- Author: John R Acerra, MD; Chief Editor: Pamela L Dyne, MD more...
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- GABHS rapid antigen detection test
- This is the preferred method for diagnosing GAS infection in the emergency department because of difficulties with culture follow-up.
- Only patients with a high clinical likelihood of GAS pharyngitis should be tested. Patients with a Centor score of 0-1 should be treated symptomatically without testing.
- Antigens are specific, but sensitivities vary. Children with a negative antigen test should have a follow-up culture unless the antigen being used in the office has been shown to be as sensitive as a culture.
- The use of a GABHS rapid antigen detection test can decrease the use of unnecessary antibiotics in pediatric patients when used properly.
- Adults do not need follow-up culture after a negative antigen test because of the low incidence of GAS in this population.
- Throat culture
- This is the criterion standard for diagnosis of GAS infection (90-99% sensitive). Although less expensive than the rapid antigen detection test, it is not be the best test to use in the emergency department because of difficulty with follow-up. The guidelines that recommend cultures for GAS screening are aimed at office-based practices and not the emergency department.
- Patients can be treated up to 9 days after onset of symptoms to prevent acute rheumatic fever, so immediate antibiotic therapy is not crucial if patients can be easily contacted for follow-up should a culture become positive.
- Mono spot is up to 95% sensitive in children (less than 60% sensitivity in infants).
- Peripheral smear may show atypical lymphocytes in infectious mononucleosis.
- Perform gonococcal culture as indicated by history.
- A complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein have a low predictive value and usually are not indicated.
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- Imaging studies generally are not indicated for uncomplicated viral or streptococcal pharyngitis.
- Lateral neck film should be taken in patients with suspected epiglottitis or airway compromise.
- Soft tissue neck CT can be used if concern for abscess or deep-space infection exists; however, peritonsillar abscess is almost always a clinical diagnosis. Imaging is rarely needed for diagnosis.
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- The procedure for a throat swab is to vigorously rub a dry swab over the posterior pharynx and both tonsils, obtaining a sample of exudate. If any exudate is obtained, then transport it dry (not in a liquid medium).
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