(1,2) The signs and symptoms of GAS pharyngitis include an abrupt onset of a sore throat, tonsillar exudate
, tender cervical adenopathy, and fever.
The criteria consist of four findings that are each assigned one point: history of fever, absence of cough, tender or swollen lymph glands in the neck, and tonsillar exudate
Sensitivity was high in patients younger than 15 years of age who had tonsillar exudate
without a cough.
The patient's mucous membranes were moist and there was no erythema or tonsillar exudate
in her pharynx.
The symptoms that most significantly correlate with a positive strep result are tonsillar exudate
, scarlatina rash, and anterior cervical adenitis, according to a recent study by Dr: Todd and his colleagues (Pediatrics [online] 11116], 2003; www.pediatrics.org/cgi/content/full/111/6/e666).
Signs of severe episodes include a documented fever of >38[degree] C, and/or tonsillar exudate
, enlarged and tender cervical nodes, and!
The researchers compared these strategies for the entire cohort, and for a subgroup with a higher risk of having strep throat, as defined by the presence of a scarlatina rash, tonsillar exudate
or anterior cervical adenitis, without cough or runny nose.
Clinical clues to streptococcal pharyngitis include acute onset, fever, scarlatiniform rash, nausea or vomiting, cervical adenopathy, and tonsillar exudate
. Cough, sneezing, hoarseness, diarrhea, or a morbilliform rash suggest some other diagnosis, she said.
* RESULTS The presence of tonsillar exudate
or, pharyngeal exudate and a history of streptococcus exposure in the previous 2 weeks were most useful in predicting current streptococcus pharyngitis (LR+ = 3.4, 2.1, and 1.9, respectively).
Outcomes measured Outcomes measured included clinical symptoms and signs (fever, tonsillar exudate
, cervical lymphadenitis, throat pain), eradication of GABHS within 18 to 24 hours, and bacteriologic treatment failure rate at 4 to 6 and 14 to 21 days.
Several factors, including season (fall, winter); age (4 to 18 years); presence of fever, tonsillar exudate
, and anterior cervical adenopathy; and absence of cough are significantly more common in streptococcal pharyngitis than in viral pharyngitis.[3-5] Because of the low predictive value of individual signs and symptoms, several probability algorithms for diagnosis and testing have been developed.[3-11] However, some clinicians treat pharyngitis on the basis of clinical findings alone, without laboratory testing, and many base treatment on the results of a rapid assay.
Clinical manifestations of pharyngitis at times encompass tonsillar exudates
, fever, painful cervical adenopathy, ear pain and pharyngeal erythema.