A 9-Year-Old Girl's Strep Throat Showed Up With Doughnut Lesions

When our little ones get sick we want to help them feel better as quickly as possible. When they complain of a sore throat, we try to soothe it. We tuck them in bed with some warm tea, chicken soup, and marshmallows, and let them rest. But, when the soreness doesn't go away or when other symptoms begin to show up we'll take them to the doctor for help in figuring out what is going on and assuage our worry.

When a Sore Throat is Strep Throat

When a sore throat won't go away and you begin to have other symptoms, you might want to consider the possibility of strep throat. The  Centers for Disease Control and Protection (CDC) tell us that It is common for children between the ages of 5 and 15 to get strep throat—caused by bacteria called A Streptococcus pyogenes.

The CDC says typical symptoms of strep that your child can experience include:

• Sore throat—hard to swallow—for over a day or two
• Feeling feverish—100.4°F in children according to the Mayo Clinic
• Headachey
• Nauseous and vomiting in younger children
• Swollen neck lymph nodes—tender to the touch
• Swollen tonsils—at the back of the mouth on either side, near the entrance to the throat
• Red spots—on the roof of the mouth—called petechiae

The petechiae mouth rash is a giveaway of strep infection.

Doughnut Lesions of Strep

A short case study reported in the New England Journal of Medicine in 2019 that was shared by Medical Dialogues shows vivid photos of what experts call "doughnut lesions." A 9-year-old girl’s mouth shows the rash. In the report, Japanese researchers Akira Kobayashi, MD, and Hiromichi Iwasaki, MD describe the case of a healthy girl who went to a primary care clinic with some pretty run-of-the-mill symptoms. Namely: a sore throat and fever of 101.3 degrees Fahrenheit.

Then the doctor saw her throat. Her uvula—the thing that hangs down at the back of your throat—was inflamed, her tonsils were enlarged, and she had so-called doughnut lesions dotting the inside of her mouth. Her lymph nodes were also swollen.

The pics show it all—from far away it looks like the roof of her mouth is dotted with red spots. Upon closer inspection, the zoomed-in photo shows that these round, red spots have a pale center, which is where they get their doughnut name. Her tongue also looks like it’s covered in a white film.

The doctor swabbed her throat to perform a rapid strep culture for group A strep. Sure enough, it was positive.

Causes

Bacteria cause this common throat infection, and it’s most likely to affect school-age kids 5 to 15 years old, according to the CDC. In fact, the patient had many of the most common signs and symptoms of strep.

It’s worth noting that strep may also be caused by a virus—not bacteria—if you also have a cough and runny nose along with your sore throat.

Treatment

The fastest cure for strep is with the antibiotics penicillin or amoxicillin, the CDC tells us. The patient in this report took amoxicillin.

It’s important to get treated because, in the unlikely event strep spreads, you can experience ear and sinus infections or even more serious conditions like rheumatic fever—which affects the heart.

Doughnut lesions are a classic sign of strep. But while it may have been obvious to the doctor, a culture test was necessary for a true diagnosis. Doctors can’t diagnose strep just by looking at someone’s throat.

Cautions With Antibiotic Use

If you happen to have antibiotics at home—left over from when you did not complete a full treatment—you don’t want to administer the antibiotics “just to be safe.”

One in three antibiotic prescriptions is unnecessary, according to a study published in JAMA and reprinted by the CDC. This unnecessary use includes those doled out to treat sore throats. Antibiotic overuse promotes antibiotic resistance—when the drugs don’t work when needed to kill bacteria.

All that's to say, if you find that your kids have strep—doughnut lesions or not—make sure they get the strep test before popping antibiotics.