Group A Streptococcal Infections

Abstract

1. Preeti Jaggi, MD* 2. Stanford T. Shulman, MD† 1. *Pediatric Infectious Disease Fellow, Children’s Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Ill 2. †Professor of Pediatrics; Chief, Division of Infectious Diseases, Children’s Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Ill After completing this article, readers should be able to: 1. Discuss the differential diagnosis of pediatric acute pharyngitis and the epidemiology and transmission of group A Streptococcus (GAS) pharyngitis. 2. Delineate the rationale for and the treatment regimens of GAS pharyngitis as well as the complications of GAS pharyngitis. 3. Know the carrier state of GAS. 4. Describe the clinical criteria for rheumatic fever and streptococcal toxic shock syndrome. Group A Streptococcus (GAS) causes the widest range of syndromes of any bacterium, including simple skin infections and pharyngitis, severe suppurative infections, the toxin-mediated streptococcal toxic shock syndrome (STSS), and immune-mediated illnesses such as acute rheumatic fever and acute glomerulonephritis. Specific manifestations of GAS infections represent the complex interplay of bacterial virulence factors and host immunogenetic factors. GAS accounts for about 15% to 30% of acute pharyngitis cases in children. Children ages 5 to 11 years have the highest incidence of GAS pharyngitis, although it occurs among all age groups. The major rationale for accurate diagnosis and treatment of GAS pharyngitis is the prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD). In temperate climates, GAS pharyngitis is more common during the winter and early spring months. The incubation period for streptococcal pharyngitis is short (2 to 5 days). Transmission occurs with close contact via inhalation of organisms in large droplets or by direct contact with respiratory secretions. GAS is only one of the causes of acute pharyngitis; others are listed in Table 1. One of the most crucial decisions in evaluating a patient who has pharyngitis is whether to perform a rapid antigen test or bacterial culture of the throat for GAS. The clinician must keep in mind three important principles. First, accurate detection and treatment of GAS pharyngitis are needed to prevent ARF and other complications. Second, unnecessarily performing these …