A 6-year-old child comes to the school nurse reporting a sore throat, and the nurse verifies that the child has a fever and a red, inflamed throat. when a parent of the child arrives at school to take the child home, the nurse urges the parent to seek treatment. if the sore throat is not treated, what illness is of most concern to the nurse?

In a child with sore throat, otherwise known as pharyngitis, the most common etiologic agent that causes pharyngitis is adenoviruses. Although, with a high grade fever and a red, inflamed throat, a bacterial etiology can be considered and the most common bacterial agent in pharyngitis is Streptococcus pyogenes. There are suppurative and non-suppurative complications following an untreated streptococcal infection. Suppurative complications (which involves pus) includes tonsillar abscess or collection of pus within the tonsils, otitis media or the infection of the middle compartment of the ear canal, sinusitis, etc. The non-suppurative complications are more serious than suppurative complications. There are two non-suppurative complications, (1) acute rheumatic fever which can progress to rheumatic heart disease which affects the valves of the heart and can ultimately lead to heart failure, and (2) acute glomerulonephritis which involves streptococcal antibodies attacking the glomerular basement membrane in the kidneys and this will present as oliguria (decreased urine production), hypertension (from fluid overload), and hematuria (blood in the urine).