The spotlights on Covid have gone out – although it should be emphasized that it still exists and is contagious – and they have turned on streptococcus. A real epidemic that is affecting everyone without distinction, but especially children. Now that’s all we talk about. Analysis centers and pharmacies do rapid swabs and cultures in large quantities, the telephones of pediatric studies are hot and the diagnosis is often the same: Group A beta-haemolytic streptococcus, to be treated with antibiotics.
But why is it only now that we hear so much about strep and why is it essential to treat it well and immediately? We talked about it with the pediatrician Valentina Paolucci, better known on the web as “The children’s doctor”, very active on Instagram, Facebook, TikTok and, recently, also on Youtube where she explores specific issues of the world of pediatrics in a simple and understandable way .
Doctor, let’s clarify a bit: what is streptococcus?
The strep that needs to be treated and which is a pathogen for children and adults is Group A beta-hemolytic strep, also called Streptococcus pyogenes. It is a bacterium that dwells in the pharynx, in fact it gives pharyngitis as its first symptom, therefore sore throat, with the formation of the typical plaques. It can also manifest itself through a cutaneous form, or scarlet fever, of very small and reddish bubbles.
How do you know it’s just scarlet fever and not another rash disease?
Scarlet fever is also called the “velvet effect” because it affects more or less the whole body evenly. Furthermore, there is a test that we can all do, it consists of pressing a finger on the tummy or on another area affected by the rash, releasing a yellow imprint on the skin. In fact, there is talk of “yellow hand sign” and it is precisely a characteristic of scarlet fever. Then, of course, there are the swabs which are essential for the diagnosis.
Can you be asymptomatic?
Yes, there are 30% healthy carriers. It is good to say that strep should only be treated if there are symptoms. There has been a real swab rush lately: was there a case of strep in class? All the parents took their children to be swabbed even if they had nothing, so asymptomatic positives came out and were treated with antibiotics. In reality it is good to tell mothers and fathers that the swab must be done only and exclusively in symptomatic children, who therefore have pharyngitis, fever, scarlet fever.
What is the distinction between swab and culture?
The difference is substantial: if we urgently need a diagnosis, a quick swab is done which, a bit like that of Covid, gives the answer in 10 minutes. If it is positive, it usually responds to the amoxicillin molecule, so pediatricians give this antibiotic by default. However, it happened – and this epidemic brought it to light – that after therapy, many children did not improve and repeating the swab still tested positive. For this reason it is advisable to also do the culture swab that shows the antibiogram, therefore the most sensitive antibiotic for rooting that bacterium.
What happens if you don’t treat strep well?
It is good to say this: even if not treated, streptococcus heals by itself, it has its own life cycle, but if not reclaimed it has the ability to become chronic in the body and produce, to evade controls, a series of antibodies that go to attack the heart valves, the joints, the kidneys, they give the so-called rheumatic disease but weeks or months after the infection. This rheumatic disease leads to monthly injections of penicillin for at least 5 years or even until the age of 21. The percentage of cases in which this occurs is very low, but it has a very important impact on life. It is good, therefore, not to abuse the swab, but not to be light-hearted in not treating any streptococcus accurately.
Only now do we hear so much about strep, why? Was there never an epidemic like this before?
Small outbreaks form every year. Surely the media process since Covid has led to amplifying everything, we are always on the alert. The infections really exist and the explanation that we pediatricians are always giving ourselves is that debt of immunity that two years of masks have developed in everyone. Emergency management, distancing, have generated few infections, our body has trained little and now we are paying the consequences, especially children.
So, in summary, what are the main symptoms of strep?
Pharyngitis with fever, the child speaks in a slurred voice because the tonsils have swollen, sore throat, fever, plaques, scarlet fever.
How does the infection occur among children in the first place?
The contagion occurs through particles of saliva, because it is in the pharynx precisely. So coughing, sneezing, exchanging games are among the main causes of contagion.
How long does the incubation last and after when do symptoms appear?
The incubation is less than a week, about 4-5 days.
Can strep throat be prevented? What precautions can be taken?
Hygiene mainly. There are also supplements that perform a vaccine-like action and make the body ready to recognize this type of strain, but you get infected anyway.