Strep Throat (Group A Streptococci Infections)

Signs and Symptoms
Approximately 15% of children who have a sore throat and fever are infected by Group A streptococci. When Group A streptococci infect the throat, they cause pharyngitis, which is a painful inflammation of the throat (pharynx). Swallowing may become so painful that the child has difficulty eating.

A child with strep pharyngitis often has a fever above 101 degrees Fahrenheit (38.3 degrees Celsius), with chills, body aches and loss of appetite. There also may be abdominal symptoms, like nausea, vomiting, and abdominal pain. The tonsils and the back of the throat may look red, swollen, and dotted with whitish or yellowish specks of pus. There may be swollen glands in the neck and at the angles of the jaw. Strangely, in spite of all the throat pain, hoarseness and loss of voice are not common.

Some rare cases of strep infection may result in the production of a toxin that causes a bright red skin rash. This is the rash of "scarlet fever," and it usually lasts from the second to the sixth day of the strep throat infection.

In infants, strep throat infections - although rare unless infants are in child care - tend to cause symptoms that seem less limited to the throat. Infants may have a runny nose, crusting and sores around the nostrils and a low fever. They may also begin to feed poorly.

Rarely, strep throat infections that are either untreated or incompletely treated can lead to rheumatic fever, an illness that can result in heart disease and arthritis. Another rare complication of a group A strep infection is acute glomerulonephritis, a kidney problem that begins 2 to 3 weeks after the initial infection.

Group A streptococci may also cause sinusitis, ear infections, pneumonia and skin infections (impetigo).

Description
Group A streptococci are bacteria. They cause throat infections (pharyngitis), especially during cold winter months when people are crowded together indoors. Strep A bacteria spread from person to person through fluid droplets from the nose or throat of someone with a strep infection. Of all age groups, school- aged children and children in child care are most affected.

Group A streptococci also cause many different kinds of skin infections, most commonly impetigo. In very rare cases, strep A may also cause pneumonia, most often after a previous viral infection like the flu, measles, chickenpox or whooping cough.

Prevention
In normal everyday life, there is no perfect way to avoid strep throat infections. At home, when someone is sick with strep throat, it's always safest to wash drinking glasses and eating utensils with hot soapy water, and to wash your hands often as you care for the affected person.

Care of a patient with strep-caused rheumatic fever usually requires medical specialists who may recommend ways to avoid future strep infections.

Incubation
The incubation period for Group A strep throat is usually 2 to 7 days after exposure.

Duration
In Group A strep throat infections, fever typically stops within 3 to 5 days, and the sore throat passes soon afterward. Antibiotic therapy is usually completed within 7 days. If symptoms have improved, and the patient is without fever, she or he may return to school after 24 hours of antibiotic treatment. It is important, however, that they continue to take the full course of prescribed antibiotics even after they are back in class.

Contagiousness
Strep throat is contagious, and strep bacteria can be passed through contact with the nasal or throat fluids of someone who is infected. After completing two days of appropriate antibiotics, one is no longer contagious. Estimates are that in a home where someone already has strep, about one out of every four family members will get it, too. There are also cases where persons, especially children, can be carriers of strep bacteria without having any symptoms (asymptomatic carriers). This means that the bacteria are present, but not causing any apparent problem or disease. Among school-age children, 5% to 15% may be asymptomatic carriers of strep bacteria.

Home Treatment
A child with a severe strep throat may find that eating is painful, so provide soft foods or a liquid diet, if necessary. Include soothing teas and warm nutritious soups, or cool soft drinks, milk shakes and ice cream. Make sure that plenty of fluids are available, and take the temperature at least once each morning and each evening. Let the child rest in bed and play quietly.

Children who are old enough to gargle can try gargling with either double-strength tea or warm salty water. Be sure that they spit out the salty water after they've finished.

Use a cool-mist humidifier to add moisture to the air, since this will help soothe the child's throat. A moist warm towel may also help soothe swollen glands around the child's neck.

Make sure that the child takes all prescribed antibiotics on schedule and for as many days as your doctor has directed. This will help prevent complications like rheumatic fever or an abscess around the tonsils.

Professional Treatment
A doctor who suspects that your child has a strep throat will take a throat culture (a painless swab of throat secretions) to see if strep A bacteria grow in the laboratory. If they do grow, this will confirm a Group A Strep infection and be the basis for your doctor's ordering antibiotic treatment. Some doctors also use an "instant" strep test that can confirm a strep infection within 10 minutes while you remain at the office.
Once a strep A infection is confirmed, it is treated with penicillin or another antibiotic that may either be injected or given by mouth. Since the risk of allergic reactions may be lower when oral medication is given, many doctors prefer to give an antibiotic prescription to be taken at home. They depend on the patient or the patient's parents to make sure that the full course of antibiotics is taken. This means up to 7 days of medicine at home.

When to Call Your Child's Doctor
Call your doctor if your child has symptoms of strep throat, especially if someone in your family or in your child's school has recently had a strep infection.
If your child is already being treated for strep throat, call your doctor for any of the following symptoms: fever that returns after several days of normal temperature; skin rash; earache; nasal discharge with discolored or bloody mucus; cough, especially if it produces mucus; chest pain, shortness of breath or extreme tiredness; convulsions; painful, red, swollen joints; nausea or vomiting.