Andrea Blain’s 8-year-old son Joshua came home during the last school year with a note that’s familiar to most parents of school-age children. The note said there had been a case of strep throat in Joshua’s class, and warned parents to seek immediate medical treatment if any family member presented such strep symptoms as a sore throat, high fever, headache, abdominal pain and/or vomiting.
With children starting to head back into classrooms, concerns about strep will soon be an issue for many parents. The Harvard Medical School Family Health Guide states that although viruses cause most sore throats, bacteria also infect the throat. The guide says that the best known bacterial infection is strep throat, and is caused by streptococcus bacteria.
“If a classroom full of healthy children with no symptoms of strep have their throats cultured,” says Dr. Robert Tanz, director of medical education, Department of Pediatrics at Northwestern University Medical School and Children’s Memorial Hospital, “somewhere between 8 to 25 percent of the children in that class will test positive for strep.”
In Joshua’s case, he got sick but not with the symptoms of strep. Nevertheless, a strep test came back positive. He was treated with antibiotics, his mother said, and recovered quickly.
So what does it mean to “test positive for strep”? Is it possible to have strep throat without any symptoms?
“The way I explain it to parents,” Tanz says, “is that if you have an infection from strep, it will make you sick and show up in a test. Strep causes symptoms such as sore throat, swollen glands and high fever.”
Tanz adds that if there is a rash with the illness, it’s called scarlet fever. But a runny nose, diarrhea and/or laryngitis are not strep symptoms, doctors say, adding that a positive strep test accompanied by those symptoms-commonly associated with colds and flu-is purely coincidental.
Left untreated, a person with strep will develop a significant antibody response, Tanz says, which is the body’s attempt to fight the illness. The Harvard Medical School guide says that untreated strep can lead to nephritis, a kidney disorder, or rheumatic fever, an inflammatory disease that can attack the body’s connective tissue of the heart, joints, skin and, sometimes, the brain.
So what if a child frequently has positive throat cultures showing strep, but never shows the symptoms? Physicians call such people “strep carriers.”
“If they’re carriers, this can only be shown with a culture when there are no symptoms,” says Tanz. “It’s like dirt behind your child’s ear-if you don’t see it, it does no harm. If you see it, you get grossed out and want to get rid of it. Carriers cause little or no harm to others; therefore it’s usually unimportant to know that someone is a carrier. Testing a person without symptoms is unnecessary and usually makes them worry unnecessarily.”
Vicki Denstaedt of Grayslake says that all three of her children tested positive for strep within a two-month period. The only significant symptom among the three was a fever for Isabelle, who was about 16 months old at the time.
First, daughter Taylor, 8, had cold symptoms and sinus drainage that gave her a red throat. The emergency room doctor who examined her said it was most likely viral, but tested her for strep. The doctor and Taylor’s parents were surprised when the test came back positive.
A short time later, Taylor’s twin brother, Trevor, had allergy symptoms. By their third visit to the doctor in as many weeks, Trevor was found to have a sinus infection. On their second doctor’s visit, Trevor had beguna preventive round of penicillin, which didn’t help. Strep was diagnosed on the third visit, at the same time the sinus infection was diagnosed. Trevor was well after a course of amoxicillin.
Soon after Trevor’s illness, Isabelle developed a fever for three days. With no other symptoms, Denstaedt attributed the fever to teething. Back at the physician’s office, the doctor told the Denstaedts, “We normally don’t test for strep in children this young.” During the exam, the doctor noted sinus drainage. At her mom’s insistence, Isabelle was tested for strep; the results were positive.
Tanz, who is not the Denstaedts’ pediatrician, said that Taylor and Trevor could be strep carriers, bouncing the infection among other family members and weakening everyone’s resistance. Tanz added that sinusitis is different from strep; if there is strep in a child’s throat, there is no scientific evidence that it’s related to sinusitis, although it is possible to have both infections at the same time.
With regard to Isabelle, most pediatricians and infectious disease experts believe it isn’t necessary to test a child under 2 years old for strep. The main reason for testing –and treating–a strep infection is to avoid the complications of rheumatic fever and nephritis. But medical experts cite clinical studies that have found children under 2 years are not at risk for either of these complications. Having said this, Tanz also added, “If one discovers strep in a child with fever, no matter the age, that child should be treated.”
Tanz says that there are two circumstances involving strep that warrant special monitoring: when there is someone in the household who is immuno-compromised, such as on chemotherapy, or when someone suffers repeated cases of strep despite treatment.
“It’s essential that there’s communication between parents and their doctor,” says Dr. Ilham Algayed of ENH Pediatrics in Glenview. “If you get a notice from your child’s schoolstating to watch for symptoms [of strep], if you have any questions whatsoever, or if you have special circumstances within the family, discuss it with your doctor. He or she knows your child and will be able to answer questions that are particular to your family.
“In today’s world of `educated consumers’ of health care, if you don’t feel comfortable discussing these matters with your physician, perhaps you need to see a different doctor.”
QUICK FIX COULD SPELL TROUBLE LATER
When a child isn’t feeling well and parent knows he or she has been exposed to strep, it’s tempting to seek the quick fix of a round of antibiotics. But Dr. Robert Tanz, director of medical education, Department of Pediatrics at Northwestern University Medical School and Children’s Memorial Hospital, says that overuseof antibiotics is a problem. He says that prescribing unnecessary antibiotics can cause the development of drug allergies and, more seriously, give rise to antibiotic-resistant strains of bacteria.
“No strains of strep have developed any resistance whatsoever to penicillin and amoxicillin,” Tanz says. “If the patient is allergic to penicillin, then you should move to erythromycin cousins like Biaxin and Zithromax. These drugs should only be used on those allergic to penicillin, because strep does become resistant to erythromycin and related drugs. It’s a really important thing for people and their doctors to know: Penicillin and amoxicillin are the drugs of choice for strep. This is because strep has never become resistant to these drugs.
“We’ve created a very large problem inadvertently. In countries where use of erythromycin-related drugs for strep was strongly discouraged, the resistance to that drug has decreased within a year. We should steer clear of the other drugs to treat strep, to prevent resistance within the body to other bacteria.”
Bottom line: An unreasonable fear of strep–Tanz called it “streptophobia”–is rampant.
“This unfortunately leads to people doing some very strange things,” says Tanz. How strange? Some pediatricians prescribe antibiotics that a child must take every day or every other day for a year, he says, something Tanz advises against if at all possible.
He also says parents should be wary of strep cultures being done on a large group of childrenn.
“You’ll end up with carriers being treated unnecessarily, and increasing their resistance to antibiotics for other types of bacteria,” Tanz says. “In the absence of doing a formal study, group cultures should be strongly discouraged.”
SORTING OUT A STREP CARRIER
Many parents have sensitive radar when it comes to their child’s health; they will know when a child isn’t feeling well before symptoms of strep appear. But how can a parent find out if their child is a strep carrier or infected with asymptomatic strep?
Dr. Ilham Algayed of ENH Pediatrics in Glenview says that it can be very difficult to make such a differentiation.
“A child who has been successfully treated with antibiotics after a strep infection will test negatively following the medication. A child who still has a positive culture after antibiotics is probably a carrier, and should not be treated continuously with unnecessary antibiotics.”
The exceptions to the rule of not treating carriers are in the case of a family with a history of rheumatic fever or nephritis, or when family members keep passing each other active strep infections.
