Physical therapy

Overview

Physical therapy involves the interaction between physical therapist, patients/clients, other health care professionals, families, care givers, and communities in a process where movement potential is assessed and diagnosed, goals are agreed upon, using knowledge and skills unique to physical therapists. Physical therapy is performed by a physical therapist (PT) or physiotherapist (physio), and sometimes services are provided by a physical therapist assistant (PTA) acting under their direction. In some cases, physical rehabilitation technicians may provide physiotherapy services. PTs are healthcare professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions, illnesses, or injuries that limit their abilities to move and perform functional activities as well as they would like in their daily lives. PTs use an individual's history and physical examination to arrive at a diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity testing) may also be of assistance. PT management commonly includes prescription of or assistance with specific exercises, manual therapy, education, manipulation and other interventions. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles, providing services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing services in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Functional movement is central to what it means to be healthy.

Physical therapy has many specialties including sports, wound care, EMG, cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics. PTs practice in many settings, such as outpatient clinics or offices, health and wellness clinics, inpatient rehabilitation facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial and this workplaces or other occupational environments, fitness centers and sports training facilities.

Physical therapists also practice in non-patient care roles such as health policy, health insurance, health care administration and as health care executives.Physical therapists are involved in the medical-legal field serving as experts, performing peer review and independent medical examinations.

Education qualifications vary greatly by country. The span of education ranges from some countries having little formal education to others having doctoral degrees and post doctoral residencies and fellowships.

History

Physicians like Hippocrates and later Galenus are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 BCE.After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.^[14]

The earliest documented origins of actual physical therapy as a professional group date back to Per Henrik Ling, “Father of Swedish Gymnastics,” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, manipulation, and exercise. The Swedish word for physical therapist is sjukgymnast = someone involved in gymnastics for those who are ill. In 1887, PTs were given official registration by Sweden’s National Board of Health and Welfare.

Other countries soon followed. In 1894 four nurses in Great Britain formed the Chartered Society of Physiotherapy. The School of Physiotherapy at the University of Otago in New Zealand in 1913, and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."

Modern physical therapy was established in Britain towards the end of the 19th century. Soon following American orthopedic surgeons began treating children with disabilities and began employing women trained in physical education, massage, and remedial exercise. These treatments were applied and promoted further during the Polio outbreak of 1916. During the First World War women were recruited to work with and restore physical function to injured soldiers, and the field of physical therapy was institutionalized. In 1918 the term "Reconstruction Aide" was used to refer to individuals practicing physical therapy. The first school of physical therapy was established at Walter Reed Army Hospital in Washtington D.C. following the outbreak of World War I.

Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in "The PT Review." In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for polio.^[19]

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.^[20][21] Later that decade, physical therapists started to move beyond hospital-based practice to outpatient orthopedic clinics, public schools, colleges/universities healthcentres, geriatric settings (skilled nursing facilities), rehabilitation centers and medical centers.

In 1921 in the United States physical therapists formed the first professional association called the American Women's Physical Therapeutic Association. This gave birth to what is known today as the APTA (American Physical Therapy Association), and currently represents approximately 76,000 members throughout the United States. The APTA defines physical therapy as: "clinical applications in the restoration, maintenance, and promotion of optimal physical function."

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Physical Therapists was formed,which has ever since played an important role in advancing manual therapy worldwide.

[edit] Education

Main article: Physical therapy education

World Confederation of Physical Therapy (WCPT) recognises there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. WCPT recommends physical therapist entry-level educational programs be based on university or university-level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition. [2] WCPT acknowledges there is innovation and variation in program delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any program should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines. Professional education prepares physical therapists to be autonomous practitioners, that may work in collaboration with other members of the health care team.[7]

Physical therapist entry-level educational programs integrate theory, evidence and practice along a continuum of learning. This begins with admission to an accredited physical therapy program and ending with retirement from active practice.[2]

Two hundred eight (208) of two hundred thirteen (213) of accredited physical therapy programs in the US are accredited at the doctoral level offering the Doctor of Physical Therapy degree (DPT)

The physical therapist professional curriculum includes content and learning experiences in the clinical sciences (e.g., content about the cardiovascular, pulmonary, endocrine, metabolic, gastrointestinal, genitourinary, integumentary, musculoskeletal, and neuromuscular systems and the medical and surgical conditions frequently seen by physical therapists).

Curriculum related to Patient/Client Management^[24] includes:

• Screening to determine when patients/clients need further examination or consultation by a physicaltherapist or referral to another health care professional.
• Examination: Examine patients/clients by obtaining a history from them and from other sources. Examine patients/clients by performing systems reviews. Examine patients/clients by selecting and administering culturally appropriate and age related tests and measures. Tests and measures include, but are not limited to, those that assess: a. Aerobic Capacity/Endurance, b. Anthropometric Characteristics, c. Arousal, Attention, and Cognition, d. Assistive and Adaptive Devices, e. Circulation (Arterial, Venous, Lymphatic), f. Cranial and Peripheral Nerve Integrity, g. Environmental, Home, and Work (Job/School/Play) Barriers, h. Ergonomics and Body Mechanics, i. Gait, Locomotion, and Balance, j. Integumentary Integrity, k. Joint Integrity and Mobility, l. Motor Function (Motor Control and Motor Learning), m. Muscle Performance (including Strength, Power, and Endurance), n. Neuromotor Development and Sensory Integration, o. Orthotic, Protective, and Supportive Devices, p. Pain, q. Posture, r. Prosthetic Requirements, s. Range of Motion (including Muscle Length), t. Reflex Integrity, u. Self-Care and Home Management (including activities of daily living [ADL] and instrumental activities of daily living [IADL]), v. Sensory Integrity, w. Ventilation and Respiration/Gas Exchange, x. Work (Job/School/Play), Community, and Leisure Integration or Reintegration (including IADL)
• Evaluation: Evaluate data from the examination (history, systems review, and tests and measures) to make clinical judgments regarding patients/clients.
• Diagnosis: Determine a diagnosis that guides future patient/client management.
• Prognosis: Determine patient/client prognoses.
• Plan of Care: Collaborate with patients/clients, family members, payers, other professionals, and other individuals to determine a plan of care that is acceptable, realistic, culturally competent, and patient-centered.
• Intervention:Provide physical therapy interventions to achieve patient/client goals and outcomes. Interventions include: a. Therapeutic Exercise, b. Functional Training in Self-Care and Home Management, c. Functional Training in Work (Job/School/Play), Community, and Leisure Integration or Reintegration, d. Manual Therapy Techniques (including Mobilization/Manipulation Thrust and Nonthrust Techniques), e. Prescription, Application, and, as Appropriate, Fabrication of Devices and Equipment, f. Airway Clearance Techniques, g. Integumentary Repair and Protection Techniques, h. Electrotherapeutic Modalities,
• Provide effective culturally competent instruction to patients/clients and others to achieve goals and outcomes.
• Prevention, Health Promotion, Fitness, and Wellness: Provide culturally competent physical therapy services for prevention, health promotion, fitness, and wellness to individuals, groups, and communities. Apply principles of prevention to defined population groups.
• Students completing a Doctor of Physical Therapy program are also required to successfully complete clinical internships prior to graduation.

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy, the American Board of Physical Therapy Specialties list eight specialist certifications.

Cardiovascular & Pulmonary

Cardiovascular and pulmonary rehabilitation respiratory practitioners and physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is used in this field to assist in clearing lung secretions experienced with cystic fibrosis. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit from cardiovascular and pulmonary specialized physical therapists.

Clinical Electrophysiology

This specialty area encompasses electrotherapy/physical agents, electrophysiological evaluation (EMG/NCV), physical agents, and wound management.

Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapists specialize in treating older adults.

Integumentary

Integumentary (treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments.

 Neurological

Neurological physical therapy is a field focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, Charcot-Marie-Tooth disease (CMT), ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common impairments associated with neurologic conditions include impairments of vision, balance, ambulation, activities of daily living, movement, muscle strength and loss of functional independence. Physiotherapy can address many of these impairments and aid in restoring and maintaining function, slowing disease progression, and improving quality of life.

In layman's terms, neurological massage is directed toward correcting and healing out-of-normative body systems, unlike traditional massages, such as Swedish massage, that are directed toward comfort and relaxation.

Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopaedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions, and amputations.

Joint and spine mobilization/manipulation, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are modalities often used to expedite recovery in the orthopedic setting. Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining. Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons will benefit from assessment by a physical therapist specialized in orthopedics.

Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, or torticollis may be treated^{[citation needed]} by pediatric physical therapists.^{[26][verification needed]}

[edit] Sports

Physical therapists can be involved in the care of athletes from recreational to professional and Olympians. This area of practice includes athletic injury management, including acute care, treatment and rehabilitation, prevention, and education. Physical therapists are also active in sports medicine programs.

Women's health

Women's health physical therapy addresses women's issues related to child birth, and post partum. These conditions include lymphedema, osteoporosis, pelvic pain, prenatal and post partum periods, and urinary incontinence.

Remuneration and Career Advancement

Physiotherapists are relatively poorly remunerated, given the stringent standards of entry to training institutions, the level of tertiary education and supervised training required, high standards of practice demanded, and time and effort devoted. In addition, clinical practice can be highly physically demanding. People considering a career in physiotherapy would be well advised to thoroughly research possible career opportunities and conditions of service prior to committing to a career limited in scope of practice and promotion opportunities.

DRINK WATER ON EMPTY STOMACH

DRINK WATER ON EMPTY STOMACH
It is popular in Japan today to drink water immediately after waking up every morning. Furthermore, scientific tests have proven its value. We publish below a description of use of water for our readers. For old and serious diseases as well as modern illnesses the water treatment had been found successful by a Japanese medical society as a 100% cure for the following diseases:
Headache, body ache, heart system, arthritis, fast heart beat, epilepsy, excess fatness, bronchitis asthma, TB, meningitis, kidney and urine diseases, vomiting, gastritis, diarrhea, piles, diabetes, constipation, all eye diseases, womb, cancer and menstrual disorders, ear nose and throat diseases.
METHOD OF TREATMENT
1. As you wake up in the morning before brushing teeth, drink 4 x 160ml glasses of water
2. Brush and clean the mouth but do not eat or drink anything for 45 minute
3.. After 45 minutes you may eat and drink as normal.
4. After 15 minutes of breakfast, lunch and dinner do not eat or drink anything for 2 hours
5. Those who are old or sick and are unable to drink 4 glasses of water at the beginning may commence by taking little water and gradually increase it to 4 glasses per day.
6. The above method of treatment will cure diseases of the sick and others can enjoy a healthy life.
The following list gives the number of days of treatment required to cure/control/reduce main diseases:
1. High Blood Pressure (30 days)
2. Gastric (10 days)
3. Diabetes (30 days)
4. Constipation (10 days)
5. Cancer (180 days)
6. TB (90 days)
7. Arthritis patients should follow the above treatment only for 3 days in the 1st week, and from 2nd week onwards – daily..
This treatment method has no side effects, however at the commencement of treatment you may have to urinate a few times.
It is better if we continue this and make this procedure as a routine work in our life. Drink Water and Stay healthy and Active.
This makes sense .. The Chinese and Japanese drink hot tea with their meals ..not cold water. Maybe it is time we adopt their drinking habit while eating!!! Nothing to lose, everything to gain...
For those who like to drink cold water, this article is applicable to you.
It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion.
Once this 'sludge' reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine.
Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal.
A serious note about heart attacks:
· Women should know that not every heart attack symptom is going to be the left arm hurting,
· Be aware of intense pain in the jaw line.
· You may never have the first chest pain during the course of a heart attack.
· Nausea and intense sweating are also common symptoms.
· 60% of people who have a heart attack while they are asleep do not wake up.
· Pain in the jaw can wake you from a sound sleep. Let's be careful and be aware. The more we know, the better chance we could survive...
A cardiologist says if everyone who gets this mail sends it to everyone they know, you can be sure that we'll save at least one life.
Please be a true friend and send this article to all your fr

Canker Sores

What are canker sores?

Canker sores are small ulcer craters in the lining of the mouth that are frequently painful and sensitive. Canker sores are very common. About 20% of the population (one out of five people) have canker sores at any one time. Canker sores are also medically known as aphthous ulcers or aphthous stomatitis.

Women are slightly more likely than men to have recurrent canker sores. It can occur at any age, but it is more commonly seen in teenagers. Genetic studies show that susceptibility to recurrent outbreaks of the sores is inherited in some patients. This partially explains why family members often share the condition.

Canker sores are generally classified into three groups based on size.

1. Minor sores have a diameter of 1millimeter (mm) to 10mm. They are the most common (80% of all canker sores) and usually last about 7-10 days.
   
2. Major sores (10% of all canker sores) have a diameter of greater than 10mm and they may take anywhere between 10-30 days to heal. They may leave a scar after they heal.
   
3. Herpetiform ulcers (10% of all canker sores) are formed by a cluster of multiple small individual sores (less than 3mm). They also usually heal within 7-10 days.

What are symptoms of canker sores?

Canker sores are usually found on the movable parts of the mouth, such as the tongue or the inside lining of the lips and cheeks, and at the base of the gums. The ulcers begin as small oval or round reddish swellings that usually burst within a day. The ruptured sores are covered by a thin white or yellow membrane and edged by a red halo. Generally, the sores heal within two weeks without scarring. Fever is rare, and the sores are rarely associated with other diseases. Usually, a person has only one or a few canker sores at a time.

Most people experience their first bout with canker sores between the ages of 10 and 20. Children as young as 2 years old, however, can develop the condition. The frequency of canker sore recurrences varies considerably. Some people have only one or two episodes a year, while others may have a continuous series of canker sores. 

What are the causes of canker sores?

The cause of canker sores is not well understood. More than one cause is likely, even for individual patients. Canker sores do not appear to be caused by viruses or bacteria, although an allergy to a type of bacterium commonly found in the mouth may trigger them in some people. The sores may be an allergic reaction to certain foods. In addition, there is research suggesting that canker sores may be caused by a faulty immune system that uses the body's defenses against disease to attack and destroy the normal cells of the mouth or tongue.

British studies show that in about 20 percent of patients, canker sores are due partly to nutritional deficiencies, especially lack of vitamin B12, folic acid, and iron. Similar studies performed in the United States, however, have not confirmed this finding. In a small percentage of patients, canker sores occur along with gastrointestinal problems, such as an inability to digest certain cereals. In these patients, canker sores appear to be part of a generalized disorder of the digestive tract. Vitamin C deficiency has also been associated with canker sores.

Emotional stress and local trauma or injury to the mouth, such as sharp metal braces, brushing with hard toothbrushes, and hot foods can lead to canker sores. Smoking and dentures can also contribute to the problem. Some studies have shown a connection with toothpaste containing sodium lauryl sulfate in some individuals, although, other studies have not found any connection.

Other possible causes of canker sores include illnesses in which the immune system causes swelling or inflammation of the body tissues (autoimmune disorders). Examples of autoimmune disorders are systemic lupus erythematosus, Crohn's disease, and Behçet's disease.

Female sex hormones also apparently play a role in causing canker sores. Many women experience bouts of the sores only during certain phases of their menstrual cycles. Additionally, most women experience improvement or remission of their canker sores during pregnancy. Researchers have used hormone therapy successfully in clinical studies to treat some women. 

Are canker sores the same thing as fever blisters?

The simple answer is no. Canker sores are generally inside the mouth or the oral cavity and are not contagious. However, fever blisters mostly occur on the lips and outside of the mouth and are very contagious. Fever blisters, or cold sores, are infections caused by the herpes simplex virus (HSV).

What steps can be taken to help canker sores?

If you have canker sores:

• Avoid abrasive foods such as potato chips that can stick in the cheek or gum and aggravate the sores.
  
• Take care when brushing your teeth not to stab the gums or cheek with a toothbrush bristle.
  
• Avoid acidic and spicy foods.
  
• Canker sores are not contagious, so patients do not have to worry about spreading them to other people.
  
• A toothpaste free of sodium lauryl sulfate and other ingredients that are irritating to the tissues inside the mouth can be helpful in some patients, as can a toothpaste that inhibits the growth of irritating plaque. Therefore, something as simple as changing toothpastes may help with recurrent canker sores.

What is the treatment for canker sores?

Canker sores typically resolve without any specific treatment. But measures can be taken to alleviate the pain and discomfort and to hasten the course. Therapies include topical medications (applied directly on), mouthwashes, and oral medications.

What kind of topical medications (gels or ointments) are available for canker sores?

Topical medications include numbing ointments, such as benzocaine (Oragel), which are available in drug stores without a prescription. The ointment should be applied a few times daily directly to the sore in order to reduce irritation form eating, drinking, or brushing. Topical 2% lidocaine (an anesthetic) gel has also been used effectively in some patients, but it may associated with some toxicity, especially in children. In very painful cases, injection of local anesthetics may help relieve the symptoms effectively, but it is usually temporary. However, in April 2011 the U.S. FDA issued a warning about an association between benzocaine and methemoglobinemia, a rare but serious condition in which oxygen delivery to tissues is compromised. Because of this association, the FDA has stated that benzocaine products should not be used on children less than two years of age, except under the advice and supervision of a healthcare professional. Further, adults who use benzocaine gels or liquids to relieve pain in the mouth should follow the recommendations in the product label. Benzocaine products should be stored out of reach of children, and FDA encourages consumers to talk to their healthcare professional about using benzocaine.

Anti-inflammatory (steroid) gels may also be applied locally to reduce the inflammation. These products are generally provided by prescription from a physician or a dentist. The main ingredient in these medications is usually fluocinonide (Lidex) or triamcinolone. Topical antibiotics (for example, tetracycline (Achromycin]) may also be recommended by your doctor. 

Can mouthwash solutions be used to treat canker sores?

Yes, there are several mouthwash solutions you can use. One type of mouthwash used for canker sores is diphenhydramine suspension (Benadryl Allergy liquid and others). This liquid medication can be used as a mouth rinse in adults to provide temporary relief from the pain caused by canker sores. Patients should not swallow the diphenhydramine, but simply use it as a mouth rinse. This is generally available over the counter.

Furthermore, steroid anti-inflammatory mouth rinses can be prescribed for patients with severe sores. Steroid mouth rinses have been shown to reduce the inflammation and number of recurrences and are reserved for more severe cases due to potential side effects. These potent drugs can cause many undesirable side effects, and should be used only under the close supervision of a dentist or physician.

There are also mouth rinses containing the antibiotic tetracycline that may reduce the unpleasant symptoms of canker sores and speed healing by preventing bacterial infections in the sores. Clinical studies at the National Institute of Dental Research have shown that rinsing the mouth with tetracycline several times a day usually relieves pain in 24 hours and allows complete healing in five to seven days. The U.S. Food and Drug Administration warns, however, that tetracycline given to pregnant women and young children can permanently stain the children's teeth.

Both steroid and tetracycline treatments require a prescription and care of a dentist or physician.

What oral medications are available to help canker sores?

Oral pain medications such as, ibuprofen (Advil) or acetaminophen (Tylenol) may be taken for pain relief if the sores are intolerable. Some patients may get relief from sucking on zinc lozenges, or taking vitamin B and C complex.

There is no evidence that antibiotics taken orally are helpful. If the canker sores are caused by a yeast infection, a topical anti-fungal medication can be used, [for example, nystatin (Mycostatin, Nystatin)]. Some people with AIDS (HIV infection) who have repeated bouts of canker sores respond well to thalidomide (Thalomid oral). This medication can also be used for severe canker sores not related to AIDS. Thalidomide is associated with very severe birth defect and, therefore, its use is very limited.

Patients with severe recurrent and non-healing canker sores may also need to take steroid or other immuno-suppressant drugs orally. But they are associated with major side effects if taken long term and their use should be closely monitored by the prescribing doctor.

In other situations, if the presumed cause is another illness, such as lupus, treating the underlying illness often results in healing the ulcers. Vitamins and other nutritional supplements often prevent recurrences or reduce the severity of canker sores in patients with a nutritional deficiency. L-lysine over-the-counter is used as a preventative treatment. Patients with food allergies can reduce the frequency of canker sores by avoiding those foods. 

What should I do if I get canker sores frequently?

Contact your healthcare professional. Most cases of canker sores do not reflect an underlying illness. However, if you are having canker sores frequently, your healthcare professional can take a patient history and order tests to assure you there isn't a serious underlying cause. Certain diseases are sometimes associated with recurrent canker sores. Examples include Crohn's disease, celiac disease, Behçet's disease, lupus, or even AIDS. It should be mentioned that these are complex diseases and canker sores may be only a part of the disease and not the only feature of the disease. Canker sores also may not be present at all in some persons with these conditions.

Most doctors also recommend that patients who have frequent bouts of canker sores undergo blood and allergy tests to determine if their sores are caused by a nutritional deficiency, an allergy, or some other preventable cause.

What research is being done in the area of canker sores?

Researchers are trying to identify the malfunctions in patients' immune systems that make them susceptible to repeated bouts of canker sores. By analyzing the blood of people with and without canker sores, scientists have found several differences in the immune function between the two groups. Whether these differences cause canker sores is not yet known and more research may need to be performed.

Researchers also are developing and testing new drugs designed to treat repeated canker sores in patients with possible immune causes of canker sores. Most of these drugs alter the patient's immune function. Although some of the drugs appear to be effective in treating canker sores in some patients, the data are still inconclusive. Until these drugs are proven to be absolutely safe and effective, they will not be available for general use.

One of the new medications which has been tested is called amlexanox (Aphthasol topical paste). This is an anti-inflammatory and an anti-allergic drug. It has shown some promise in treatment of symptoms and healing of canker sores.

More invasive treatment options for canker sores are being investigated, but for now they remain somewhat limited, controversial, and impractical. These options include laser therapy, low intensity ultrasound, silver nitrate, and surgical removal. More studies are necessary before these options can be recommended for treatment of canker sores. 

Fever

What is a fever?

Fever refers to an elevation in body temperature. Technically, any body temperature above the normal oral measurement of 98.6 F (37 C) or the normal rectal temperature of 99 F (37.2 C) is considered to be elevated. However, these are averages, and one's normal body temperature may actually be 1 F (0.6 C) or more above or below the average of 98.6 F. Body temperature can also vary up to 1 F (0.6 C) throughout the day.

Fever is not considered medically significant until body temperature is above 100.4 F (38 C). Anything above normal but below 100.4 F (38 C) is considered a low-grade fever. Fever serves as one of the body's natural defenses against bacteria and viruses which cannot live at a higher temperature. For that reason, low fevers should normally go untreated, unless accompanied by troubling symptoms.

Also, the body's defense mechanisms seem to work more efficiently at a higher temperature. Fever is just one part of an illness, many times no more important than the presence of other symptoms such as cough, sore throat, fatigue, joint pains or aches, chills, nausea, etc.

Fevers of 104 F (40 C) or higher demand immediate home treatment and subsequent medical attention, as they can result in delirium and convulsions, particularly in infants and children.

Fever should not be confused with hyperthermia, which is a defect in your body's response to heat (thermoregulation), which can also raise the body temperature. This is usually caused by external sources such as being in a hot environment.

How should I take a temperature for fever?

Digital thermometers can be used to measure rectal, oral, or axillary (under the armpit) temperatures. The American Academy of Pediatrics does not recommend use of mercury thermometers (glass), and they encourage parents to remove mercury thermometers from their households to prevent accidental exposure to this toxin.

Measuring an axillary (under the armpit) temperature for fever:

Axillary temperatures are not as accurate as rectal or oral measurements, and these generally measure 1 degree lower than a simultaneously obtained oral temperature.

• Place the tip of the digital thermometer in your child's armpit.


• Leave in place about one minute or until you hear a beep to check a digital reading.

Measuring fever by eardrum temperature:

Tympanic (ear) thermometers must be placed correctly in your child's ear to be accurate. Too much earwax can cause the reading to be incorrect.

Eardrum temperature measurements are not accurate in small children and should not be used in children under 3 years (36 months) of age. This is especially true in infants below 3 months of age when obtaining an accurate temperature is very important.

Measuring fever by oral temperature:

People 4 years old and older can have their temperature taken with a digital thermometer under the tongue with their mouth closed.

• Clean the thermometer with soapy water or rubbing alcohol and rinse.


• Turn the thermometer on and place the tip of the thermometer as far back under the tongue as possible.


• The mouth should remain closed, as an open mouth can cause readings to be inaccurate.


• The thermometer should remain in place for about one minute or until you hear the beep. Check the digital reading.

Avoid hot or cold drinks within 15 minutes of oral temperature measurement to ensure correct readings.

Measuring fever by rectal temperature:

The American Academy of Pediatrics recommends rectal temperature measurements for children under 3 years of age, as this gives the most accurate reading of core temperature.

• Clean the thermometer with soapy water or rubbing alcohol and rinse with cool water.


• Use a small amount of lubricant, such as petroleum jelly, on the end.


• Place the child prone (belly-side down) on a firm surface, or place your child face up and bend his legs to his chest.


• After separating the buttocks, insert the thermometer approximately ½ to 1 inch into the rectum. Do not insert it too far.


• Hold the thermometer in place, loosely keeping your hand cupped around your child's bottom, and keep your fingers on the thermometer to avoid it accidently sliding further into the rectum. Keep it there for about one minute, until you hear the beep.


• Remove the thermometer, and check the digital reading.


• Label the rectal thermometer so it's not accidentally used in the mouth.

A rectal temperature will read approximately 1 degree higher than a simultaneously obtained oral temperature.

What is the treatment for a fever?

Generally, if the fever does not cause discomfort, the fever itself need not be treated. It is not necessary to awaken an adult or child to treat a fever unless instructed to do so by your health-care practitioner.

The following fever-reducing medications may be used at home:

• Acetaminophen (Tylenol and others) can be used to lower a fever. The recommended pediatric dose can be suggested by the child's health-care provider. Adults without liver disease or other health problems can take 1,000 mg (two "extra strength" tablets) every four to six hours or as directed by your physician.


• Ibuprofen (Motrin/Advil) can also be used to break a fever in patients over 6 months of age. Discuss the best dose with your doctor. For adults, 400-600 mg (two to three 200 mg tablets) can be used every six hours.


• Aspirin should not be used for fever in children or adolescents. Aspirin use in children and adolescents during a viral illness (especially chickenpox and influenza, or flu) has been associated with Reye syndrome. Reye syndrome is a dangerous illness which causes prolonged vomiting, confusion, and even coma and liver failure.

An individual with a fever should be kept comfortable and not overdressed. Overdressing can cause the temperature to rise further. Tepid water (85 F [30 C]) baths are a home remedy that may help bring down a fever. Never immerse someone in ice water. This is a common misconception. Never sponge a child or an adult with alcohol; the alcohol fumes may be inhaled, causing many problems.

When should I seek medical care for a fever?

Any child below 3 months of age who has a temperature of 100.4 F (38 C) or greater should be seen by a physician or other health-care worker. If a child or adult has a history or diagnosis of cancer, AIDS, or other serious illness, such as heart disease, diabetes, or is taking immunosuppressant drugs, medical care should be sought for a fever.

Otherwise, observe the person with the fever. If they appear sick or have symptoms that would suggest a major illness, such as meningitis (headache, stiff neck, confusion, problems staying awake), urinary tract infection (shaking chills, burning with urination), pneumonia (shortness of breath, cough), or any other signs of a serious illness, contact your health-care provider.

Other symptoms that may be indicative of a severe illness include repeated vomiting, severe diarrhea, or skin rashes (could be a sign of dengue fever, Rocky Mountain spotted fever, scarlet fever, rheumatic fever, or chickenpox).

Fever blisters (herpangina) are small blisters that turn into ulcers, usually on the lips, mouth or tongue, that are caused by a virus. When a child contracts this virus for the first time, the symptoms and the fever blisters can be quite severe. If the child is not eating or drinking, contact your child's health-care provider.

On the other hand, if the fever accompanies a simple cold or virus, you can treat the fever as described above and be assured that the fever is only a symptom of the illness. This is not to say that you should ignore a fever. If there are other associated symptoms that are bothersome, you should contact your health-care professional.

Some vaccines given in childhood can cause a low-grade fever within a day or two of getting the injection. This fever is usually self-limited and short-lived. If the reaction seems severe or the skin at the injection site is red, hot, and painful, contact your child's doctor.

About 3% of all children between 18 months to 3 years of age will have a seizure (convulsion) with a high fever. Of those with a history of febrile seizure, approximately one-third will have another seizure associated with another febrile episode. Febrile seizures, while frightening to the parents, are not associated with long-term nervous-system side effects. Children used to be prescribed phenobarbital following a febrile seizure as a preventive measure (prophylaxis). This has not been shown to be beneficial and possibly may be harmful, so it is not always recommended.

Common Cold

What is the common cold, and what causes it?

The common cold is a self-limited contagious illness that can be caused by a number of different types of viruses. The common cold is medically referred to as a viral upper respiratory tract infection. Symptoms of the common cold may include cough, sore throat, nasal congestion, runny nose, and sneezing. More than 200 different types of viruses are known to cause the common cold, with rhinovirus causing approximately 30%-35% of all adult colds. Other commonly implicated viruses include coronavirus, adenovirus, respiratory syncytial virus, and parainfluenza virus. Because so many different viruses can cause a cold and because new cold viruses constantly develop, the body never builds up resistance against all of them. For this reason, colds are a frequent and recurring problem. In fact, children in preschool and elementary school can have six to 12 colds per year while adolescents and adults typically have two to four colds per year. The common cold occurs most frequently during the fall and winter months.

The common cold is the most frequently occurring illness in the world, and it is a leading cause of doctor visits and missed days from school and work. It is estimated that individuals in the United States suffer 1 billion colds per year, with approximately 22 million days of school absences recorded annually.

How is the common cold transmitted?

The common cold is spread either by direct contact with infected secretions from contaminated surfaces or by inhaling the airborne virus after individuals sneeze or cough. Person-to-person transmission often occurs when an individual who has a cold blows or touches their nose and then touches someone or something else. A healthy individual who then makes direct contact with these secretions can subsequently become infected, often after their contaminated hands make contact with their own eyes or nose. A cold virus can live on objects such as pens, books, telephones, computer keyboards, and coffee cups for several hours and can thus be acquired from contact with these objects.

What are the symptoms and signs of the common cold in adults, children, and infants?

The symptoms of the common cold typically begin two to three days after acquiring the infection (incubation period). Symptoms and signs of the common cold vary depending on the virus responsible for the infection and may include the following

• nasal stuffiness or drainage,

• sore or scratchy throat,

• sneezing,

• hoarseness,

• cough,

• watery eyes,

• low-grade fever,

• headache,

• body aches, and

• fatigue.

The signs and symptoms of the common cold in infants and children are similar to those seen in adults. The cold may begin with a runny nose with clear nasal discharge, which later may become yellowish or greenish in color. Infants and children may also become more fussy and have decreased appetite.

The symptoms of the common cold will typically last anywhere from four to 14 days, with most individuals improving in one week.

Does it have anything to do with exposure to cold weather?

Though the common cold usually occurs in the fall and winter months, the cold weather itself does not cause the common cold. Rather, it is thought that during cold-weather months people spend more time indoors in close proximity to each other, thus facilitating the spread of the virus. For this same reason, children in day care and school are particularly prone to acquiring the common cold.

What is the difference between the common cold and influenza (the flu)?

Many people confuse the common cold with influenza (the flu). Influenza is caused by the influenza virus, while the common cold generally is not. While some of the symptoms of the common cold and influenza may be similar, patients with the common cold typically have a milder illness. Patients with influenza usually appear more ill and have a more abrupt onset of illness with fever, chills, headache, substantial muscle and body aches, dry cough, and extreme weakness.

Though differentiating between the common cold and influenza can be difficult, there is laboratory testing available to confirm the diagnoses of influenza.

How is the common cold diagnosed?

Your physician or health-care practitioner will generally diagnose the common cold based on the description of your symptoms and the findings on your physical exam. Laboratory testing and imaging studies are generally not necessary unless there are concerns about another underlying medical condition or potential complications.

What is the treatment for the common cold? Are there any home remedies for the common cold?

There is no cure for the common cold. The common cold is a self-limited illness that will resolve spontaneously with time. Home remedies and treatments are directed at alleviating the symptoms associated with the common cold while the body fights off the infection.

Home treatment for the common cold includes getting rest and drinking plenty of fluids. In older children and adults, over-the-counter medications such as throat lozenges, throat sprays, cough drops, and cough syrups may help relieve symptoms, though they will not prevent or shorten the duration of the common cold. Gargling with warm saltwater may help those with a sore throat. Decongestants such as pseudoephedrine (Sudafed) or antihistamines may be used for nasal symptoms, while saline nasal sprays may also be beneficial. It is important to note that over-the-counter medications may cause undesirable side effects, therefore they must be taken with care.

Acetaminophen (Tylenol and others) and ibuprofen (Advil, Motrin) can help with fever, sore throat, and body aches.

The treatment for infants and small children with the common cold is supportive as well. It is especially important to allow rest and encourage plenty of fluids in order to prevent dehydration. Nasal drops and bulb suctioning may be used to clear nasal mucus in infants. Medications such as acetaminophen and ibuprofen may be taken for pain or fever based on the package recommendations for age and weight. Do not use aspirin or aspirin-containing medications in children or teenagers because it has been associated with a rare, potentially fatal condition called Reye's syndrome. Finally, over-the-counter cough and cold medications for infants and children are not recommended (see WARNING below).

WARNING: The United States Food and Drug Administration (FDA) recommends that over-the-counter cough and cold medications not be used in children younger than 4 years of age because serious and potentially life-threatening side effects can occur.

Are antibiotics a suitable treatment for the common cold?

No. Antibiotics play no role in treating the common cold. Antibiotics are effective only against illnesses caused by bacteria, and colds are caused by viruses. Not only do antibiotics not help, but they can rarely also cause severe allergic reactions that can sometimes be fatal. Furthermore, using antibiotics when they are not necessary has led to the growth of several strains of common bacteria that have become resistant to certain antibiotics. For these and other reasons, it is important to limit the use of antibiotics to situations in which they are medically indicated.

Though occasionally a bacterial infection, such as sinusitis or a middle ear infection, can develop following the common cold, the decision to treat with antibiotics should be determined by your physician or health-care practitioner.

When should a physician or other health-care practitioner be consulted?

Generally, the common cold can be treated at home and managed with over-the-counter medications. However, if you develop more severe symptoms such as shaking chills, high fever (greater than 102 F), severe headache, neck stiffness, vomiting, abdominal pain, difficulty breathing, chest pain, confusion, or failure to improve after 10 days, you should consult your physician or health-care practitioner immediately. Infants 3 months of age or younger who develop a cold or fever should consult their health-care practitioner as well.

If you have a sore throat and a fever with no other cold symptoms, you should also be evaluated by your physician. This illness may be strep throat, a bacterial infection requiring treatment with antibiotics.

Finally, if you notice facial pain or yellow/green drainage from your nose accompanied by a fever, it is possible that you have a sinus infection (sinusitis) that would benefit from a medical evaluation and a possible course of antibiotics.

Strep Throat

Strep Throat Symptoms

Strep Throat Symptoms and Signs

Throat infection with strep bacteria is contagious and can cause a variety of symptoms associated with inflammation of the throat and its nearby structures. Symptoms usually begin within a few days (1-4 days) after contracting the infection (incubation period).
Typical signs of strep throat infection are:

• fever;
  
• swollen, tender lymph nodes on the sides of the neck;
  
• white patches seen on the tonsils and throat.

Some other more non-specific signs and symptoms of strep throat which can also be seen in strep throat  due to other causes are:

• sudden onset of sore throat,
  
• headache,
  
• odynophagia (painful swallowing),
  
• nausea, vomiting, abdominal pain,
  
• red, swollen soft palate (uvula), and/or
  
• rash (diffuse red patchy rash).

Read more of the symptoms and signs of strep throat »

What is strep throat?

While many people use the terms sore throat, tonsillitis, and strep throat interchangeably, there are significant clinical differences between these conditions. Understanding the differences can give patients a better idea of how and when to be concerned and when to seek advice from a physician.

Strep throat is only one of many possible causes of throat infection and sore throat. While strep throat is most common in children and adolescents, it can affect people of all ages.

What causes sore throat?

Sore throat has many causes. The most common causes of sore throat are infections of the throat and the surrounding structures. Any inflammation or infection of the pharynx, tonsils, esophagus (the food pipe), or larynx (the top opening part of the windpipe) may cause sore throat.

What are the tonsils and tonsillitis?

The tonsils are red, oval clumps of tissue located at the back and to the sides of the throat. This location allows the tonsils to intercept germs as they enter the body through the nose and throat. They contain infection-fighting cells and antibodies (infection-fighting proteins in the body) that stop the spread of the germs further into the body.

Tonsillitis refers to conditions in which the tonsils become red, sore, and swollen because of inflammation. This is not a specific term, as there are many causes of inflammation of the tonsils. Tonsillitis is a common cause of sore throat.

What are the pharynx and pharyngitis?

The pharynx is the area in the back of the throat shared by the oral cavity and the nasal cavity behind the palate. An infection or inflammation of the pharynx is called pharyngitis. The infectious causes are similar to those causing tonsillitis, which are mainly related to viruses and less commonly to bacterial infection.

Because it is difficult to always distinguish exactly between pharyngitis and tonsillitis, throat infections are commonly referred to as tonsillopharyngitis, which signifies an infection of the tonsils, or pharynx, or both.

Viral causes of throat infection

Viruses are the most common cause of throat infection in children and in adults. Many types of viruses are known to cause throat infection, and their symptoms may be difficult to distinguish from those of a bacterial infection.

Throat infections caused by viruses usually occur in non-winter months.

Bacterial causes of throat infection

Bacterial causes of throat infections (tonsillopharyngitis) require further attention from individuals (and their parents or caregiver if the sick person is a child) and physicians.

Streptococcus, or strep, is the most frequently found bacterial cause of sore throat.

The commonly known strep throat is due to only one member of the Streptococcus family of bacteria. This certain streptococcus (Streptococcus pyogenes) belongs to the Group A Streptococcus bacteria (GAS for short). This group of bacteria is also known to cause infections other than strep throat such as skin infections, soft tissue infections, and pneumonia (lung infection).

There are many other bacteria that may also cause throat infections. Group A Streptococcus is the most common cause in children and adolescents. Mycoplasma, Neisseria, Corynebacterium, Yersinia, and non-Group A Strep bacteria are some of the other bacterial causes of throat infection.

Bacterial throat infections typically occur in the winter months.

How common is strep throat?

Group A streptococcus is the most common bacterial cause of throat infection. Approximately 15% to 30% of tonsillopharyngitis in children between 5 to 15 years of age is caused by group A strep. This age group (5 to 15) has the peak incidence of strep throat infection. In adults, 5% to 10% of cases of pharyngitis are estimated to be caused by strep bacteria.

Some reports suggest that over 600 million cases of strep throat occur annually worldwide.

Is strep throat contagious?

Yes, strep throat is contagious. The most common way to catch strep throat is by contact with an infected person.

Close contact with airborne droplets of an infected individual is the most common way of catching Streptococcus infection. Close quarters such as college dormitories, day care centers, military facilities, schools, and families provide ideal conditions for transmission of strep throat from one person to another. The risk of acquiring strep throat from an affected family member nears 40%. Spread through food-borne outbreaks is less common, but possible.

The risk of being contagious with strep throat diminishes substantially after initiation of proper antibiotic treatment.

What are the signs and symptoms of strep throat?

Throat infection with strep bacteria can cause a variety of symptoms associated with inflammation of the throat and its nearby structures. Symptoms usually begin within a few days (1-4 days) after contracting the infection (incubation period).

With strep throat infection, the throat can become red and swollen. White patches may be visible on the back of the throat and the tonsils, suggesting the presence of pus. The presence of fever, swollen lymph nodes on the sides of the neck, and white patches on the tonsils along with the absence of cough raise the suspicion for strep pharyngitis. Not all of these signs need to be present with strep tonsillopharyngitis. On the other hand, their presence is not specific only to strep throat.

Typical signs of strep throat infection are:

• fever;
  
• swollen, tender lymph nodes on the sides of the neck (cervical lymphadenopathy);
  
• white patches seen on the tonsils and throat (tonsillar exudates).

Some other more non-specific signs and symptoms of strep throat which can also be seen in tonsillopharyngitis due to other causes are:

• sudden onset of sore throat,
  
• headache,
  
• odynophagia (painful swallowing),
  
• nausea, vomiting, abdominal pain,
  
• red, swollen soft palate (uvula), and/or
  
• rash (diffuse red patchy rash).

The strep throat rash is caused by toxins released from the bacteria, and not necessarily because of the spread of infection to the skin. This rash is also known as scarlet fever, which can occur in about 10% children with strep throat infection, and typically starts around the face and neck area and can spread to the rest of the body. It has a raised, rough "sand-paper" quality. The rash may start within 12 to 24 hours of the onset of fever and may last for several days.

Other features that are more likely to be seen in tonsillopharyngitis due to viral causes include the following:

• conjunctivitis (eye redness),
  
• runny nose (coryza),
  
• skin rash (exanthem or small spotted rash),
  
• generalized weakness and malaise,
  
• muscle aches and pains,
  
• cough,
  
• hoarseness,
  
• diarrhea, and/or
  
• oral ulcers.

Are strep throat symptoms different in children compared to adults?

Some of the general and constitutional symptoms of strep throat infection may vary quite a bit depending on the patient's age.

• Infants primarily experience a thick "colorful" (yellow or green) drainage from the nose and possibly a low-grade fever, with fussiness, irritability, and a decrease in appetite.
  
• Children aged one to three ("toddlers") may complain of a sore throat, trouble swallowing, poor appetite, crankiness, and swollen glands (lymph nodes) beneath the jaws.
  
• Older children and adolescents generally look and feel awful with strep throat. They can have high fevers, very painful throats, often severe difficulty swallowing, and pus, which can sometimes be seen covering the tonsils.
  
• Adults with strep throat may have milder symptoms, and in some cases the illness may be undetected. Symptoms vary; adults may also have severe pain and trouble swallowing.

When should I be concerned about a possible strep throat?

Parents should be concerned about a sore throat that does not improve after a sip of water after arising from sleep, or one that is accompanied by a headache, high fever, stomachache, vomiting, or severe tiredness. The presence of a red, somewhat rough-to-the-touch rash is also a concern, known as scarlet fever (but this is no more dangerous than strep throat without a rash).

An urgent call to the doctor's office or emergency room visit is appropriate, especially in a child who has extreme difficulty swallowing that causes drooling or difficulty breathing.

How is strep throat diagnosed?

Throat culture

During the doctor's physical examination, a throat culture might be taken by touching a soft cotton swab to the throat and tonsil area. Germs from the swab are smeared onto a special plate and sent to the laboratory for evaluation of strep or other bacteria. After 24-48 hours, the rapidly-growing strep germs can be identified if present in the sample. Throat culture is the gold standard in diagnosing strep throat infection.

A culture for strep throat may not be done as a screening test in an individual without any symptoms suggestive of strep throat. This is because bacteria may be present without causing an infection. A person may be a carrier of the bacteria but not infected.

Rapid strep test

Rapid strep tests (also called the Rapid Antigen Detection Test or RADT) are available that can give results in minutes. A sample from the back of the throat or tonsils is taken using a swab similar to the sample for culture. Using a RADT kit, the doctor can determine within a few minutes if strep is the likely cause of sore throat. This test is less precise than throat cultures. Therefore, if the health care practitioner has a high suspicion for strep throat, both tests (RADT and throat culture) may be performed, and treatment should be started as soon as possible even if the rapid test is negative for strep while waiting for the definitive culture results.

Taking any "self prescribed" antibiotic prior to seeing the doctor should be avoided because even a single dose of antibiotic can interfere with the culture results and the health care practitioner's ability to correctly diagnose and treat the infection.

Blood test for strep throat infection

Streptococcus infection can be detected by measuring the antibodies produced by the body against the bacteria. This is called the Anti-streptolysin O or ASO titer. This antibody may not be present in the blood for a few weeks after an infection, and therefore its measurement may not be accurate to detect an active or acute infection. ASO titers also may not be detectable if the person had been appropriately treated with antibiotics.

This test may be useful in detecting prior infections and evaluating a person with complications of strep throat infection such as rheumatic fever or glomerulonephritis (see below).

Who should be tested for strep throat?

There is not an easy system to decide who should be tested for strep throat. However, there are certain predictors that make the possibility of strep tonsillopharyngitis likely. These include:

1. Children and adolescents between the ages of five and 15
   
2. Illness occurring in the late fall, winter, or early spring months
   
3. Clinical evidence of acute pharyngitis:

• redness and swelling in throat, white discharge on the tonsils
  
• fever of 101 F to 103 F (38 C to 39.4 C)
  
• large and tender lymph nodes in the neck

4. Absence of upper respiratory infection symptoms, such as runny nose, nasal congestion, and cough

Some clinical studies suggest that if all of these points are present, then the likelihood of strep throat may be up to 85%. The doctor may decide if testing is necessary based on these or other clinical factors.

How is strep infection treated?

Because of potential significant complications (described below), if strep throat is detected, it must be treated adequately with antibiotics. It is important to take the full course of antibiotics as prescribed and not to stop the medication when symptoms resolve. Prematurely discontinuing antibiotics can result in the infection being inadequately treated, with potentially adverse consequences or relapse of the infection.

Antibiotics

Streptococcus is highly responsive to penicillin and the cephalosporin antibiotics. Penicillin has shown good effectiveness, and it is reliable and cheap.

Oral penicillin V (Pen-Vee-K, Veetids) is the preferred oral form of penicillin for strep throat. The usual dose is 250 milligrams three times a day or 500 milligrams twice a day. A full 10 day course must be completed even though patients usually feel better only after two to three days.

Injectable penicillin G (Bicillin) is also very effective and may be used in individuals who may not reliably take 10 days of antibiotics orally. The drug may last in the body for up to 21 days and can therefore adequately treat the infection.

Other penicillin derivatives such as amoxicillin (Amoxil), amoxicillin-clavulanate (Augmentin), cloxacillin (Cloxapen, Tegopen), and dicloxacillin (Dynapen) are all adequate treatments for strep. They may be even slightly more effective than penicillin because of better absorption and greater potency.

Cephalosporin antibiotics are also a very effective in treating group A streptococcus. In some studies, they were found to be better than penicillin, and there is some suggestion that they may be the first choice antibiotic for this infection. For now, they remain a very good choice in patients with mild penicillin allergies.

Some examples of cephalosporin antibiotics used to treat strep throat are:

• cephalexin (Keflex, Keftabs),
  
• cefadroxil (Duricef),
  
• cefaclor (Celcor),
  
• cefixime (Suprax),
  
• cefprozil (Cefzil),
  
• cefuroxime axetil (Cefitn),
  
• loracarbef (Lorabid),
  
• cefpodoxime (Vantin), and
  
• cefdinir (Omnicef).

Other options are macrolides, such as erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), azithromycin (Zithromax), and clarithromycin (Biaxin). These antibiotics have shown similar to superior effectiveness compared to penicillin for the treatment of group A streptococcus. Erythromycin is thought to be the optimum choice for people with severe penicillin allergy.

The current recommendations still list penicillin as the first choice for the treatment of group A streptococcus. Erythromycin is recommended as the first choice in penicillin-allergic individuals. First generation cephalosporins such as cephalexin and cefadroxil, are alternatives to erythromycin. 

How can viral throat infection be treated?

For viral infections, generally no antibiotic is needed (unless the infection becomes complicated by a subsequent bacterial infection). Most viral infections can be expected to run a four-to-six day course. During this period, the child or other infected individuals can be treated with lots of fluids, rest, and "feel better" medicines that reduce pain and/or fever, such as acetaminophen (Tylenol, Tempra, Liquiprin, etc.) or ibuprofen (Motrin, Advil, etc.). It is important to note that these measures do not treat the viral infection and only provide some relief of the symptoms. These measures can also be helpful in treating the symptoms of bacterial throat infection, such as strep throat.

Are there any recommended strep throat remedies?

Recommended home remedies for sore throat and tonsillopharyngitis (both strep throat and non-strep throat) are easily available in most circumstances. These remedies are generally geared towards relieving symptoms of sore throat and should not replace antibiotics in cases of proven strep infection.

• Saltwater gargle is an old therapy for sore throat symptom relief. Typically, ¼ to ½ teaspoon of salt is added to a cup (8 ounce) of warm water. Portions of the solution are used for each gargle. Gargling can be repeated a few times daily. Children younger than 8 years of age are not capable of gargling and this therapy should be avoided in this age group.
  
• Hard candies can be used to treat sore throat symptoms. Sucking on a hard candy is as beneficial as some of the other listed therapies.
  
• Lozenges (cough drops, troches, or pastilles) are also available for symptomatic relief of sore or dry throat. Cooling (Menthol), anesthetic (phenol or benzocaine), antiseptic, or anti-inflammatory agents may be used in these products to provide adequate symptom relief. The use of lozenges is not recommended for children under 4 years old.
  
• Other home remedies for symptomatic relief of sore throat and strep throat include warm tea with honey, lemon tea, chicken soup, cold beverages, ice cream, and Popsicles. Honey should be avoided in children less than 1 year of age because of increased risk of botulinum toxicity and paralysis.

It cannot be overemphasized that despite these therapies, antibiotics are the most important treatment for adequately diagnosed strep throat because of the dreaded complications of untreated strep infection.

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 need for surgical removal of the tonsils (tonsillectomy) if an individual:

1. is experiencing frequent episodes of tonsillitis (especially those caused by the strep bacteria),
   
2. 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
   
3. 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 for strep throat such as penicillin, individuals become minimally contagious.

More importantly, there are many potential sequelae of untreated strep infection, as described in the following section.

What are the potential complications of untreated strep throat infection?

Possible complications of untreated or partially treated strep throat infection are:

• rheumatic fever (described below);
  
• glomerulonephritis (described below);
  
• otitis media (spread of infection to the middle ear);
  
• meningitis (spread of infection to the lining of brain and spinal canal);
  
• pneumonia (lung infection);
  
• toxic shock syndrome (a rare but severe complication of strep pharyngitis, causing severe widespread infection and organ failure); and/or
  
• abscess formation around the tonsils and behind the throat (peri-tonsillar abscess and retro-pharyngeal abscess).

Formation of an abscess behind the throat (retro-pharyngeal abscess) due to untreated or under-treated strep throat infection can lead to severe illness causing pain in throat and neck, difficulty swallowing, and potential respiratory compromise. These abscesses may need to be drained by an ear-nose-throat (ENT) specialist urgently, and hospitalization may be required.

There is also a condition called Pediatric Autoimmune Neuropsychiatric Disorder associated with group A Streptococcus infection (PANDAS). This is a theoretical and somewhat controversial condition linking group A strep infection with possible exacerbation of obsessive compulsive disorders or tic disorders (Tourette's syndrome) in children.

Rheumatic fever

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 (causing inflammation of the joints or arthritis) and the heart valves. The involvement of heart valves can cause damage of the heart valves and potential heart failure.

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.

Kidney problems

Theoretically, a similar immune process to acute rheumatic fever may involve 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 after an episode of strep throat. This condition is less common and less severe than rheumatic fever. It typically resolves spontaneously after a few weeks and generally does not lead to permanent kidney damage. 

Is there a vaccine for strep throat?

Currently, there are no vaccines available against group A streptococcus bacteria. There are currently concerns about whether a vaccine may initiate immune responses similar to those causing rheumatic fever and glomerulonephritis.

Can strep throat be prevented?

The important aspect of preventing strep throat infection is to prevent its spread to others. Simple steps can be taken in order to limit the spread of strep throat:

• Covering mouth and nose when sneezing or coughing
  
• Washing hands frequently
  
• Washing dishes and utensils used by the infected individual frequently
  
• Keeping dishes, utensils, and other household items used by the infected person separate from those used by other family members
  
• Do not share food or drinks with the infected individual

Strep Throat At A Glance

• Most throat infections are caused by viruses.
  
• The symptoms of strep throat include fever, sore throat, and swollen lymph glands in the neck.
  
• The diagnosis of strep throat is confirmed by a throat culture or rapid-strep test.
  
• Strep throat is treated with antibiotics.
  
• If left untreated, strep throat may cause heart and kidney problems.