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| |    Strep Infections: An Overview by Dr. Ed Kaplan reviewed by Lynn Cates, M.D., F.A.A.P. You might as well accept it--no matter how careful you are, your child will have many sore throats before he grows up, and some of them will probably be strep throats. You probably already know something about strep throat and throat cultures, and you may know that strep throat should be treated with antibiotics to prevent serious problems. What you may not be clear about is just exactly what makes this kind of sore throat special, or that the same bacterium that causes strep throat, the group A streptococcus (GAS or strep), can cause other infections, some of which can be very serious. What are strep infections? Group A strep respiratory tract infections like strep throat and scarlet fever (which is just a strep infection with a distinctive rash) are very common, usually relatively mild, and among the most easily transmitted from person to person. Of all the many different kinds of bacteria and viruses that can cause infections of the throat (or pharyngitis) and tonsils (or tonsillitis), group A strep often is the one of most concern because if it is untreated or not treated effectively, it can lead to complications. These include acute rheumatic fever and rheumatic heart disease, as well as a disease of the kidneys called acute glomerulonephritis (AGN). Group A strep is a cause of a mild skin infection called impetigo, but it also can be responsible for very serious infections of the blood and other tissues. One form of invasive strep disease (necrotizing fasciitis) can cause such serious tissue destruction it has been dubbed "the flesh-eating bacteria." Appropriate management of the infections in the upper respiratory tract can reduce the possibility of all of these complications. Who gets strep infections? Group A strep is often found in the throat and on the tonsils, especially in children. In fact, this strep infection has been called an ?occupational disease of school children.? Why it most often affects children of school age is not completely understood. The infection also may occur in younger children, as well as in adults and the elderly. It has been estimated that there are approximately 4 to 5 million cases of strep throat in the United States each year. In one study of families over a 10-year period of time, the average child had three proven strep throat infections by the time he reached age 13; the range was from one to eight infections during this period. How are strep infections spread? One of the most important factors in the normal spread of group A strep is crowding. Strep is primarily spread by respiratory droplets (e.g., sneezing, coughing, dripping), so it's not surprising that strep infections spread easily in daycare centers, schools, military barracks, offices, and other crowded conditions. Group A strep often is found in the throat and on the skin, and may be carried for long periods of time without causing any illness. Carriers of group A strep do not seem to be harmed by carrying the organism, do not appear to develop long-term complications, and do not spread it to family members or classmates at school. The only natural host for this bacterium is the human. It is extremely rare for domestic or wild animals to harbor this organism and be involved with its spread. When do strep infections occur? Although strep infections occur year-round, streptococcal respiratory tract infections are more common in the fall, winter, and early spring in temperate climates such as North America. In contrast, however, streptococcal skin infections like impetigo seem to be more common in the summer. This is probably related to the fact that exposed skin on arms and legs is more likely to be the site of either minor trauma or insect bites, which then become secondarily infected. Treatment of strep infections Appropriate treatment of strep infections, usually with penicillin, almost always is successful in curing the acute disease, as well as preventing long-term complications such as rheumatic fever. Currently, there is no vaccine to prevent group A strep infections.
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