I already told some people and some of you may already know. Those who know, keep it to yourself until I finish. If you take an antibiotic for strep throat, you would probably feel better one day sooner than you would have with no antibiotic therapy. So you get one day that your symptoms might be encouraged to diminish, if you take the antibiotic, just symptoms. But the key clinical success to this type of infection is eradication. If you don't eradicate that organism, there is always the possibility that you'll have a condition leading on to rheumatic fever. If you lead on to rheumatic fever, you may get heart valve damage. Once there is heart valve damage, this site presents a potential niche for bacterial growth and infection.

Every time you undergo oral surgery or even cleaning of teeth, there is some bleeding in the oral cavity and an opportunity for oral bacteria to enter the blood stream. This is called a transient bacteremia, i.e. bacteria in the circulating blood. In a normal person, this is of little to no consequence. However, if one has a history of heart valve or other heart problems, there are sites that may provide a opportunity for bacteria to establish growth within the heart. Not so good to have things growing in your heart but your body says, "I've got a nice immune system. I'm going to attack that site." They then start destroying the organism. The only problem is, these creatures, not the Strep. pyogenes, but the ones in the oral cavity share a protein that's almost identical to your heart. Then your immune system can't distinguish between the bacteria and your heart tissue; you start destroying your own heart. That's subacute bacterial endocarditis. It's irreversible and it's a nasty, nasty infection to treat. It's auto immune disease of your heart. So that's why you take the antibiotic and that's why you have to take a full course to make sure you get complete eradication. It's rare to go on to the scenario I described for subacute bacterial endocarditis. But it's not worth taking that risk. That's why you take the antibiotic and youngsters that have a strep throat should monitored to insure that they take their full coarse of therapy.

That's the way strep looks if you stained it. Before I had it, I guess I didn't show this one. We did have the organism under phase contrast microscopy. This is a Gram stain so you can see it's gram positive (purple color). Again, it's got the chain-like feature. I think I'll go on to my next slide.

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