Diagnosis and Treatment of Group A Streptococcus Pharyngitis

Pharyngitis secondary to group A beta-hemolytic Streptococcus (Streptococcus pyogenes) (GAS)is

usually self-limited, diagnosis and treatment are important to prevent potential serious sequelae,
especially rheumatic fever.
Diagnosis
Patients in whom the diagnosis is suspected should have diagnostic testing performed.

A "rapid strep" test detects a streptococcal antigen from a throat swab obtained by swabbing
the tonsils and posterior pharynx. This test is highly specific, but there is variable sensitivity.

A positive rapid strep test generally does not require any further laboratory confirmation;
however, a negative result should be confirmed by standard throat culture.
Initiating Antibiotics
Ideally, there should be documentation of infection with GAS prior to initiating antibiotics. However,
some physicians will treat patients with antibiotics based on a clinical diagnosis of GAS pending results
of the culture. Others will wait for culture results in the setting of a negative rapid strep test.
Appropriate antibiotics started within nine days from the start of the acute illness will prevent acute
rheumatic fever.
Antibiotic Selection
Although penicillin is the drug of choice for GAS pharyngitis, the suspension form does not have a
pleasant taste. Therefore, many physicians opt for oral amoxicillin, which is more palatable.
In a child who refuses oral medications or when adherence to a 10-day regimen will be difficult for the
family, a single intramuscular injection of penicillin may be the best option.

1. Why he was given amoxicillin prior to documentation of infection?

Because of the high transmission rate among family members
2. Differential Diagnosis for a Child with Fever and a Rash

3. Causes of Unilateral Cervical Lymphadenopathy

Bacterial cervical adenitis, Cat scratch disease, Mycobacterial infection, Kawasaki disease
4. Strawberry Tongue
Streptococcal pharyngitis, Kawasaki disease, Toxic shock syndrome
5. Complications of Kawasaki Disease
The complications associated with Kawasaki diseaseand the approximate percentages of patients who develop
these complicationsare as follows:
Complication
Central nervous system manifestations (including irritability,
lethargy, aseptic meningitis)

Percentage of KD Patients
Who Experience

90%

Complication

Percentage of KD Patients
Who Experience

Coronary artery aneurysm

20-25% of untreated patients

Liver dysfunction

40%

Arthritis

30%

Hydrops of the gallbladder

10%

Of these, the greatest risk is the development of coronary aneurysms. The main purpose of treatment is to minimize
this risk.
Timing
Aneurysms may be present by the end of the first week, but usually present later, almost always within four weeks of
the onset of the disease.
Monitoring
All patients should receive an echocardiogram during the acute phase, both to look for the presence of aneurysms and
to provide a baseline for future comparison.