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Strep throat - still a potential killer.

Before the arrival of antibiotics, "strep throat" or scarlet fever was a dreaded diagnosis. Caused by the Group A beta-hemolytic streptococcus (one variety of which produces a rash, therefore the name "scarlet fever"), the disease often leads to rheumatic fever, which could permanently damage the heart.

Today, strep throat is easily and effectively treated with various forms of penicillin or other antibiotics. Complete relief from a high fever and sore throat may occur within 24 hours. Yet, unless the antibiotic is taken for a full course of 10 days to eliminate the streptococcal organisms completely, the danger of rheumatic fever is still present.

Rheumatic fever resulting in damage to the valves of the heart is the most common cause of acquired--as opposed to congenital--heart disease worldwide. Protection against it consists of rapid, accurate diagnosis and prompt, appropriate treatment of the preceding strep infection.

Although rheumatic fever usually occurs about two to four weeks after a strep throat infection, the heart damage may not become apparent until long afterward.

Although most cases of strep throat do not result in rheumatic fever, it is important that such infections be treated promptly. However, many sore throats are not caused by streptococcal infection. In mid-January this year, the American Heart Association published new, updated guidelines that emphasize the importance of early detection of strep throat and rheumatic fever. Although strep throat can be diagnosed by means of a throat culture, there is no single symptom, sign or laboratory test that is diagnostic of acute rheumatic fever.

The most common signs of strep throat are soreness, fever, and swollen, tender nodes in the neck. It is difficult, however, for a layperson-- and, without a throat culture, for physicians--to decided whether a sore throat may be due to strep. A throat culture is the most accurate means of diagnosis but requires at least 24 hours.

Newer, faster tests take only a few minutes to perform. If such a test is positive, a throat culture is sent to a laboratory for confirmation, but treatment with penicillin or other antibiotic is started immediately.

Rheumatic fever (RF) and rheumatic heart disease (RHD) have declined in recent years in the United States and other developed countries, but RHD is still a major health problem in the Third World. Nonetheless, RHD still afflicts more than a million Americans and caused about 6,000 deaths in 1990. Although usually found in poorer communities, recent outbreaks have occurred in suburban or rural neighborhoods, primarily in children of white, middle-class families.

In 1984, the medical community was shocked by the sudden occurrence of a major epidemic of rheumatic fever in Salt Lake City and the surrounding mountain areas of Utah, Idaho, Nevada, and Wyoming. Increased hospital admissions for acute RF have also been reported in Columbus and Akron, Ohio; Nashville and Memphis, Tennessee; Kansas City, Missouri; Dallas, Texas; and Pittsburgh, Pennsylvania.
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Publication:Medical Update
Date:Mar 1, 1993
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