UPDATED Feb. 27: All You Ever Wanted to Know about Group A Streptococcal Pharyngitis But Were Afraid to Ask

Why I Disagree with the IDSA Guidelines for GAS in Children Under 3   IDSA Statement: Diagnostic studies for GAS pharyngitis are not indicated for children under age 3 because acute rheumatic fever is rare in children under 3 and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group [emphasis added]. Selected children under 3 who have other risk factors, such as an older sibling with GAS infection, may be considered for testing (strong, moderate).   The prevalence of GAS pharyngitis is significantly lower for children under 3; it ranges from 10% to 14% [emphasis added].   GAS causes only 5% to 15% [emphasis added] of cases of acute pharyngitis in adults. My Beef: I don’t see any difference in frequency between adults and children under 3 years of age.   IDSA Statement: However, the prevalence of GAS pharyngitis is significantly lower for children under 3, ranging from 10% to 14%, and if a corresponding rise in ASO is required, the prevalence can be as low as 0% to 6% [emphasis added].   Such testing, however, is not useful in the diagnosis of acute pharyngitis because antibody titers of the two most commonly used tests, antistreptolysin O (ASO) and anti-DNase B, may not reach maximum levels until 3-8 weeks after acute GAS pharyngeal infection [emphasis added] and may remain elevated for months even without active GAS infection.   My Beef: The IDSA, to support its argument that GAS pharyngit...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs