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Acute Pharyngitis01:30

Acute Pharyngitis

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Viral Features and Testing for Streptococcal Pharyngitis.

Daniel J Shapiro1,2, Christina E Lindgren3, Mark I Neuman4,5

  • 1Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; daniel.shapiro@childrens.harvard.edu.

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This summary is machine-generated.

Many children with sore throats show viral symptoms, yet testing for group A Streptococcus (GAS) pharyngitis is still recommended in some cases. This study found GAS prevalence was lower in children with viral features, suggesting more targeted testing can improve antimicrobial stewardship.

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Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Antimicrobial Stewardship

Background:

  • The Infectious Diseases Society of America advises against testing for group A Streptococcus (GAS) pharyngitis in patients with viral illness symptoms.
  • The prevalence of viral features in pediatric patients undergoing GAS testing is not well-established.

Purpose of the Study:

  • To determine the prevalence of viral features in pediatric patients tested for GAS pharyngitis using rapid antigen detection tests (RADTs).
  • To compare GAS prevalence and RADT sensitivity between patients with and without viral features.

Main Methods:

  • A secondary analysis of a prospective cohort study involving children aged 3 to 21 years presenting with sore throat.
  • Viral features were defined as cough, rhinorrhea, oral ulcers/vesicles, and/or conjunctival injection.
  • Prevalence of GAS and RADT sensitivity were compared between groups with and without viral features.

Main Results:

  • 63% of patients exhibited at least one viral feature.
  • GAS pharyngitis prevalence was significantly higher in patients without viral features (42%) compared to those with viral features (29%) (P = .01).
  • RADT sensitivity was 84% and did not differ significantly between groups.

Conclusions:

  • The presence of viral features in pediatric patients with sore throat is common.
  • Lower GAS prevalence in patients with viral features supports more judicious testing.
  • Optimizing GAS testing is crucial for antimicrobial stewardship, considering asymptomatic carriage.