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Treating Strep Throat to Prevent PANDAS & Other Health Issues

Strep throat is incredibly common among children and young teens. In fact, 30% of sore throat cases in children aged 5 to 15 are caused by strep compared with 10% of cases in adults. Strep is so common that it can be easy to assume an emerging infection is just another sore throat that will go away on its own. However, this can lay the foundation for even more serious illnesses.

Untreated strep infections can spread and cause additional complications, including autoimmune diseases in which the body’s immune system starts to attack healthy cells in response to a bacterial infection. In extreme health risks associated with strep the science is unclear, but genetics and virulence of the strep bacteria likely factor in. For example, PANDAS typically seems to emerge “overnight,” often because a strep infection went unnoticed and therefore untreated—or in some cases, because a treated strep infection never completely went away. For this reason, it’s incredibly important to know the signs and symptoms of a strep infection so you can get it diagnosed and treated early.

What is strep throat?

Strep throat is a bacterial infection caused by streptococcus pyogenes (sometimes referred to as group A streptococcus). These bacteria are primarily found in the throat and secretions of the respiratory system, so the infection is typically spread by coughing or sneezing. In some cases, a strep infection can also be located on the skin and cause a red, bumpy rash more commonly known as scarlet fever.  

While children ages 5 through 15 are more likely to get strep throat, adults are still susceptible to infection. Because the body does not build long-term immunity to a strep infection after recovery, it is possible to get strep throat multiple times throughout a person’s life. Some people are “genetically” more prone to continual strep than others; this is part of the research PANDAS/PANS researchers are working on because it has never been fully understood. Many school-aged children will experience multiple strep infections from childhood through their early teen years.

What are the symptoms of strep throat?

While many sore throats are caused by basic viral infections that will go away on their own, strep infections should be diagnosed and treated early to reduce the risk of complications like scarlet fever, rheumatic fever and PANDAS. 

So how do you know whether to have your child tested for strep throat? If a sore throat lasts more than 5 to 7 days or is accompanied by fever, you should take your child to the doctor immediately. Additionally, it may be a sign of a strep infection if they experience any of the following symptoms at the same time as a sore throat:

  • Nausea and vomiting
  • Drooling or difficulty swallowing
  • Red, bumpy skin rash
  • White patches on back of throat
  • Trouble breathing
  • Swollen lymph nodes
  • Ear pain or aching joints

It’s important to know that while convenient, rapid-result strep tests don’t always catch the infection. Blood tests can also come back negative for strep antigens even when an infection is still present. These false negatives can enable a strep infection to worsen and spread, and can lead to the development of PANDAS and other dangerous autoimmune responses.

If your child is experiencing any of the possible symptoms of strep throat, ask your doctor to do a throat culture test—even if a rapid antigen test or blood test has come back negative. In the case of negative blood tests ask the doctor to be aware that you will be following your child closely for several weeks and may need a repeat visit to consider antibiotics if symptoms persist.

Can untreated strep cause PANDAS?

When a strep infection goes untreated or antibiotics fail to fully eliminate the infection, it can result in autoimmune diseases like rheumatic fever and PANDAS. In the case of PANDAS, the body produces antibodies to fight streptococcal-A bacteria, and for reasons that aren’t completely understood, these antibodies begin to also target healthy cells in the brain.

PANDAS symptoms could start soon after a strep infection or may take months to appear. In some cases, antibiotics may not completely eliminate a strep infection, and lingering bacteria may provoke a sudden onset of PANDAS symptoms well after a child’s case of strep throat seems to have been resolved.

Treating a strep infection early with antibiotics can reduce the risk of PANDAS. The longer an infection lasts, the higher the likelihood of bacteria becoming resistant to antibiotics. This in turn may increase the chance that more intensive PANDAS treatments like IVIG and plasmapheresis will be required in the future. 

What other complications can arise from untreated strep throat?

There are additional risks to letting a strep infection go untreated. Bacterial infections that resist the body’s own immune response are likely to spread to other areas. Other possible complications of an untreated strep infection include:

  • Infection spreading to the ears, tonsils, sinuses or lymph nodes
  • Rheumatic fever
  • Sydenham’s chorea 
  • Scarlet fever
  • Kidney problems (particularly a disorder known as glomerulonephritis)
  • Toxic shock syndrome (strep bacteria releasing toxins into the bloodstream)
  • In rare cases, necrotizing fasciitis

What are the best ways to treat strep throat?

Most cases of strep throat will be treated with a full round of antibiotics and a follow-up appointment with your child’s doctor to make sure the infection has been completely eliminated. While you will likely see symptoms start to improve within a few days, it is incredibly important to make sure your child finishes their entire course of antibiotics. Stopping antibiotics early—even when all noticeable strep symptoms have subsided—can result in the infection lingering, spreading or coming back in a stronger form. If your child’s symptoms worsen or fail to improve after 48 hours, you should contact their doctor.  

There are a variety of other home treatments you can use to help alleviate strep throat pain while your child is completing their course of antibiotics, including:

  • Over-the-counter pain relievers like Tylenol or ibuprofen
  • Gargling with salt water
  • Plenty of rest
  • Drinking lots of clear fluids
  • Soft and mild foods

It’s important to understand that the only safe way to treat a strep infection is through antibiotics prescribed by your child’s doctor. You can also consult them about safe and effective ways to help your child deal with the pain and discomfort of strep throat while they’re recovering. 

If your family is dealing with PANDAS, we are here to help. We offer resources on getting a PANDAS diagnosis, treatment options and how to support your loved ones during the recovery process. Looking for additional resources and community support? Find a PANDAS support group in your area.