METHODS: Patients aged 6 months to 18 years presenting to a pediatric ED with suspected GABHS pharyngitis were prospectively enrolled in the study. [ncbi.nlm.nih.gov]

A total of 578 children aged between 1 and 15 years with a mean of 6.3 +or- 3.7 years, presenting with sore throat were enrolled in the study. [popline.org]

†Higher scores of the prediction model equal more severe presentation of the clinical feature. [acpjc.org]

• Cervical Lymphadenopathy

  Patients were stratified according to the number of clinical features present by using modified Centor criteria, ie, history of fever, absence of cough, presence of pharyngeal exudates, and cervical lymphadenopathy. [ncbi.nlm.nih.gov]

  Description of prediction guide During the clinical evaluation, the examining physician recorded 4 variables from the tested model: cervical lymphadenopathy, tonsillar swelling (2-category severity scale: absent or mild and moderate or severe), coryza [acpjc.org]

  On clinical examination, patients with group A strep pharyngitis usually have Pharyngeal and tonsillar erythema Tonsillar hypertrophy with or without exudates Palatal petechiae Anterior cervical lymphadenopathy Patients with group A strep pharyngitis [cdc.gov]

• Lymph Node Tenderness

  Patients had at least 1 of pharyngeal erythema or exudate, tenderness of cervical lymph nodes, or fever. [acpjc.acponline.org]

• Fever

  Outbreak of acute rheumatic fever in northeast Ohio. J Pediatr 1987;111:176-9. [20.] Acute rheumatic fever among Army trainees. MMWR Morb Mortal Wkly Rep 1988;37:519-22. [21.] [drplace.com]

  No patient developed rheumatic fever or nephritis. Treatment-related adverse events were similar between the two groups; mild vomiting (2%) was most frequently reported. [ncbi.nlm.nih.gov]

  Patients had at least 1 of pharyngeal erythema or exudate, tenderness of cervical lymph nodes, or fever. [acpjc.acponline.org]

  Scarlet fever The symptoms of scarlet fever include: inflammation of the throat a pink-red rash spreading across the abdomen, side of the chest and in the skin folds. [betterhealth.vic.gov.au]

• Chills

  Besides getting a fever, chills, and a throat that really hurts, people can develop some pretty nasty-looking white stuff at the very back of the throat where the bacteria have settled in. [study.com]

  Symptoms include extreme tiredness, weakness, fever, chills, night sweats, and weight loss. The infection can progress, resulting in problems with heart function in some cases. [humanillnesses.com]

  Symptoms of group A streptococcal infection Streptococcal sore throat (pharyngitis) Typical symptoms include of streptococcal sore throat include: a sore, red throat with thick pus-like fluid around the tonsils fever and chills enlarged and tender lymph [betterhealth.vic.gov.au]

  Typical symptoms include fever (usually greater than 101.3°F), red throat, sore throat, headache, stomach ache, nausea, chills, malaise, loss of appetite, abnormal taste, swollen lymph nodes in the neck, and difficulty swallowing.[3,5] While a sore throat [austincc.edu]

  During influenza season, the early symptoms of influenza, such as fever, chills, headache, sore throat, and muscle pain, may mimic strep throat. [labtestsonline.org]

• Malaise

  The first symptoms appear after the incubation period (1 – 3 days) and include headache, fever, nausea and general malaise. Stomach pain may also occur. Swollen tonsils are visible in the throat and soon become covered in white streaks of pus. [littledotapp.com]

  In older children several nonspecific signs and symptoms can be associated with the disease, including headache, nausea, abdominal pain, malaise and vomiting (especially in older children). [news-medical.net]

  Typical symptoms include fever (usually greater than 101.3°F), red throat, sore throat, headache, stomach ache, nausea, chills, malaise, loss of appetite, abnormal taste, swollen lymph nodes in the neck, and difficulty swallowing.[3,5] While a sore throat [austincc.edu]

  Early symptoms of TSS are nonspecific and often begin with influenza-like symptoms of mild fever and malaise. However, TSS often suddenly advances with symptoms of high fever, nausea, vomiting, diarrhea, skin rash, and a low blood pressure. [medicinenet.com]

  The majority of scarlet fever patients do experience associated symptoms of malaise, fever, head- ache, and abdominal pain, with or without vomiting. On examination, patients are not ill. [ahcmedia.com]

• Infectious Mononucleosis

  Infectious Diseases Society of America" (PDF). Clin. Infect. Dis. 35 (2): 113–25. doi : 10.1086/340949. PMID 12087516. ^ Ebell MH (2004). "Epstein-Barr virus infectious mononucleosis". Am Fam Physician. 70 (7): 1279–87. PMID 15508538. [en.wikipedia.org]

  Mononucleosis (EBV) Other bacterial and viral pharyngitis etiologies (see below) PFAPA (Periodic Fever, Apthous lesions, Pharyngitis, lymphAdenitis) Peritonsillar abcess Retropharyngeal abcess Epiglottitis Lemierre’s Syndrome - Fusibacterium infection [pedclerk.bsd.uchicago.edu]

  Differential Diagnosis See Pharyngitis Causes Common other causes Infectious Mononucleosis Posterior cervical adenopathy, Fatigue and prolonged Pharyngitis Hand, foot and mouth disease Oral Lesion s, hand and foot skin lesions VIII. [fpnotebook.com]

  Infectious mononucleosis. Consultant. 2000;40:134–136. Google Scholar 18. Breese BB. A simple scorecard for the tentative diagnosis of streptococcal pharyngitis. Am J Dis Child. 1977;131:514–517. PubMed Google Scholar 19. [link.springer.com]

• Constitutional Symptom

  Constitutional symptoms include fever and chills, myalgias, headaches and nausea. Physical findings may include petechiae of the palate, pharyngeal and tonsillar erythema and exudates, and anterior cervical adenopathy. [aafp.org]

• Vomiting

  Treatment-related adverse events were similar between the two groups; mild vomiting (2%) was most frequently reported. [ncbi.nlm.nih.gov]

  Significant predictors of GABHS pharyngitis were: age 10-15 years, the presence of dysphagia, vomiting, pharyngeal exudate, and scarlatiniform rash. [popline.org]

  […] infection Streptococcal sore throat (pharyngitis) Typical symptoms include of streptococcal sore throat include: a sore, red throat with thick pus-like fluid around the tonsils fever and chills enlarged and tender lymph nodes in and around the neck vomiting [betterhealth.vic.gov.au]

  In older children several nonspecific signs and symptoms can be associated with the disease, including headache, nausea, abdominal pain, malaise and vomiting (especially in older children). [news-medical.net]

  Symptoms include fever, weakness, vomiting, irritability, and stiff neck. [humanillnesses.com]

• Nausea

  Leukopenia and nausea, the most common side effects observed, were more common in the cefprozil-treated group. [ncbi.nlm.nih.gov]

  The beta-hemolytic streptococcus produces several poisons (toxins) which cause debility and nausea. [littledotapp.com]

  In older children several nonspecific signs and symptoms can be associated with the disease, including headache, nausea, abdominal pain, malaise and vomiting (especially in older children). [news-medical.net]

  Typical symptoms include fever (usually greater than 101.3°F), red throat, sore throat, headache, stomach ache, nausea, chills, malaise, loss of appetite, abnormal taste, swollen lymph nodes in the neck, and difficulty swallowing.[3,5] While a sore throat [austincc.edu]

  […] also known as strep throat, is an infection of the back of the throat including the tonsils caused by group A streptococcus (GAS). [1] Common symptoms include fever, sore throat, red tonsils, and enlarged lymph nodes in the neck. [1] A headache, and nausea [en.wikipedia.org]

• Abdominal Pain

  Penicillin was shown to reduce fever and relieve sore throat, dysphagia, headache, abdominal pain, lethargy and anorexia significantly beyond that achieved with aspirin or acetaminophen alone. Penicillin had no effect on culture-negative cases. [ncbi.nlm.nih.gov]

  Using data from all 453 patients, the groups did not differ for adverse effects, lymph node tenderness, abdominal pain, or recurrence. [acpjc.acponline.org]

  Strep symptoms include sore throat, fever, ear pain, abdominal pain, and headache. There may be swollen and perhaps tender lymph nodes in the neck, bright red tonsils, and dark red hemorrhagic petechiae on the soft palate and uvula. [drhull.com]

  In older children several nonspecific signs and symptoms can be associated with the disease, including headache, nausea, abdominal pain, malaise and vomiting (especially in older children). [news-medical.net]

  […] http://www.lumen.luc.edu/lumen/MedEd/medicine/pulmonar/diseases/pul43b.htm Clinical features of Group A Beta Hemolytic Strep Pharyngitis unusual before three years of age and greatest between 5-15 Sore throat-usually sudden onset Fever Abdominal pain/ [pedclerk.bsd.uchicago.edu]

• Odynophagia

  Management: Acute Episode Sore Throat symptomatic management Prescribe medications in liquid form if odynophagia Antibiotic Course Penicillin use requires 10 day course Five days of alternative antibiotics effective Amoxicillin Clavulanate ( Augmentin [fpnotebook.com]

  Clinical Features Group A strep pharyngitis is an acute pharyngitis that commonly presents with Sudden-onset of sore throat Odynophagia Fever Figure 1. Streptococcus pyogenes (group A Streptococcus ) on Gram stain. [cdc.gov]

  Recommendation ACP (endorsed by the CDC and AAFP) AAP IDSA UKNHS Screening for acute pharyngitis Use Centor criteria (see Figure 1 ) Use clinical and epidemiologic findings to assess patient’s risk of GABHS (e.g., sudden onset of sore throat, fever, odynophagia [aafp.org]

  Dysphagia, odynophagia, and respiratory embarrassment are more variable than when the disease is caused by other pathogens. 71,73,74 Patients with GABHS supraglottitis tend to have involvement of the epiglottis. [ahcmedia.com]

• Constipation

  Constipation (in Pregnancy) Contusions COPD Coronary Artery Disease (CAD) Coronary Heart Disease Cough Crohn's Disease Cuts CVA Cyclic Mastalgia Cyclic Mastitis Cystitis [therapy.epnet.com]

  Those severely affected become adverse to defecation; obstipation and constipation follow. On examination, a superficial, sharply marginated anal rash is noted. [ahcmedia.com]

• Strawberry Tongue

  Pus on the tonsils was less common and strawberry tongue more common in patients with eruptions than in those without. Skin eruptions were much more common in the patients infected with T4 than with other T types (p < 0.001). [ncbi.nlm.nih.gov]

  The rash may feel like sandpaper when touched a bright red tongue (known as ‘strawberry tongue’) paleness around the mouth. Impetigo blisters, typically around the nose and mouth and the legs fever and swollen lymph nodes in severe cases. [betterhealth.vic.gov.au]

  Tonsils (if present) are usually enlarged and erythematous with patchy exudates on their surfaces, while the tongue is red and swollen (often designated “strawberry tongue” for that reason). Lymph nodes of the neck can be enlarged and tender. [news-medical.net]

  There is circum- oral pallor and a strawberry tongue. There may be Pasita lines (petechiae) in the antecubital fossa area. May be accentuated in the underpants area. Can be pruritic and will often peel at the end of the illness. [pedclerk.bsd.uchicago.edu]

  A strawberry tongue (inflamed papillae protruding through a bright red coating) also occurs and must be differentiated from that seen in toxic shock syndrome and Kawasaki disease. [merckmanuals.com]

• Tonsillar Exudate

  A culture positive case of streptococcal pharyngitis with typical tonsillar exudate in an 8-year-old. [en.wikipedia.org]

  Physical examination may reveal erythema and swelling of the pharynx, enlarged and erythematous tonsils, tonsillar exudate and palatal petechiae. [drplace.com]

  26 88 2 0.85 Streptococcal exposure in past two weeks 19 91 2 0.9 Temperature ≥ 100.9° F (38.3° C) 22 to 58 53 to 92 0.68 to 3.9 0.54 to 1.3 Tonsillar exudates 36 85 2.3 0.76 Tonsillar or pharyngeal exudates 45 75 1.8 0.74 Table 1. [aafp.org]

  About 20% of patients present with sore throat, fever, a beefy red pharynx, and a purulent tonsillar exudate. The remainder have less prominent symptoms, and the examination resembles that of viral pharyngitis. [merckmanuals.com]

  Physical findings suggestive of GABHS infection include pharyngeal erythema, tonsillar exudates or petechial lesions on the palate. 63-65 A number of oral antibiotic agents may be prescribed to ameliorate the symptoms of GABHS pharyngitis ( see Table [ahcmedia.com]

• Palatal Petechiae

  On clinical examination, patients with group A strep pharyngitis usually have Pharyngeal and tonsillar erythema Tonsillar hypertrophy with or without exudates Palatal petechiae Anterior cervical lymphadenopathy Patients with group A strep pharyngitis [cdc.gov]

  Physical examination may reveal erythema and swelling of the pharynx, enlarged and erythematous tonsils, tonsillar exudate and palatal petechiae. [drplace.com]

  Mouth wide open showing the throat Note the petechiae, or small red spots, on the soft palate. [en.wikipedia.org]

  Palatal petechiae and scarlatiniform rash are highly specific but uncommon; a swollen uvula is sometimes noted. Cough, coryza, conjunctivitis, and diarrhea are more common with viral pharyngitis. [aafp.org]

• Exudative Pharyngitis

  The triad of fever, pharyngeal exudate and anterior cervical adenopathy is present in only 15 percent of cases.[7] Exudate occurs in fewer than 50 percent of patients with GABHS pharyngitis; culture of an exudative pharyngitis leads to a diagnosis of [drplace.com]

• Skin Lesion

  People with skin lesions or blisters should not handle food until the infection has cleared. [betterhealth.vic.gov.au]

  Differential Diagnosis See Pharyngitis Causes Common other causes Infectious Mononucleosis Posterior cervical adenopathy, Fatigue and prolonged Pharyngitis Hand, foot and mouth disease Oral Lesion s, hand and foot skin lesions VIII. [fpnotebook.com]

  GAS bacteria are contagious and spread through contact with fluid from the mouth or nose of an infected person or contact with infected skin lesions *. * strains are various subtypes of organisms, such as viruses or bacteria. * fetus (FEE-tus) is the [humanillnesses.com]

  As in other invasive streptococcal and staphylococcal skin infections, the site of inoculation is usually at area of minor trauma or the skin lesions of varicella. [antimicrobe.org]

• Skin Rash

  However, TSS often suddenly advances with symptoms of high fever, nausea, vomiting, diarrhea, skin rash, and a low blood pressure. [medicinenet.com]

  Drawbacks Gastrointestinal side effects and skin rash are more common with amoxicillin. Amoxicillin dosage: Children: 50 mg/kg (maximum 1,000 mg) once daily; or alternatively 25 mg/kg (maximum 500 mg) twice daily for 10 days 9. [emedexpert.com]

  However, gastrointestinal side effects and skin rash may be more common with amoxicillin. [aafp.org]

• Flushing

  Scarlet fever is caused by group A streptococcal strains that produce an erythrogenic toxin, leading to a diffuse pink-red cutaneous flush that blanches with pressure. [merckmanuals.com]

• Circumoral Pallor

  The rash of scarlet fever, which is characterized by a fine, blanching appearance, sandpaper texture, circumoral pallor and hyperpigmentation in the skin creases, is highly suggestive of GABHS infection. [drplace.com]

  The rash is seen best on the abdomen or lateral chest and as dark red lines in skinfolds (Pastia lines) or as circumoral pallor. [merckmanuals.com]

  The exanthem spares the mouth creating circumoral pallor. The rash is finely papular with a texture of coarse sandpaper. [ahcmedia.com]

  S carlet Fever: Scarlet fever is characterized by high fever, circumoral pallor and a diffuse erythematous rash over the neck, trunk, face and limbs. There is a sandpaper consistency to the rash which blanches with pressure. [antimicrobe.org]

• Headache

  Penicillin was shown to reduce fever and relieve sore throat, dysphagia, headache, abdominal pain, lethargy and anorexia significantly beyond that achieved with aspirin or acetaminophen alone. Penicillin had no effect on culture-negative cases. [ncbi.nlm.nih.gov]

  Hepatitis Chronic Obstructive Pulmonary Disease Chronic Pancreatitis Chronic Pelvic Pain Syndrome (in men) Chronic Prostatitis Cigarette Addiction Cigarette Smokers, Nutrition Cirrhosis of the Liver Classic Migraine Climacteric Clinical Depression Cluster Headache [therapy.epnet.com]

  Major end points were sore throat, pharyngeal erythema or exudate, lymph node tenderness, fever, abdominal pain, headache, drug side effects, and bacteriologic cure. [acpjc.acponline.org]

  Strep symptoms include sore throat, fever, ear pain, abdominal pain, and headache. There may be swollen and perhaps tender lymph nodes in the neck, bright red tonsils, and dark red hemorrhagic petechiae on the soft palate and uvula. [drhull.com]

"Cost-effective workup for tonsillitis. Testing, treatment, and potential complications". Postgrad Med. 113 (3): 115–8, 121. doi : 10.3810/pgm.2003.03.1391. [en.wikipedia.org]

Because there are many other groups of Streptococcus spp., positive identification of the infecting bacteria is necessary to separate out other bacteria that may cause some similar symptoms but may require a different workup, different treatment, and [medicinenet.com]

• Positive Throat Culture

  Twelve demographic and clinical features of patients with positive throat cultures were compared with the features of patients with negative throat cultures. [ncbi.nlm.nih.gov]

  Furthermore, the physician made a subjective probability estimate for a GABHS-positive throat culture result (11-point scale: 0 = most unlikely and 10 = extremely likely). [acpjc.org]

  Unfortunately, the study fails to make clear which patients, if any, with positive throat cultures after treatment were symptomatic. [acpjc.acponline.org]

  Also may do a rapid strep test which is less sensitive(80-90%) and as specific(95%) as the throat culture. If rapid test is positive treatment may be initiated. If negative, you must plate a throat culture. [pedclerk.bsd.uchicago.edu]

• Gram-Positive Bacteria

  Group A beta-hemolytic streptococci (GABHS) are gram-positive bacteria that grow in culture as pairs or chains of variable length. [pedsinreview.aappublications.org]

  A Gram stain is performed to show Gram-positive cocci in chains. [en.wikipedia.org]

  Mupirocin is effective against gram-positive bacteria, especially methicillin-sensitive Staphylococcus aureus (MSSA) and GABHS. [ahcmedia.com]

• Gram-Positive Coccus

  Crowding increases transmission as evidenced by common outbreaks in institutional settings, the military, school, etc.[5] Reservoirs: The human throat and skin are the reservoirs for S. pyogenes .[2] Specific Microbial Characteristics: S. pyogenes is a gram-positive [austincc.edu]

  Wilde, MD, FAAP, Associate Professor, Emergency Medicine and Pediatrics, Section Chief, Pediatric Emergency Medicine, Medical College of Georgia, Augusta, GA Streptococcus pyogenes is an aerobic, gram-positive coccus, forming either short or long chains [ahcmedia.com]

  G ENERAL DESCRIPTION M icrobiology Streptococcus pyogenes, or Group A streptococcus (GAS), is a facultative, Gram-positive coccus which grows in chains and causes numerous infections in humans including pharyngitis, tonsillitis, scarlet fever, cellulitis [antimicrobe.org]

Delay in penicillin treatment did not increase GABHS intrafamilial spread. Symptoms of both groups were assessed for 2 days following the initiation of treatment. [ncbi.nlm.nih.gov]

Clarithromycin vs penicillin in the treatment of streptococcal pharyngitis. J Fam Pract. 1992 Dec;35:622-6. [acpjc.acponline.org]

What is the prognosis for group A streptococcal infections? The prognosis for mild GAS infections is usually good to excellent. [medicinenet.com]

The Infectious Diseases Society of America guidelines and Red Book address determining someone if is a carrier and their management. 1, 2 Prognosis and Complications Rarely, suppurative and nonsuppurative complications can occur after group A strep pharyngitis [cdc.gov]

[…] allergies [9] and some evidence supports cephalosporins as superior to penicillin. [31] [32] Streptococcal infections may also lead to acute glomerulonephritis ; however, the incidence of this side effect is not reduced by the use of antibiotics. [12] Prognosis [en.wikipedia.org]

Long-term prognosis is generally thought to be excellent, but some studies found that up to 20% of patients develop urinary abnormalities ( 13 ). [antimicrobe.org]

Most children and adolescents who develop a sore throat do not have GABHS as the cause; their infection is viral in etiology. [ncbi.nlm.nih.gov]

Acute Pharyngitis: Etiology and Diagnosis Schwartz B et al. Pharyngitis - Principles of Judicious Use of Antimicrobial Agents. Pediatrics. 1998; 101(1 Suppl.):171-174. [pedclerk.bsd.uchicago.edu]

Etiology: Streptococcus Pyogenes V. Symptoms Stretococcal exposure in last 2 weeks ( Test Sensitivity 19%, Test Specificity 91%) Pharyngitis Fever ( Temperature >100.9) Cough absent Headache Myalgia VII. [fpnotebook.com]

These symptoms strongly suggest a viral etiology. [cdc.gov]

Therefore etiologic diagnosis should be pursued in order to initiate timely antibiotic therapy. [news-medical.net]

130 Clarithromycin 132 Azithromycin 133 Flurithromycin 135 Telithromycin 136 Conclusion 137 Mechanisms of Antibiotic Resistance in Streptococcus pyogenes 143 Mechanisms of Macrolides Resistance in Streptococcus pyogenes 144 Efflux System 146 Molecular Epidemiology [books.google.com]

PATIENTS AND METHODS: Residents of Rochester, Minn (age, 4-15 years), who had 3 or more GABHS pharyngitis episodes In 1 year, at least 1 month apart, between January 1, 1996, and December 31, 1998, were Identified using the resources of the Rochester Epidemiology [ncbi.nlm.nih.gov]

Epidemiological analysis of group A streptococci recovered from patients in China. J Med Microbiol 2006;55:1101-7. [Table 1], [Table 2] [jlponline.org]

Modes of transmission, age distribution of cases, and other epidemiologic features are similar to those for streptococcal pharyngitis. [emedicine.medscape.com]

Evolving epidemiology of pediatric Staphylococcus aureus cutaneous infections in a Baltimore hospital. Pediatr Emerg Care 2006;22:717-723. 22. Kilbane BJ, Reynolds SL. [ahcmedia.com]

Recent interest in the pathophysiology of this disorder has focused on the role of streptococcal pyrogenic exotoxins (SPEs), extracellular products of group A streptococci that mediate not only scarlatiniform-like rashes but also multi-organ damage and [antimicrobe.org]

Antibacterial therapy is appropriate for GAS pharyngitis and may help prevent complications. [ncbi.nlm.nih.gov]

Cachexia Calcium Oxalate Stones Cancer Prevention (Reducing the Risk) Cancer Treatment Support Candida Candida/Yeast Hypersensitivity Syndrome Canker Sores Car Sickness Cardiac Arrhythmia Cardiac Autonomic Neuropathy, Diabetic Cardiomyopathy Caries, Prevention [therapy.epnet.com]

Prevention Most newborn cases can be prevented by testing women in the thirty-fifth to thirty-seventh week of pregnancy for the bacteria. A culture of fluid from the vagina and rectum * can determine whether a woman has GBS. [humanillnesses.com]

(November 1, 2018) US Centers for Disease Control and Prevention. Strep Throat: All You Need to Know. Available online at https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html. Accessed August 2020. [labtestsonline.it]