eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Streptococcal Infection, Group A: Differential Diagnoses & Workup

Author: Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Contributor Information and Disclosures

Updated: May 2, 2008

Differential Diagnoses

Arthritis, Septic
Nephritis
Bacteremia
Osteomyelitis
Bacterial Tracheitis
Pneumonia
Empyema
Rheumatic Fever
Epiglottitis
Rheumatic Heart Disease
Fever in the Toddler
Staphylococcus Aureus Infection
Impetigo
Streptococcal Infection, Group A
Kawasaki Disease
Toxic Shock Syndrome
Lymphadenitis
Lymphadenopathy
Mitral Valve Insufficiency

Other Problems to Be Considered

Acute appendicitis
Epstein-Barr virus
Gastroenteritis
Multiple-organ system disease
Roseola

Workup

Laboratory Studies

  • As noted, culture of group A streptococci is the criterion standard for diagnosis.
  • Depending on disease manifestations, cultures of pharyngeal secretions, blood, cerebrospinal fluid, joint aspirate, leading edge aspirate of cellulitis, skin biopsy specimen, epiglottic secretions, bronchoalveolar lavage fluid, thoracocentesis fluid, or abscess fluid may be sources for locating the organism. In cases of suspected necrotizing fasciitis, a frozen section biopsy obtained in the operating room may be of great value in confirming the diagnosis and may aid in defining how much surgical debridement of devitalized tissue is necessary.
  • As discussed elsewhere in this article, serologic assays (antistreptococcal antibodies) are a potential useful adjunct for diagnosis.
  • Other ancillary laboratory tests (eg, CBC count, WBC count, erythrocyte sedimentation rate, C-reactive protein) may be useful depending on the manifestations of disease under consideration.
  • This is discussed in a disease-by-disease fashion in Medical Care.

Imaging Studies

  • Various imaging studies may be warranted for streptococcal pneumonia, septic arthritis, osteomyelitis, brain abscess, and for complications of streptococcal infection, such as acute rheumatic fever or glomerulonephritis.
  • Possible imaging studies include plain radiography, CT scanning, ultrasonography, echocardiography, and radioisotope renal scanning.
  • For CNS manifestations, such as chorea or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) syndrome, modalities such as MRI or positron emission tomography/single-photon emission CT (PET/SPECT) may be valuable. These are addressed on a disease-by-disease basis in Medical Care.

Other Tests

  • Other tests, depending on disease syndrome, can be very diverse in nature. For example, a histopathologic analysis of skin biopsy specimens, which may need to be analyzed intraoperatively, is warranted in cases of suspected necrotizing fasciitis.
  • Calculation of creatinine clearance may be valuable in assessing the extent of renal dysfunction for nephritis.
  • These issues are reviewed by disease in Medical Care.

Procedures

  • Necessary procedures for the management of the diverse nature of group A streptococcal infections may include endotracheal intubation, thoracocentesis, lumbar puncture, abscess or skin aspiration, and even surgical debridement of devitalized tissue.
  • These issues are reviewed by disease in Medical Care.

Histologic Findings

  • As noted above, histologic analysis of skin biopsies may be an important tool in the diagnosis of streptococcal necrotizing fasciitis. In this setting, one of the hallmarks of the histologic findings is the absence of inflammatory cells, which suggests the necrotic, avascular nature of the affected tissue.

More on Streptococcal Infection, Group A

Overview: Streptococcal Infection, Group A
Differential Diagnoses & Workup: Streptococcal Infection, Group A
Treatment & Medication: Streptococcal Infection, Group A
Follow-up: Streptococcal Infection, Group A
Multimedia: Streptococcal Infection, Group A
References
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References

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Further Reading

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Keywords

Streptococcus pyogenes, S pyogenes, group A Streptococcus; beta-hemolytic Streptococcus, Lancefield group A, acute rheumatic fever, ARF, acute glomerulonephritis, poststreptococcal glomerulonephritis, PSGN, necrotizing fasciitis, toxic shock syndrome, TSS, streptococcal pharyngitis, group A streptococcal pharyngitis, sore throat, streptococcal skin infections, streptococcal impetigo, impetigo contagiosa, scarlet fever, upper respiratory tract infection, puerperal sepsis, Streptococcus pneumoniae, bacteremia, streptococcal pyoderma, septic arthritis

osteomyelitis, brain abscess, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections syndrome, PANDAS syndrome, streptococcosis, tonsillopharyngeal erythema, a red edematous uvula, palatal petechiae, tender anterior cervical adenopathy, strawberry tongue, scabies, atopic dermatitis, streptococcal tonsillitis, ecthyma, streptococcal cellulitis, vaginitis, erysipelas, cervical adenitis, peritonsillar abscess, retropharyngeal abscess, otitis media, mastoiditis, sinusitis, pneumonia, meningitis, endocarditis, streptococcal gangrene, varicella-zoster virus, VZV, hypotension

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Contributor Information and Disclosures

Author

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

José Rafael Romero, MD, Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center
José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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