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June 19, 2012 > A sore throat can be a big deal

A sore throat can be a big deal

By John Giddens, M.D.

So, what's the big deal about a sore throat?

Let's say you have a sore throat. Not the mild, scratchy variety accompanied by a stuffy nose and a little cough. This sore throat really hurts. There may be a fever and you may have swollen glands in your neck. You wait it out for a couple of days but it doesn't get better. What should you do?

Go to the doctor. He will swab the back of your throat with a stick, and may say: "You have strep throat." He gets a serious look on his face. What's the big deal? It's just a sore throat, right?

"Strep throat" is shorthand for Streptococcus Pyogenes Group A Pharyngotonsillitis (Now do you see why it's called strep throat?).

Strep is unique among germs. If you do not treat strep throat, for a full ten days with the correct prescribed antibiotic, more serious conditions may be triggered: Rheumatic Fever and Post-Streptococcal Glomerulonephritis (a form of kidney failure).

First let's talk about rheumatic fever. If you haven't heard the term rheumatic fever before, it's because, thankfully, it's rare these days. I have been a doctor for 32 years and personally, I have seen only two cases. Curiously, both patients were young women who were traveling in Italy when they became ill with sore throats. One case was in 1982, and the other in 2002. Luckily, neither suffered any of the serious complications of rheumatic fever.

So what's the big deal about rheumatic fever? Rheumatic fever can be a devastating disease. It can cause heart failure, scarring of the heart valves requiring open-heart surgery to replace the damaged valve, chronic arthritis and more. The typical scenario is for an individual to contract strep throat and not see a doctor. Their body's immune system fights off the strep infection and they think they are well, but two-four weeks later they get rheumatic fever.

Symptoms of rheumatic fever are often bizarre and puzzling. Besides fever, there is swelling and aching of the joints and a strange red rash may develop. The heart may become inflamed causing shortness of breath, fatigue, malaise and irregular heartbeats. The strangest manifestation of rheumatic fever is called Sydenham's Chorea, which at one time was called St. Vitus Dance. It is a condition characterized by rapid, uncoordinated jerky movements involving mostly the face, hands and feet. It can occur at the onset of acute rheumatic fever or up to six months later. Patients can develop 'milking hands' in which their hands move spontaneously as if milking a cow. They can have tremors of the tongue and strange facial grimaces in addition to the sudden and uncontrolled jerking of their hands or feet.

Compared to rheumatic fever, poststreptococcal glomerulonephritis seems benign. Glomerulonephritis is a type of kidney disease which results in acute kidney failure. Though it is usually caused by a strep infection of the skin (impetigo), it can also be caused by strep throat. Again, the symptoms are fatigue and malaise and often swelling of the legs as the kidney fails to perform its function. Luckily, most cases resolve spontaneously, though progression to chronic renal failure and the need for dialysis is a possibility.

If you are diagnosed with strep throat there are three very important things you must do:

Throw away your toothbrush on day three of your medication.
Make sure you take your antibiotic until it is gone.
If, after being off your antibiotic two-four days, your symptoms return and your throat becomes sore again, call your doctor immediately.

There you have it: the big deal about a sore throat. May you never get one, but if you do, remember no appointment is necessary at Fremont Urgent Care providing urgent medical care and occupational medicine services to the Tri-City area since 1984. We are located at 3161 Walnut Avenue, Fremont; contact us at (510) 796-1000 or visit www.fremonturgentcare.com

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