Strep throat 469

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medication, children will not experience this. Instead, parents should watch for behavior patterns to help assess how Strattera works, such as sitting through dinner time, settling at bedtime, getting off to school in the morning, or participating in group activities.

Side Effects

Side effects of the drug include decreased appetite, upset stomach, nausea or vomiting, and fatigue.

strawberry birthmark Also called strawberry nevus, this is a bright red birthmark that usually appears shortly after birth, when it enters a rapid growth phase during the first several months. Growth then gradually slows down and stops, beginning to regress by age one. Most of these birthmarks will have disappeared completely by age seven.

Treatment

Because these birthmarks eventually disappear on their own, treatment is not often recommended. Treatment is indicated when the mark grows rapidly, interfering with function or vital organs. In most cases, a limited course of oral corticosteroids will cause the marks to regress.

strep throat The common term for streptococcal pharyngitis, a bacterial throat infection caused by group A beta-hemolytic Streptococcus, a bacterium also known as S. pyogenes. Only group-A strep causes the infection known as strep throat; most kinds of sore throats are not strep infections.

Strep throat usually affects school-age children in the winter and spring in temperate zones of North America. Some children have a tendency toward developing multiple strep throat infections, while others rarely come down with the disease. It is rare in children under age three.

Because there are many types of group-A strep bacteria, one bout of strep throat does not confer long-term immunity; children can therefore come down with repeated episodes.

Cause

Some children carry group A strep in their throats and nasal passages and remain healthy, but these

"carriers" can spread the infection to others, as can those who are actively ill. A sneeze or a cough can project the organisms up to two feet, so it spreads easily in schools and group living situations. Some epidemics have been traced to infected health-care workers in operating rooms and to infected food handlers; other outbreaks have been caused by eating contaminated food.

Children are most infectious in the beginning of the illness; untreated, a child is infectious for 10 days to three weeks. Carriers are infectious for two to three weeks, although the bacteria may be carried in nose and throat for several months. Those who receive antibiotics are no longer infectious after 24 hours. This means that children with strep throat can go back to school or child care one or two days after receiving an antibiotic, if they feel well and have no fever.

Symptoms

Up to half of all children with strep throat have no symptoms but are considered healthy carriers. If symptoms do appear, they show up one to three days after the initial infection. Young children often have high fevers and red, swollen throats, but their throats are usually less painful than those of adults with the same infection. A few children (one in 10) become quite ill, with extremely high fevers, nausea, and vomiting. Most children simply have a sore throat, fever, and pain in swallowing.

A strep throat is different from the sore throat caused by a common cold or the flu. With strep throat, there is no runny nose or cough, and symptoms appear abruptly, with a fever as high as 104°F, headache, stomachache, and a red, swollen throat. By the second day, the throat and tonsils may be covered with white or yellow patches that spread together to cover the entire throat. However, it is also possible to have strep throat without these telltale white patches, or even without a fever.

Most children with strep throat also have swollen lymph glands in the front of the neck just below the point where the ear and jawbone meet. These glands may remain swollen for up to a month after recovery from the infection.

WARNING SIGNS OF STREP THROAT COMPLICATIONS

The doctor should be notified immediately for any of the following signs:

• breathing problems

• drooling in older child

• extreme problems in swallowing

• fever that goes away and then returns

• less urine than normal

• no improvement in two days

• vision changes

Diagnosis

Because almost all of the symptoms of strep throat also can occur with viral infections, lab tests are needed to confirm the diagnosis. Anyone with a suspected strep throat should be seen by a doctor for a throat culture or rapid strep test. A throat culture is the best, most accurate test, but rapid strep tests are also widely used in doctors' offices and can give results within three minutes.

Treatment

A positive strep test requires antibiotic treatment to prevent complications. Antibiotics given seven to nine days after the illness starts will prevent rheumatic fever. High temperatures may be treated with fever reducers; easy-to-swallow food or cold food (ice cream, mashed cold bananas, or frozen juice bars) are good choices. Fluids are very important in the treatment of strep throat.

Complications

The risk of severe complications is the primary concern with strep throat and the reason why it is so important to be properly diagnosed and treated. one of the most serious complications is rheumatic fever, a disease that affects up to 3 percent of children with untreated strep infection. Rheumatic fever can lead to rheumatic heart disease.

Kidney inflammation is another possible complication of strep throat, which can appear from 10 days to six weeks after the throat infection. In this case, the bacteria do not directly infect the kidneys; instead, the body's immune system response damages the kidney's filtering mechanism. Warning signs of impending kidney problems include swelling hands, face, and feet; dark or bloody urine; headaches; vision problems; and decreased urinary output. Children usually recover, albeit slowly.

scarlet fever is an uncommon strep infection that may follow untreated strep throat within two days, producing a fever and a red rash over the upper body. With antibiotics, recovery is complete within two weeks, although skin may peel on fingers and toes afterward. A severe form of scarlet fever can cause serious illness.

Prevention

People should avoid any child with strep throat who has not received antibiotics. Children should not return to school until they have taken antibiotics for 24 hours, or if there is still a fever and sore throat. (See also streptococcal infections.)

streptococcal infections A group of infections caused by bacteria of the Streptococcus family, which are among the most common bacteria in humans. These infections are responsible for a wide range of health problems, including scarlet fever or wound infections. Different groups of Strep bacteria are separated according to letters, from Group A through T. Some types of strep exist harmlessly in the throat; if the bacteria gets in the bloodstream, they are usually destroyed, unless the child has a heart condition, which may lead to bacterial endocarditis. other types of strep bacteria can lead to sore throats, tonsillitis, ear infections, strep throat, or pneumonia. These same bacteria may lead to rheumatic fever.

Common throughout the world among school-aged children, incidence of infection has decreased since the beginning of the 21st century. The dangers of resistance to antibiotics were of little concern with these infections until the 1970s, when penicillin-resistant strains of strep bacteria began to crop up. In addition, various types of strep bacteria continue to mutate, some becoming less virulent and others becoming more so. For example, as strep A infections became less worrisome, strep B infections became more virulent. Then in the 1980s strep A became more dangerous again; a much stronger S. pneumoniae is part of this resurg-ing tide of infection.

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