Strep Throat

picture by James Heilman, MD

Streptococcal pharyngitis is caused by Group A Streptococcus.  It accounts for 95% of all cases of bacterial pharyngitis.  It is most common in children ages 5 to 10 years old and most commonly occurs between the months of October to April.

Mode of Transmission: spread by direct person-to-person contact via droplets of saliva or nasal secretions.  Up to 20% of school children can be carriers.  Pets may also be carriers.

Please watch carefully for the following symptoms:

• Temperature of 101 to 104 degrees F.
• Sore throat with severe pain on swallowing.
• A beefy, red pharynx (throat)
• Enlarged, edematous tonsils and uvula.
• Swollen glands along the jaw line.
• Tonsillar exudate:  in other words, white patches on the tonsils.
• Generalized malaise and weakness.
• Headache.
• Abdominal discomfort.
• Nausea, and sometimes one incidence of vomiting that does not appear to be the flu (occurs from swallowing the Strep. bacteria.
• Up to 40% of small children have symptoms too mild for diagnosis.
• Fever abates in 3 to 5 days;  nearly all symptoms subside within a week.

Treatment:

• Penicillin or erythromycin for infection - DO NOT SKIP DOSES OF MEDICATION - TAKE IT ALL!
• Analgesics/antipyretics for pain and fever (non-aspirin type due to complications of Reye's Syndrome)
• ISOLATION from other children for 24 hours after antibiotic treament.  NO SCHOOL FOR 24 HOURS AFTER ANTIBIOTICS BEGIN BECAUSE STREP IS VERY CONTAGIOUS.
• FINISH THE ANTIBIOTIC PRESCRIPTION even if the symptoms subside.
• Properly dispose of soiled tissues. 
• GOOD HANDWASHING.

        

Incubation and Communicability:

Infection occurs through person-to-person spread from nose and throat secretions of infected persons or carriers; rarely, indirect contact through objects. Outbreaks may follow ingestion of food contaminated by an infected food handler’s nasal secretions or streptococci present on skin.

Incubation is short, usually 1-3 days, rarely longer

A person is contagious:

 In untreated, uncomplicated cases, 10-21 days;

 In untreated conditions with purulent discharges, weeks or months

 In treated cases, only 24 hours after treatment has begun.

Exclusion from School:

Until 24 hours after treatment has begun and no fever is present [has been fever-free for 24 hours without medication].  If your child is still tired, his/her throat is very sore, and he/she is not able to sit in school the whole day, it may be advisable to keep him/her home that extra day to recuperate!

Complications: acute otitis media and acute sinusitis occur most frequently.  Scarlet fever develops in some people, especially when Strep. Throat goes untreated.  Rarely:  bacteremic spread may cause arthiritis, endocarditits, meningitis, osteomylitis, or liver abscess.  Post-streptococcal sequalae:  acute rhematic fever or acute glomerulonephritis.  Reye's syndrome is also a known complication.