Strep throat

Symptoms

A child with a streptococcal throat infection may experience one or more of the following symptoms: sore throat, throat pain upon swallowing, fever, headache, or abdominal pain (with or without vomiting). Symptoms not typical of strep throat include nasal congestion, hoarseness, cough, or diarrhea; these symptoms are often indicators that a child's illness is caused by something else, commonly a viral syndrome.

In a child with strep throat, the tonsils and pharynx will appear reddened, sometimes to the point of being almost hemorrhagic, and exudates (pus) may be seen. The anterior cervical lymph nodes (the lymph nodes in the front of the neck, below the ear and just behind the jaw) may be tender or swollen, and the uvula in the back of the throat or the soft palate may have a red, rash-like appearance. Some children and adults with a GAS infection of the throat develop a highly characteristic skin rash known as scarlet fever . The diagnosis of strep throat is made with a throat culture, or in recent years, with rapid antigen detection tests or gene probe tests, both of which, like throat cultures, are performed on material obtained from swabbing the throat and tonsils.

At present, the treatment and outcome for streptococcal pharyngitis is the same whether a scarlet fever rash is present. However, some authorities believe that decades ago, scarlet fever may have represented a more severe disease that sometimes resulted in serious illness and even death.

Complications

Local complications of untreated strep throat can include infections of the sinuses, mastoids (bones behind the ear), and lymph nodes. The most serious complication of untreated streptococcal pharyngitis is a late immunologic complication known as rheumatic fever. This problem can occur several weeks after strep throat and cause inflammation of the heart valves with subsequent scarring. Glomerulonephritis (a kidney inflammation resulting in blood and protein in the urine) can also follow a GAS infection of the throat several weeks later, but is quite rare.

Treatment

To reduce the risk of complications and prevent transmission to others, streptococcal pharyngitis should be treated with an antibiotic , most often penicillin (either injectable or oral). For patients allergic to penicillin, erythromycin is the primary drug used. In addition to treatment of the infection itself, the discomfort of strep throat may be alleviated with over-the-counter analgesics (such as acetaminophen). After treatment with antibiotics, some children will continue to have throat cultures that are positive for GAS, and re-culturing asymptomatic patients after antibiotic therapy is not recommended.

Prevention

Antibiotics are sometimes used to prevent GAS pharyngitis in patients who have had rheumatic fever. If such patients contract strep throat again, they will experience exacerbations of their valvular disease and additional scarring; for this reason, they must be given streptococcal prophylaxis lifelong, which can be in the form of either monthly injections of long-acting penicillin or a daily oral antibiotic dose.

Gale Encyclopedia of Childhood & Adolescence. Gale Research, 1998.