Elsevier

The Journal of Pediatrics

Volume 97, Issue 3, September 1980, Pages 337-345
The Journal of Pediatrics

The group A streptococcal upper respiratory tract carrier state: An enigma

https://doi.org/10.1016/S0022-3476(80)80178-8Get rights and content

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    • Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics

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      In the absence of host immunologic response to the organism, GABHS can reside in the oropharynx without symptoms and, in this setting, the individual is considered a carrier. Up to 20% of asymptomatic school-aged children are carriers, which increases to 25% if household contacts are positive for GABHS (16,17). Because other etiologies may present similarly, the history and physical examination are not definitive for the diagnosis of GABHS pharyngitis.

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    • Enzyme-linked immunosorbent assay for group A Streptococcal anti-DNase B in human sera, using recombinant proteins - Comparison to the DNA methyl green micromethod

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      These infections can lead to complications such as glomerulonephritis, rheumatic fever and heart disease, neurological motor and behavioral disorders, including Sydenham's chorea, and pediatric autoimmune neuropsychiatric disorders associated with group A Streptococcal infections (PANDAS). Diagnosis of strep throat is complicated by the fact that 10–30% of healthy children harbor GAS in their throats, depending on age and season of the year (Kaplan, 1980); therefore, isolation of Streptococci from individuals with symptoms caused by other infectious agents may be misleading. On the other hand the onset of symptoms associated with the above sequelae can occur after Streptococci have been eliminated from the throat or when small undetectable numbers of Streptococci are missed by culture or rapid tests.

    • Asymptomatic Group A Streptococcus carriage in children with recurrent tonsillitis and tonsillar hypertrophy

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      Children who are carriers of GAS must be distinguished from asymptomatic children or children with subclinical infections. These groups of children do not present with the overt clinical symptoms of GAS pharyngitis, but they may transiently acquire a pharyngeal infection and may be at risk for non-suppurative sequelae [11]. The pathogenesis of the carrier state of GAS is not well understood, but several hypotheses have been proposed.

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      15–20% of pharyngitis in children is caused by GAS and the remaining 80% are viral.1,5–7 The incidence of GAS pharyngeal infections varies between countries and also within the same country depending on several factors including season (usually winter), age group, socio-economic conditions, environmental conditions and level of primary health care.1,4,5,8–10 GAS carrier rates occur from 10% to 50% of asymptomatic school children.1,8

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    Supported in part by a grant from the National Heart, Lung and Blood Institute (HL-19307), and in part by the Dwan Family Fund.

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