Question

A 10-year-old girl presents with a sore throat and fever that has lasted 1 day. She appears flushed and moderately ill. Physical examination reveals a temperature of 39°C, tender bilateral anterior cervical lymph nodes that are 1 to 2 cm in the greatest dimension, and erythema and whitish-yellow exudate over enlarged tonsils and the posterior pharynx.

Diagnostic Testing Results:

Fever: 39°C

Cough: No cough present in patient

Cervical nodes: Swollen and tender

Tonsils: Tonsillar swelling or exudate

Patient Referral:

Due to symptoms, patient had their throat swabbed.

Based on what you know about GAS, would you have been able to diagnose her quickly from the clinical symptoms only?

What is one way to differentiate between Group A and Group B Strep?

Answer 1

1. Streptococcal infection is a bacterial infection caused by a group of bacteria called streptococcus. This streptococci group of bacterium is classified into two groups. They are:

• Alpha hemolytic streptococci
• Beta hemolytic streptococci

Beta hemolytic streptococci is again divided into:

• Group A Streptococci (GAS)
• Group B Streptococci (GBS)

Streptococcus pyogenes is a Group A streptococci which can cause many infections which may range from throat infections to severe pneumonia and blood infections.

Strep throat is the most common streptococcal infection which affects people of all ages especially children. The symptoms include:

• Throat pain
• Painful swallowing
• Red and swollen tonsils, sometimes streaked with pus
• Swollen, tender lymph nodes of the neck.
• Fever
• Body pain.

Here, the patient is a of 10 years old presented with most of the clinical features of GAS as mentioned above. So it is possible to diagnose her as GAS from her symptoms itself.

2. Group B Streptococcus is Streptococcus agalactiae which lare colonized in the digestive system and the female genitals. These infections are transmitted either through sexually or from mother to baby during delivery. In newborns, if left untreated it can lead to serious complications such as meningitis, pneumonia. But in most cases it poses no symptoms as it is included in the normal bacterial flora.

Streptococcus A is the most common disease producing organism when compared to streptococcus B.