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Poststreptococcal Inflammatory Syndromes

Following any infection by a group-A streptococcus bacteria (such as strep throat), a number of different inflammatory syndromes can occur in the body. These include:

  • rheumatic fever
  • poststreptococcal reactive arthritis
  • poststreptococcal glomerulonephritis

These “post-strep” diseases can affect people of all ages, but are most common in children and teenagers. They usually occur at least one week after strep infection. However, it may not be apparent that the patient was previously infected with strep, since some infections may cause no immediate, recognizable symptoms. In fact, the symptoms associated with these diseases are not caused by the strep bacteria itself but rather by the immune system’s response to the prior infection.

Symptoms

  • Reumatic fever affects the joints, skin, heart, blood vessels and brain. In addition to fever, it can causes several other symptoms, such as arthritis (joint inflammation), rashes, subcutaneous nodules (bumps under the skin), chorea (involuntary movements of the extremities) and heart disease. The arthritis typically moves from joint to joint and may be very painful.
  • Post-strep reactive arthritis also causes joint pain and swelling, but patients do not typically have heart disease or other symptoms associated with rheumatic fever.
  • Post-strep glomerulonephritis patients have changes in the color their urine and may have swelling in their feet or face. This disease is a kidney disorder and requires a consultation with a nephrologist (kidney specialist).

Diagnosis

If rheumatic fever or another strep-related disease is suspected, your child’s doctor will perform a throat culture and/or send blood work to look for evidence of a prior strep infection. Blood work may also be useful to look for general signs of inflammation or to rule out other causes of the symptoms. If post-strep glomerulonephritis is suspected, your child may be referred to a cardiologist to get an EKG (electrocardiogram) and echocardiogram, or to a nephrologist.

Treatment

If there is concern for strep, the patient will be prescribed antibiotics. Typically, penicillin or amoxicillin are prescribed. If the patient has a history of allergies to these medications, a different class of antibiotics may be used. After completing a treatment course of antibiotics, children with rheumatic fever are typically treated with low-dose antibiotics until adulthood in order to prevent reinfection and possible heart damage. Aspirin and other NSAIDs are helpful for joint pain complaints Other medications may be required if other organs are affected.

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