Strep Throat - Complications

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What are the potential complications of strep throat?

The possible complications of strep throat include:

  • Acute rheumatic fever (see below),
  • Glomerulonephritis (see below),
  • Otitis media (middle ear infection),
  • Toxic shock syndrome (a rare but severe complication which may result in the failure of multiple organs and may thus be fatal),
  • Peritonsillar abscess or retropharyngeal abscess (walled off infection containing GAS bacteria and pus which may encroach upon the structures in the back of the throat or invade and rupture into deeper structures which may ultimately be fatal), and
  • PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep) - (see below).

Acute rheumatic fever (ARF): While rare, this complication of an untreated or inadequately treated strep infection can have devastating and lifelong consequences. It is believed that due to incomplete eradication of the strep bacteria, certain GAS develop an immune response which may attack the joints leading to permanent arthritis. More concerning is the autoimmune response to the heart valves which may damage them and may result in heart failure. Many studies have shown that effective and appropriate antibiotic therapy for strep throat vastly reduces the likelihood of developing ARF.

Glomerulonephritis: Similar to the aberration of the immune response seen with ARF, autoantibodies may develop to the microscopic filters (glomeruli) of the kidney. This complication more commonly affects children between 7 to 10 years of age. While more common than acute rheumatic fever, glomerulonephritis carries a less ominous prognosis. Helpful therapies exist and most children make a complete recovery and do not experience long-term kidney damage. Unlike ARF, the development of glomerulonephritis is not necessarily prevented by effective antibiotic treatment.

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep): Specialists debate the proposed link of a GAS infection in children with the development and/or worsening of obsessive-compulsive behaviors or tic disorder (Tourette's syndrome in the extreme). One area being researched in this controversial condition is whether antibiotic therapy affects the development of or severity of the disorder.

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