You are seeing a 35 month old boy with fever and sore throat x 2 days. He has no cough or runny nose, but his sister also had fever and sore throat recently, and his mom has a cough. His temp is 38.5. He has no tonsillar exudate or palatal petechiae, and only tender cervical lymphadenopathy. He is otherwise well appearing, previously healthy, and is well hydrated.
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September 21, 2016 at 9:43 pm
The IDSA guidelines for strep pharyngitis state: “Diagnostic studies for GAS pharyngitis are not indicated for children <3 years old because acute rheumatic fever is rare in children <3 years old and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group. Selected children <3 years old who have other risk factors, such as an older sibling with GAS infection, may be considered for testing (strong, moderate)."
Of course, this particular child came back about 1.5 weeks later with tea-colored urine. But, can't practice anecdotal medicine and treatment for strep wouldn't have prevented the post-strep glomerulonephritis anyways.
October 25, 2016 at 12:44 am
Using the Centor criteria, this child has score of two ( fever + cervical lymphadenopathy). So the best standard of care is to do Strep test and manage accordingly.
I agree use of antibiotics will not change the risk of glomerulonephritis but indeed it has a place in prevention of rheumatic heart disease.