From the Guidelines
The differential diagnosis for a 7-year-old with sore throat should prioritize viral pharyngitis, group A streptococcal pharyngitis, and other less common causes, with a thorough history and physical examination guiding the workup, as recommended by the Infectious Diseases Society of America 1.
Key Considerations
- The child's age, symptoms, and exposure history should be taken into account when determining the likelihood of group A streptococcal pharyngitis (GAS) 1.
- A rapid strep test is recommended if the child has fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough (Centor criteria) 1.
- If the rapid test is positive, treatment with amoxicillin or penicillin V is recommended, with azithromycin as an alternative for penicillin-allergic patients 1.
Workup and Treatment
- Initial workup should include a thorough history and physical examination, focusing on duration of symptoms, presence of fever, cough, rhinorrhea, and exposure history 1.
- Physical examination should assess for tonsillar enlargement, exudates, cervical lymphadenopathy, and rash 1.
- Symptomatic treatment includes acetaminophen or ibuprofen, warm salt water gargles, and adequate hydration 1.
- If symptoms persist beyond 7 days, worsen after initial improvement, or if the child has difficulty swallowing or breathing, further evaluation is necessary to rule out complications or alternative diagnoses 1.
Important Considerations
- GAS testing should be performed on selected patients with clinical symptoms and signs on physical examination that are suggestive of GAS 1.
- Treatment of GAS pharyngitis is primarily aimed at preventing suppurative and nonsuppurative complications, such as acute rheumatic fever (ARF) 1.
- Treatment within 9 days of the onset of illness is effective in preventing ARF 1.
From the Research
Differential Diagnosis for a 7-year-old with Sore Throat
- Viral pharyngitis
- Group A beta-hemolytic streptococcal pharyngitis
- Other bacterial causes of pharyngitis
Workup for Sore Throat in a 7-year-old
- Clinical evaluation using the modified Centor score, which includes factors such as fever, tonsillar exudate, cervical lymphadenitis, and absence of cough 2
- Rapid antigen detection testing (RADT) for group A beta-hemolytic streptococcal pharyngitis, which has a sensitivity of 78-91% and a specificity of 91% 3, 4
- Throat culture, which is considered the diagnostic standard, but has a sensitivity of only 87% 3
- Consideration of clinical decision rules, such as the modified Centor score, to assess the risk of group A beta-hemolytic streptococcal infection and guide further testing and treatment 5
Diagnostic Considerations
- The predictive value of a negative RADT is high (94-98%), but a negative result does not completely rule out group A beta-hemolytic streptococcal pharyngitis 3, 4
- Throat culture is recommended after a negative RADT result in children and adolescents to confirm the diagnosis 5
- Clinical features such as fever, tonsillar exudate, and cervical lymphadenitis increase the suspicion of group A beta-hemolytic streptococcal pharyngitis, while a cough is more suggestive of a viral etiology 5, 2