If you are a regular listener of Portable Practical Pediatrics, you’ve heard me say things like, “From mommy all the way to matriculation”, if it involves children, we talk about it here. That’s my way of saying that I take on a variety of topics in this blog. Today is no exception. In today’s podcast, I am going to broaden your understanding of strep infections in children by telling you a story, a story that happened in my family almost a hundred years ago so stay tuned for a very interesting and historical edition of Portable Practical Pediatrics.
The Story of Blanch
Imagine you are a six year child and you have a five year old sister. The year is 1929 and your younger sister just came down with a sore throat, a fever, and is developing a rash. Your parents seem worried, very worried, and take her to the doctor who diagnoses your sister with scarlet fever, a relatively common form of strep throat that still exists today. Since this is 1929, there is no penicillin, no clindamycin, or any other medication for that matter that can treat this infection– and your parents and sister’s doctor know that fact. Your sister’s doctor makes some suggestions to help you dear sister get better, but in reality, her own immune system is all the healing power that she has available. Your parents and her doctor know she has about a 20% of dying from her infection. Your sister’s doctor recommends to your parents that they “treat her” by they leaving your sister’s window open to let in fresh air (thought at the time to be vital to good health), that they lower her body temperature with alcohol baths since her fever was thought to be the actual disease, that they start placing a “mustard plaster” on her neck to draw the illness from her throat, and that they make sure that your sister wears an undershirt to keep warm. Of course your sister was put in quarantine by the health department. You are sent to stay with relatives, banned from your own home and contact with your sick sister. Even in 1929, doctors understood that scarlet fever was very contagious and often lethal. Very sadly, the worst happens. Despite your parent’s faithfully following all the doctors orders and giving your sister all the loving care and attention that they could, your sister dies two days later. Your sister is now gone forever at the tender age of five years old and you are now an only child. Your parents are devastated and really never recover from the experience of their child’s death, especially your mother. Well, this is a true story and that six year old child was my mother who is now 93 years old. Those events actually happened in her family in 1929 and she still gets emotional to this day when she talks about her little sister.
Strep, A Brutal Foe
The strep germ has plagued children for centuries. Just listen to some of the terminology that developed to describe strep infections: scarlitina, erysipilus, impetigo, rheumatic fever, tonsilopharyngitis, omphalitis, and cellulitis. Sounds like you are reading words right out of a Dickens novel, doesn’t it? All this terminology was developed because strep infections have been devastating children for centuries, probably for millennia. Fortunately, a myriad of microbiologists, physicians, and other scientists in the 20th century developed potent ways to stop the serious damaging effects of strep and convert it to a mostly nuisance illness of childhood that it is today. But parents of young children still need to be knowledgeable about this potentially serious infection. In today’s pedcast, I am going to give my listeners some background about the biology and potential complications of Group A beta hemolytic strep infections, also known as strep throat in children. So, charge up that mp3 player, dust off your ear buds, and get ready to pay close attention to this important edition of Portable, Practical, Pediatrics. Get ready to find out what your strep IQ is?
What is Strep and why does it mainly affect children?
Strep is actually a genus of round bacteria (also known as cocci) that are capable of causing a lot of misery for both humans and animals. If you are listening to this pedcast, take a minute to look at the transcript of this post at my blog, www.docsmo.com and you will see a partial list of some of the strep species that are capable of causing disease. The strep that we are focusing on today and the strep that gets top billing with most parents is strep pyogenes. It is the one that causes step throat and scarlet fever among other diseases. It gets the name pyogenes because it is usually pus forming when it gets into a child’s body.
So why do children get most of the disease that is caused by strep pyogenes? Why is it that parents are rarely ill with strep when their children come to the doctor with strep, something that is not true when their children have the flu or a diarrhea illness? Well, the answer is simple; parents have been there and done that when they were children. Parents have developed resistance to many strep infections from having these illnesses when they were young. Their children however, are encountering these germs often for the first time. For them, no experience plus lots of exposure means sickness has arrived.
You are probably wondering if group A beta hemolytic strep causes plain strep throat AND scarlet fever. How are these infections different? They are not different except in the fact that with the scarlet fever strep strain, the strep germ has developed the ability to produce a skin toxin, that’s a protein that can damage the child’s skin at the same time it infects the child’s throat. These strep germs are referred to as scarlet strains- like the one that killed my aunt in 1929. It turns out that scarlet strains tend to be more virulent than the non scarlet strains as my family discovered.
Before Penicillin what happened to children with strep infections?
Most children simply recovered from their strep infection. Gradually, after many of these infections during their childhood, they became less and less prone to coming down with strep throat, including scarlet fever. Their immune systems just learned to fight it off even before it got started. But strep posed another real danger for children in 1929, before penicillin–it sometimes had another trick up its sleeve. The germ had the ability to provoke such a strong immune reaction in an infected young child that even after the germ was gone for a week or two, the infected child’s immune system would go crazy and start attacking various parts of the child’s body. This after strep immune reaction was known as rheumatic fever since joint swelling was such a strong part of the reaction. The child seemed to have recovered from the strep infection but now their joints swelled terribly, their heart enlarged, fever returned, and other bizarre things started happening to the child. Rheumatic fever could permanently damage a child’s heart, crippling them for the rest of their life. This germ is horrible. No wonder grandparents still get a fearful look to this day when a pediatrician tells them that their grandchild has scarlet fever or another type of strep infection. Fear of strep is visceral for them because they understand how dangerous this germ used to be.
Myths and Facts about strep infections
OK, now we have talked a little about strep infections in children, it’s time to put your knowledge to the test. I am going to ask you a series of questions related to strep infections and i want you to make your best guess at the answers. Here we go.
- -A child’s tonsils are the only part of their bodies that strep can infect? (Wrong)
2. -Doctors can tell who has strep throat by looking in a child’s throat? (Wrong)
3. -Unless a strep throat is treated, it will not go away? (Wrong)
4. -Once a child has had strep throat, they can’t get it again? (Wrong)
5. -The peak ages children get strep throat is between 4-8 years of age? (Correct)
6. -Scarlet fever is different form of strep throat? (Correct)
7. -Group A strep can provoke serious immune reactions that can injure a child’s heart or kidneys or brain? (Correct)
8. -Removing a child’s tonsils reduces their chance of getting strep throat? (Correct)
9. -Good hand washing or hand sanitizer use is a child’s best way of avoiding a strep infection? (Correct)
I hope that little exercise has broadened your knowledge about strep infections. Speaking of strep, have you ever read the story of the Velveteen Rabbit to your children. It is a classic children’s book, written in 1922 by Margery Williams. The book is actually partly about strep throat and scarlet fever. I recommend that you get this book out and read it again, now that you have more knowledge about scarlet fever and strep. And of course, read it to your children. They will enjoy the story and the time with you.
As always, thanks for joining me today. If you enjoy learning about child health with pedcasts, please take a minute to write a review on iTunes, subscribe to my blog at www.docsmo.com, or share an episode with a friend or family. And of course, write me with your comments and insights. I will share them with my many listeners. This is Dr. Paul Smolen, hoping when it comes to strep throat, we can soon say “that’s all she wrote”. Until next time.
My Thanks to Dr. Monica Miller for editing this pedcast. Thanks Monica.
Table of strep species
Amazon link to Velveteen Rabbit illustrated book