Strep Throat in the Shadow of COVID-19: A Case Report of Co-Infection

The COVID-19 pandemic is a global health crisis that has been sweeping across the world since December 2019, causing more than 130 million cases and over 2.8 million deaths. COVID-19 is a multifaceted disease that presents many symptoms, including some of the same symptoms as strep throat. It can be hard to know if it’s just strep throat or if it’s actually COVID. Or could it be both? The only way to know is by testing.


We’ve learned a lot about COVID so far, and we’re still learning as the pandemic wears on. One thing we’ve learned is that COVID-19 and strep throat can occur together, which is what happened in this case. This happened to a 38-year-old man who came into an emergency department in Newark, New Jersey, complaining of the following symptoms: 


  • fever
  • productive cough (with yellow sputum)
  • sore throat and runny nose
  • loss of sense of smell and taste


The difficult thing about COVID is that the symptoms this man had align with a COVID infection, but they are also associated with a few different illnesses, like Strep throat, the flu, and the common cold. When the patient was examined by the doctors, he had redness, inflammation, and swelling of the tonsils and throat. These symptoms are both found in COVID-19 and strep throat infections. 


To distinguish between the two, a PCR test was ordered for COVID-19, and a Streptococcal rapid antigen detection test was ordered in case it was strep throat. Surprisingly, both tests came back positive, and the patient was diagnosed with both strep throat and COVID-19. 


The patient received antibiotics for strep throat and was discharged to isolate at home and monitor for COVID-19, with instructions to social distance and wear a mask. From this case, we see that although strep throat affects mostly young children and adolescents, it can also occur among adults, with a peak of Strep throat infection at the age of 40. 


Additionally, there are so many overlapping symptoms between COVID-19 and strep throat, which can be a source of anxiety and fear for patients. This is why using an early detection method like rapid antigen testing for strep throat is crucial since they deliver accurate and timely results. Treating Strep throat is important for alleviating patient anxiety and fear, and it's especially important in order to avoid deadly complications of untreated strep throat. Complications of untreated strep throat range from Rheumatic heart disease, toxic shock syndrome, reactive arthritis, kidney damage (glomerulonephritis), sinusitis, and necrotizing fasciitis, a serious bacterial infection that destroys healthy tissue. 

Don't Ignore Strep Symptoms 

This case has shown that with COVID-19 infections overwhelming hospitals, clinics, and workers, other serious diseases like strep throat could be easily missed. Healthcare workers should be aware that strep throat symptoms often overlap with COVID-19 symptoms. It’s especially important that physicians keep an eye out for possible strep throat infections that could be hiding in the shadow of a COVID-19 diagnosis. Testing for strep throat using rapid antigen detection methods could save a patient's life by detecting and treating a strep throat infection.


Strep throat is easily treatable with oral antibiotics like penicillin, cephalosporins, and macrolides. However, if the diagnosis is missed, it can lead to complex and dangerous complications that have a much higher cost to both the individual and the health system as a whole. Just as we’ve come to the point of at-home COVID testing, we’ll soon be able to run at-home rapid Strep tests, too. Early detection is key with both of these illnesses, both in terms of treatment and stopping community spread.