Title:Group A β-hemolytic Streptococcal Pharyngitis: An Updated Review
Volume: 21
Issue: 1
Author(s): Alexander K.C. Leung*, Joseph M. Lam, Benjamin Barankin, Kin F. Leong and Kam L. Hon
Affiliation:
- Department of Pediatrics, The University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
Keywords:
Centor score, group A ß-hemolytic Streptococcus, McIssac score, pharyngitis, strawberry tongue, Streptococcus pyogenes.
Abstract:
Background: Group A ß-hemolytic Streptococcus (GABHS) is the leading bacterial
cause of acute pharyngitis in children and adolescents worldwide.
Objective: This article aims to familiarize clinicians with the clinical manifestations, evaluation, diagnosis,
and management of GABHS pharyngitis.
Methods: A search was conducted in December 2022 in PubMed Clinical Queries using the key
term “group A β-hemolytic streptococcal pharyngitis”. This review covers mainly literature published
in the previous ten years.
Results: Children with GABHS pharyngitis typically present with an abrupt onset of fever, intense
pain in the throat, pain on swallowing, an inflamed pharynx, enlarged and erythematous tonsils, a
red and swollen uvula, enlarged tender anterior cervical lymph nodes. As clinical manifestations
may not be specific, even experienced clinicians may have difficulties diagnosing GABHS pharyngitis
solely based on epidemiologic or clinical grounds alone. Patients suspected of having GABHS
pharyngitis should be confirmed by microbiologic testing (e.g., culture, rapid antigen detection test,
molecular point-of-care test) of a throat swab specimen prior to the initiation of antimicrobial therapy.
Microbiologic testing is generally unnecessary in patients with pharyngitis whose clinical and
epidemiologic findings do not suggest GABHS. Clinical score systems such as the Centor score and
McIssac score have been developed to help clinicians decide which patients should undergo diagnostic
testing and reduce the unnecessary use of antimicrobials. Antimicrobial therapy should be initiated
without delay once the diagnosis is confirmed. Oral penicillin V and amoxicillin remain the
drugs of choice. For patients who have a non-anaphylactic allergy to penicillin, oral cephalosporin
is an acceptable alternative. For patients with a history of immediate, anaphylactic-type hypersensitivity
to penicillin, oral clindamycin, clarithromycin, and azithromycin are acceptable alternatives.
Conclusion: Early diagnosis and antimicrobial treatment are recommended to prevent suppurative
complications (e.g., cervical lymphadenitis, peritonsillar abscess) and non-suppurative complications
(particularly rheumatic fever) as well as to reduce the severity of symptoms, to shorten the duration
of the illness and to reduce disease transmission.
