DEAR DR. GOTT: When my son was in elementary school, I took him to the doctor for a sore throat with fever. He stated it was probably a virus and to just treat it with Tylenol, rest and fluids. After a few days the sore throat cleared and my son was feeling better. I believe it was about two weeks later that we returned to the doctor because I noticed he had a very enlarged lymph node in his neck and a sore neck. The doctor’s eyes about popped out of his head and he exclaimed, “He’s got strep!” He then prescribed an antibiotic and the node went down and my son has seemed fine. He is now 16 years old and during a routine BP check at school he was found to have an elevated BP. I recheck him at home and it was 140/84. could this be related to the late treatment for strep? I know that untreated strep can cause heart problems. The doctor I had seen is no longer in the same practice and I would not go back to him in any case. How concerned should I be? What are your recommendations?
DEAR READER: Strep is a bacterial infection, most commonly of the throat, but it can also affect the skin, tonsils, sinuses, middle ear and blood (typically following throat infection).
Symptoms are similar to those of more common viral throat infections but are usually more severe. These include throat pain, difficulty swallowing, tiny red spots on the roof (soft and hard palates) of the mouth, red/swollen tonsils that may also have white patches or streaks of pus, fatigue, fever, swollen and tender neck lymph nodes, headache, rash, and stomach ache that may cause vomiting.
Diagnosis is most commonly made with a throat culture which can take up to 48 hours before results are known. Another possibility is a rapid antigen test, often done in office, that gives an answer in minutes but can result in false negatives. The final diagnostic test is the newest — a strep DNA test which is considered as accurate as the culture but results can be seen in 24 hours or less.
Treatment consists of antibiotics, fluids, rest, and over-the-counter pain relievers.
If strep is not treated, serious complications may occur but in the US this is extremely uncommon. Heart problems are not directly caused by strep but indirectly by a reaction caused by the bacteria. These include kidney inflammation (post-streptococcal glomerulonephritis), rheumatic fever, and scarlet fever.
Rheumatic fever is characterized by joint pain and swelling, a rash, heart valve damage and failure. Typically the heart damage causes fatigue, murmur, shortness-of-breath, palpitations, edema (fluid-retention and swelling) and more. Valve damage typically causes low blood pressure.
Post-streptococcal glomerulonephritis can cause rust-colored urine, edema, decreased urine output, joint pain and stiffness. Kidney damage can cause high blood pressure, but if your son developed this complication, he would likely have other symptoms as well.
In my opinion, your son’s current blood pressure issue is NOT related to his delayed strep throat treatment. (I wrote about teenage hypertension a few months ago which you can read on my website at: www.askdrgottmd.com/17-year-old-with-high-blood-pressure-cant-keep-up/.)
High blood pressure increases the risk of heart attack and stroke. Your son needs to be under the care of a physician, preferably one familiar with hypertension in teens, who can monitor him and test for any possible underlying cause. Your son also needs to exercise regularly and reduce his salt and fat intake. If necessary, he should also be on a blood pressure lowering medication.
Readers who are interested in learning more can order my Health Report “Hypertension” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.
