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Group A beta-hemolytic streptococcal pharyngitis in preschool children aged 3 months to 5 years
M Nussinovitch1, Y Finkelstein, J Amir
1Department of Pediatrics C, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel.
Insights
Group A beta-hemolytic streptococcus (GABHS) pharyngitis can occur in infants under one year old. This study found true GABHS infections in children as young as three months, challenging previous assumptions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Group A beta-hemolytic streptococcus (GABHS) is a common cause of pharyngitis in children.
- The incidence and presentation of GABHS pharyngitis in infants under one year old are not well-established.
Purpose of the Study:
- To investigate the prevalence of GABHS pharyngitis in young children (3 months to 5 years) presenting with fever and pharyngitis.
- To determine the incidence of true GABHS infection versus carrier state in this age group.
Main Methods:
- Prospective study of 420 pediatric patients with fever and pharyngitis symptoms.
- Throat cultures for GABHS and antistreptolysin O (ASO) titers were performed.
- Serial ASO titers were obtained for culture-positive GABHS patients.
Main Results:
- GABHS was detected in 14.7% of patients.
- True GABHS infection (positive culture and elevated ASO titers) was confirmed in 8% of all patients.
- The incidence of GABHS infection and carrier state increased with age, but true GABHS pharyngitis was present in infants under one year.
Conclusions:
- True GABHS pharyngitis can occur in children less than one year of age.
- The proportion of true infection among GABHS-positive children remained consistent across age groups up to four years.
Abstract:
The authors describe a prospective study of 420 patients aged 3 months to 5 years who presented to a primary pediatric clinic owing to fever > or = 38 degrees C and signs of pharyngitis and were not treated with antibiotics in the preceding week. Throat cultures and blood antistreptolysin O (ASO) titers were examined. In group A beta-hemolytic streptococcus (GABHS)-positive patients, a second ASO sample was obtained 2-3 weeks later. Positive throat cultures to GABHS were found in 61 of 415 patients (14.7%) (five patients were lost to follow-up). Thirty-three of these (54.1% of the culture-positive group and 8% of the total study group) had the streptococcal infection with elevated ASO titers. The incidence of both true infection and carrier state gradually increased with age. Nevertheless, true streptococcal pharyngitis was found even in patients younger than 1 year and its percentage related to carriers did not increase with age and was > or = 50% in all age groups up to 4 years. The authors conclude that true GABHS pharyngitis may present in the first year of life.