| Strep throat is a contagious bacterial infection that is caused by a group A streptococcal bacterium called Streptococcus pyogenes. Streptococci are commonly referred to as "strep." The bacterium is spread through the air by sneezing or coughing or by physical contact. The incubation period generally lasts 3 to 5 days.
In the vast majority of cases, strep throat is a short-lived, uncomplicated infection that is easily treated with antibiotics. Untreated strep throat, however, can lead to complications, including heart and kidney damage. Although it is very rare, death can occur due to heart or kidney failure. Some strains of streptococci produce a toxin that causes a red rash known as scarlet fever.Risk: The infection spreads easily in schools, military barracks, or other areas where individuals are in close, continued contact with each other. Cases tend to peak in late winter or early spring. Individuals with a compromised or suppressed immune system are not only at a higher risk for strep throat, but they tend to experience more severe symptoms. Fatigue, smoking, and excessive alcohol consumption reduce immunity and increase an individual's risk of contracting this illness. Children aged 5 to 16 are more likely to contract the infection than younger children or adults. Incidence and Prevalence: Several million cases of strep throat are diagnosed each year. Strep throat accounts for about 5% to 10% of all pharyngitis in adults and 30% of cases in children (Thomas). |
Source: Medical Disability Advisor
| History: Individuals complain of the sudden development of sore throat with pain on swallowing. Other symptoms may include headache, loss of appetite, fatigue, and/or hoarseness. Upon questioning, the individual may reveal contact with another infected individual.
Symptoms of complicated strep disease may include persistent sore throat, joint pain, skin rash, abdominal pain, and occasionally involuntary movements. Individuals may report the sudden appearance of blood in the urine that indicates kidney involvement. There may also be swelling around the ankles or eyes and shortness of breath or fatigue. Physical exam: Although 20% of cases have no symptoms (asymptomatic), most individuals experience fever that may be high (over 102° F [38.9° C]) and a dry cough. The throat is beefy red upon examination, and the tonsils are enlarged. White spots on the throat (collections of pus) may also be present. Lymph nodes in the neck may be tender and enlarged.
Advanced streptococcal infection can also involve the joints, especially the knees, ankles, wrists, or elbows and manifest with swollen, painful joints (acute arthritis). The arthritis often moves from one joint to another. A red, raised rash may appear on the skin for short periods of time. If the infection has affected the heart, a heart murmur may be detected. Elevated blood pressure or swelling (edema) may indicate kidney involvement. Tests: Strep throat is diagnosed by swabbing the throat and then culturing the collected bacteria on a special culture medium called blood agar for 24 to 48 hours. Although a rapid antigen detection test (RADT) can be done immediately in the doctor's office, these tests have a 10% to 20% false negative rate. Negative results are routinely retested using the standard blood agar culture. In systemic infection, bacteria may be isolated from blood, or the infection may be diagnosed indirectly by the presence of Streptococcus-specific antibodies in serum. When kidney disease is suspected, a urinalysis will show protein or blood in the urine, and bacteria may be cultured from either the blood or urine. A kidney biopsy is rarely done to diagnose involvement of the kidneys. |
Source: Medical Disability Advisor
| Strep throat is treated with antibiotics. The type of antibiotic chosen varies, depending on the individual, but penicillin drugs are usually the first choice in nonallergic individuals. Between 5% and 20% of strep infections are penicillin-resistant (Rakel 221).
The antibiotics are usually taken for 10 days. If compliance with a 10-day treatment regimen is difficult, newer antibiotics can provide similar effectiveness with a 5- or 6-day treatment. These newer agents are often more expensive than the standard treatments. In moderate to severe infections, a single dose of antibiotic may be injected. Individuals are considered to be noncontagious after 24 hours of antibiotic treatment. Those who do not feel better after 2 to 3 days should return to the doctor, because failure to improve suggests an antibiotic-resistant strain of strep.
Nonprescription medications may be used for relief of pain (analgesics) and to reduce fever (antipyretics).
If systemic disease develops, individuals take antibiotics to treat residual strep throat infection. Anti-inflammatory drugs control joint pain and swelling. For more serious inflammation, corticosteroids may be needed. If rheumatic fever develops, bed rest may be prescribed for 2 to 12 weeks. Prolonged antibiotic therapy may be required to prevent reinfection. When the heart is damaged, preventive antibiotic therapy may be needed prior to any dental or surgical procedures for the rest of the individual's life. Damaged heart valves may require surgical repair (valvuloplasty).
Kidney disease is treated symptomatically. High blood pressure is treated with antihypertensive drugs. Diuretics and a low-salt diet help reduce water retention. For severe complications, kidney dialysis may be needed. |
Source: Medical Disability Advisor
| The prognosis for treated strep throat is good. Symptoms usually resolve within 5 to 7 days, although prescribed therapy may need to continue for 10 days. Residual effects are not expected in the vast majority of cases.
The predicted outcome for untreated or complicated disease varies. Significant long-term medical problems can develop, including rheumatic heart disease and kidney disease (glomerulonephritis). Although it is very rare, death from heart or kidney failure can occur. |
Source: Medical Disability Advisor
| Suppurative (associated with pus) complications from a strep infection include sinusitis, otitis media, mastoiditis, peritonsillar abscess, and lymph node involvement. Scarlet fever produces a rash caused by bacterial toxins. More serious complications include rheumatic fever or rheumatic heart disease that can damage the valves and muscle of the heart. Another complication is acute glomerulonephritis, an inflammation of the kidneys. In severe cases, kidney failure may occur. Strep can also involve the brain (strep meningitis). Other relatively uncommon infections that may be caused by group A streptococci include arthritis, pneumonia, empyema, endocarditis, necrotizing fasciitis, and a syndrome similar to toxic shock.
Individuals with an internal prosthesis such as a knee or hip replacement must contact their physician immediately if a strep infection is suspected, as the infection may localize at the site of the prosthesis in the absence of immediate antibiotic therapy. |
Source: Medical Disability Advisor
| Individuals should not return to work until the fever is gone. If work involves strenuous exercise, workload should be slowly increased until normal strength and endurance return. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of streptococcal infection been confirmed by positive culture? Have other conditions, such as adenoviruses, mononucleosis, diphtheria, candidiasis, necrotizing ulcerative gingivostomatitis, or viral pharyngitis that cause similar symptoms, been ruled out?
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Was diagnosis or treatment delayed?
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Has individual experienced complications such as sinusitis and otitis media?
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If treatment was delayed, did individual experience more serious complications affecting the valves and muscle of the heart or causing kidney failure?
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Does individual have an underlying condition, such as advanced age or a compromised immune system, which may affect recovery?
Regarding treatment:
- Is individual taking the medication correctly, at the proper times during the day, and for the required number of days?
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If individual is unable to comply or incapable of complying with medication regimen, is there someone else in the household who could monitor or administer medication?
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Has individual stopped taking antibiotics before completion of the prescribed course due to improvement of symptoms? Why?
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If individual stopped taking antibiotics because of side effects, can an alternate antibiotic be substituted?
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If symptoms persist despite treatment, was culture and sensitivity performed to determine the appropriate antibiotics and to rule out antibiotic-resistant organisms?
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If individual has an internal prosthesis (knee or hip replacement), has individual received immediate antibiotic therapy to prevent localized infection?
Regarding prognosis:
- How much longer than expected has illness persisted?
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Would individual benefit from a different or longer course of antibiotics?
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If individual developed complications, is he or she responding to treatment?
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Would individual benefit from consultation with a specialist (infectious disease specialist, cardiologist, nephrologist)?
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Source: Medical Disability Advisor
| Rakel, Robert E., and Edward T. Bope, eds. Conn's Current Therapy. 57th ed. Philadelphia: W.B. Saunders, 2004.Thomas, Benoy J., and Robert D. Powers. "Pharyngitis, Bacterial." eMedicine. Eds. Kenneth C. Earhart, et al. 17 Nov. 2004. Medscape. 28 Oct. 2004 <http://emedicine.com/med/topic1811.htm>. |
Source: Medical Disability Advisor
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