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Strep, Scarlet Fever Share Symptoms, Cure

Battling Back From Life-Threatening Strep

It was a typical Saturday in March 2006 for healthy 9-year-old Tyler Wiesmann. He played in a basketball tournament, went to a party afterward and had a great time playing with friends. When Sunday came, however, things were very different. Tyler awoke that morning and told his mom, Jennifer, and dad, Mark, that he couldn't put any weight on his left foot.

As his temperature rose throughout the day, his parents realized something was very wrong. A life squad rushed Tyler to Cincinnati Children's where doctors discovered he had a severe streptococcus A infection. It had made its way into his bloodstream and settled in his hip, sending him into septic shock.

His parents recall that he almost didn't make it. In intensive care, Tyler had to be resuscitated. Then, after nearly a week of worry and prayer, they finally saw him take a turn for the better.

Still, Tyler would spend the next four months in the hospital: six weeks in intensive care and nine weeks lying in bed. The infection was so severe, he had to have all of his toes and portions of the fingers on his right hand amputated.

Now, Jennifer says, Tyler has prosthetics for his shoes to help him walk. Ongoing therapy at Cincinnati Children's is helping him re-learn how to do many of the daily activities that were second nature before the infection.

He's such a determined fighter. He has taught himself to write left-handed and how to tie his shoes," says Jennifer. "It's amazing to see him a year later. During the school year, he went from a wheelchair to a walker to a cane. By the end of the school year he was running."

Tyler is continuing his rehabilitation at Cincinnati Children's Mason Campus, and he is focusing on learning those sports he can participate in despite his injuries, including golf and placekicking for football.

Jennifer says Tyler's experience demonstrates just how serious strep can be. "Strep is so common, yet Tyler's case was life-threatening," she explains. Jennifer advises parents to be aware of the symptoms of strep and to seek help immediately if your child shows any of them.

"Strep is nasty," she warns. "Don't mess with it."

After a restless night, your 9-year-old plops down at the breakfast table complaining that she's having trouble swallowing because her throat hurts. Just a sore throat, you wonder, or could it be strep? Is it worth keeping her home from school to see the pediatrician?

Yes, says Lauren Peck, MD, if the symptoms also include a high fever that came on suddenly and swollen lymph nodes on the neck.

"Not all sore throats are strep. Many are caused by viruses that will run their course," says Dr. Peck, with Liberty Sharonville Pediatrics. "Doctors will treat the symptoms to ease the child's pain."

Take a Stand Against Strep

Unlike a sore throat, strep throat is caused by group A streptococcus (strep) bacteria. It can and should be treated.

Although strep throat sometimes clears up on its own, pediatricians recommend a round of antibiotics, which reduce serious consequences, ease the severity and duration of symptoms, and help prevent the spread of infection to others.

The highest incidence of strep throat occurs among grade school children, says Dr. Peck. "Winter and early spring are the heaviest times for strep, which can spread quickly through classrooms and families."

Sometimes the sore throat, fever and swollen lymph nodes are also accompanied by a headache, stomach pain, nausea or vomiting. A more toxic strain of strep includes a rash that leads to a diagnosis of scarlet fever.

Signs of Scarlet Fever

"It's a fine sandpaper-like rash, like sunburn, mostly in the body creases, such as in the armpits or private areas, but it can appear anywhere. Scarlet fever is no more dangerous than strep throat, and is treated the same way," says Dr. Peck.

Pediatricians test everyone who has the three primary symptoms, using a rapid strep antigen test. If the test is positive, the child will begin a course of antibiotics. Since the rapid strep test can miss 10 percent of the cases, doctors often follow up a negative initial test with a full throat culture when the symptoms are present.

Because strep spreads rapidly from person to person through nasal or oral secretions, children should not return to school until they've been on antibiotics for 24 hours and have been fever-free for 24 hours. To prevent recurrence, it's important that they stay on antibiotics for 10 days, even if their symptoms subside.

Early Treatment Avoids Complications

Stopping antibiotics too early or not treating strep can lead to serious health risks, according to Dr. Peck. These include inflammation of the kidneys, invasive strep in the bloodstream (see Tyler's story at right) or acute rheumatic fever. While rheumatic fever has become rare since the advent of antibiotics; symptoms include permanent inflammation of the heart, arthritis, a rash and rapid, non-purposeful movements.

Some children are more susceptible to strep than others, ending up in the pediatrician's office regularly. If strep is treated, however, it is curable with no longterm side effects.

"Strep may be highly contagious, but you can lower the risk of contracting it," says Dr. Peck. "Children should avoid exposure to those who have it and should be reminded of basic good hygiene, such as covering their mouths and noses when they sneeze and washing their hands thoroughly."