JOSEPH R. ANTICAGLIA MD
Medical Advisory Board
A sore throat can be more than a throat that hurts. It can vary from mild to severe, from viral to bacterial and the consequences range from insignificant to life changing. Testing for strep can make all the difference.
The throat, or oral pharynx, is a passageway that begins in the back of the mouth and goes down to the area of the voice box. It’s a pathway for food that leads into the esophagus that squeezes the food into the stomach. The pharynx is also a passageway for air from the nose and mouth that eventually winds up in the lungs.
Consider Linda, an 11 y/o girl, whose mother told the ER doctor that her child has had a one week history of a mild scratchy, sore throat. Her mother continued, “Two days ago, Linda developed a low grade fever and her sore throat became so painful she was barely able to swallow solid foods. This morning she had trouble swallowing liquids. When I took her temperature it was 103F and now she says her ear hurts.”
Upon examination, she’s in distress and she is dehydrated. She cannot open her mouth normally. She’s drooling and when you put a tongue depressor in her mouth to exam the back of the throat, she screams out in pain. The back of the throat is inflamed; she has bad breath, the tonsils are red, enlarged and touching each other. The lymph glands in the neck are swollen and tender.
An IV (intravenous fluid) was started in the emergency room, her dark urine was collected and analyzed. A culture & sensitivity (C&S) was obtained from the back of the throat and antibiotics given through the IV. The laboratory reported Linda tested positive for group A streptococcus.
Strep caused her sore throat, tonsillitis and the dark color to her urine. Unfortunately, ‘strep throat’ is a pernicious infection that has a tendency to spread beyond the pharynx and attack other organs if not treated early and adequately
Despite being admitted into the intensive care unit of the hospital, the administration of IV fluids and sensitive antibiotics, her condition rapidly deteriorated. She suffered kidney failure and was placed on a dialysis machine to keep the chemicals in her body in balance, eliminate waste and control her blood pressure.
Another situation involved Jacqueline, a 37 y/o mother of two children, who complained of joint pain and shortness of breath over the past year “that keeps getting worse.” She finds it more difficult to walk up the two flights of steps to her apartment and now has trouble walking two blocks to go shopping without getting out of breath. . She made an appointment to see a cardiologist and told him: “I’ve always had a lack of energy and at times I get heart palpitations.”
She mentioned that years ago, when she was a young girl living at home, her sister had a very bad sore throat, high temperature and an abscess in her neck that had to be cut opened and drained. About a week later Jacqueline said: “I got a sore throat and a fever that went away. What was peculiar, three weeks later, on my 13th birthday, ‘my joints started to ache?’ Everyone said I was experiencing ‘growing pains’ and indeed they went away and I never thought of it until recently. Over the past year, I noticed my joints are bothering me again.”
When the cardiologist listened to her heart, it occasionally skipped a beat and he heard a heart murmur. A cardiogram (EKG) done in his office was abnormal in part because of irregular heartbeats. The doctor informed Jacqueline that more tests are needed, but he suspected a damaged heart valve to be the problem.
Damage to the heart valve is a common complication of rheumatic heart disease due to streptococcal infection. Most likely she got the strep infection from her sister. Jacqueline needed cardiac surgery for her diseased heart valve (‘prolapsed mitral valve’) that was causing a backflow of blood and her problems. The surgery was successful and afterwards she said: “I feel as if I have a new lease on life.”
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Now back to Linda. She successfully got off the dialysis machine and is enjoying her teenage years. Strep throat can provoke painful symptoms as in Linda’s case or it can be relatively silent for years as in Jacqueline’s case. . Both cases demonstrate the devastating effects of untreated streptococcal infections.
The take home message; untreated streptococcal infections can cause life changing complications. Make arrangements to get a throat culture if you or your child has recurrent or persistent sore throats. If the sore throats are recurrent, it may be worthwhile to have family members get a throat culture as well.
Although most sore throats are viral, a positive strep throat test demands the early use of antibiotics to prevent renal complications, rheumatic fever and other serious complications. Gargling in these instances with salt water will delay valuable time for the successful treatment of strep throat.