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Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015.

Abstract Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged <3 years, because acute rheumatic fever is extremely rare in this age group; and asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1).
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Authors

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Diagnostic Errors

Streptococcus pyogenes

Keywords
Journal Title mmwr. morbidity and mortality weekly report
Publication Year Start
%A Harrist, Alexia; Van Houten, Clayton; Shulman, Stanford T.; Van Beneden, Chris; Murphy, Tracy
%T Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015.
%J MMWR. Morbidity and mortality weekly report, vol. 64, no. 50-51, pp. 1383-1385
%D 01/2016
%V 64
%N 50-51
%M eng
%B Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged <3 years, because acute rheumatic fever is extremely rare in this age group; and asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1).
%K Adolescent, Adult, Ambulatory Care Facilities, Anti-Bacterial Agents, Child, Child, Preschool, Diagnostic Errors, Diagnostic Tests, Routine, Humans, Middle Aged, Pharyngitis, Practice Guidelines as Topic, Rural Health Services, Streptococcal Infections, Streptococcus pyogenes, Wyoming, Young Adult
%P 1383
%L 1385
%Y 10.15585/mmwr.mm6450a4
%W PHY
%G AUTHOR
%R 2016.......64.1383H

@Article{Harrist2016,
author="Harrist, Alexia
and Van Houten, Clayton
and Shulman, Stanford T.
and Van Beneden, Chris
and Murphy, Tracy",
title="Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015.",
journal="MMWR. Morbidity and mortality weekly report",
year="2016",
month="Jan",
day="01",
volume="64",
number="50-51",
pages="1383--1385",
keywords="Adolescent",
keywords="Adult",
keywords="Ambulatory Care Facilities",
keywords="Anti-Bacterial Agents",
keywords="Child",
keywords="Child, Preschool",
keywords="Diagnostic Errors",
keywords="Diagnostic Tests, Routine",
keywords="Humans",
keywords="Middle Aged",
keywords="Pharyngitis",
keywords="Practice Guidelines as Topic",
keywords="Rural Health Services",
keywords="Streptococcal Infections",
keywords="Streptococcus pyogenes",
keywords="Wyoming",
keywords="Young Adult",
abstract="Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20\%-30\% of pediatric and 5\%-15\% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged <3 years, because acute rheumatic fever is extremely rare in this age group; and asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1).",
issn="1545-861X",
doi="10.15585/mmwr.mm6450a4",
url="http://www.ncbi.nlm.nih.gov/pubmed/26719990",
language="eng"
}

%0 Journal Article
%T Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015.
%A Harrist, Alexia
%A Van Houten, Clayton
%A Shulman, Stanford T.
%A Van Beneden, Chris
%A Murphy, Tracy
%J MMWR. Morbidity and mortality weekly report
%D 2016
%8 January 01
%V 64
%N 50-51
%@ 1545-861X
%G eng
%F Harrist2016
%X Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged <3 years, because acute rheumatic fever is extremely rare in this age group; and asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1).
%K Adolescent
%K Adult
%K Ambulatory Care Facilities
%K Anti-Bacterial Agents
%K Child
%K Child, Preschool
%K Diagnostic Errors
%K Diagnostic Tests, Routine
%K Humans
%K Middle Aged
%K Pharyngitis
%K Practice Guidelines as Topic
%K Rural Health Services
%K Streptococcal Infections
%K Streptococcus pyogenes
%K Wyoming
%K Young Adult
%U http://dx.doi.org/10.15585/mmwr.mm6450a4
%U http://www.ncbi.nlm.nih.gov/pubmed/26719990
%P 1383-1385

PT Journal
AU Harrist, A
   Van Houten, C
   Shulman, ST
   Van Beneden, C
   Murphy, T
TI Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015.
SO MMWR. Morbidity and mortality weekly report
JI MMWR Morb. Mortal. Wkly. Rep.
PD 01
PY 2016
BP 1383
EP 1385
VL 64
IS 50-51
DI 10.15585/mmwr.mm6450a4
LA eng
DE Adolescent; Adult; Ambulatory Care Facilities; Anti-Bacterial Agents; Child; Child, Preschool; Diagnostic Errors; Diagnostic Tests, Routine; Humans; Middle Aged; Pharyngitis; Practice Guidelines as Topic; Rural Health Services; Streptococcal Infections; Streptococcus pyogenes; Wyoming; Young Adult
AB Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged <3 years, because acute rheumatic fever is extremely rare in this age group; and asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1).
ER

PMID- 26719990
OWN - NLM
STAT- MEDLINE
DA  - 20160101
DCOM- 20160426
IS  - 1545-861X (Electronic)
IS  - 0149-2195 (Linking)
VI  - 64
IP  - 50-51
DP  - 2016
TI  - Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural
      Urgent-Care Clinic--Wyoming, March 2015.
PG  - 1383-5
LID - 10.15585/mmwr.mm6450a4 [doi]
AB  - Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis,
      implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for
      sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis
      symptoms include fever, headache, and bilateral tender cervical lymphadenopathy
      (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for
      limiting antibiotic overuse and preventing rheumatic fever (2), but
      distinguishing between GAS and viral pharyngitis clinically is challenging (1).
      Guidelines for diagnosis and management of GAS pharyngitis have been published by
      the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that
      patients with sore throat be tested for GAS to distinguish between GAS and viral 
      pharyngitis; however, IDSA emphasizes the use of selective testing based on
      clinical symptoms and signs to avoid identifying GAS carriers rather than acute
      GAS infections (1). Therefore, testing for GAS usually is not recommended for the
      following: patients with sore throat and accompanying symptoms (e.g., cough,
      rhinorrhea) that strongly suggest a viral etiology; children aged &lt;3 years,
      because acute rheumatic fever is extremely rare in this age group; and
      asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA
      recommends penicillin or amoxicillin as the treatment of choice based on
      effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS 
      has never been documented (1).
FAU - Harrist, Alexia
AU  - Harrist A
FAU - Van Houten, Clayton
AU  - Van Houten C
FAU - Shulman, Stanford T
AU  - Shulman ST
FAU - Van Beneden, Chris
AU  - Van Beneden C
FAU - Murphy, Tracy
AU  - Murphy T
LA  - eng
PT  - Journal Article
DEP - 20160101
PL  - United States
TA  - MMWR Morb Mortal Wkly Rep
JT  - MMWR. Morbidity and mortality weekly report
JID - 7802429
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Ambulatory Care Facilities
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - *Diagnostic Errors
MH  - Diagnostic Tests, Routine
MH  - Humans
MH  - Middle Aged
MH  - Pharyngitis/*diagnosis/drug therapy/etiology
MH  - Practice Guidelines as Topic
MH  - Rural Health Services
MH  - Streptococcal Infections/*diagnosis/drug therapy
MH  - *Streptococcus pyogenes
MH  - Wyoming
MH  - Young Adult
EDAT- 2016/01/01 06:00
MHDA- 2016/04/27 06:00
CRDT- 2016/01/01 06:00
AID - 10.15585/mmwr.mm6450a4 [doi]
PST - epublish
SO  - MMWR Morb Mortal Wkly Rep. 2016 Jan 1;64(50-51):1383-5. doi:
      10.15585/mmwr.mm6450a4.
TY  - JOUR
AU  - Harrist, Alexia
AU  - Van Houten, Clayton
AU  - Shulman, Stanford T.
AU  - Van Beneden, Chris
AU  - Murphy, Tracy
PY  - 2016/01/01
TI  - Notes from the Field: Group A Streptococcal Pharyngitis Misdiagnoses at a Rural Urgent-Care Clinic--Wyoming, March 2015.
T2  - MMWR Morb. Mortal. Wkly. Rep.
JO  - MMWR. Morbidity and mortality weekly report
SP  - 1383
EP  - 1385
VL  - 64
IS  - 50-51
KW  - Adolescent
KW  - Adult
KW  - Ambulatory Care Facilities
KW  - Anti-Bacterial Agents
KW  - Child
KW  - Child, Preschool
KW  - Diagnostic Errors
KW  - Diagnostic Tests, Routine
KW  - Humans
KW  - Middle Aged
KW  - Pharyngitis
KW  - Practice Guidelines as Topic
KW  - Rural Health Services
KW  - Streptococcal Infections
KW  - Streptococcus pyogenes
KW  - Wyoming
KW  - Young Adult
N2  - Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, implicated in 20%-30% of pediatric and 5%-15% of adult health care visits for sore throat (1). Along with the sudden onset of throat pain, GAS pharyngitis symptoms include fever, headache, and bilateral tender cervical lymphadenopathy (1,2). Accurate diagnosis and management of GAS pharyngitis is critical for limiting antibiotic overuse and preventing rheumatic fever (2), but distinguishing between GAS and viral pharyngitis clinically is challenging (1). Guidelines for diagnosis and management of GAS pharyngitis have been published by the Infectious Diseases Society of America (IDSA)* (1). IDSA recommends that patients with sore throat be tested for GAS to distinguish between GAS and viral pharyngitis; however, IDSA emphasizes the use of selective testing based on clinical symptoms and signs to avoid identifying GAS carriers rather than acute GAS infections (1). Therefore, testing for GAS usually is not recommended for the following: patients with sore throat and accompanying symptoms (e.g., cough, rhinorrhea) that strongly suggest a viral etiology; children aged <3 years, because acute rheumatic fever is extremely rare in this age group; and asymptomatic household contacts of patients with GAS pharyngitis (1). IDSA recommends penicillin or amoxicillin as the treatment of choice based on effectiveness and narrow spectrum of activity. To date, penicillin-resistant GAS has never been documented (1).
SN  - 1545-861X
UR  - http://dx.doi.org/10.15585/mmwr.mm6450a4
UR  - http://www.ncbi.nlm.nih.gov/pubmed/26719990
ID  - Harrist2016
ER  - 
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