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Published on: February 10, 2011
Streptococcal pharyngitis in a paediatric emergency department
K M Edmond1, K Grimwood, J B Carlin
1Royal Children's Hospital, Melbourne, VIC.
Insights
Group A beta-haemolytic streptococci (GABHS) are common in children over 4 with pharyngitis symptoms like rash and swollen nodes. For children under 4, GABHS is rare, suggesting symptomatic treatment is often sufficient.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Acute pharyngitis is a common childhood illness.
- Identifying streptococcal infections is crucial for appropriate antibiotic use.
- Beta-haemolytic streptococci, particularly Group A (GABHS), are significant pathogens.
Purpose of the Study:
- To determine the prevalence of beta-haemolytic streptococcal infections in children with acute pharyngitis.
- To identify clinical features associated with GABHS.
- To guide antibiotic therapy decisions for pediatric pharyngitis.
Main Methods:
- Prospective case-control study involving 271 children with pharyngitis and 135 age-matched controls.
- Oropharyngeal cultures were used to detect groups A, C, and G beta-haemolytic streptococci.
- Demographic and clinical characteristics were recorded for all participants.
Main Results:
- GABHS was isolated in 21% of children with pharyngitis compared to 7% in controls (OR, 3.7; P < 0.001).
- Groups C and G beta-haemolytic streptococci were found in 4% and 2% of cases, respectively.
- Clinical features associated with GABHS included age ≥ 4 years, tender cervical nodes, pharyngotonsillitis, absent coryza, and scarlatiniform rash.
Conclusions:
- GABHS is an unlikely cause of acute pharyngitis in children under 4 years, where symptomatic treatment may suffice.
- In children aged 4 years and older, the likelihood of GABHS increases with the presence of a rash, pharyngotonsillitis, and tender cervical nodes.
- Clinical assessment aids in determining the need for antibiotic therapy in pediatric acute pharyngitis.
Objective:
To determine the prevalence and clinical features of beta-haemolytic streptococcal infection in children with acute pharyngitis and thereby to define those requiring antibiotic therapy.
Design:
Prospective 2:1 case--control study.
Setting:
Emergency Medicine Department of the Royal Children's Hospital, Melbourne, between May 1994 and May 1995.
Participants:
Cases (n = 271) were the first 10 self-referred children in each week with pharyngitis and no antibiotic use in the previous week. Controls (n = 135) were age-matched children without infection.
Main Outcome Measures:
Presence of groups A, C or G beta-haemolytic streptococci in oropharyngeal cultures; demographic and clinical characteristics.
Results:
Group A beta-haemolytic streptococci (GABHS) were isolated from significantly more case than control children (cases, 57/271 [21%]; controls, 9/135 [7%]; odds ratio [OR], 3.7; P < 0.001). Groups C and G beta-haemolytic streptococci were isolated from 10 (4%) and 5 (2%) case children, respectively, but not from controls. Age > or = 4 years, tender cervical lymph nodes, pharyngotonsillitis, absent coryza and scarlatiniform rash were significantly associated with GABHS (P < 0.02). GABHS was uncommon in children aged < 4 years (4%), but was present in 12 of 14 children > or = 4 years with a rash (86%). However, most cases lacked a rash, and for children > or = 4 years likelihood of GABHS varied from 10%-65%, depending on other clinical features.
Conclusions:
In children aged < 4 years, GABHS is an unlikely cause of acute pharyngitis and symptomatic treatment alone should be considered. In children > or = 4 years, the likelihood of GABHS being the cause of acute pharyngitis increases with presence of scarlatiniform rash, pharyngotonsillitis and tender cervical nodes.
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