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Don’t let strep throat go untreated

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By Dr. Jeff Daniels EBS Medical Columnist

A sore throat is one of the most common complaints of patients visiting an urgent care center. This problem is not restricted to just children or adolescents; there are many adults who develop one of several infections where the main manifestations are pain on swallowing, swollen glands in the neck, fever, and a feeling of general malaise. Other names for this illness include pharyngitis and tonsillitis.

The culprits causing this type of infection include a wide variety of bacteria and viruses. Viruses cause the vast majority of infections, especially in adults. Most people who catch a “common cold” will have some kind of throat discomfort, along with a stuffy nose, sinus pain and a cough. However, the likelihood that bacteria are responsible rises if there are no nasal or sinus symptoms, and no cough.

For many people, a sore throat brings up the concern about “strep,” referring to an infection caused by the streptococcus group of bacteria, particularly one designated group A strep (GAS). Studies show that anywhere from 5 to 15 percent of adults with pharyngitis will have a positive culture for GAS, whereas in children and teenagers, the percentage of GAS can be as high as 40 percent.

Strep is most commonly associated with swollen tonsils covered with whitish exudate, indicating a vigorous immune attack made by the body against the bacteria. The glands in the front of the neck are usually swollen and tender.

Strep infections are often self-limited, and if left untreated, symptoms will disappear after about five days. However, it is very important to treat group A strep. Treatment with antibiotics will reduce the duration and severity of symptoms. Untreated strep is contagious, but 48 hours after antibiotics are started, a child can return to school because the risk of spreading strep is greatly reduced.

A final reason to treat strep with antibiotics is that there are complications from a group A strep infection that can be avoided. Although greatly reduced since antibiotics became widely available in the 1950s, strep complications still crop up, and the results can be devastating.

Scarlet fever, rheumatic fever, and acute glomerulonephritis, seen mostly in kids and adolescents, can result from an untreated or incompletely treated strep infection. There has even been an association noted between strep infection and an autoimmune neuropsychiatric disorder in children.

The first step to diagnosing strep is basically a common sense evaluation of the patient. Are symptoms consistent with a viral illness? Are there nasal symptoms, sinus symptoms, ear clogging, a cough, hoarseness, or ulcers on the inside surface of the cheeks or lips? These are all commonly found in viral upper respiratory infections, and not consistent with strep.

We have two ways of testing specifically for group A strep: a rapid strep detection test done right in the office, giving immediate results, and a throat culture, which can take 24 to 48 hours to give results. The throat culture is the more sensitive of the two tests, identifying strep correctly in about 90 to 95 percent of cases.

The rapid strep test can miss (come back negative) up to one in four cases of strep. In many patients, a culture will be sent if the rapid test is negative but the patient still looks like they might have strep, and clinical judgment is then used to decide whether or not an antibiotic should be started immediately.

Group A strep infection will respond to common antibiotics like penicillin, amoxicillin, and a variety of cephalosporin in all but rare cases. In some areas in the country, resistance is developing to erythromycin and azithromycin (Z-pak). Antibiotic treatment should be continued for 10 days.

Have a healthy November, and start getting in shape for ski season!

Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.

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