●Epidemiology – Group A Streptococcus (GAS) is the most common cause of bacterial pharyngitis in children and adolescents. It accounts for 15 to 30 percent of all cases of pharyngitis in children between the ages of 5 and 15 years. In temperate climates, the incidence of GAS pharyngitis peaks during the winter and early spring.
●Clinical features – GAS pharyngitis typically has an abrupt onset. Fever, headache, abdominal pain, nausea, and vomiting may accompany the sore throat. Additional features may include exudative pharyngitis, enlarged tender anterior cervical lymph nodes, palatal petechiae, inflamed uvula, and scarlatiniform rash. Symptoms usually resolve spontaneously in three to five days.
●Diagnosis – The diagnosis of GAS pharyngitis is supported by a positive microbiologic test (throat culture, rapid antigen detection test [RADT], or molecular assay for GAS) in a patient with symptoms of GAS pharyngitis and absence of signs and symptoms of viral infections (eg, rhinorrhea, conjunctivitis, cough, hoarseness, anterior stomatitis, discrete ulcerative lesions or vesicles, diarrhea). In children and adolescents, GAS pharyngitis should be confirmed microbiologically before antimicrobial therapy is initiated.
•We suggest microbiologic testing for GAS in children and adolescents with:
–Evidence of acute pharyngitis (erythema, edema, and/or exudates) or scarlatiniform rash on physical examination and absence of multiple signs and symptoms of viral infections
–Exposure to an individual with GAS at home or school or a high prevalence of GAS infections in the community and symptoms of GAS
–Suspected acute rheumatic fever or poststreptococcal glomerulonephritis
•For children and adolescents in whom microbiologic testing for GAS is necessary, we suggest initial testing with a RADT. Standard throat culture or molecular assay is an acceptable alternative.
●Differential diagnosis – The differential diagnosis of GAS pharyngitis includes both infectious and noninfectious causes. Most children and adolescents with negative microbiologic tests for GAS have viral pharyngitis, which is a self-limited condition and can be treated symptomatically without additional testing. Additional testing may be necessary to differentiate GAS pharyngitis from other infectious causes of pharyngitis that require treatment or infection control. and in children and adolescents whose symptoms worsen or persist for more than five to seven days (whether or not they were treated for GAS)
