Tonsillectomy, although once a reasonable treatment for recurrent streptococcal pharyngitis, is not indicated, as a person can still be infected with group A streptococcus without their tonsils. Antibiotic resistance and resurgence
A drug-resistant strain of scarlet fever, resistant to macrolide antibiotics such as erythromycin, but retaining drug-sensitivity to beta-lactam antibiotics such as penicillin, emerged in Hong Kong in 2011, accounting for at least two deaths in that city—the first such in over a decade. About 60% of circulating strains of the group A streptococcus that cause scarlet fever in Hong Kong are resistant to macrolide antibiotics, says Professor Kwok-yung Yuen, head of Hong Kong Universitys microbiology department. Previously, observed resistance rates had been 10–30%; the increase is likely the result of overuse of macrolide antibiotics in recent years.There was also an outbreak in the UK in 2014, and the National Health Service reported a 68% increase in the number of S. pyogenes identified in laboratory reports between 2014 and 2018.New research published in October 2020 in the journal that the bacterium appears to be getting more robust after being infected with viruses, specifically the North-East Asian serotype M12 (emm12) (group A Streptococcus, GAS). They found three new genes, acquired from viruses, leading to the development of "superantigens" targeting white blood cells, leading to a more virulent strain of the bacterium.A vaccine that will protect against the 180 to 200 types of bacteria causing the disease has been worked on for over 20 years, but as of 2020 a safe one had not yet been developed.
A subconjunctival bleeding initially appears bright-red underneath the transparent conjunctiva. Later, the bleeding may spread and become green or yellow as the hemoglobin is metabolized. It usually disappears within 2 weeks. Causes
Mechanical
Increased venous pressure (e.g. extreme g-force, straining, vomiting, choking, coughing or strangling) or from straining due to constipation
External pressure changes:Atmospheric pressure changes due to aircraft altitude changes. Mask squeeze from diving without equalizing mask pressure during descent or from diving deeply in water
Eye injury
Head injury
Laser eye surgery or other eye surgery
Zygoma fracture (results in lateral subconjunctival bleeding)
Medical conditions that cause increased venous pressure:
Whooping cough or other extreme sneezing or coughing
Severe hypertension
Medical conditions that affect blood or blood vessels:
Certain infections of the outside of the eye (conjunctivitis) where a virus or a bacterium weaken the walls of small blood vessels under the conjunctiva
Coagulation disorder (congenital or acquired) including Ebola
Acute hemorrhagic conjunctivitis (caused by Enterovirus 70 or Coxsackie A virus)
LeptospirosisSubconjunctival bleeding in infants may be associated with scurvy (a vitamin C deficiency),abuse or traumatic asphyxia syndrome. Diagnosis
Diagnosis is by visual inspection, by noting the typical finding of bright red discoloration confined to the white portion (sclera) of the eye. Management
A subconjunctival bleeding is typically a self-limiting condition that requires no treatment unless there is evidence of an eye infection or there has been significant eye trauma. Artificial tears may be applied four to six times a day if the eye feels dry or scratchy. The elective use of aspirin is typically discouraged. References


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