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[Diagnosis and management of acute pharyngotonsillitis in the primary care pediatrician's office].
[acute rheumatic fever]
Acute
pharyngotonsillitis
is
one
of
the
most
frequent
causes
of
visits
in
the
primary
care
pediatrician
'
office
.
Group
A
b
-
hemolytic
streptococci
(
GABHS
)
or
Streptococcus
pyogenes
causes
15
-
30
%
of
cases
of
acute
pharyngotonsillitis
in
pediatric
age
.
Children
with
pharyngotonsillitis
due
to
GABHS
commonly
present
sore
throat
,
fever
more
than
38
°
C
,
tonsillar
exudate
,
and
tender
cervical
adenopathy
,
but
the
severity
of
illness
ranges
from
mild
throat
pain
to
classic
exudative
tonsillitis
with
high
fever
.
The
McIsaac
criteria
is
a
clinical
scoring
system
to
predict
the
likelihood
of
streptococcal
infection
among
children
.
This
score
is
based
on
5
clinical
criteria
:
age
3
-
14
years
,
fever
more
than
38
°
C
,
tonsillar
swelling
or
exudate
,
tender
and
enlarged
anterior
cervical
lymph
nodes
,
and
absence
of
cough
,
but
none
of
these
findings
is
specific
for
GABHS
pharyngotonsillitis
.
Culture
of
a
throat
swab
on
a
blood
agar
plate
(
BAP
)
remains
the
gold
standard
for
the
diagnosis
of
acute
streptococcal
pharyngotonsillitis
.
Because
of
the
major
disadvantage
of
culturing
throat
swabs
on
BAP
culture
is
the
delay
in
obtaining
the
results
(
at
least
1
day
)
,
in
the
past
decades
rapid
antigen
detection
test
(
RAD
)
were
introduced
for
the
rapid
identification
of
GABHS
directly
from
throat
swabs
.
Accurate
diagnosis
and
treatment
of
GABHS
pharyngotonsillitis
provides
positive
benefits
,
including
prevention
of
complications
,
such
as
acute
rheumatic
fever
and
peritonsillar
abscess
and
reduce
the
acute
morbidity
associated
with
the
illness
.
Conversely
,
improper
diagnosis
may
result
in
negative
consequences
,
including
unnecessary
antibiotic
prescriptions
that
confer
increased
health
care
costs
and
contibute
to
the
development
of
bacterial
resistance
.
Diseases
Validation
Diseases presenting
"but the severity of illness ranges from mild throat pain to classic exudative tonsillitis with high fever"
symptom
acute rheumatic fever
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