Ep. 25: Severe Strep Throat Complications You Need to Know About
This episode of the Dr. Momma Says podcast will discuss strep throat, which is a common cause of throat pain. I have previously discussed that most tonsil infections are caused by viruses, but when they are caused by bacteria, antibiotics are useful. Strep throat is more than a simple tonsil infection and many parents assume it is a simple illness that kids will outgrow. However, it is extremely important to know that in both kids and adult, there are some potentially severe or life-threatening Strep throat complications that exist.
What is Strep Throat?
Strep throat is a specific bacterial infection called group A Streptococcus, or more commonly called group A strep.
There are lots of bacteria that cause Strep infections, like the common one I previously discussed in my ear infections podcast episode, one that leads to many ear and sinus problems.
The point is…there are many Strep infections but Group A strep is the one we all get concerned about in the throat, so when we say Strep, we mean Group A strep.
So Strep affects tonsils AND the throat!
- Aaaah, it says it in the name. This is not just tonsillitis.
- The pharynx is the fancy name for the back of the throat, so when it is infected or inflamed it is called pharyngitis.
- When infections, whether due to bacteria or viruses happen in the pharynx, all areas have the potential to be involved.
- The tonsils happen to sit in the pharynx. And because they are similar to lymph nodes, they step up, or maybe say they swell up, to help fight the infection.
- As discussed in another podcast, tonsils that become a problem may have recurrent infections or become too large and block eating or breathing.
ANYWAY…The concept that Strep throat is more than Strep tonsillitis IS an important concept because many people have their tonsils removed but continue to have Strep throat infections. Therefore, these people are still at risk of developing severe strep throat complications.
Who Gets Strep Throat?
Anyone can get Strep throat, but there are some factors that can increase the risk of getting this common infection.
It is more common in children than adults and usually occurs between ages 5 and 15 years old. It is rare in children younger than 3 years old, but as a Peds ENT, I have seen more than my fair share of toddlers with Strep.
Adults who are most at risk for Strep throat include:
- Parents of school-aged kids
- Adults who are often in contact with children, like daycare workers and teachers
- In essence, the more often you are exposed to sick kids, the more likely you are to get infected. And the more often you get infected, the more chances you have of developing Strep throat complications.
How Do You Get Strep Throat?
Group A Strep usually causes symptoms when it enters the nose or mouth, but it can also live in these areas without causing disease.
And of course, just because you are exposed to the illness doesn’t mean you will catch it. This is true of most infectious problems.
- Everyone exposed to diseases like chicken pox and measles does not catch them even though these are aggressive viruses. Sadly, this little nugget of information empowers the anti-vax crowd.
- By not vaccinating their kids, anti-vax parents are banking on not everyone catching the illness or only having a mild case. This is not how healthcare works!
- Healthcare is indeed meant to treat illnesses but also to prevent them. Understanding the diseases and how they are spread is sooo important for prevention.
- And when it comes to some of the most aggressive viral illnesses, the best treatment is prevention…and that means vaccines. I have shared my truth about witnessing the vaccine revolution. Always remember: #Vaccines Work and #VaccinesCauseAdults.
Okay back to the topic at hand….Strep
It is a rather aggressive bacterium and can easily spread to other people.
- Most people who are infected spread the bacteria by coughing or sneezing, which creates small droplets of mucus that contain the bacteria.
- But Group A Strep also forms a skin infection called impetigo
- To be clear, impetigo is also commonly caused by another bacteria called Staph but many do not know Strep is also a big offender
- Impetigo is a highly contagious bacterial skin infection which mostly affects young children and infants.
- Impetigo usually appears as red sores on the face, especially around the nose and mouth of a child, and on hands and feet.
- The sores often have pustules and the liquid contains the bacteria. This infection tends to be highly contagious so if you touch the sores of a person with impetigo or anything that they touch.
Classic Symptoms of Strep Throat
- Throat pain that usually comes on quickly
- Painful swallowing
- Red and swollen tonsils, sometimes with white patches or streaks of pus
- Tiny red spots on the area at the back of the roof of the mouth (soft or hard palate)
- Swollen, tender lymph nodes in your neck
- Body and joint aches
- Rash, called Scarlatina
- Nausea or vomiting, especially in younger children
To be honest, many patients I see with recurrent Strep throat do not even complain of a sore throat! Headache and stomach ache are two of the most common symptoms, and parents often think there is a viral infection. This explains why many kids can develop an infection and not receive the treatment that could prevent severe Strep throat complications!
How Do You Diagnose Strep?
Even though physicians may be suspicious that Strep is the problem, you cannot absolutely know if someone has strep throat just by looking at his or her throat.
Only a rapid strep test or throat culture can determine if group A strep is the cause.
- A rapid strep test involves swabbing the throat and running a test on the swab. The test quickly shows if group A strep is causing the illness.
- If the test is positive, doctors can prescribe antibiotics. If the test is negative, but a doctor still suspects strep throat, then the doctor can take a throat culture swab.
- A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses.
Patients need to make sure they follow up to get those test results because an untreated infection leads to a greater chance of developing one of the Strep throat complications.
How Do You Treat Strep Throat?
Physicians are constantly sounding the alarm to avoid asking for antibiotics so we can avoid over-prescribing them. But antibiotics are valuable assets for treating the appropriate diseases. And this is one!
Antibiotics are used to treat Strep and generally work very fast. Most people start to feel better within 24-48 hours.
Either penicillin or amoxicillin is recommended as the first choice for people who are not allergic to penicillin. We usually use other antibiotics if there is a penicillin allergy or if we think we need to treat more complex infections at the same time…like that sinus infection or ear infection.
So, what about those people who test positive for Strep throat but have no symptoms? These are the people often called a “carrier”. Most of the time, these people do not need antibiotics because they do not tend to be at risk for Strep throat complications. Listen to the podcast to hear more about the problem with treating Strep carriers.
Why are Antibiotics Used for Strep?
It is true that Strep throat can resolve without antibiotics but there are some very clear benefits to using antibiotics, such as:
- Reducing how long someone is sick
- Making symptoms go away faster
- Preventing the bacteria from spreading to other people
- Preventing serious strep throat complications
4 Severe Strep Throat Complications
They are not common, but they can happen and when they do, it can be a big deal. Or a huge deal.
Abscesses (pockets of pus) around the tonsils
- Although peri-tonsillar abscesses can happen with any bacteria, Strep is a common offender
- Personally, I have seen more of these in kids who either only used part of their course of antibiotics or were allergic to PCN so antibiotics were avoided or used short-term to “avoid becoming allergic to more antibiotics”
- Just a sidebar here…taking your antibiotics as prescribed is important. The dosing is based on science so when you stop early or modify how you are taking them, you modify how the problem will respond to treatment.
- In teens and adults, this can be treated in the emergency room by draining the pus with a needle placed into the back of the throat or making a small incision. So yeah….can you imagine young kids letting you do this? Nope
- Young kids are taken to the operating room to drain the abscess.
Rheumatic Fever (a heart disease)
- Rheumatic Fever is not common these days since antibiotics are readily available, but I have 2 personal experiences with this complication. (check out the details in the podcast)
- This severe Strep throat complication is not a problem that occurs directly because of the bacteria, but instead, it occurs because the immune system mounts a reaction to attack the bacteria but instead it attacks the body.
- There are many areas in the body which become inflamed, but this problem is associated with damage to heart valves.
- The heart valves swell up then become scarred and do not work properly.
- Long term, this can lead to heart failure
Post-Streptococcal glomerulonephritis (a kidney disease)
- Post-streptococcal glomerulonephritis is not due to the bacteria actually causing the problem but the body’s reaction to the bacteria.
- In this case, the inflammatory reaction causes the blood vessels in the kidney to swell so they do not filter the urine well.
- The symptoms can include swelling of the legs, hands, and face as well as blood in the urine.
- Often there is no specific treatment for this condition, but the Strep infection should be treated with antibiotics and measures may be needed to support the kidneys while they heal.
- Kids usually recover very well from this condition within 6 to 8 weeks. Adults are more likely to develop complications, like high blood pressure and permanent kidney damage.
PANDAS (a neurologic disease)
- PANDAS are initials that stand for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
- Be sure to check out my podcast episodes which delve deeper into the struggle to diagnose PANDAS and the controversies surrounding PANDAS treatments.
- This is a problem that occurs due to the immune response to Strep, but this time there are neurologic problems that occur because of inflammation in the brain.
- The symptoms often occur suddenly and include things like behavior and personality changes, tics, and new-onset obsessive-compulsive disorder. The symptoms may occur in episodes but may become severe and constant over time.
- I have personally treated many patients who were suspected of having this Strep throat complication but never had a diagnosis of Strep made. If cultures are negative, it is difficult for physicians to proceed with treatment.
- This has become a controversial problem because there is clearly an inflammatory neurologic problem but it can be unclear if it is caused by strep, another bacteria or even viral-induced.
How Can You Prevent Strep Throat complications?
People can get Strep throat more than once because getting Strep throat does not protect you from getting it again. Wouldn’t it be great if there were a vaccine to prevent Strep throat complications? Well, there isn’t. So, doing things to prevent the spread of any illness is helpful here. Basically, use good hygiene.
- Wash your hands often.
- Cover your mouth and nose with a tissue when you cough or sneeze
- Put your used tissue in a trash can
- If you do not have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands
- Wash your hands with soap and water for at least 20 seconds
- Use an alcohol-based hand rub if soap and water are not available
- You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.
As always, much love for supporting my work. I will be adding many more posts to highlight parenting and healthcare tips, so be sure to consider subscribing to my podcast or to my blog to avoid missing a post!
Thank you for this episode about strep. I am a grandmother of 9, and I am constantly surprised and worried about new disease diagnoses that my grandchildren are exposed to – or show possible symptoms of. PANDAS is especially worrying because of the neurological effects. My daughters (their mothers) and I look forward to your podcast on this subject and best treatment.
Yes, PANDAS has so many different symptoms that it can be hard to recognize especially when there is not a clear association with Strep Throat. I have spoken to many physicians and there is still no consensus about this problem. I’m still researching the subject, so be sure to subscribe to my blog so you are updated once my episode is launched.
I agree that there are significant complications from strep throat. There are other abscesses, such as retropharyngeal and lymph nodes that should also be mentioned. However, post-strep glomerulonephritis can not be prevented through treatment. If you’re boing to get it, you’ll get it despite antibiotics. It is also usually caused by skin infections, not throat.
Thanks for your comments! Yes, there are other abscess areas but I have found that the retropharyngeal ones are typically in toddlers and infants who most commonly don’t have Strep. Peritonsillar abscesses are much more common. And indeed, many of these complications occur in people at risk, not just to anyone. I guess I wanted to point out that Strep Throat is serious. Many of my patients do not get tested because they think if it is Strep, it will not go away on its own. Understanding the risks that could happen will hopefully bring awareness to the reasons physicians perform the Strep Test that some parents think is not needed!
Thank you so much for your insight on strep! More information on the neurological side effects (PANDAS) would be appreciated.
Oh yes! I have started this episode several times but it is like going down a rabbit hole since many aspects are not agreed upon. I want to introduce the ideas and talk about how physicians utilize the information to decide on treatment since the symptoms and results vary so much between patients.