What is the recommended approach for diagnosing Group A Streptococcal infections in children presenting with sore throat?

For diagnosing Group A Streptococcal (GAS) infections in children presenting with a sore throat, clinical assessment alone is considered unreliable, necessitating laboratory confirmation (Shulman et al., 2012; Curatola et al., 2024).

Initial Assessment:

• Clinical scoring systems, such as the Centor or McIsaac scores, can be used to help identify children at a higher risk for GAS pharyngitis (Shulman et al., 2012). However, these scores do not replace the need for laboratory testing (Shulman et al., 2012; Curatola et al., 2024).

Laboratory Confirmation:

• Rapid Antigen Detection Tests (RADTs): These are commonly used for initial diagnosis due to their high specificity, although their sensitivity can be variable (Shulman et al., 2012; Curatola et al., 2024).
• Confirmatory Throat Culture: In children, a negative RADT result should typically be confirmed by a throat culture (Shulman et al., 2012; Curatola et al., 2024). This is crucial due to the potential risk of acute rheumatic fever if GAS pharyngitis is missed (Shulman et al., 2012; Curatola et al., 2024). Throat culture is considered the gold standard for diagnosis (Shulman et al., 2012; Curatola et al., 2024).
• Molecular Tests: Newer molecular diagnostic tests, such as nucleic acid amplification tests (NAATs), offer higher sensitivity and specificity compared to traditional RADTs (Cohen et al., 2024; Curatola et al., 2024). These advanced tests can potentially reduce the need for confirmatory throat cultures following a negative result (Cohen et al., 2024).

The overarching goal of accurate diagnosis is to prevent serious complications like acute rheumatic fever and post-streptococcal glomerulonephritis, while also promoting appropriate antimicrobial stewardship by avoiding unnecessary antibiotic prescriptions (Cohen et al., 2024; Curatola et al., 2024).