Health
Perhaps, often, in the fight against diseases, we expect miraculous solutions from doctors.
Doctor Sandra Mureșan, Primary Physician Family Medicine, MedLife
However, we must be aware of the fact that, in our daily activity, it is enough to follow a few simple rules of personal hygiene and we can avoid a lot of traps for our health. Washing hands with soap and water is a very effective “weapon” to fight infections of all kinds. In this context, we offer you a discussion with Dr. Sandra Mureșan, Primary Physician Family Medicine, MedLife Cluj, who explains in detail the causes, symptoms and treatment method for two of the most common infections in children, respectively streptococcal angina and scarlet fever.
— What are strep throats and how dangerous are these conditions?
— Streptococcal angina (streptococcal pharyngitis) is caused by bacteria from the group A beta hemolytic streptococcus or Streptococcus Pyogenes. There are other types of streptococcus that can cause pharyngitis, but we will refer to the group A one, because it occurs most frequently in children between the ages of 3 and 14 and because of the complications that can arise from this infection. Complications can be early (local – tonsil abscesses, adenoiditis, otitis, sinusitis, pneumonia), disseminated (sepsis, endocarditis, meningitis) and late complications: acute articular rheumatism, acute poststreptococcal gomerulonephritis or erythema nodosum. By carrying out the correct treatment, the risk of these complications is greatly reduced.
— What exactly generates these diseases and what are the conditions that favor them, what are the risk elements?
— As I mentioned, these sore throats are caused by beta hemolytic streptococcus of group A. It is a bacterium transmitted predominantly by the respiratory tract, through respiratory droplets, but other ways of transmission are also described, such as through contact with contaminated objects. In children between the ages of 3 and 14, streptococcal angina represents between 20 and 40% of all acute pharyngitis. Epidemics with beta hemolytic streptococcus are frequent in winter and spring and the risk of their occurrence is high in those who attend the community (kindergarten, school).
— How is strep throat diagnosed and what is the usual treatment?
— The difference between a pharyngitis of viral etiology and a streptococcal pharyngitis cannot be made with certainty only on clinical data, i.e. following a doctor’s consultation. On this occasion, I would like to specify that the diagnosis of streptococcal angina is made by the family doctor, the pediatrician or the infectious disease doctor and, necessarily, with the help of laboratory criteria.
There are clinical criteria that can guide us towards the streptococcal etiology of a pharyngitis: pharyngeal pain (sore throat) usually intense, age between 3-14 years, the epidemiological context – i.e. contact with an infected person -, generally medium or high fever ( over 38 degrees Celsius), chills, altered general condition. Usually, when it is a streptococcal infection, there is no cough, dysphonia (stuffy nose), rhinitis (runny nose), conjunctivitis, diarrhea. The latter are usually present in viral infections of the upper respiratory tract.
Many times, in medicine, a definite diagnosis cannot be made without the help of paraclinical examinations (this is valid for any disease), and in our case it is the pharyngeal exudate. As treatises on infectious diseases say, pharyngeal exudate is the “golden investigation” for the correct diagnosis of this disease. The presence of beta hemolytic streptococcus in the pharyngeal exudate has a diagnostic accuracy of 90-95%. There is currently also the possibility of performing rapid tests for the detection of streptococcal antigens. It should be noted here that a negative streptococcus rapid detection test does not exclude the presence of streptococcus. In this case, if the symptomatology, the clinical examination, the epidemiological context are suggestive of a streptococcal infection, it is recommended to perform the pharyngeal exudate.
Treatment of strep throat is mandatory with antibiotics. In this period when we are “struggling” with the use of antibiotics in excess, without a doctor’s indication, with the emergence of antibiotic resistance due to this, a correct antibiotic treatment must be carried out, both in terms of dose and period of administration. Antibiotics must be prescribed by a doctor. The “choice” treatment, that is, with the highest rate of sterilization of streptococcus, is penicillin. But this too must be nuanced according to each patient: his age, history of streptococcal infection, possible allergies, known allergies to penicillin, parental compliance. Of course, I will specify the other groups of antibiotics that can be used according to medical guidelines: amoxicillin, cephalosporins, macrolides (clarithromycin, azithromycin). The treatment must be carried out only on the recommendation of the doctor, taking into account the specifications made previously. In addition, we treat the symptoms with antithermics, oral disinfectants, effective hydration, isolation at home.
— How common is this disease and how can we avoid it?
— As I mentioned, the incidence of strep throat in children is between 20-40%, especially in the cold season and spring. Ensuring hygienic conditions in kindergartens and schools: airing the rooms, periodic disinfection, testing upon entering the community, detecting early cases and isolating them are ways to reduce the spread of this disease. Also, an important way to limit the spread of streptococcal infection is to inform parents in the community, not to overlook detected cases, to detect contacts both in the community and in the family environment.
— Decades ago, scarlet fever seemed to be an obligatory “crossing point” in childhood. What is the “status” of this disease now, what is its frequency of occurrence and how serious is the disease?
— First of all, I want to state that not all children who have been diagnosed with beta hemolytic streptococcus develop scarlet fever. Certain serotypes of strep, those that release an erythrogenic toxin will lead to this disease. Currently, the incidence of scarlet fever has decreased compared to other years, and it is not a disease that we have to “go through” mandatorily. It appears in outbreaks, in communities, has a high frequency in the cold season and has a multi-year evolution, that is, it appears in the form of epidemics once every 5-6 years. It is a disease that must be treated correctly due to the higher frequency of complications that can appear late, as I mentioned.
— What is the manifestation of the disease and how long does it take to heal?
— Scarlet fever appears in an epidemiological context in children diagnosed with beta hemolytic streptococcus. About 2-4 days after the appearance of the signs of acute streptococcal pharyngitis (mentioned above), a characteristic rash (“rush”) appears on the upper part of the trunk, then on the extremities, covering the palms and soles. This rash is rough to the touch.
Other signs appear: the characteristic “raspberry” tongue, an accentuation of the rash at the level of the envelopes. The rash disappears in about 6-10 days after onset, the skin may then peel off. Cases of scarlet fever must be reported to the public health authorities regardless of the doctor who diagnosed them: family doctor, pediatrician, school doctor, infectious disease doctor. This is done to be able to have a more accurate picture of the spread of scarlet fever, with the aim of limiting its spread.
Cases of scarlet fever are treated in hospital or at home, depending on the severity of the symptoms. If they are treated at home, they should be monitored to see how the disease progresses. Family contacts should also be followed for 10 days after the isolation of the scarlet fever patient to see if symptoms suggestive of strep throat or the characteristic rash appear.
“Does it have consequences we should be concerned about?”
— Failure to carry out a correct antibiotic treatment, both in terms of dose and duration (10 days), increases the risk of complications: poststreptococcal glomerulonephritis or acute articular rheumatism. Nowadays, the prevalence of these complications has decreased a lot. It is important that a “battery” of laboratory tests be carried out after the end of the treatment. It is recommended to be done approximately 30 days after the onset of the disease and is recommended by the doctor who followed the patient.
The treatment is the one recommended in streptococcal pharyngitis, explained above. If minor poststreptococcal syndrome appears following the laboratory tests, then its prophylaxis is necessary, that is, treatment must be given to try to “sterilize” this bacterium. We are talking here about prophylaxis with Moldamin. Everyone has heard of Moldamin, is afraid of it, both because of the allergenic risk of penicillin (it is a prolonged-release penicillin) and because of the pain that occurs when it is administered. There is good news regarding this aspect: currently the Moldamin formula has been improved, there is no more pain during administration and the risk of nodules at the injection site is greatly reduced. However, the risk of allergies remains, therefore, before administration, a penicillin test can be done. Speaking of novelties in the treatment of scarlet fever and post-streptococcal syndrome, other oral antibiotics (clarithromycin or azithromycin) are also used, the treatment regimens being established by the doctor.
– How do we avoid this disease?
— Washing hands with soap and water is the most important step in preventing this disease. Disinfection in the outbreak of scarlet fever detected in kindergartens, schools, nurseries. Health education of teaching staff, parents and children regarding the mode of transmission of this disease and the risk of streptococcal diseases.
I would also like to point out one aspect: I am often asked by parents if it is necessary to do antibiotic treatment in the case of healthy carriers of streptococcus. We must know that 20% of streptococcus carriers are asymptomatic. If it is not an outbreak, an epidemic, treatment is not mandatory. If it is an epidemiological context, as it is currently, if reinfections occur shortly after the end of a treatment, if there is a history of acute articular rheumatism in that patient, then pharyngeal exudate and treatment are recommended, including in healthy carriers. This is true both in the community and in the family.
Article sponsored by Medlife.
