Streptococcus pyogenes in pediatrics: is it time to reconsider the odynophagia assessment?

Abstract

Introduction: Group A Streptococcus is the main pathogen responsible for bacterial pharyngitis, but it’s also associated with invasive forms of disease which are mainly caused by M1T1 genotype, although recently it’s been reported an increase in these severe manifestations due to a new strain identified as M1_UK, not only internationally but also in the country. Objective: To analyze the available evidence about the most known clinical prediction rules in the approach of the child with sore throat.  Methodology: A narrative review was conducted of the available literature in English and Spanish, searching in the database “PubMed”, including reviews and original articles related to Group A Streptococcus, clinical prediction rules and M1_UK. Result and Discussion: M1_UK owes it’s virulence to the higher production of the toxin SpeA, but also to a synergy to viral infections such as influenza and chickenpox. Besides, the most commonly used clinical prediction rules in clinical practice have not shown an acceptable performance to diagnose a Group A Streptococcus infection as an only resource and are not validated in pediatric patients. Conclusion: With this new epidemiological scenario, it’s important to consider including rapid antigen tests in the healthcare centers arsenal to aid in a better diagnosis, considering this new strain, alongside to reinforce the importance of vaccines.