As retired physicians, my husband and I don’t see patients anymore, but sometimes an employee will ask to be seen, and if it needs medicine, we send them on to get free care from our niece.

Usually it’s just a cold or headache, but a couple weeks ago, one of our staff brought in her eight year old who had high fevers for three days, and was developing a rash. She was worried about Dengue, since there have been some cases in the area.

However, when we checked the child, he had no signs of Dengue, but a red throat and a fine “sandpaper” rash of scarlet fever, so we treated him.

Strep throat and tonsillitis is common all over the world, and most cases go away with or without treatment. The tonsillitis and glands of Strep looks the same as some viruses, especially mononucleosis, so most docs do a throat swab for strep before treatment, so we aren’t giving out penicillin when the person doesn’t need it.

People nowadays don’t usually worry too much about strep. Oh, there are complications sometimes, such as once every couple of years we see an abcessed tonsil, but most people just take an antibiotic and two days later are better. Usually it’s penicillin, but a cephalosporin or Zithromax or Erythromycin will do. To prevent relapse, you are supposed to take ten days worth of medicine, but 90% of people don’t take it correctly, so we do see some people back in two weeks who admit they “forgot” to finish the medicine.

Now, most people don’t consider tonsillitis that serious, but that is not necessarily true. Untreated strep can lead to immune reactions against the kidneys and heart: the much dreaded diseases Rheumatic fever and Acute Nephritis,(acute post streptococcal Glomerulonephritis).
Back in the 1940’s the germ was much more vicious, causing 33 cases of rheumatic fever per 100 000 cases of strep throat. Now the percentage is much lower, 1-2 cases per 100 000. But in the third world, I still saw a lot of cases, and most docs have a few people with bad heart valves from having had rheumatic fever as a kid.

The other disease, Nephritis, is more common after a strep infection of the skin, i.e. impetigo.(Moms know this, it’s where you get a mild infection on a cut or bug bite or face of your child, and it is reddish oozy and has yellow scabs). And unlike Rheumatic fever, it can occur even if you treat the infection. Ten days later, the child’s face swells up and starts urinating blood. This can be fatal, or lead to permanent kidney damage, but luckily in kids most cases are mild.

Although I mentioned the strep germ has become milder over the last fifty years, there have been outbreaks of more severe types.

And there are other ways Strep can infect the body. If a person has a weak immune system, it can spread through the body like wildfire, causing the body to go into shock and even die. (Acute Septic shock).
And another sub-type of the strep germ can cause “flesh eating bacteria”, where the infection spreads quickly and a lot of people can die. We had one case where literally we could see the infection spread in front of our eyes during the two hours while we were arranging transfer to the city hospital. That lady luckily made it, but it took two years of skin grafting and rehab to be back to normal.

But for most people, skin strep is either mild impetigo, or what is commonly called “blood poisoning”, where a cut or bugbite gets red and red streaks go up your arm or leg and starts to hurt. Again, in pre penicillin days, this was highly fatal, but most cases are treated by the local doc and better by the next day.

The Strep germ has quite a few other types, including the strain that can infect newborns.

So the simple strep throat or tonsillitis can be bad, and the germ can even kill. But luckily since we have had penicillin, few docs have seen the problems that killed many children and adults in the past.

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Nancy Reyes is a retired physician living in the rural Philippines with her huband. Her website is Finest Kind Clinic and Fishmarket. Her medical essays are usuall posted to Hey Doc’s Xanga blog

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