Strep Throat (cont.)
When should the tonsils be taken out?
Surgical removal of the tonsils is much less common today thanks to the
present ability to rapidly and accurately diagnose strep infection, and thanks
to the excellent antibiotics currently available. But occasionally, your doctor
might suggest the possibility of the need for surgical removal of the tonsils
(tonsillectomy) if an individual:
- is experiencing frequent episodes of tonsillitis (especially those caused
by the strep bacteria),
- has tonsils that are so large, even when the individual is well, that they
cause not just "snoring" but significant obstruction or blockage of the airway
during sleep (sleep apnea), or
- develops an uncommon but serious deep-seated infection within and
surrounding one or both of the tonsils, called a "peri-tonsillar abscess".
Why is it very important to detect and treat a strep throat?
Studies have shown that if treated within the first 48 hours of
symptoms, the duration of the symptoms is reduced by one to two days. If untreated, the
body will generally clear the infection within two to five days, and this is the usual
course of the illness.
Another reason to treat strep infection early is that there is a 35%
reduction in transmitting the disease by contact. There are reports that within
24 hours of starting antibiotics such as penicillin, individuals become
minimally contagious.
What are the potential complications of untreated strep throat infection?
Acute rheumatic fever is a known and serious complication of strep throat. It
is thought that if the strep throat infection is untreated or inadequately
treated by antibiotics, the bacteria remain in the tonsils and promote a
persistent immune response from the body. Certain strains of the bacteria are
more likely to cause this response. At times, this ongoing immune response may
trigger the immune system to mistakenly attack other organs in the body
including the joints and the heart valves, as seen in rheumatic fever.
Treatment with appropriate antibiotics, even if started several days after
the resolution of the infection, may prevent acute rheumatic fever. Fortunately,
it is now uncommon in the current antibiotic era.
Theoretically, a similar process may cause involvement of the kidneys and
result in kidney inflammation called glomerulonephritis (or post-streptococcal
glomerulonephritis). There is however, no evidence to support the use of
antibiotics to prevent this condition. Children under the age of seven are at the
highest risk of developing this condition. This condition is less common and
less severe than rheumatic fever. It typically resolves spontaneously after a
few weeks and generally does not to lead to permanent kidney damage.
Other complications of untreated strep throat infection include formation of
an abscess behind the throat (retro-pharyngeal abscess), which may cause severe
pain and illness. These abscesses may need to be drained by an ear-nose-throat
specialist urgently.
Next: Is there a vaccine for strep throat? »
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