What is Poststreptococcal Disorder?
Poststreptococcal disorder is a group of autoimmune
disorders that occur after an infection with the bacteria Streptococcus pyogenes, also known as group A Streptococcus (GAS). An autoimmune disorder occurs when your immune
system mistakes your healthy cells as foreign invaders and begins to attack
them. In poststreptococcal disorders, the antibodies that your immune system created
to fight against GAS mistakenly start destroying your healthy cells along with
The initial infection might only cause a sore throat, fever,
and rash, but poststreptococcal disorders can lead to many different problems.
The exact disorder depends on which part of the body is attacked by your immune
system. The disorder can affect the kidneys, heart, skin, brain, or joints. Examples
of poststreptococcal disorders include the following:
- acute rheumatic fever
- obsessive-compulsive disorders
- movement disorders such as tics and myoclonus
- kidney problems like glomerulonephritis
The disorder more commonly affects children. It may come on
suddenly. There is no cure for poststreptococcal disorder, but treatments are available
to help manage the symptoms and most people recover fully.
What Are the Symptoms of Poststreptococcal Disorder?
The symptoms depend on which part of the body is under
attack. There are many disorders associated with GAS infections. Some are still
being researched. Some of the known disorders associated with GAS include the
Acute rheumatic fever (ARF)
Acute rheumatic fever usually develops about two to four
weeks after a strep infection. It leads to inflammation in the joints, heart,
skin, and central nervous system.
The symptoms include:
- painful joints
- swollen joints
- heart murmur
- chest pain
- uncontrollable movements
Most outbreaks happen in areas where people are living in
overcrowded conditions and don’t have access to antibiotics.
Post streptococcal related myalgia
Symptoms of myalgia includes severe muscle pain and
Sydenham’s chorea (SC)
Sydenham’s chorea is characterized by jerking and twisting
movements of the limbs. These rapid movements can’t be controlled. Chorea is
more common in girls and occurs more often in children ages 5 to 15 years old.
Poststreptococcal glomerulonephritis (GN)
GN may develop a week or two after a strep throat infection.
It occurs when the body produces antibodies that attack the glomeruli. These
are the very tiny blood vessels in the kidney that filter out urine. Symptoms
- pink or dark urine due to blood in your urine
- foamy urine due to too much protein
- high blood pressure
- fluid retention
- kidney failure
PANDAS stands for Pediatric Autoimmune Neuropsychiatric
Disorders Associated with Streptococcal
infections. These disorders include obsessive-compulsive disorder (OCD) and tic
disorders that appear suddenly after strep throat or scarlet fever. Symptoms
- motor tics (involuntary movements)
- vocal tics (involuntary sounds or words)
- obsessions and compulsions
- children may be moody, irritable, and experience
What Causes Poststreptococcal Disorder?
Poststreptococcal disorder is caused by an infection with
bacteria called Streptococcus pyogenes,
also known as group A Streptococcus
(GAS). The initial infection may not cause any symptoms. If you do experience
symptoms, the most common are:
- sore throat (strep throat)
- swollen tonsils covered in a white coating
- tender lymph nodes
- red skin rash and reddened tongue (scarlet
- impetigo: an skin infection with open sores,
fever, sore throat, and swollen lymph nodes
Your immune’s system job is to defend your body against
foreign invaders like the GAS bacteria. The immune system produces substances
called antibodies that target and kill the foreign invaders. The antibodies
usually ignore healthy cells. Autoimmune diseases occur when your immune system
mistakes the healthy cells as the foreign invaders and begins to attack them
The Streptococcus bacterium
is unique because it survives in the body by putting molecules on its cell wall
that are almost identical to the molecules found on the skin, heart, joints,
and brain tissues. This is called “molecular mimicry.” By doing this, the
bacteria hides from the immune system. The immune system eventually realizes
that these are foreign cells and attacks them. However, since they are so
similar to healthy cells, the immune system might accidentally begin to attack
the healthy cells that were mimicked. Poststreptococcal disorder happens when
the antibodies that your immune system created to fight against GAS erroneously
start attacking your healthy cells. The exact disorder depends on which of your
organs are being attacked.
How Is Poststreptococcal Disorder Diagnosed?
The diagnosis of poststreptococcal disorder is a clinical
diagnosis. This means that there are no specific lab tests available to
diagnose the conditions. Instead, your doctor will often take a full medical
history and a physical examination. They will ask if you or your child has been
infected with strep throat, scarlet fever, or impetigo within the last few
months. The doctor will ask about the symptoms and whether or not they came on
If the symptoms have been present for more than a week,
blood tests (antistreptococcal titers) may be done to find out if there has
been a recent GAS infection.
If your doctor suspects you or your child is suffering from
GN, they may recommend a urinalysis (a chemical and microscopic analysis of
urine). If your doctor suspects acute rheumatic fever, you may have some tests
done on your heart.
It’s important to remember that many children have tics or
display signs of OCD, and many kids also get strep throat at some point.
Poststreptococcal disorders, like PANDAS, are only considered when there is a
clear relationship between the onset of symptoms like OCD or tics, and a recent
How Is Poststreptococcal Disorder Treated?
Treatment depends on the exact disorder. Since there is no
cure, treatment is aimed at treating the symptoms. Antibiotics are given to
make sure that the GAS infection is gone, and also to prevent acute rheumatic
Treatment for ARF includes nonsteroidal anti-inflammatory
Sydenham’s chorea is often not treated because the symptoms
are so mild and the condition will most likely go away on its own after a few
months. More severe cases of chorea may be treated with:
- intravenous immune globulin (to help get rid of
the antibodies that make the symptoms worse)
Therapy and counseling may be used for emotional issues,
compulsions, and other behavioral problems. Medications include the following:
- anti-anxiety medications
Outlook for Poststreptococcal Disorder
Acute rheumatic fever can cause permanent damage to the
heart. In some cases, the inflammation from ARF may result in long-term
- valve stenosis (narrowing of the valve, which results
in decreased blood flow)
- valve regurgitation (a leak in the valve, which may
cause the blood to flow in the wrong direction)
- damage to heart muscle, making it weaker
- damage to the mitral valve
- atrial fibrillation (irregular heartbeat of the
upper chambers of the heart)
- heart failure
Chorea and myalgia usually will go away on their own without
problems. An article in American Family Physician
states that more than 95 percent of people with poststreptococcal
glomerulonephritis will get better on their own within a month.
Can Poststreptococcal Disorder Be Prevented?
You can prevent acute rheumatic fever by receiving prompt
and complete treatment with antibiotics for a strep infection. This means
taking all prescribed doses on time.
You can’t always prevent poststreptococcal disorder, but you
can take measures to prevent getting a strep infection to begin with. These
- avoiding contact with anyone who has a strep
- washing your hands often
- not sharing toothbrushes or eating utensils
Strep throat is highly contagious and fairly common in
children. Not all children who have a GAS infection will end up with