Strep throat, a common bacterial infection caused by Streptococcus pyogenes, typically affects children but is a notable concern for older adults. While often considered mild, its impact can be more severe in the elderly.
Increased Vulnerability in Older Adults
Older adults often experience a natural decline in immune system function, known as immunosenescence. This age-related change compromises both innate and adaptive immune responses. This makes them more susceptible to infections like strep throat.
Co-existing chronic health conditions further increase vulnerability in the elderly. Conditions like diabetes, heart disease, chronic lung disease, and kidney issues can exacerbate infection effects and complicate recovery. Older adults, especially those in long-term care facilities, face a higher risk of severe outcomes from strep throat.
Identifying Symptoms
The typical symptoms of strep throat include a sudden and severe sore throat, pain when swallowing, and a fever often above 101 degrees Fahrenheit. Individuals may also notice red and swollen tonsils, sometimes with white patches or streaks of pus, and tiny red spots on the roof of the mouth. Swollen and tender lymph nodes in the neck, headaches, and body aches are also common.
Symptoms in older adults can be atypical or milder than those seen in younger individuals. They might present with less specific signs, such as subtle throat redness, a lack of fever, or even gastrointestinal issues. Unlike viral sore throats, strep throat does not involve a cough, runny nose, or hoarseness. These symptoms generally appear within two to five days after exposure to the bacteria.
Serious Health Complications
Untreated strep throat can lead to serious health complications, especially in older adults. One complication is post-streptococcal glomerulonephritis (PSGN), an inflammation of the kidneys. Although less common in the elderly, PSGN can lead to a poor prognosis, with acute mortality and chronic renal disease. Symptoms may include decreased urine output, blood in the urine, swelling in the abdomen or lower extremities, and difficulty breathing.
More concerning are the invasive Group A Streptococcal (iGAS) diseases, where the bacteria spread to normally sterile body parts like the bloodstream, deep muscle, or lungs. Necrotizing fasciitis, or “flesh-eating bacteria,” is a rapidly progressing infection destroying muscle, fat, and skin tissue. Early signs include fever, severe pain, swelling, and redness at an infection site, carrying a high mortality rate.
Streptococcal Toxic Shock Syndrome (STSS) is another life-threatening iGAS complication. This condition involves the release of toxins by the bacteria, leading to widespread organ damage and dangerously low blood pressure. Initial symptoms like fever, chills, muscle aches, and nausea can rapidly progress within 24 to 48 hours to organ failure affecting kidneys, liver, or lungs, accompanied by a rapid heart rate and breathing. Older adults have the highest incidence of iGAS infections, accounting for a significant portion of cases and deaths.
Diagnosis and Treatment
Prompt diagnosis of strep throat is important to prevent complications. Healthcare providers typically perform a physical examination and may use a rapid strep test, detecting the bacteria within minutes. If the rapid test is negative but strep throat is suspected, a throat culture may be performed, with results usually available in one to two days.
Antibiotics are the standard treatment for strep throat. Penicillin or amoxicillin are commonly prescribed due to their effectiveness and safety. For individuals with penicillin allergies, alternative antibiotics like cephalexin, clindamycin, or azithromycin can be used. Complete the entire 10-day course of antibiotics, even if symptoms improve, to ensure full eradication and prevent serious complications or antibiotic resistance.
Antibiotic treatment also reduces the period of contagiousness, often within 24 hours of starting medication. Alongside antibiotics, supportive care can help manage symptoms, including pain relievers, adequate hydration, soothing foods, gargling with warm salt water, and using a humidifier. Seek medical attention if symptoms do not improve after 48 hours of antibiotic treatment, or if there is difficulty breathing or swallowing.
Proactive Prevention
Preventing strep throat in older adults involves a combination of hygiene practices and maintaining overall health. Frequent handwashing with soap and water is a primary defense, especially after being in public places, before eating, and after contact with sick individuals. Alcohol-based hand sanitizer is a suitable alternative when soap and water are not available.
Avoiding close contact with individuals who are sick and refraining from sharing personal items like utensils, cups, or toothbrushes can limit transmission. Covering coughs and sneezes, and regularly cleaning commonly touched surfaces, helps reduce bacterial spread. Maintaining general good health through a balanced diet, adequate sleep, and managing stress supports a robust immune system, enhancing the body’s natural ability to resist infections.