Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Sore throat At least one of the following: Cervical lymphadenopathy (lymph nodes tender or > 2 cm) Tonsillar exudates Positive culture showing group A β-hemolytic streptococci Fever > 38.3°C +++ General Considerations ++ Approximately 20–30% of children with pharyngitis have a group A streptococcal infection Most common in children between ages 5 and 15 years in the winter or early spring Causes include Mycoplasma pneumoniae, Chlamydia pneumoniae, groups C and G streptococci, and Arcanobacterium hemolyticum M pneumoniae is more common than other pathogens and may cause over one-third of all pharyngitis cases in adolescents and adults +++ Clinical Findings +++ Symptoms and Signs ++ Sudden onset of sore throat, fever, tender cervical adenopathy, palatal petechiae, a beefy-red uvula, and a tonsillar exudate suggest streptococcal infection Other symptoms may include headache, stomachache, nausea, and vomiting +++ Differential Diagnosis ++ Viral pharyngitis Infectious mononucleosis Bacterial pharyngitis other than streptococcal Diphtheria Peritonsillar abscess +++ Diagnosis ++ Throat culture or rapid antigen test provide definitive diagnosis Rapid antigen tests are very specific, but have a sensitivity of only 85–95% Therefore, a positive test indicates S pyogenes infection, but a negative result requires confirmation by performing a culture The presence of conjunctivitis, cough, hoarseness, symptoms of upper respiratory infection, anterior stomatitis, ulcerative lesions, viral rash, and diarrhea should raise suspicion of a viral etiology +++ Treatment ++ Suspected or proven group A streptococcal infection should be treated with Penicillin V, 250 mg 2–3 times per day for 10 days if < 27 kg; 500 mg 2–3 times per day for 10 days if > 27 kg or Benzathine penicillin, 600,000 units intramuscularly in single dose if < 27 kg; 1.2 million units intramuscularly in single dose if > 27 kg or Amoxicillin 50 mg/kg/d once daily for 10 days (max 1200 mg) For patients allergic to penicillin, alternative treatments include Cephalexin, 25–50 mg/kg/d in 2 divided doses for 10 days Azithromycin, 12 mg/kg once daily for 5 days (max 500 mg/d) Clindamycin, 20 mg/kg/d in 3 divided doses for 10 days For patients with recurrent streptococcal tonsillitis, tonsillectomy is preferred over daily penicillin prophylaxis because of concerns about drug resistance +++ Outcome +++ Follow-Up ++ Repeat culture after treatment is not recommended and is indicated only for those who remain symptomatic, have a recurrence of symptoms, or have had rheumatic fever Of note, children who have had rheumatic fever are at a high risk for recurrence if future group A streptococcal infections are inadequately treated In this group of patients, long-term antibiotic prophylaxis is recommended, sometimes lifelong in patients with residual rheumatic heart disease +++ Complications ++ Untreated streptococcal ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.