Some weeks it seems as if there is way too much bad health news. Everyone seems to be suffering from an upper respiratory tract infection. This “tripledemic” is overwhelming hospitals across the country. I would actually go so far as to suggest it’s a “quintupledemic.” Even that scary name might not cover all the infections that are raging: COVID-19, RSV, influenza, invasive group A strep and rhinoviruses (colds). Be especially cautious if someone has a nasty sore throat! That’s because both strep throat and F-Throat can be dangerous.
Rise in Strep Throat Infections!
I am not going to discuss colds, COVID or RSV (respiratory syncytial virus). You have already read enough about this tripledemic that is overwhelming pediatricians and hospitals across the country. What you will learn about is iGAS (invasive group A strep) infections and something you have probably never heard of before: F-Throat.
The CDC updated its warning about an “Increase in Invasive Group A Strep Infections” on December 22, 2022.
It also reported an “Amoxicillin Shortage”:
“There is a national shortage of the liquid antibiotic (amoxicillin suspension) most often prescribed to children to treat group A strep infections. The shortage is anticipated to last several months.
“Clinicians: View the American Academy of Pediatrics guidance for alternative therapies during the shortage.
“Parents: If your child’s doctor prescribes and you are unable to find liquid amoxicillin in your area, talk with the doctor about other antibiotic options.”
Strep Throat in Other Countries:
Last week we were reading about rising numbers of iGAS infections in the UK. There were also reports that children in Ireland, Spain, France, Sweden and the Netherlands had become ill from the same invasive bacteria.
It’s not just children, though. The UK Health Security Agency (UKHSCA) is reporting that of the 94 deaths associated with severe strep infections in England, almost half were in senior citizens.
How Can You Tell If It’s a Strep Throat?
All the circulating infections can cause sore throats. That includes COVID-19, influenza, cold viruses and RSV. Invasive Group A Strep infections can cause a really nasty sore throat. These strep throat infections are often accompanied with a significant fever, body aches, swollen glands and other flu-like symptoms.
If there is a rash, it could be something called “scarlet fever.” The group A streptococcal bacteria secrete something called streptococcal pyrogenic exotoxins (aka “scarlet fever toxin”). It produces a distinctive strep throat look that is bright red. The CDC describes symptoms this way:
“Common Signs, Symptoms of Scarlet Fever
• Very red, sore throat
• Fever (101°F or higher) or chills
• Whitish coating on the tongue early in the illness
• “Strawberry” (red and bumpy) tongue
• Red skin rash that has a sandpaper feel
• Bright red skin in the creases of the underarm, elbow, and groin
• Swollen glands in the neck
Other general symptoms:
• Headache or body aches
• Nausea, vomiting, or abdominal pain”
What To Do About Strep Throat?
The CDC is quite clear about how to treat pharyngitis caused by Streptococcus pyogenes (aka strep throat):
“Penicillin or amoxicillin is the antibiotic of choice to treat group A strep pharyngitis. There has never been a report of a clinical isolate of group A strep that is resistant to penicillin.”
The Amoxicillin Shortage:
As already mentioned, there is a shortage of amoxicillin for children. The FDA states that the reason for the shortage is because of a “Demand increase for drug.”
I find that somewhat lame. Amoxicillin is a form of penicillin that has been on the market over 50 years. There should never be a shortage of this critical medicine!
We are fed up with drug shortages in the United States! The FDA takes no responsibility. The CDC takes no responsibility. Big Pharma takes no responsibility. Doctors take no responsibility. Hospitals take no responsibility. Everyone shrugs their shoulders, passes the buck and says it’s not our problem.
I beg to differ. It is everyone’s problem if there is not enough amoxicillin to treat sick children! In 2022, we should be able to treat children with strep throat with the drug of choice: amoxicillin!
The CDC suggests other antibiotics if someone is allergic to penicillin. They include cephalexin, cefadroxil, azithromycin or clarithromycin. Dosing instructions are available at this link.
How Do Doctors Diagnose Strep Throat?
The CDC states:
“Worried your sore throat may be strep throat? Doctors can do a quick test to see if a sore throat is strep throat. Antibiotics can help people with strep throat feel better faster and prevent spreading it to others.”
“A simple test gives fast results
“A doctor will determine what type of illness you have by asking about symptoms and doing a physical exam. If they think you might have strep throat, they will swab your throat to test for strep throat. There are two types of tests for strep throat: a rapid strep test and throat culture.
“Rapid strep test
“A rapid strep test involves swabbing the throat and running a test on the swab. The test quickly shows if group A strep bacteria are causing the illness.
• If the test is positive, doctors can prescribe antibiotics.
• If the test is negative, but a doctor still suspects strep throat, then the doctor can take a throat culture swab.
“A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses.”
Did you pay attention to that last sentence?
…infections that the rapid strep test misses.”
So, the rapid strep test is not perfect, but it’s pretty good. We often turn to the Cochrane Review for trusted evaluations. On July 4, 2016 it published this analysis:
“What is the performance of rapid tests for the diagnosis of strep throat in children?”
“On average, rapid tests for strep throat had a sensitivity (ability to correctly detect people with the disease) of 86% and a specificity (ability to correctly identify people who do not have the disease) of 95%… Based on these results, we would expect that amongst 100 children with strep throat, 86 would be correctly detected with the rapid test while 14 would be missed and not receive antibiotic treatment. Of 100 children with non-streptococcal sore throat, 95 would be correctly classified as such with the rapid test while 5 would be misdiagnosed as having strep throat and receive unnecessary antibiotics.”
What If It’s F-Throat Instead of Strep Throat?
Most parents have heard of strep throat. What they have not heard about is F-Throat. We suspect that many health care professionals are not aware of this potentially deadly disease either.
As far as we can tell, F-Throat is not an official medical term. Our dear friend Dr. Alan Greene coined the term. It stands for Fusobacterium necrophorum. Dr. Greene is a pediatrician.
He points out on his website that F-Throat:
“…is a common, important, treatable illness — but because it doesn’t show up on a typical strep test that most doctors would routinely perform, it’s usually missed.
“Knowing about it could save a life…”
Please note Dr. Greene’s message: the F. necrophorum bacterium “doesn’t show up on a typical strep test.”
We first learned about this nasty bacterial infection from Dr. Lisa Sanders. She writes the “Diagnosis” column for the New York Times Magazine. On Sept. 14, 2008 she published a tragic story titled:
Dr. Sanders describes the case of a 17-year-old boy who developed a bad sore throat and a fever. His mother took him to see a doctor who diagnosed strep throat and treated him with azithromycin. No culture was taken because the doctor felt pretty strongly that this was strep.
Sadly, this young person continued to deteriorate. He had shaking chills, continued fever and a sore throat that got worse and localized on one side of his neck. His parents took him to the local emergency department, but they too missed the diagnosis.
None of the antibiotics that were prescribed were effective against F. necrophorum. You can read the details of this case at this link. Tragically, the teenager died.
Learn About F-Throat and Strep Throat!
Medical students are taught to perform a rapid strep test if a child (or young adult) has a nasty-looking sore throat. But if it’s F-Throat instead of strep throat, the test won’t be helpful. Our article about how to recognize F-Throat describes the distinctive symptoms at this link.
Most physicians think this is a rare infection and not something they need to worry much about. An article in the Annals of Internal Medicine (Feb. 17, 2015) suggests that Fusobacterium necrophorum may be far more common than most doctors think. Such an infection requires very thoughtful antibiotic treatment that is tailored to F. necrophorum infections.
As we stated at the start of this article, we are in the middle of a quintupledemic. There’s COVID-19, influenza, RSV, cold viruses and invasive group A strep throat. Is there F. necrophorum circulating too? So far, we haven’t seen anything about this pathogen from the CDC. That does not mean F-Throat is not out there, though.
We encourage parents to monitor sore throats carefully. If a strep test is positive, make sure you can obtain an appropriate antibiotic.
To read about symptoms of F-Throat, check this link. It does not only affect teenagers. You will read about a 44-year-old woman who dodged death because an infectious disease expert correctly diagnosed F. necrophorum and prescribed the appropriate antibiotics.
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