School Nurse Notes
12-13-12
CHECK YOUR STREP IQ
What percentage of sore throats is caused by strep?
Strep (beta-hemolytic Group A streptococcus) bacteria cause 10-20% of all
sore throats. Viral infections (such as colds or flu) cause most; mouth-breathing and postnasal
drip (from hay fever and sinusitis) cause some; and a variety of other organisms (such as
mycoplasma and Hib) cause few.
How can you tell whether your sore throat is strep or viral?
The signs and symptoms overlap so much that it is often impossible to distinguish one from the
other. The diagnosis should be confirmed by throat culture or strep antigen (rapid strep) test
before starting antibiotics.
I don’t have fever, so it can’t be strep…right?
It’s atypical, but strep is confirmed in people without fever fairly often.
Aren’t there a few clues we can look for?
Strep is unpredictable, but the onset is typically sudden. Some kids have a headache or a
stomachache without a sore throat. Some have nausea and vomiting. Some are quite sick, while
others are fairly chipper. The throat and tonsils can look normal, or they can be red, swollen and
covered with a white exudate (slimy stuff). The lymph nodes at the angle of the jaw are often (but
not always) enlarged and tender. Other suggestive findings include circumoral pallor (flushed
face with a pale, diamond-shaped area around the nose and mouth), “strep breath” (you know it
when you smell it), a red, swollen uvula (the little thing that hangs down in the back of your
throat), strawberry tongue (red tongue with white elevated “taste buds”), and petechiae (tiny
reddish-purple dots) on the soft palate, near the uvula at the back of the throat.
Which symptoms are more suggestive of viral infections (colds, flu, etc.)?
Cough, hoarseness, conjunctivitis (red eyes) and a runny nose are usually not seen with strep
throat. However, some viruses also cause sore throats without nasal symptoms; for example,
adenovirus, coxsackievirus (herpangina) and Epstein-Barr (mononucleosis).
What is scarlet fever?
Strep with a rash. A red, sunburned-looking sandpaper-like rash (scarlatina) is highly suggestive
of strep even if there are no other symptoms. The rash starts on the chest and spreads to the
abdomen, cheeks and practically everywhere within 24 hours. Skin folds in the groin, armpits and
elbow creases become especially red. It is no more dangerous or difficult to treat than strep
without a rash.
Should I take my child to the doctor for every sore throat?
I recommend it. Trust your doctor to decide whether or not to test for strep. Acute rheumatic
fever (damage to heart valves) and other rare but serious complications may occur in children not
treated for strep within ten days of symptom onset. Eight out of ten strep tests will be negative.
That’s okay.
When can my child return to school?
24 hours after starting antibiotics if the fever is gone without help from Tylenol or Motrin.
How can we prevent it?
Wash hands, disinfect surfaces, and avoid contact with other people’s saliva and mucus.
Discourage sharing food and drinks and kissing on the lips. Keep sick children home from
school, and keep sick people away from your family.
My child was diagnosed with impetigo. Is that strep, too?
Impetigo is a superficial bacterial skin infection typically caused by staph or strep. Any sore or
wound that grows and doesn’t heal is usually impetigo. Impetigo begins as small red bumps that
rapidly change into cloudy blisters, then pimples, then open, weeping sores. The sores are often
covered by yellowish-brown scabs which must be soaked off in order to get to (and kill) the
bacteria hiding underneath. Try some warm, moist compresses or hydrogen peroxide. Impetigo
is frequently found around the mouth or nose and wherever insect bites are scratched. Keep the
sores covered to prevent scratching and spread, wash your hands frequently and disinfect
contaminated surfaces. Consult your doctor. Impetigo responds well to antibiotics. You may
be instructed to apply antibiotic ointment inside your nostrils. Bacteria love to hide there, build
their little impetigo empires and emerge to plant new colonies.
When is it safe for relatives and friends to visit?
Strep is contagious from the onset of sore throat until 24 hours on antibiotics. The incubation
period is typically 2-5 days (potentially 1-10 days). It’s spread by close, direct contact with saliva,
hands, droplets (sneezing, cough, tissues), infected sores and contaminated surfaces.
‘TIS THE SEASON… FOR CHAPPED LIPS
I have seen lots and lots of painful, cracked and bleeding lips. Please send lip moisturizer
(chapstick, Carmex, Vaseline, etc.) to school with your child during the winter months. Teach
your children that although licking their lips might feel better temporarily, it actually perpetuates
chapping. Some kids also develop a lip-licking habit. If you make sure that they have chapstick
handy, and if they get really tired of sore, cracked lips, they might develop a habit of using their
chapstick instead. We can hope.