Streptococcal Pharyngitis In Children Research Articles

Diagnosis and Treatment of Group A Streptococcal Pharyngitis in Children

The purpose of this review is to summarize the current evidence regarding the management of streptococcal pharyngitis in children. This article aims to provide a valid support to discriminate streptococcal pharyngitis from viral cases and treat it appropriately to avoid the development of complications. Differential diagnosis based only on clinical features is not always easy. For this reason, different clinical scores were created to provide an accurate diagnosis. Microbiological tests are valuable tools as well, but their use is not recommended unanimously. Concerning treatment, all guidelines agree on the drug to be used. However, doubts remain about the optimal duration of antibiotic therapy, especially in this specific historical moment as we are experiencing a peak in streptococcal infections. [ Pediatr Ann . 2024;53(6):e234–e238.]

The rise and fall of acute rheumatic fever and rheumatic heart disease: a mini review.

The incidences of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), which were leading causes of death in children in the 1920s, have decreased substantially. Considering the recent resurgence of scarlet fever and increased incidence of streptococcal pharyngitis in children, an investigation of the current status of ARF and RHD may be worthwhile. To summarize the prevalence trends, pathogenic factors, and prevention strategies for ARF and RHD in children. A selective search of literature published between January 1920 and February 2023 was done in PubMed, using the terms "acute rheumatic fever", "rheumatic heart disease", "group A Streptococcus", "pharyngitis", "pharyngeal tonsillitis", "scarlet fever", "impetigo", "obstructive sleep apnea syndrome" and "child". Overcrowded homes and inadequate sanitation led to recurrent group A streptococcal infection, and the causal relationship between group A streptococcal infection and ARF/RHD was well established. Streptococcal infectious diseases, such as group A streptococcal pharyngeal tonsillitis, SF, impetigo, and obstructive sleep apnea syndrome, were associated with the occurrence of ARF and RHD. ARF and RHD were still prevalent in young people of developing countries and economically poor populations of high-income countries. Universal disease registration systems were critical to locating disease outbreaks, tracking disease transmission, and identifying high-risk populations. Four-level prevention strategies were effective in reducing the incidence and mortality of ARF and RHD. Registry and preventive measures for ARF and RHD should be strengthened in areas of dense population; poor sanitation; resurgence of SF; and high incidence of streptococcal pharyngitis, impetigo, and obstructive sleep apnea syndrome.

Identifying Group A Streptococcal Pharyngitis in Children Through Clinical Variables Using Machine Learning.

Background Group A Streptococcus(GAS) is the most common bacterial cause of pharyngitis in children.GAS pharyngitis requires antimicrobial agents, and rapid antigen detection tests (RADTs) are currently considered useful for diagnosis. However, the decision to perform the test is based on the pediatrician's examination findings, but the indicators are not clear. Therefore, we used machine learning (ML) to create a model to identify GAS pharyngitis from clinical findings and to explore important features. Methods ML with Python programming language was used for this study. Data from the included study involved 676 children aged 3 to 15 years diagnosed with pharyngitis, with positive results on the RADT serving as exposures, and negative results serving as controls. The ML performances served as the outcome. We utilized six types of ML classifiers, namely, logistic regression, support vector machine, k-nearest neighbor algorithm, random forest, an ensemble of them, Voting Classifier, and the eXtreme Gradient Boosting (XGBoost) algorithm. Additionally, we used SHapley Additive exPlanations (SHAP) values to identify important features. Results Moderately performing models were generated for all six ML classifiers. XGBoost produced the best model, with an area under the receiver operating characteristics curve of 0.75 ± 0.01. The order of important features in the model was palatal petechiae, followed by scarlatiniform rash,tender cervical lymph nodes, and age. Conclusion Through this study, we have demonstrated that ML models can predict childhood GAS pharyngitis with moderate accuracy using only commonly recorded clinical variables in children diagnosed with pharyngitis. We have also identified four important clinical variables. These findings may serve as a reference for considering indicators under the current guidelines recommended for selective RADTs.

The Epidemiology of Influenza Virus Infection and Group A Streptococcal Pharyngitis in Children Between 2011 and 2018 in an Outpatient Pediatric Clinic.

Background The frequency of influenza virus infections and group A beta-hemolytic streptococcus (GAS) pharyngitis varies according to populations. We aimed to investigate the frequency of influenza virus and streptococcal pharyngitis infections in a pediatric outpatient cohort with many pediatric admissions in Istanbul. Materials and methods Children with upper respiratory tract infection (URTI) symptoms between 2011 and 2018 who underwent rapid diagnostic tests for influenza virus or streptococcal infection were evaluated retrospectively. Results Thetotal number of pediatric cases admitted between 2011 and 2018 was 185,228, of which 119,928 were under five years oldand 66,300 were children over five years old. The mean frequency of the influenza virus was 1,283 per 100,000 children, and the mean frequency of streptococcal pharyngitis was 1,764 per 100,000 children. The frequency of influenza has increased over the years. The frequency of streptococcal infection is higher in children over five years of age, and its frequency has decreased in this group. Conclusions Thefrequency of influenza virus infection and GAS pharyngitis varies according to years and seasons. Winter and spring were the seasons with the most frequent positive influenza virus and GAS pharyngitis. Although influenza frequency increased annually, this phenomenon was not observed in the frequency of GAS pharyngitis.

Inappropriate Testing of Streptococcal Pharyngitis in Children Aged Below 3 Years: Application of Statistical Process Control.

Group A strep tests in patients aged below 3 years are not recommended unless the patient has appropriate symptoms and a positive contact or signs of complications. The purpose of this quality improvement project was to increase the percentage of appropriately ordered strep tests among providers. Data were collected retrospectively and prospectively from 1163 patient visits. Providers were exposed to educational interventions, an electronic medical record order change, and provider feedback. Proportional control charts characterized the providers' behaviors and determined significant improvement among testing. The result was an increase in appropriate tests (13.7% to 37.8%), and the control charts showed sustainable results over time. This project demonstrates the efficacy of these methods to encourage antibiotic stewardship among providers. Furthermore, the interventions used here can be applied to other areas with low-value diagnostic testing. Future studies should investigate whether parental anxiety and educational programs influence testing and evaluate the efficacy of certain strategies.

Prevalence and Clinical Presentation of Group A Streptococcal Pharyngitis in Children at a Tertiary Hospital in Gombe, North-East Nigeria

Background: Globally, Group A ß-Haemolytic Streptococcus (GAßHS) pharyngitis and its complications are major contributors to childhood morbidity and mortality, especially in developing countries. The diagnosis and treatment of GAßHS pharyngitis in these countries is often empirical resulting in frequent misdiagnosis and inappropriate treatment. Determining the local prevalence and clinical presentations of GAßHS pharyngitis will be essential for making informed clinical decision. Objective: The objective of the study was to determine the prevalence and clinical presentations of GAßHS among children with pharyngitis at a tertiary hospital in Gombe, North-eastern Nigeria. Methods: 324 children aged 3-18 years were consecutively recruited at the out-patient clinic between 1st April 2018 to 30th September 2018. Socio-demographic and clinical features were recorded and throat swab samples were cultured on 5% sheep blood agar to diagnose GAßHS.Result: The prevalence of GAßHS pharyngitis was 25.9% and was significantly higher; in females (67.1%) (p=0.046), in children aged 11-14 years (32.1%) (p= 0.008) and during peak rainfall (p=0.001). The clinical features significantly associated with GAßHS pharyngitis were; runny nose (p<0.001), cough (p<0.001) and sorethroat (p<0.001), fever (p<0.001), palatal petechiae (p<0.001), pharyngeal erythema and exudates (p=0.001), tonsillar enlargement and exudates (p<0.001), cervical lymph node tenderness (p=0.010), halitosis (p=0.029), and scarlet rash (p=0.001). Conclusion: GAßHS pharyngitis is prevalent in children especially during peak of rainfall and some clinical features are commoner among patients with GAßHS pharyngitis. These clinical symptoms and signs can be used to guide empiric treatment decision.

Streptococcal Pharyngitis in Children: A Tertiary Pediatric Hospital in Bucharest, Romania.

Streptococcal Pharyngitis in Children: A Tertiary Pediatric Hospital in Bucharest, Romania.

The incidence of sore throat and group A streptococcal pharyngitis in children at high risk of developing acute rheumatic fever: A systematic review and meta-analysis.

BackgroundGroup A streptococcal (GAS) pharyngitis has traditionally been considered the sole precursor of acute rheumatic fever (ARF). Evidence from Australia, however, suggests that GAS skin infections may contribute to the pathogenesis of ARF. A missing piece of evidence is the incidence of sore throat and GAS pharyngitis in this setting. We conducted a systematic review and meta-analysis of the incidence of sore throat and GAS pharyngitis in all children at risk of developing ARF.MethodsDatabases were systematically searched for studies reporting on the incidence of pharyngitis among children from low to upper-middle income countries, and Indigenous children living in high-income countries. Studies were subjected to data extraction by two independent reviewers. Following an assessment of the methodological quality of the studies, we extracted incidence rates (IRs) and conducted a meta-analysis. This systematic review is registered on PROSPERO (CRD42019113019).ResultsFrom 607 titles identified by the search, 11 articles met the predetermined inclusion criteria; ten studies reported IRs while for the remaining study, the incidence was calculated. The pooled incidence estimated for sore throat was 82.5 per 100 child-years (95% confidence interval [CI], 6.5 to 1044.4 per 100 child-years, I2 = 100%) and GAS pharyngitis was 10.8 per 100 child-years (95% CI, 2.3 to 50.0 per 100 child-years, I2 = 99.9%).ConclusionsThe pooled IRs for sore throat in children at risk of developing ARF were higher than rates reported in developed nations (32.70–40 per 100 child-years) and similar for GAS pharyngitis (12.8–14 per 100 years). The limited Australian data lend support to the need for further studies to inform the role of GAS pharyngitis in the development of ARF in Australian Indigenous children, so as to inform local primary prevention strategies for ARF and Rheumatic Heart Disease (RHD).

The Challenge of Patient Notification and the Work of Follow-Up Generated by a 2-Step Testing Protocol for Group A Streptococcal Pharyngitis in the Pediatric Emergency Department.

Current guidelines recommend confirmatory testing for negative rapid antigen detection tests (RADTs) for group A streptococcal pharyngitis in children. We sought to describe the work of follow-up generated by this process and frequency of our inability to notify patients of positive results. We retrospectively reviewed laboratory and outreach nurse records of patients who had group A streptococcal pharyngitis testing performed in an academic pediatric emergency department during 2014. For patients with a negative RADT and subsequent positive backup direct nucleic acid probe test, we recorded whether the patient was successfully notified of the positive result, the number of contact attempts, and the time to antibiotic prescription. There were 6504 patients who had an RADT performed, of which 5474 (84.2%) were negative with a confirmatory test performed. There were 234 patients with positive confirmatory testing and not prescribed antibiotics at the time of the initial visit. Of these, 90.1% were ultimately contacted and prescribed appropriate antibiotics, whereas 7.3% were lost to follow-up and 2.6% had potentially unnecessary repeat visits. Of those contacted, 43.1% were reached only after multiple telephone calls or a letter. The median time from the negative RADT to the submission of an electronic prescription was 19.6 hours (interquartile range, 7.5-24.9 hours; range, 6-144 hours). Although confirmatory testing after a negative RADT in children is currently the standard of care, this practice requires a substantial amount of work. Furthermore, a significant fraction of patients are lost to follow-up or have unnecessary repeat visits.

Diagnosis and antibiotic treatment of group a streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction

BackgroundTo compare the sensitivity and specificity of the recommended 2-step rapid antigen detection test (RADT) with confirmatory culture vs the point-of-care (POC) polymerase chain reaction (PCR) Roche cobas® Liat® Strep A test for detection of group A Streptococcus (GAS) in pediatric patients with pharyngitis, and to investigate the impact of these tests on antibiotic use in a large pediatric clinic.MethodsThis prospective, open-label study was conducted at a single site during fall/winter 2016–2017. A total of 275 patients aged 3 to 18 years with symptoms of pharyngitis had a throat-swab specimen analyzed using RADT, POC PCR, and culture. The sensitivity, specificity, and percentage agreement (95% CI) between assays and a laboratory-based nucleic acid amplification test were calculated. DNA sequencing was used to adjudicate discrepancies. The RADT or POC PCR result was provided to clinicians on alternating weeks to compare the impact on antibiotic use.ResultsA total of 255 samples were evaluated; 110 (43.1%) were GAS positive. Sensitivities (95% CI) for POC PCR, RADT, and culture were 95.5% (89.7–98.5%), 85.5% (77.5–1.5%), and 71.8% (62.4–80.0%), respectively. Specificities (95% CI) for POC PCR, RADT, and culture were 99.3% (96.2–99.98%), 93.7% (88.5–97.1%), and 100% (97.5–100%), respectively. Compared with RADT, POC PCR resulted in significantly greater appropriate antibiotic use (97.1% vs 87.5%; P = .0065).ConclusionUnder real-world conditions, RADT results were less specific and culture results were less sensitive than found in established literature and led to increased rates of inappropriate antibiotic use. POC PCR had high sensitivity and specificity and rapid turnaround times, and led to more appropriate antibiotic use.Trial registrationID number ISRCTN84562679. Registered October 162,018, retrospectively registered.

A Pragmatic Study to Evaluate the Use of a Rapid Diagnostic Test to Detect Group A Streptococcal Pharyngitis in Children With the Aim of Reducing Antibiotic Use in a UK Emergency Department.

Sore throat is a common presentation to the children's emergency department (ED), and many patients are likely prescribed antibiotics unnecessarily. We aimed to reduce antibiotic prescribing for sore throat in our UK ED through use of an established scoring system combined with a rapid diagnostic test (RDT) to detect group A streptococcal (GAS) pharyngitis. AB single-subject and diagnostic accuracy studies were used to measure both antibiotic prescribing rates over time and the performance of the McIsaac clinical score combined with RDT to screen for and treat GAS pharyngitis. All children between the age of 6 months and 16 years with symptoms of sore throat were eligible for inclusion. The study adhered to SQUIRE guidelines. During 2014 and 2016, antibiotic prescribing rates for 210 children at baseline (median age, 3 years) and 395 children during the intervention (median age, 2 years) were assessed. The baseline prescribing rate was 79%, whereas rates after intervention were 24% and 27%, respectively. The RDT had an acceptable false-negative rate of 7.9%, poor sensitivity of 64.3%, and a negative predictive value of 92.1% when compared with conventional throat culture. A McIsaac score of 3 or more had good sensitivity (92.11%) but very low specificity (12.62%) for predicting GAS infection. Despite poor RDT sensitivity and the McIsaac score's poor specificity in children, their use in combination decreased antibiotic prescribing rates in a children's ED setting.

Narrow-spectrum, compared with broad-spectrum, antibiotics equally effective with less adverse events

Gerber JS, Ross RK, Bryan M, Localio AR, Szymczak JE, Wasserman R, et al. Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections. JAMA 2017;318:2325-36. Question Among children with acute respiratory infections (acute otitis media, group A streptococcal pharyngitis, and acute sinusitis), what is the efficacy and safety profile of broad-spectrum, compared with narrow-spectrum, antibiotics? Design Retrospective and prospective cohorts. Stratified and propensity score-matched analyses. Setting Thirty-one pediatric practices in Pennsylvania and New Jersey. Participants Children 6 months to 12 years, with acute otitis media, group A streptococcal pharyngitis, and acute sinusitis. Intervention Broad- versus narrow-spectrum antibiotics. Outcomes Effectiveness and adverse events. Main Results Broad-spectrum antibiotics were not associated with less treatment failure, risk difference 0.3% (95% CI, −0.4% to 0.9%), and were associated with more clinician-reported and patient-reported adverse events, risk difference 1.1% (95% CI, 0.4% to 1.8%) and 12.2% (95% CI, 7.3% to 17.2%), respectively. Conclusions Narrow-, compared with broad-spectrum antibiotics were equally effective and demonstrated a lower rate of adverse events. Commentary This cohort study supports guidelines recommending narrow-spectrum amoxicillin or penicillin for treatment of acute otitis media, acute sinusitis, and group A streptococcal pharyngitis in children. Although broad-spectrum antibiotics, such as amoxicillin-clavulanate, are commonly prescribed based on conflicting guidelines for these conditions, they were not associated with improved outcomes compared to narrow-spectrum therapy. This large retrospective cohort demonstrated convincingly that broad-spectrum antibiotics do not lower overall rates of treatment failure, even when adjusting for differences in provider prescribing practices or illness severity using clinician-stratified and propensity-score matched analyses. The unique inclusion of patient-reported outcomes in a prospective cohort detected a 10-fold higher rate of adverse events compared with the retrospective cohort, which suggests most antibiotic adverse events are unreported and/or unrecognized by clinicians. Also, in this group, broad-spectrum antibiotics were associated with an increased risk of adverse events with no improvement in quality of life. While observational cohorts undoubtedly include children with viral infections that may obfuscate differences in antibiotic efficacy, this study reflects real clinical practice where the empiric choice of broad rather than narrow-spectrum antibiotics for acute respiratory infections in children may lead to more harm than benefit.

Streptococcal group A, C and G pharyngitis in school children: a prospective cohort study in Southern India.

Diagnosing streptococcal pharyngitis in children on the basis of clinical appearance and throat culture is complicated by high colonisation rates and by the ability of other pathogens to cause clinically similar disease. To characterise the epidemiology of Lancefield Group A, C and G β-haemolytic streptococcus (GAS, GCS and GGS, respectively) in children, we conducted a 2-year prospective study of 307 school children between 7 and 11 years old. GGS and GAS were commonly identified organisms both for silent streptococcal colonisation and symptomatic sore throat, while GCS was uncommonly found. Streptococcal culture positivity at the time of clinical pharyngitis was estimated to reflect true streptococcal pharyngitis in only 26% of instances, with the frequency varying from 54% for children rarely colonised to 1% for children frequently colonised. Numerous GAS emm types were identified, including several types previously associated with severe pharyngitis (e.g. emm types 1, 3 and 28). No severe complications were seen in any child. These data suggest that the clinical diagnosis of streptococcal pharyngitis is likely to remain difficult and that treatment decisions will remain clouded by uncertainty. There remains a need for organism-specific rapid point-of-care streptococcal diagnostic tests and tests that can distinguish between streptococcal colonisation and disease.

Molecular Characterization of Streptococcus pyogenes Isolated from Children with Pharyngitis

Streptococcus pharyngitis nbsp is a significant issue all nbsp around nbsp the world The S pyogeninfection ldquo pharyngitis rdquo is not much more studied previously To examine the prevalence of streptococcal pharyngitis in children gives a better idea about its occurrence and pattern of development We also determine the role of sAg and M protein in the spread of infection and surveillance in the human body in the presence of strong immune system This study help to find the measure nbsp for nbsp the control of streptococcal pharyngitis like the production of vaccine using M protein should be a better option for safe and efficient eradication of the disease from society

Evaluating the use of dedicated swab for rapid antigen detection testing in group a streptococcal pharyngitis in children

Background : Group A streptococcus (GAS) is the most common and fearful bacterial cause in pediatric acute pharyngitis due to its serious complications. Several generations of rapid antigen detection tests (RADTs) have been developed to facilitate rapid detection of GAS pharyngitis. We assessed the value of using a dedicated swab for RADT rather than using the same swab for throat culture and RADT. Methods : We conducted a prospective, single-center study that included children with suspected GAS pharyngitis. Paired throat swabs were taken simultaneously from each child. We dedicated one swab for RADT (RADT#1) and used the other swab to inoculate blood agar plate surface, and then immediately to process the RADT (RADT#2). Results: The prevalence of GAS pharyngitis among the participants was 28% based on throat culture positive results. The RADT#1 and RADT#2 had sensitivity results of 92.9% and 84.3% respectively. Both RADT#1 and RADT#2 had 96.1% specificity. Conclusion: We found that RADT resulted in a better sensitivity when one swab was dedicated for the test. Therefore, physicians are encouraged to use separate swabs for each diagnostic test when both RADT and throat culture are performed. Key words: GAS, pharyngitis, rapid antigen detection test Evaluation de l'utilisation d'un swab dedice pour des essais rapides de detection d'antigene dans le groupe a pharyngite streptococale en enfants Contexte : Le streptocoque du groupe A (GAS) est la cause bacterienne la plus frequente et la plus effrayante de la pharyngite aigue pediatrique due a ses graves complications. Plusieurs generations de tests de detection d'antigene rapide (RADT) ont ete developpes pour faciliter la detection rapide de la pharyngite GAS. Nous avons evalue la valeur de l'utilisation d'un tampon dedie pour RADT plutot que d'utiliser le meme ecouvillon pour la culture de la gorge et la RAD Methodes : Nous avons mene une etude prospective et a centre unique comprenant des enfants atteints de pharyngite soupconnee de GAS. Des ecouvillons de gorge apparies ont ete pris simultanement par chaque enfant. Nous avons dedie un ecouvillon pour RADT (RADT # 1) et utilise l'autre ecouvillon pour inoculer la surface de la plaque d'agar de sang, puis immediatement pour traiter le RADT (RADT # 2). Resultats: La prevalence de la pharyngite GAS chez les participants etait de 28% selon les resultats positifs de la culture de la gorge. Le RADT # 1 et le RADT # 2 ont des resultats de sensibilite de 92,9% et 84,3% respectivement. Les deux RADT # 1 et RADT # 2 avaient une specificite de 96,1%. Conclusio n: Nous avons constate que RADT a permis une meilleure sensibilite lorsqu'un tampon a ete dedie au test. Par consequent, les medecins sont encourages a utiliser des ecouvillons separes pour chaque test de diagnostic lorsque la RADT et la culture de la gorge sont effectuees. Mots cles: GAS, pharyngite, test rapide de detection d'antigene

The Cape Town Clinical Decision Rule for Streptococcal Pharyngitis in Children.

Existing clinical decision rules (CDRs) to diagnose group A streptococcal (GAS) pharyngitis have not been validated in sub-Saharan Africa. We developed a locally applicable CDR while evaluating existing CDRs for diagnosing GAS pharyngitis in South African children. We conducted a prospective cohort study and enrolled 997 children 3-15 years of age presenting to primary care clinics with a complaint of sore throat, and whose parents provided consent. Main outcome measures were signs and symptoms of pharyngitis and a positive GAS culture from a throat swab. Bivariate and multivariate analyses were used to develop the CDR. In addition, the diagnostic effectiveness of 6 existing rules for predicting a positive culture in our cohort was assessed. A total of 206 of 982 children (21%) had a positive GAS culture. Tonsillar swelling, tonsillar exudates, tender or enlarged anterior cervical lymph nodes, absence of cough and absence of rhinorrhea were associated with positive cultures in bivariate and multivariate analyses. Four variables (tonsillar swelling and one of tonsillar exudate, no rhinorrhea, no cough), when used in a cumulative score, showed 83.7% sensitivity and 32.2% specificity for GAS pharyngitis. Of existing rules tested, the rule by McIsaac et al had the highest positive predictive value (28%), but missed 49% of the culture-positive children who should have been treated. The new 4-variable CDR for GAS pharyngitis (ie, tonsillar swelling and one of tonsillar exudate, no rhinorrhea, no cough) outperformed existing rules for GAS pharyngitis diagnosis in children with symptomatic sore throat in Cape Town.

A Study to Determine if Addition of Palatal Petechiae to Centor Criteria Adds More Significance to Clinical Diagnosis of Acute Strep Pharyngitis in Children.

Objective. A study to determine if addition of palatal petechiae to Centor criteria adds more value for clinical diagnosis of acute strep pharyngitis in children. Hypothesis. In children, Centor Criteria does not cover all the symptoms and signs of acute strep pharyngitis. We hypothesize that addition of palatal petechiae to Centor Criteria will increase the possibility of clinical diagnosis of group A streptococcal pharyngitis in children. Methods. One hundred patients with a complaint of sore throat were enrolled in the study. All the patients were examined clinically using the Centor Criteria. They were also examined for other signs and symptoms like petechial lesions over the palate, abdominal pain, and skin rash. All the patients were given rapid strep tests, and throat cultures were sent. No antibiotics were given until culture results were obtained. Results. The sample size was 100 patients. All 100 had fever, sore throat, and erythema of tonsils. Twenty of the 100 patients had tonsillar exudates, 85/100 had tender anterior cervical lymph nodes, and 86/100 had no cough. In total, 9 out of the 100 patients had positive throat cultures. We observed that petechiae over the palate, a very significant sign, is not included in the Centor Criteria. Palatal petechiae were present in 8 out of the 100 patients. Six out of these 8 with palatal petechiae had positive throat culture for strep (75%). Only 7 out of 20 with exudates had positive strep culture. Sixteen out of the 100 patients had rapid strep test positive. Those 84/100 who had negative rapid strep also had negative throat culture. Statistics. We used Fisher’s exact test, comparing throat culture positive and negative versus presence of exudates and palatal hemorrhages with positive and negative throat cultures and the resultant P value <.0001. Conclusion. Our study concludes that addition of petechiae over the palate to Centor Criteria will increase the possibility of diagnosing acute group A streptococcal pharyngitis in children.

Effects of meteorologic factors and schooling on the seasonality of group A streptococcal pharyngitis.

The objective of this study was to determine the seasonal pattern of group A streptococcal pharyngitis in children attended at a hospital emergency department in the Mediterranean island of Mallorca (Spain), and its association with meteorologic factors and schooling. We conducted a retrospective review of the medical records of children aged 1-15 years with a diagnosis of Streptococcus pyogenes pharyngitis between January 2006 and December 2011. The number of S. pyogenes pharyngitis was correlated to temperature, humidity, rainfall, atmospheric pressure, wind speed, solar radiation, and schooling, using regression and time series techniques. A total of 906 patients (median, 4 years old) with S. pyogenes pharyngitis, confirmed by throat culture, were attended during the study period. A seasonal pattern was observed with a peak activity in June and a minimum in September. Mean temperature, solar radiation, and school holidays were the best predicting variables (R(2) = 0.68; p < 0.001). S. pyogenes activity increased with the decrease of mean temperature (z = -2.4; p < 0.05), the increase of solar radiation (z = 4.2; p < 0.001), and/or the decrease in school holidays (z = -2.4; p < 0.05). In conclusion, S. pyogenes pharyngitis had a clear seasonality predominating in springtime, and an association with mean temperature, solar radiation, and schooling was observed. The resulting model predicted 68 % of S. pyogenes pharyngitis.

Identifying and treating group A streptococcal pharyngitis in children.

See related research article on page [23][1] and at [www.cmaj.ca/lookup/doi/10.1503/cmaj.140772][2]; see also case on page [50][3] and at [www.cmaj.ca/lookup/doi/10.1503/cmaj.140155][4] Pharyngitis is common and a frequent presentation to family physicians and pediatricians.[1][5] Most of these

Streptococcal pharyngitis in children: to treat or not to treat?

Controversy remains about the need for antibiotic therapy of group A streptococcal (GAS) pharyngitis in high-resource settings. Guidelines on the management of GAS pharyngitis differ considerably, especially in children. We performed a literature search on the diagnosis and treatment of GAS pharyngitis in children and compared different guidelines with current epidemiology and the available evidence on management. Some European guidelines only recommend antibiotic treatment in certain high-risk patients, while many other, including all American, still advise antimicrobial treatment for all children with GAS pharyngitis, given the severity and re-emerging incidence of complications. Empirical antimicrobial treatment in children with sore throat and a high clinical suspicion of GAS pharyngitis will still result in significant overtreatment of nonstreptococcal pharyngitis. This is costly and leads to emerging antibiotic resistance. Early differential diagnosis between viral and GAS pharyngitis, by means of a 'rapid antigen detection test' (RADT) and/or a throat culture, is therefore needed if 'pro treatment' guidelines are used. Large scale randomized controlled trials are necessary to assess the value of antibiotics for GAS pharyngitis in high-resource countries, in order to achieve uniform and evidence-based guidelines. The severity and the possibly increasing incidence of complications in school-aged children suggests that testing and treating proven GAS pharyngitis can still be beneficial.