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Group A streptococcal infection in children younger than three years of age
R M Levin1, M Grossman, C Jordan
1Department of Pediatrics, Rush Medical College, Christ Hospital and Medical Center, Oak Lawn, IL 60453.
Insights
Group A beta-hemolytic streptococcal (GABHS) upper respiratory infections (URIs) in young children present differently than previously thought. Cultures of the throat and anterior nares are recommended for children aged 18-36 months with a reddened throat.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Group A beta-hemolytic streptococcal (GABHS) upper respiratory infection (URI) is common in children.
- The classic presentation of GABHS URI, established in the 1940s, may not accurately reflect the disease in children younger than 3 years.
Purpose of the Study:
- To evaluate the clinical presentation of GABHS URI in children younger than 3 years.
- To identify indications for GABHS culture and optimal specimen sites.
Main Methods:
- A study evaluated 758 sick children younger than 3 years for GABHS URI.
- Clinical data and culture results were analyzed.
Main Results:
- GABHS infection was confirmed in 4.6% of children.
- The classic presentation was not confirmed; pharyngitis, common cold symptoms, and acute otitis media were frequent.
- Anterior nares cultures were crucial for diagnosing 6 of 32 GABHS cases.
- Children aged 18-36 months were more likely to have GABHS disease.
- Irritability, reddened throat/palate, and uvular edema were associated with GABHS URI.
Conclusions:
- The clinical presentation of GABHS URI in children younger than 3 years differs from the classic description.
- Cultures of the throat and anterior nares are recommended for children aged 18-36 months presenting with a reddened throat.
Abstract:
We evaluated 758 sick children younger than 3 years of age for Group A beta-hemolytic streptococcal (GABHS) upper respiratory infection (URI) to determine the usual clinical presentation of the disease in this age group, indications for culture and the optimal site(s) from which to isolate the organism. GABHS infection was documented in 35 subjects (4.6%). The classic presentation (as proposed in the 1940s) of GABHS URI in children younger than 3 years of age was not confirmed by this study. In 32 of the GABHS cases there were pharyngitis, common cold symptoms or both, and these were associated with acute otitis media 10 times and with otitis media with effusion 3 times. Clinical impetigo was associated with GABHS URI (4 of 32 cases). GABHS URI would not have been documented in 6 of 32 cases if cultures of the anterior nares had not been performed. Children between 18 and 36 months of age were more likely to have GABHS disease than were younger children. Hoarseness and vomiting occurred less frequently in children younger than 36 months with GABHS infection than in those of that age who had non-beta-hemolytic streptococcal illnesses. A history of two or more siblings at home or a family member with a recent streptococcal infection and the presence of irritability, a reddened throat or palate or uvular edema were each associated with GABHS URI. We concluded that sick children between 18 and 36 months of age with a reddened throat should have cultures taken of the throat and anterior nares for GABHS.(ABSTRACT TRUNCATED AT 250 WORDS)