Clinical Features of Group A Streptococcus in Children With Pharyngitis: Carriers versus Acute Infection. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Rick, Anne-Marie; Zaheer, Haniah A.; Martin, Judith M.
• Is Part Of: Pediatric infectious disease journal. Volume 39:Issue 6(2020)
• Publication Date: 2020-06
• Subjects: Streptococcus pyogenes -- streptococcal pharyngitis -- streptococcal colonization -- carriage -- pharyngitis; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000002602
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Among children with pharyngitis who test positive for group A Streptococcus (GAS), 10%–25% are GAS carriers. Current laboratory methods cannot distinguish acute infection from colonization. Methods: We examined 2 separate longitudinal studies of children with symptomatic pharyngitis associated with a positive GAS throat culture (illness culture). In cohort 1, children presented with pharyngitis symptoms to a clinician, then had follow-up cultures at regular intervals. In cohort 2, throat cultures were performed at regular intervals and with pharyngitis symptoms. Illness cultures were categorized as acute infection or carrier based on follow-up culture results. In cohort 2, carriers were further categorized as a GAS carrier with a new emm -type or a GAS carrier with a previous emm -type based on typing data from prior culture results. For each cohort, symptoms were compared at the time of illness culture between carriers and those with acute infection. Results: Cohort 1 (N = 75 illness cultures): 87% of the children were classified as acutely infected versus 13% carriers. Carriers were more likely to have upper respiratory (URI) symptoms [odds ratio (OR): 5.5; 95% confidence interval (CI): 1.4–22.1], headache (OR: 6.0; 95% CI: 1.2–40.5) or vomiting (OR: 5.5; 95% CI: 1.2–24.5). Cohort 2 (N = 122 illness cultures): 79% were acutely infected and 21% were carriers. Children determined to be carriers with a previous detected emm -type were more likely to have URI symptoms compared with those with acquisition of a new emm -type. Conclusions: Children with symptomatic pharyngitis and GAS on throat culture identified as carriers were more likely to present with URI and atypical symptoms than children who were acutely infected. Abstract : Supplemental Digital Content is available in the text.