2330. Comparison of Clinical Symptoms in Children Who Present With Sore Throat Who Are Later Determined to Be Carriers vs. Acutely Infected

Abstract

BackgroundAmong symptomatic children who test positive for Group A Streptococcus (GAS) by throat swab, approximately 20–25% are GAS carriers. Current laboratory methods cannot distinguish acute infection from the carrier state at time of diagnosis.MethodsWe examined findings from two longitudinal studies of children 5 to 15 years of age who had throat cultures performed for the detection of GAS while endorsing at least one symptom consistent with streptococcal pharyngitis. Cohort 1 was a surveillance study in which cultures were performed at regular intervals and with illnesses. Cohort 2 were children who were selectively tested by their care providers and then followed. Symptoms were assessed systematically at the time of the first positive culture. Each participant had at least two follow-up cultures performed between 7–21 days and 22–35 days after the first culture. We defined acute infection as two or more negative follow-up cultures for GAS and carriage as two or more positive follow-up cultures in the absence of symptoms. We compared symptoms at the time of the first positive culture between those with acute infection or carriage using chi-square statistics.ResultsA total of 181 children contributed 228 symptomatic episodes; 52% were female, with a mean age of 8.9 years. In cohort 1: 96/122 (79%) were acute infections vs. 26/122 (21%) were carriers. Children endorsed at least one upper respiratory symptom (other than sore throat) in 40/65 (62%) of those with acute infection and 13/21 (62%) in those who were carriers (P = 0.976). In cohort 2: 94/106 (89%) were acutely infected and 12/106 (11%) were carriers. Children had at least one upper respiratory symptom in 24/94 (26%) acute infection and 6/12 (50%) of carriers (P = 0.076). In cohort 2, symptoms of nasal congestion alone (P = 0.009), vomiting (P = 0.018), and abdominal pain (P = 0.015) were more common among carriers compared with acutely infected. There was no difference in severity score or duration of symptoms.ConclusionThis study highlights that when children are selectively tested for GAS based on clinical judgement fewer GAS carriers are identified. For those who were selectively tested, clinical symptoms, including nasal congestion, were more common in children identified as GAS carriers.Disclosures All authors: No reported disclosures.