Streptococcus: Strep Demands Immediate Care

by Food and Drug Administration (FDA)

Few childhoods go by without the tell-tale fever and sore throat of a Streptococcus, or "strep," infection. Although these throat infections are common and easily treated, the recent rise of particularly deadly or troublesome strains of Group A Streptococcus has pushed the bacterium into the medical limelight — again.

In the past, Group A strep has played a starring role in a number of deadly medical epidemics, particularly the scourges of rheumatic fever that swept across the nation in the first half of this century, killing or debilitating thousands of children each year.

After World War II, the number of cases of rheumatic fever dramatically declined until, during the 20 years between 1965 and 1985 alone, the yearly number of cases of rheumatic fever among school-age children dropped by more than 90 percent. The medical community had assumed that less crowded living conditions and the use of antibiotics were keeping the disease at bay. Some physicians even went so far as to call rheumatic fever a "vanishing disease in suburbia."

That complacency was shaken in the mid-1980s when outbreaks of rheumatic fever were reported among children and young adults in various cities scattered throughout the country. Those reports were followed by others of a new and deadly form of strep infection that was afflicting adults. This disease, which is called toxic streptococcal syndrome, made the headlines when public television's "Sesame Street" puppeteer Jim Henson was reported to have died from it last year. There's also evidence to suggest that blood infections caused by Group A strep are on the rise.

"Group A Streptococcus seems to have taken a little twist again," says Rosemary Roberts, M.D., a medical officer with the Food and Drug Administration's division of anti-infective drug products. "We're seeing manifestations like rheumatic fever that we haven't seen for awhile, as well as more invasive strains of Group A strep that are making people sicker much more quickly."

The jury isn't in yet on why Americans are experiencing such a boost in the severity of strep infections. Preliminary findings by researchers at the national Centers for Disease Control in Atlanta suggest that a population increase among previously rare strep types may be behind both the recent rheumatic fever outbreaks and cases of the new toxic streptococcal syndrome. Heightened production of disease-causing toxins by more common strep types may also be responsible for the latest strep casualties.

There are more than 80 known types of Group A Streptococcus, which can cause more than a dozen different illnesses. Group A Streptococcus, in turn, is part of a broader category of strep organisms that cause an even larger number of diseases.

Some of the more well-known Group A strep afflictions include upper respiratory diseases such as strep throat and scarlet fever, skin disorders such as impetigo, and inflammatory diseases such as rheumatic fever or kidney disease. In addition, blood infections due to Group A strep are a serious and frequent complication of wounds or surgery.

Group A strep infections are treatable with antibiotics, the drug of choice being penicillin. Other antibiotics, such as erythromycin and various cephalosporins, are effective alternatives for patients allergic to penicillin. FDA is responsible for ensuring the safety and effectiveness of these drugs.

Strep Throat

Strep throat (streptococcal pharyngitis) is probably the most well-known Group A strep infection. Although strep throat can occur at any age and at any time of the year, it mainly afflicts school-age children during the winter and spring. The many symptoms of strep throat include an extremely red and painful sore throat, ear pain, fever, enlarged and tender lymph nodes in the neck, white spots on the tonsils, or dark red spots on the soft palette. However, about 1 out of 5 people who has strep throat experiences no symptoms.

Because nearly all the symptoms of strep throat can also occur with viral infections, laboratory tests are used to confirm a doctor's suspicion that a patient's sore throat is caused by Group A strep. The traditional laboratory test to identify strep is a throat culture. To isolate and identify Group A strep from a throat swab takes from one to three days using the culture method. In recent years, a number of tests have become available that use antibodies to detect the presence of Group A strep directly on a throat swab, and these devices can provide test results in a matter of minutes. Many physicians feel that the rapid tests do not detect as many positive results as the culture method, so if the rapid test results are negative, a follow-up throat culture is recommended.

Strep throat is highly contagious among children because they are in close contact with one another. In addition, they have not yet developed resistance to any of the strains, as adults have.

The incubation period for strep throat is two to five days. During epidemics, siblings of a strep throat patient have a fifty-fifty chance of also succumbing to the disease, whereas only 20 percent of the parents of such patients will develop strep throat. Children with strep throat should not return to school until their fever returns to normal and they've had at least a day's worth of antibiotics.

Strep throat is easily treated with antibiotics. Treatment is usually not necessary for those individuals who harbor the strep throat microbe but show no signs of an active infection. These people are unlikely to spread infection to others, according to the American Academy of Pediatrics, or experience the complications of a strep infection, which include rheumatic fever and kidney disease.

Scarlet Fever

One of the more colorful variants of a strep infection is scarlet fever. The hallmarks of this disease include a bright red tongue, a brilliant scarlet rash (particularly on the trunk, arms and thighs), a flushed face, sore throat, and fever.

"Scarlet fever is simply strep throat with a rash," says Roberts. The red rash that typifies this disease is prompted by a toxin generated by the Streptococcus bacterium. The striking symptoms of scarlet fever make it easy to diagnose, but most physicians confirm their clinical diagnosis with laboratory tests.

Like strep throat, scarlet fever primarily afflicts school-aged children during the winter and spring months. Scarlet fever is easily treated with antibiotics, and, if left untended, the disease can foster the same complications prompted by strep throat.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.