Pediatrics
An 8-year-old girl presents with sore throat and a temperature of 38°C.
History reveals, she has not received any childhood immunization. A clinical examination confirms a severely swollen and edematous neck region with enlarged cervical lymph nodes. Her pharynx is erythematous with bleeding spots when a swab is taken for culture. An inspiratory stridor is noted upon auscultation of the lungs. Which of the following is the most likely diagnosis?
الشرح
Core Concept: Streptococcal pharyngitis ("strep throat") is a bacterial infection of the throat caused by Group A Streptococcus (GAS). Severe cases can present with marked inflammation, pharyngeal erythema, exudates, and significant cervical lymphadenopathy.
Clinical Presentation:
- Classic symptoms: Sudden onset of sore throat, fever, tonsillar erythema and exudates, palatal petechiae, and tender anterior cervical lymphadenopathy. Exudates may occasionally bleed when aggressively swabbed.
- Complications: Suppurative (peritonsillar abscess, cervical lymphadenitis) and non-suppurative (acute rheumatic fever, post-streptococcal glomerulonephritis).
Diagnosis:
- First-line diagnostic plan/tool: Rapid antigen detection test (RADT).
- Most accurate (gold standard) diagnostic test: Throat culture on sheep blood agar.
Management:
- Acute management: Oral penicillin V or amoxicillin for 10 days to eradicate the bacteria and relieve symptoms. Analgesics and antipyretics for comfort.
- Gold standard long-term/definitive management: Completing the full 10-day course of antibiotics is essential to prevent non-suppurative complications like acute rheumatic fever.