Getting going...on the Evil Hidden Dangers of Strep Throat

We did not intend this blog to be (entirely) devoted to John Kerry's Boston shopping habits. And so, with second year fully in progress, I'll get started with a little cautionary tale.

This week's Diagnosis in the New York Times Magazine (a weekly feature that, lately, my medical parents have taken to leaving clipped out for me as some kind of boards-prep quiz...) is about a disease - a phenomenon - that I learned about last year. (Read it now if you want to be surprised.)


The clinical vignette is about a case of Lemierre's syndrome. I first learned about this last year, when I heard an alarming story about a friend of a friend, a field organizer during the 2006 elections, who, run down after months of endless work and no sleep, came down with a nasty strep throat - just after the elections. Healthy and in her early 20's, she ended up in a coma for over a week, septic and near death, because of Lemierre's. She made a complete recovery, but, I did a little reading about Lemierre's at the time and made a mental note not to underestimate strep. In this case, the 17-year old patient died, which was probably avoidable, if the diagnosis had been made earlier - and his doctor describes breaking down and crying with guilt.

And this perfectly illustrates the increasingly frustrating - and scary - paradox of use and abuse of antibiotics in the current system, where MRSA is always on the rise and antibiotic development lags behind bacterial adaptation. Concerned about antibiotic resistance, doctors prescribe less potent antibiotics for strep, have young children cry through their ear infections rather than pump them through the courses of antibiotics that I took as a kid (and loved 'em - because the pain I endured without them was unbearable) - and cases like this can be the result. The article notes that Lemierre's is on the rise because of the decrease in penicillin use for strep. Yet, in an essay earlier this week in the NYT, Sandeep Jauhar starts out his castigation of "pay for performance" schemes with a case in which an elderly man was started on IV antibiotics as part of the hospital's anti-pneumonia initiative, didn't get pneumonia, but did get a severe case of C. diff diarrhea - a common, debilitating, expensive consequence of antibiotic use and overuse. Two sides of the same coin - which makes appropriately conservative, exquisitely tailored, sensible standards of care all the more important. So, what about Lemierre's? Follow-up cultures for everyone? Back to penicillin?