11 If performed properly, the sensitivity of a single throat swab culture for detecting GABHS is 90% to 95%. The culture of a throat swab specimen on sheep blood agar plate remains the gold standard for documenting the presence of GABHS but requires 18 to 24 hours. If the modified Center score is greater than 2, a microbiologic test should be performed. 10Ĭlinical criteria can help a physician select patients who have higher likelihood of GABHS pharyngitis and who need to be tested. One point is taken from the score for patients 45 years of age and above. 9,10 One point is assigned to each of 5 criteria: temperature above 38☌, swollen tender anterior cervical nodes, tonsillar exudates, age between 3 and 14 years, and absence of cough. 9 The modified Centor score is one in popular use, and it has been validated for use in children and adults with sore throat. Many clinical scoring systems have been developed to assist in the diagnosis of GABHS pharyngitis. 4,7 The presence of cough, rhinorrhea, hoarseness, conjunctivitis, stomatitis, herpangina, viral exanthem, generalized lymphadenopathy, and splenomegaly favors a viral etiology. 4,7 Viral causes of pharyngitis include adenovirus, rhinovirus, coronavirus, Epstein-Barr virus, influenza virus, and parainfluenza virus. Other bacterial causes of pharyngitis include group C and group G β-hemolytic streptococci, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and anaerobic species. The rash may be more prominent in flexor skin creases, especially in the antecubital fossae (Pastia lines).Ĭlinical diagnosis can be difficult, because with the exception of the rash of scarlet fever, none of the clinical findings described in the preceding section is specific for GABHS pharyngitis. 6 Typically, the rash blanches on pressure, has the texture of gooseflesh or coarse sandpaper, and is better felt than seen. The latter is caused by streptococcal pyrogenic exotoxins and, when present, signifies scarlet fever. 5 Physical findings include a beefy red pharynx, enlarged and erythematous tonsils, pharyngeal exudates, enlarged tender anterior cervical lymph nodes, and sometimes palatal petechiae, a strawberry tongue, and a scarlatiniform rash. Other symptoms, such as headache, nausea, vomiting, and abdominal pain, also may be present, especially in younger children. 6 Children commonly present with a sudden onset of sore throat, pain on swallowing, and fever. The incubation period is from 2 to 5 days. 6 Patients are most contagious during the acute stage of the illness and usually are not contagious 24 hours after appropriate antibiotic therapy has been started. 6 Asymptomatic carriage is common in young children. 6 Fomites and household pets are the most common vectors of GABHS infection. The major route of spread is person-to-person via respiratory droplets. 2 It is estimated that GABHS accounts for 20% to 30% of cases of acute pharyngitis in school-aged children. 4 In temperate climates, the incidence is highest in the winter and early spring. 2,3 Although the infection can occur at any age, it is uncommon before 3 years of age and after 45 years of age. 1 GABHS pharyngitis occurs mainly in children aged 5 to 15 years. GABHS, also known as Streptococcus pyogenes, is the most common bacterial cause of acute pharyngitis in children. The diagnosis was confirmed with a throat culture that grew group A β-hemolytic streptococcus (GABHS). The history and physical examination findings were suggestive of group A β-hemolytic streptococcal pharyngitis. She did not have a skin rash, peeling of skin, conjunctival congestion, oral ulcers, or splenomegaly.Īnswer: Group A β -hemolytic streptococcal pharyngitis Physical examination findings included a temperature of 38.5☌, an inflamed pharynx, enlarged tonsils, tonsillar exudates, a strawberry tongue (Figure), and enlarged tender anterior cervical lymph nodes. She had been exposed to a child with sore throat a few days ago. There was no associated cough, runny nose, or hoarseness. A 10-year-old girl presented with a 3-day history of fever, sore throat, pain on swallowing, and headache.
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