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Healthy
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STREP THROAT
Sore throat is a fairly common complaint in children. Most sore throats are caused by viruses, which cannot be treated with antibiotics. However, some sore throats are caused by streptococcal bacteria, or strep throat. Strep throat can have serious consequences if not treated early and appropriately with antibiotics.
Symptoms
The child or adult with strep throat usually has other symptoms in addition to sore throat. Fever is generally present, though usually to a modest degree. Loss of appetite is a typical symptom; because strep throat can be very painful, and the pain is accentuated by swallowing, many people lose their appetites. Nausea and even vomiting may occur. Occasionally there is pain in the abdomen as well.
Strep throat can look different in the childcare population, and toddlers may become quite ill with strep infection. The initial symptom of strep in toddlers is often a clear runny nose. Toddlers’ complaints tend not to emphasize a severe sore throat as often as those of older children and adults; rather, the toddler with strep may cough frequently. In older children and adults, runny nose and cough are unusual, and are more suggestive of a viral infection than strep.
If a listless child comes to you complaining of a sore throat, runny nose, or headache, take the child’s temperature to determine if there is a mild fever and look for other signs of strep. Is the throat visibly inflamed? If tonsils are present, they also may be inflamed. In cases of strep, there is often a discharge over the back of the throat, perhaps with some whitish or yellowish pus in it. This was once considered the trademark of strep throat, but it is now only suggestive, since it also can occur in some sore throats that result from viruses. Other signs of strep throat are swollen and tender lymph nodes under the jaw.
Laboratory Tests
In the past, physicians diagnosed strep throat primarily by observing the physical symptoms and considering the child’s complaints. However, as laboratory methods became more accurate and rapid, it became apparent that many cases that were diagnosed as strep were actually viral. Therefore, an accurate diagnosis is best made by a laboratory test to identify the true cause of the discomfort and other symptoms.
One test is done by swabbing the back of the throat to take a culture of the organism; it requires several hours. There are other tests that can be done very quickly, but may not be as reliable. Many doctors’ offices first perform one of the rapid tests and, if it is negative but the doctor still suspects strep, a second swab is taken and cultured. Results from this type of test usually take a day or two. The physician may start a course of antibiotics immediately or wait for the result of the second test.
Treatment
Treatment of strep throat is generally with penicillin, given orally. Remarkably, the bacteria that cause strep throat has never become resistant to penicillin as have many other bacteria. For patients who are allergic to penicillin, erythromycin is usually the antibiotic of choice for strep. Several other antibiotics also are effective against strep, but all are significantly more expensive.
It is important to treat strep throat early and adequately. This generally means 7–10 days on antibiotics. In order to completely kill the bacteria, the medication should be taken for the full period prescribed even if the symptoms disappear.
Complications
There are several complications that can occur if strep is not treated properly, such as middle ear infection and sinusitis. Another complication of strep throat is acute rheumatic fever occurring two-three weeks after strep throat. Rheumatic fever is an inflammatory disease which may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. Nephritis (kidney inflammation) also may occur. Both of these complications are very uncommon, and early and adequate treatment reduces the likelihood of their occurrence.
Scarlet fever is another possible complication of strep throat. Certain strains of strep contain a toxin that produces a generalized red rash, and severe inflammation of the tongue. Years ago, before the development of antibiotics, scarlet fever (also called “scarlatina”) was a far more serious problem than it is today. Even without antibiotics, today’s scarlet fever is a much milder disease than it once was. The typical scarlet fever rash is diffuse, with a somewhat paler appearance around the mouth. The rash has a sandpapery feel. The tongue is usually beefy red, perhaps with a whitish discharge on it. (This is sometimes called a “strawberries and cream tongue.”) Although these children often are somewhat sicker than the average child with strep throat, scarlet fever is basically strep throat with a rash, and is treated in the same way as strep.
Strep throat is far more common in children than in adults. Transmission of strep throat is generally by droplets of saliva in the breath. Objects such as tabletops, doorknobs, or toys can carry the strep bacteria if, for example, a drooling child with strep throat has contaminated various objects.
The childcare provider should alert all parents of children in the facility when a child has been diagnosed with strep throat. A corresponding requirement is that the parents of a child diagnosed with strep throat should tell the childcare provider. The incubation period for strep is fairly short--no more than four-five days; and during that period, both parents and caregivers should be alert for symptoms in other children.
Exclusion
The presence of strep throat requires exclusion from childcare for a period of at least 24 hours after antibiotics are started. This same exclusion rule applies to staff members who get strep throat.
Some children and adults are diagnosed by physicians as “carriers” of strep in their throats. These carriers are not sick, and they rarely spread it to others. These strep carriers are not considered threats and need not be excluded from childcare.
Strep throat is uncomfortable for the ill child or adult; but a greater concern is that if untreated, it can progress to acute rheumatic fever and rheumatic heart disease. Antibiotics used early and adequately are very effective and an inexpensive way to prevent this from occurring.
Donald Palmer, MD
Alabama Chapter,
American Academy of Pediatrics
Internet Resources
Kid’s Health, kidshealth.org/parent/infections/lung/strep_throat.html
Family Doctor, familydoctor.org/670.xml
Maryland Dept. Of Health and Mental Hygiene, edcp.org/factsheets/strepthr.html
Mayo Clinic, www.mayoclinic.com/invoke.cfm?id=DS00260
Resources
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892;301-402-1663; www.niaid.nih.gov/factsheets/strep.htm
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