Streptococcal origin is suggestive of sudden onset of symptoms, high fever, odynophagia, pharyngeal exudate, anterior cervicolateral lymphadenopathy, enamel on palate and uvula, scarlet rash and headache3,4. In children under 3 years of age it is difficult to differentiate, based on clinical symptoms, between viral and streptococcal etiology. In this age group, streptococcal etiology should be suspected when clinical signs such as petechial enantema on palate, uvula edema, afrabose tongue or scarlet rash, abdominal pain, nausea and vomiting are present and there is confirmation of a cohabiting with confirmed streptococcal pharyngotonsillitis. Although the existence of petechiae on the palate is suggestive of AP due to GABHS, it is not defining because they have also been described in rubella and in infections caused by herpes simplex and Epstein-Barr virus2.
|Temperature > 38 °C||1|
|Absence of cough||1|
|Anterior protruding and painful laterocervical adenopathies||1|
To decide on a treatment, the etiological diagnosis is required1,3,4,6-9. There are two tests for the detection of GABHS: rapid detection of streptococcal antigen (RDTs) and pharyngo-tonsillar sample culture. Neither one definitively differentiates patients with true streptococcal AP of those who have a viral infection and are carriers of GABHS. This limitation may result in mistakenly identifying treatment failure or recurrent tonsillitis.
The RDTs are based on the acid or enzymatic extraction of the cell wall polysaccharides of the GABHS. Their main advantage is the immediate result. RDTs have a high specificity, close to 95%, and a sensitivity that can vary between 70-95%10,11. The sample is taken scraping the surface of both tonsils and the posterior pillars of the pharynx with a swab. Avoid touching other areas of the oropharynx or mouth so that the germ inoculum does not dilute. The RDTs are specific for GABHS, and will not detect groups C and G (present only in 5% of children and not responsible for rheumatic fever).
Treatment for those allergic to Penicillin:
Most children show clinical improvement in the first 48 hours of treatment and the contagiousness disappears after 24 h of treatment2.
Amoxicillin - clavulanic is not the first-line treatment for streptococcal FFA, since GABHS is not a producer of beta-lactamase, and it is a broad-spectrum antibiotic that could lead to the selection of resistant strains of other bacteria present in the nasopharyngeal flora..