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What to do when strep strikes.

While most sore throats are caused by viral colds or flu, strep throat is a bacterial infection that, left untreated, can lead to serious health consequences.

Parents know all too well that "back to school" also means "back to the doctor" with a familiar list of common childhood complaints, including chickenpox, lice, and the common cold. Strep throat, a bacterial infection caused by Group A streptococcus, may also pay an unwelcome visit. Although most sore throats are caused by one of many viruses requiring no more than plenty of rest and extra fluids, strep throat calls for an antibiotic prescription to prevent potentially serious complications.

Strep infections are more common any time people get together. The microorganisms spread primarily, if not exclusively, through contact with someone who has the infection. Unlike the hardier cold viruses, inanimate objects such as doorknobs and telephone receivers are generally not a source of strep transmission. Microbiologists explain that strep bacteria spread when someone coughs and you breathe in the bacteria, or when you shake hands with someone with the infection, then touch your own nose, providing an easy access for bacterial entry. Strep throat, or infection of the pharynx, is the most common type of strep infection.

And it is not that simple to diagnose the illness. Parents, even physicians, are hard pressed to diagnose strep throat on the sole basis of symptoms.

"The symptoms are not specific for strep throat--that is part of the problem," says Jerome Paulson, M.D., an associate professor in the Department of Health Care Sciences and Pediatrics at George Washington University in Washington, D.C. "People with strep throat certainly have a throat that hurts; they may run a fever; they may have swollen lymph nodes underneath their jaw or in their neck. But people can have these symptoms and not have strep. They can have a sore throat that is caused by viruses or other bacteria."

The American Academy of Pediatrics recommends that any time a child under six years of age has a sore throat that persists (not one that goes away after his first drink of juice in the morning), you should call your physician. For older children, call a doctor if the child develops a sudden sore throat or has difficulty swallowing or breathing. The call is even more urgent if fever is over 104 degrees or the child is extremely weak.

Diagnosis once depended on throat cultures--actually trying to grow the streptococcal bacteria over a 24- to 48-hour period. Fortunately, a number of different and rapid strep tests are now available. Dr. Paulson believes they are very accurate at diagnosing someone who has strep, but adds that throat culture is the only reliable way to know that someone does not have a strep infection.

Once diagnosed, what is the current treatment of choice for strep?

"When you look at the research studies, streptococci still seem to generally be susceptible to penicillin," Dr. Paulson says. "Therefore, for the patient who is not allergic, penicillin is the drug of choice."

Salt water gargles and throat sprays may relieve discomfort, but these methods do not cure the infection. Left untreated, bacteria growing in the throat can go on to affect other parts of the body, such as the ears, sinuses, skin, and kidneys. But the most serious consequence of untreated strep throat is rheumatic fever.

The incidence of rheumatic fever declined in the 1960s and '70s. Since the mid-'80s, however, physicians have noted a resurgence.

"Rheumatic fever is heart disease, and permanent damage occurs to the heart as a result of the individuals' reaction to the bacteria. The patient's own antibodies begin to attack the heart," explains Dr. Paulson. "It can injure the valves of the heart and can go on and injure the muscle of the heart as well." Such damage could result in lifelong problems.

Sometimes strep bacteria take up residence in the throat without actually causing disease. The unsuspecting hosts are called carriers and, while personally not at risk of rheumatic fever, they can infect family members or other people close to them.

Thorough handwashing is the best protection against all types of infections, including streptococcal ones. People with strep throat are contagious until 24 hours after the start of antibiotic therapy. Children may return to school or day care 24 hours after beginning antibiotics and when temperature and activity level are normal.

About those antibiotics: Even if strep throat symptoms get better or go away, it is essential that the entire prescription be taken, because the full course of antibiotics is needed to eradicate the bacteria and cure the infection.
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Title Annotation:strep throat
Author:Braun, Wendy
Publication:Saturday Evening Post
Date:Sep 1, 1996
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