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From the Red Book (AAP Committee on Infectious Diseases), 2009:

"Toddlers (1 through 3 years of age) with GAS respiratory tract
infection initially can have serous rhinitis and then develop a
protracted illness with moderate fever, irritability, and anorexia
(streptococcal fever). The classic presentation of streptococcal upper
respiratory tract infection as acute pharyngitis is uncommon in children
younger than 3 years of age. Rheumatic fever also is rare in children
younger than 3 years of age."

The rest of the chapter is silent on treatment in this age group.

It has been my practice not to test or treat in children < 3 y.o. unless
there is difficulty in eradicating Strep from a family, but this is
usually the domain of the PCP, not me.



James Chamberlain, MD
Division Chief, Emergency Medicine
Children's National Medical Center
111 Michigan Avenue, NW
Washington, DC 20010

202.476.3253 (O)
202.476.3573 (F)
202.476.5433 (Emergency Access)


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Fred Wu
Sent: Thursday, May 27, 2010 9:04 PM
To: [log in to unmask]
Subject: Rapid Strep Test < 2 years old

Hello everyone,

Our PA/NPs are swabbing a lot of kids < 1-2 years old with the rapid
strep test and they're coming back positive. One of our PAs is claiming
that he's had 5-10 positives in the past 2 months. It seems pretty
unusual for strep pharyngitis to be present in a child < 2 years old
(from what I recall).

Any thoughts? Is the disease profile changing? They're all carriers?

Thanks,
Fred

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