Strep throat and rheumatic heart disease

One evening three weeks ago, one of my sons complained of sore throat and had fever overnight. When I took him to the doctor the following day, he was diagnosed with acute tonsillitis and tested positive for Streptoccocus (strep throat). The pediatrician asked me why I waited too long before taking him to see her. I didn’t. But she was right in being concerned. Because strep throat can possibly lead to rheumatic fever and even rheumatic heart disease.

Strep throat is the common term for inflammation of the tonsils, named after the bacteria Streptococcus pyogenes, one of the most common causes of tonsillitis. Testing for strep throat is usually done by wiping a sterile cotton swab at the back of the throat and inflamed tonsils. A quick strep test on the swab is done immediately using a testing kit and takes only a few minutes.

In cases where strep is left untreated, a particular strain of the causative bacteria (group A β-hemolytic Streptococcus, or GAS pharyngitis) can cause rheumatic fever.

Rheumatic fever is an inflammatory disease that can affect many of the body’s connective tissues, especially those of the heart, joints, brain or skin. When the heart valves are damaged by rheumatic fever it leads to rheumatic heart disease which can last a lifetime. …Rheumatic fever/rheumatic heart disease continues to be the leading cause of cardiovascular death during the first five decades of life in the developing world.

When diagnosed early, strep throat is easily treated with antibiotics. My son was prescribed with an oral penicillin-based antibiotic and he was as good as new the following day.

Strep throat, however, is easily misdiagnosed. Most cases of sore throat in children are actually caused by viruses and are not strep throat as such. Viruses do not respond to antibiotics. That is why performing a strep throat test is necessary to rule out Streptococcus. In some cases, a laboratory culture that takes 24 to 48 hours to give results may be necessary. According to an updated American Heart Association (AHA)scientific statement, “accurately diagnosing and treating strep throat is the key to preventing rheumatic fever and subsequent rheumatic heart disease.”

When treated with antibiotics, the patient will usually feel better within a few days. However, there are several things to keep in mind:

• It is important to continue with the medications till the full course of treatment is finished.
• It is also important that the patient be checked again by the doctor after a couple days. In some cases, an abscess behind the tonsils(peritonsillar abscess) may develop which would necessitate surgery.
• Strep throat is highly contagious. Avoid sharing eating utensils with a person with strep throat.

I was relieved when my son was given a clean bill of health on his second visit to the doctor. And I was also relieved no other family member got it. But I learned from the experience and from the latest AHA statement that there is more to sore throat than just difficulty in swallowing. It is definitely something to be taken seriously!