Common Illnesses & Injuries
Strep Infections: Strep Throat, Scarlet Fever and Impetigo
Overview
Streptococcal (strep) infections are diseases caused by bacteria normally found on the skin or in the intestines, mouth, nose or reproductive tract.
Some strep infections don’t produce symptoms. Some can be fatal.
Strep infections invade healthy tissue, and most often affect the throat. They also invade tissue already weakened by injury or illness. They frequently affect the bones, ears, eyes, joints, or intestines. Both primary and secondary strep infections can travel from affected tissues to lymph glands, enter the bloodstream, and spread throughout the body.
There are several types of strep bacteria. Types A, B, C, D, and G are most likely to make people sick.
Group A strep (GAS) is the form of strep bacteria most apt to be associated with serious illness. Two of the most severe invasive GAS infections are necrotizing fasciitis or “flesh-eating bacteria” and toxic shock syndrome (TSS).
Group B strep (GBS) most often affects pregnant women, infants, the elderly, and chronically ill adults. GBS is the cause of life-threatening illness and death in newborns. GBS exists in the reproductive tract of about one in four pregnant women. Half to three quarters of the babies born to women carrying this get an infection. This is very serious because about 75 percent of these babies will develop early-onset infection within a few hours of birth and always apparent within the first week of life. This causes meningitis, pneumonia, blood infection (sepsis) and other problems. Late-onset GBS develops between the ages of seven days and three months.
Group C strep (GCS) is a common source of infection in animals. Humans aren’t usually made sick by it.
Group D strep (GDS) is a common cause of wound infections in hospital patients, of urinary tract infection, and of infections in women who have just had a baby.
Group G strep (GGS) leads to infection in people who have chronic conditions or problems with the immune system. GGS can cause a variety of infections, including bacteria in the bloodstream (bacteremia), inflammation of the connective tissue structure surrounding a joint (bursitis), endocarditis (a condition that affects the lining of the heart chambers and the heart valves), meningitis, inflammation of bone and bone marrow (osteomyelitis), and inflammation of the lining of the abdomen (peritonitis).
Strep Throat
The medical term for this is acute streptococcal pharyngitis. This is usually a Group A strep infection. People with strep throat infections have a red and painful sore throat with white patches on their tonsils. A person may also have swollen lymph nodes in the neck, a fever, and a headache. Nausea, vomiting, and abdominal pain can occur but are more common in children than in adults.
Strep throat can spread from person to person by direct contact with saliva or nasal discharge. Most people do not get group A strep infections from casual contact with others, but a crowded environment like a dormitory, school, or an institutional setting can make it easier for the bacteria to spread. A person becomes sick within three days after being exposed to the germ. Once people become infected, they can pass the infection to others for up to two to three weeks, even if they don’t have symptoms. After 24 hours of antibiotic treatment, a person will no longer spread the bacteria to others.
A sore throat might be strep throat or it might be pharyngitis (throat inflammation) caused by viruses. Taking an antibiotic when the problem is a virus will not shorten the course of the illness. Overuse of antibiotics has resulted in some bacteria being resistant to antibiotics.
Telling the difference can be difficult, because the two may have overlapping symptoms. Strep throat usually involves fever, a yellowish exudate (coating) on the tonsils and enlarged lymph nodes in the front of the neck. Usually people don’t have a cough or a stuffy or runny nose with strep throat. When viruses cause sore throat, the person may have a cough or nasal symptoms and enlarged lymph nodes in the back part of the neck. Viruses that can cause sore throat can also cause body and joint aches.
How it is Diagnosed
Your child’s doctor or other health care worker will take a sample from your child’s throat. This will be used for a culture or a rapid strep test, which only takes 10 to 20 minutes. If the result of the rapid test is negative, your child’s doctor may do a follow-up culture to confirm the results, which takes 24 to 48 hours. If the culture test is also negative, your child’s doctor may suspect your child does not have strep, but rather another type of infection.
How it is Treated
Most sore throats are caused by viral infections. If your child’s sore throat is in fact caused by a virus, an antibiotics will be useless.
Penicillin is considered the medicine of choice for treating strep throat because it has been proven to be effective, safe, and inexpensive. Doctors often prefer to give amoxicillin to children with strep throat. If your child is allergic to penicillin there are other antibiotics your child’s doctor can give you to clear up the illness. Your child should start to feel better within four days, but it is very important to finish the antibiotic.
Other Strep Infections
Scarlet Fever
Scarlet fever is another form of group A streptococcal disease that can follow strep throat. It is usually self-limited.
A red “sandpaper” rash appears, and spreads. When pressed, the rash blanches (turns pale). People with scarlet fever may get a bright strawberry-red tongue, and their faces may be flushed while the area around the mouth remains pale. The skin often peels after recovery, usually on the tips of fingers and toes. In severe cases, a patient may have a high fever, nausea, and vomiting.
Like strep throat, a doctor treats scarlet fever with antibiotics.
Impetigo
Impetigo is an infection of the top layers of the skin and is most common among children ages two to six. It usually starts when the bacteria get into a cut, scratch, or insect bite. Impetigo is usually caused by staphylococcus, a different bacterium, but can be caused by group A streptococcus.
Symptoms start with red sores or pimples surrounded by reddened skin. These sores can be anywhere on the body, but are found mostly on the face, arms, and legs. Sores fill with pus, then break open after a few days and form a thick crust. Itching is common. The doctor can diagnose the infection by looking at the skin sores.
The infection is spread by direct contact with wounds or sores or nasal discharge from an infected person. From the time of infection until a person shows symptoms is usually a period of one to three days.
Your child’s doctor will prescribe antibiotics and an antibiotic ointment to treat this condition.
