pẹlu lilo wọn[5]. A ko nilo lati fun awọn agbalagba ti ara wọn da saka ti wọn ni ihuwasi ara si awọn oogun eyiti ko dara ni oogun apakokoro fun itọju.[18] Awọn oogun apakokoro ni a kọ fun lilo fun ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa ni ipo ti o ga gan-an ju eyiti a lero lọ nitori bi o ti ṣe l’ewu si ati bi o ṣe ntan kaakiri.[19] Oogun eritiromaisini (ati awọn oogun miiran ti a npe ni makrolidi) ni a gba awọn eniyan ti ara wọn ni ikorira ti o le si pẹnisilini niyanju lati lo.[3] Akọkọ, oriṣi oogun ti a npe ni sẹfalosporini ṣee lo fun awọn ti ara wọn ni ikorira ti ko fi bẹẹ l’ewu.[3] Awọn arun ti kokoro streptokokal ti a ko le f’oju lasan ri nfa (Streptococcal infections) tun le fa wiwu awọn kidirin. Awọn oogun apakokoro ko le din nini eyi ku.[6]

Awọn aami aisan ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa maa nsan nipa ṣiṣe abojuto rẹ tabi aiṣe abojuto rẹ, laarin ọjọ mẹta si marun.[9] Ṣiṣe abojuto pẹlu oogun apakokoro maa ndin ewu awọn aisan ti o l’ewu ku ati titan kaakiri aisan naa. Awọn ọmọde le pade si ile-iwe lẹyin wakati mẹrinlelogun (24 hours) ti wọn ba ti lo oogun apakokoro.[3]

Awọn iṣoro ti o l’ewu gan-an wọnyii le waye nitori ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa:

  • Awọn ibà ti o le gan-an, bii ibà rọọgun-rọọgun[4] tabi ibà Àlàárì (Scarlet fever)[20]
  • Aisan ti o nko ewu ba ẹmi ẹni ti a npe ni akojọ aisan ti o waye nipasẹ idiji majẹlẹ (toxic shock syndrome)[20][21]
  • Wiwu awọn kidirin[22]
  • Aisan kan ti a npe ni akojọ aisan PANDAS (PANDAS syndrome)[22], iṣoro pẹlu ajẹsara ti o maa nfa nigba miiran awọn aami aisan ti o l’ewu gan-an nipa ihuwasi, lojiji.

Awọn awoṣe ati titan kaakiri aisan naa

[àtúnṣe | àtúnṣe àmìọ̀rọ̀]

ọna-ọfun to ndun ni(tabi faringitisi), iṣori ti o gbòòrò ninu eyiti ti ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri wa, ni a ṣe awari rẹ ninu awọn eniyan milliọnu mọkanla (11 million) l’ọdọọdun ni orilẹ-ede Amẹrika.[3] Fairọsi ni o ma nfa ọpọlọpọ iṣẹlẹ ọna-ọfun to ndun ni ti kokoro ti a ko le f’oju lasan ri nfa. Ṣugbọn, ẹgbẹ bakiteria ti kokoro ti a ko f’oju ri ti bita A (group A beta-hemolytic streptococcus)maa nfa ninu ọgọrun ida 15 si 30 ọfun ti o ndun ni laarin awọn ọmọde ati 5 si 20 laarin awọn agbalagba.[3] Awọn iṣẹlẹ maa nsaba waye nigba ti jijabọ yinyin baa nkasẹ nlẹ ti Ợrinrin (Spring)si ṣẹṣẹ nbẹrẹ.[3]

  1. "streptococcal pharyngitis" at Dorland's Medical Dictionary
  2. 2.0 2.1 Shaikh N, Leonard E, Martin JM (September 2010). "Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis". Pediatrics 126 (3): e557–64. doi:10.1542/peds.2009-2648. PMID 20696723. 
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 Choby BA (March 2009). "Diagnosis and treatment of streptococcal pharyngitis". Am Fam Physician 79 (5): 383–90. PMID 19275067. http://www.aafp.org/afp/2009/0301/p383.html. 
  4. 4.0 4.1 4.2 4.3 Brook I, Dohar JE (December 2006). "Management of group A beta-hemolytic streptococcal pharyngotonsillitis in children". J Fam Pract 55 (12): S1–11; quiz S12. PMID 17137534. 
  5. 5.0 5.1 5.2 5.3 5.4 5.5 Hayes CS, Williamson H (April 2001). "Management of Group A beta-hemolytic streptococcal pharyngitis". Am Fam Physician 63 (8): 1557–64. PMID 11327431. Archived from the original on 2008-05-16. https://web.archive.org/web/20080516091711/http://www.aafp.org/afp/20010415/1557.html. Retrieved 2014-01-03. 
  6. 6.0 6.1 6.2 6.3 6.4 6.5 Baltimore RS (February 2010). "Re-evaluation of antibiotic treatment of streptococcal pharyngitis". Curr. Opin. Pediatr. 22 (1): 77–82. doi:10.1097/MOP.0b013e32833502e7. PMID 19996970. 
  7. Lindbaek M, Høiby EA, Lermark G, Steinsholt IM, Hjortdahl P (2004). "Predictors for spread of clinical group A streptococcal tonsillitis within the household". Scand J Prim Health Care 22 (4): 239–43. doi:10.1080/02813430410006729. PMID 15765640. 
  8. Smith, Ellen Reid; Kahan, Scott; Miller, Redonda G. (2008). In A Page Signs & Symptoms. In a Page Series. Hagerstown, Maryland: Lippincott Williams & Wilkins. pp. 312. ISBN 0-7817-7043-2. 
  9. 9.0 9.1 9.2 9.3 Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Schwartz RH (July 2002). "Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America". Clin. Infect. Dis. 35 (2): 113–25. doi:10.1086/340949. PMID 12087516. 
  10. Ebell MH (2004). "Epstein-Barr virus infectious mononucleosis". Am Fam Physician 70 (7): 1279–87. PMID 15508538. Archived from the original on 2008-07-24. https://web.archive.org/web/20080724055725/http://www.aafp.org/afp/20041001/1279.html. Retrieved 2014-01-03. 
  11. 11.0 11.1 Paradise JL, Bluestone CD, Bachman RZ, et al. (March 1984). "Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials". N. Engl. J. Med. 310 (11): 674–83. doi:10.1056/NEJM198403153101102. PMID 6700642. 
  12. Alho OP, Koivunen P, Penna T, Teppo H, Koskela M, Luotonen J (May 2007). "Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial". BMJ 334 (7600): 939. doi:10.1136/bmj.39140.632604.55. PMC 1865439. PMID 17347187. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1865439. 
  13. Johnson BC, Alvi A (March 2003). "Cost-effective workup for tonsillitis. Testing, treatment, and potential complications". Postgrad Med 113 (3): 115–8, 121. PMID 12647478. 
  14. Thomas M, Del Mar C, Glasziou P (October 2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract 50 (459): 817–20. PMC 1313826. PMID 11127175. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1313826. 
  15. "Effectiveness of Corticosteroid Treatment in Acute Pharyngitis: A Systematic Review of the Literature.". Andrew Wing. 2010; Academic Emergency Medicine. Archived from the original on 2012-12-04. 
  16. "Generic Name: Lidocaine Viscous (Xylocaine Viscous) side effects, medical uses, and drug interactions". MedicineNet.com. Retrieved 2010-05-07. 
  17. Bonsignori F, Chiappini E, De Martino M (2010). "The infections of the upper respiratory tract in children". Int J Immunopathol Pharmacol 23 (1 Suppl): 16–9. PMID 20152073. 
  18. 18.0 18.1 Snow V, Mottur-Pilson C, Cooper RJ, Hoffman JR (March 2001). "Principles of appropriate antibiotic use for acute pharyngitis in adults". Ann Intern Med 134 (6): 506–8. PMID 11255529. http://www.annals.org/cgi/reprint/134/6/506.pdf. 
  19. Linder JA, Bates DW, Lee GM, Finkelstein JA (November 2005). "Antibiotic treatment of children with sore throat". J Am Med Assoc 294 (18): 2315–22. doi:10.1001/jama.294.18.2315. PMID 16278359. http://jama.ama-assn.org/cgi/content/full/294/18/2315. 
  20. 20.0 20.1 "UpToDate Inc.". 
  21. Stevens DL, Tanner MH, Winship J, et al. (July 1989). "Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A". New England Journal of Medicene 321 (1): 1–7. doi:10.1056/NEJM198907063210101. PMID 2659990. 
  22. 22.0 22.1 Hahn RG, Knox LM, Forman TA (May 2005). "Evaluation of poststreptococcal illness". Am Fam Physician 71 (10): 1949–54. PMID 15926411.