Monday, August 1, 2011

Sore Throat, skin rash, yet another strep infection

I saw a lot of patients in the urgent care clinic setting.  Generally they were the acutely ill with an upper respiratory infection or an urinary tract infection.  Today was no exception. 
            I knocked on the exam door and walked in.  “Hi, I’m Sharon, I’m a physician assistant, how can I help you?”
            The patient was 15 years old, a typical looking teen-age male, whom I’ll call Drew. 
            “I’m having a bad sore throat, it hurts to swallow, my nose is dripping, I have this bad headache and I don’t want to eat.  I’m also all sweaty.”
            “Okay, Drew, how about any cough?”
            “Some, not bad.”
            “When did you symptoms start?”
            “About two days ago.”
            “Strep is going around the community, have you been around any small kids who have had it?”
            “No, not that I know of.”
            I went ahead and took his medical history, family history and then did his physical exam. 
            “Your throat and tonsils are just plain nasty red, Drew and you have the typical white exudates on your enlarged tonsils.  Are your glands here in the neck tender to touch?”
            “Yeah, especially on the left side.”
            “How long have you had this rash?”
            Drew looked at his skin and it dawned on him that his skin was redder than normal.  “I don’t know, I didn’t notice my skin until just now.”
            “Well Drew this fine red rash you have which blanches, as well as the linear red lines on the inside of your elbows is a sign of strep.  It’s called a scarlet fever rash.”
            Drew had the scarlet fever rash over both arms, chest, neck and face.  His temperature in the clinic was also 101.5. 
            “Okay, Drew you have strep throat with the typical skin rash which goes along with it.  I’m going to start you on an antibiotic called amoxil, which you will have to take for 10 days, three times a day, okay?”
            “You’re going to be infectious towards others for the next 24 hours, so no kissing of your girlfriend or coughing on anyone, understood?”
            “Okay, well here’s your antibiotic prescription, you can go home after you pick up the amoxil and make sure to drink plenty of fluids so you stay hydrated and you can take some Tylenol or motrin for your fevers.”
            Drew got up and left the clinic exam room with his script in hand. 

            Years ago when patients used to get strep infections they could end up with scarlet fever (which is strep throat with the skin rash), or just strep throat.  Even as late as the 1950s patients who came down with either of these forms of strep would need to recuperate at home for as long as six weeks.  They didn’t have the antibiotic armamentarium we have now to treat infectious agents.  Patients who had strep as a child (as late as the early 1950s) and were not treated for it with the appropriate antibiotics could then end up with post-streptococcal complications which included inflammatory arthritis (joint swelling/pain), cardiac (heart) valve scarring which over time would lead to the patient needing to have the heart valve replaced via open heart surgery.
            Nowadays patients are treated up front with a penicillin based antibiotic and they no longer suffer the long term sequalae of strep infections.  Thankfully we have antibiotics for strep, because even today this is a favorite of the young kids to spread among themselves and their older siblings.
            The fact that we don’t have the long term consequences of strep that we used to have just goes to show how much medicine has progressed and preventing illness’ that used to be common place just a mere 60 years ago. 
            So if you have a sore throat, and it feels as though you are ‘swallowing razor blades’ or you have been around someone with strep and all the sudden come down with a bad sore throat yourself, check in with your physician.  You may have acquired this common bacteria and need antibiotics yourself. 


  1. That's really great interaction with patients. Some herbal tea can provide relief from the symptoms of sore throat or you can try most commonly used remedies is salt water gargle.