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 Please post to list. I am away from my home computer and can't do it.

TO all,
I think the Centor Criteria and the AAP Redbook reccomendations use 5-18
years of age to include the highest risk group. I have never believed that
the remainder of the population coldn't get RF. ( look at David's post).
How does the disease know when your birthday is?
Does everyone rul eout febrile convulsion as a possible diagnosis in a 7
year old who present with a brief GTC, associated with fever?


Just saying,

Marty







-----Original Message-----
From: Scherzer, Daniel <[log in to unmask]>
To: [log in to unmask]
Sent: Tue, Jun 1, 2010 2:01 pm
Subject: Re: Rapid Strep Test < 2 years old


Dr. Smith,

The GAS pharyngitis that you remember might not have been the one that
sensitized you to have an autoimmune response - it might just have spurred
it
on.  The antibiotics you took during your relatively recent illness didn't
help
because the antibodies were already primed.  The sensitizing episode could
have
been subtle or remote.  It's the GAS that goes undetected or untreated (and
your
own immuno-uniqueness) that sets you up.

Your story is important and not just an isolated anecdote.
Best of luck to you.
D.J. Scherzer


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]]
On Behalf Of Dave Smith
Sent: Sunday, May 30, 2010 10:21 PM
To: [log in to unmask]
Subject: Re: Rapid Strep Test < 2 years old

I am 41 and just recovered from Acute Rheumatic Fever that developed after
an
adequately treated GAS pharyngitis.

(Without going into detail, diagnosis was arrived at by meeting Jones
Criteria
and having no other positives in my rheumatologic workup...rheumatology and
infectious disease (Duke) evaluated me and concur)

I am a white male, European descent, and never lived off the North American
continent...shouldn't have happened.

Try to incorporate that into this discussion....even I am not sure how it
fits
in or what one could learn from it.


R. David Smith, MD
Children's Acute Care
Medical Director, Peds Emergency
Christus Schumpert, Sutton Children's Hospital, Shreveport, LA
Cape Fear Valley Medical Center, Fayetteville, NC



________________________________
From: "Mittal, Manoj K" <[log in to unmask]>
To: [log in to unmask]
Sent: Sun, May 30, 2010 10:18:20 AM
Subject: Re: Rapid Strep Test < 2 years old

How about adults with sore throat? Do the EM physicians in the group test
them
for Strept. and treat with antibiotics if positive? Rheumatic fever
complicates
Strept throat only in children between 5-15 yrs (can stretch the age by 1-2
yrs
at the margin to cover the outliers). So that is not an issue in adults as
well
(similar to children under the age of 3-4 yrs).
Manoj
Manoj K. Mittal, MD, MRCP (UK)
Division of Emergency Medicine
The Children's Hospital of Philadelphia
University of Pennsylvania School of Medicine
Philadelphia, PA
________________________________________
From: Pediatric Emergency Medicine Discussion List
[[log in to unmask]]
On Behalf Of [log in to unmask] [[log in to unmask]]
Sent: Sunday, May 30, 2010 1:34 AM
To: [log in to unmask]
Subject: Re: Rapid Strep Test < 2 years old

Antibiotics have not been shown to impact post-strep GN.  The only reason to
treat is to reduce the rate of rheumatic heart disease, which in this age
range,
for all intensive purposes, does not occur.  Mike Falk

Sent from my iPhone

On 2010-05-29, at 7:09 PM, Fergus Thornton <[log in to unmask]> wrote:

You talk about treating the disease; are you equating a + strep with the
disease?
#2 is less than 24 hours; not worth a course of Ab's
#3 the latest I've read is that there is no relationship.
#4 What's the incidence of PSGN in this age group?
#5 doesn't occur in this age group
Nope, haven't convinced me yet to test or treat these kids with Ab's.

-----Original Message-----
From: Kevin Powell <[log in to unmask]>
Sent: May 29, 2010 1:26 PM
To: [log in to unmask]
Subject: Re: Rapid Strep Test < 2 years old

I treat strep infections
1.. to reduce contagion
2.. to speed healing and reduce suffering
3.. to reduce suppurative sequelae
4.. to reduce other sequelae, such as glomerulonephritis
5.. to prevent rheumatic fever
roughly in that order.

I think the 1990 era teaching that treatment didn't reduce length of illness
was supplanted by 2000 with data showing 1 day fewer of symptoms by treating
typical strep pharyngitis in older children. No data in the toddlers. There
are lots of places in ER medicine where I would like to reduce exposing kids
to antibiotics. Disease with a proven bacterial pathogen is way down the
list.

{SIDEBAR: Eliminating antibiotics for wheezing toddlers with minimal CXR
findings would be high on my list. This past year I've been working as a
hospitalist for pulmonology and I am frustrated with the number of consults
weekly that involve telling parents their child with recurrent pneumonias
doesn't have an immunodeficiency, he has undertreated asthma.}

The risk/benefit of testing will be different in toddlers.  As I said
before, I don't routinely test for strep in toddlers with sore throats - far
too many viral illnesses. But if a sib has strep or other factors raise the
concern, it is appropriate to test toddlers and, unless shown an applicable
Bayesian analysis, I would recommend treating the disease when it is found.

If an institution has a protocol in place to do rapid streps in triage on
all children with fevers or sore throats, I have minimal experience
practicing that way and defer to others to cite references on that protocol
applied to toddlers.

Kevin Powell MD PhD FAAP
SSM Cardinal Glennon Children's Medical Center
Associate Professor of Pediatrics
Saint Louis University

-----Original Message-----
From: Chamberlain, Jim [mailto:[log in to unmask]]
Sent: Saturday, May 29, 2010 8:52 AM
To: Kevin Powell; [log in to unmask]
Subject: Re: Rapid Strep Test < 2 years old


But the reason we treat Strep is to prevent rheumatic fever. Children this
age don't get RF. Data on symptom resolution suggests a minimally faster
improvement if treated. So why expose all these kids to antibiotics?


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Fergus Thornton
read my blog @ http://docdownunder.wordpress.com

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