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Detection of group A streptococci in children under 3 years of age with pharyngitis
W A Woods1, C T Carter, T A Schlager
1Department of Emergency Medicine and Pediatrics, University of Virginia Health Sciences Center, Charlottesville 22906-0014, USA.
Insights
Group A streptococci caused 30% of pharyngitis in children aged 2-3 years. Diagnostic testing is crucial as physical exams may not reliably identify the cause in this age group.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Upper respiratory tract infections are common in young children.
- Pharyngitis, or sore throat, can be caused by various pathogens, including Group A Streptococcus (GAS).
- Accurate diagnosis of GAS pharyngitis is important to prevent complications and ensure appropriate treatment.
Purpose of the Study:
- To determine the incidence of Group A streptococcal pharyngitis in preschool children presenting to the emergency department.
- To evaluate the utility of clinical examination in diagnosing GAS pharyngitis in this age group.
Main Methods:
- A prospective, observational study involving children under 3 years old with pharyngeal erythema and age-matched controls.
- Throat swabs were collected and cultured for GAS.
- Clinical signs and symptoms were recorded for all participants.
Main Results:
- GAS detection was similar between cases and controls in children under 2 years old.
- GAS was significantly more prevalent in children over 2 years old with pharyngeal erythema (29%) compared to controls (7%).
- Clinical findings did not reliably differentiate between GAS-positive and GAS-negative cases.
Conclusions:
- Group A Streptococcus accounts for approximately 30% of pharyngitis cases in children aged 2-3 years presenting to the emergency department.
- Diagnostic testing for GAS is recommended in this age group due to the limitations of clinical diagnosis.
- Early and accurate diagnosis aids in appropriate management and prevention of complications.
Objective:
To determine the frequency of group A streptococcal pharyngitis in young preschool children presenting to the emergency department with upper respiratory tract infection.
Methods:
A prospective, observational study performed between September 1995 and September 1997. Throat swabs were obtained on young children less than 3 years old with pharyngeal erythema as well as age- and time-matched controls without pharyngeal erythema or exudate. Signs and symptoms that were recorded included: age, temperature, pharyngeal erythema, tonsillar exudate, cervical adenopathy, scarlatini-form rash, rhinorrhea, school-aged child in the home, day care attendance. Swabs were inoculated on 5% sheep blood agar and incubated for 48 hours. Beta-hemolytic colonies were sero-grouped by latex agglutination.
Results:
Seventy-eight children with pharyngeal erythema, and 152 controls had pharyngeal specimens obtained and signs or symptoms recorded. Under 2 years of age, the detection of group A streptococci was similar to controls. Detection of group A streptococci was significantly different from controls in children over 2 years of age. Ten (29%) of 35 children over 2 years were positive for group A streptococci compared to 2 (7%) of 29 controls of the same age group (P = 0.03, odds ratio 5, 95% CI: 1.2-24). Findings on clinical examination in children with pharyngeal erythema did not distinguish those that would be culture-positive for group A streptococci.
Conclusion:
In our emergency department, group A streptococci caused 30% of pharyngitis seen in children between 2 and 3 years of age. Diagnostic testing is recommended because physical examination may not accurately distinguish etiology in this age group.
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