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Not to add more to this controversy..However, unless we do ASO titres or other Strep related serology how do we know the kiddo just wasn't a carrier? 
BTW I do think Strep can cause fever in babies. I remember Streptococcosis .Typically fever, mild bloody nasal discharge, some crusting at opening of nares. As for it causing pharyngitis.. sure why not?
 
My bigger question though is so what? It shold be self limited. The risks of suppurative complications is low, and certainly we don't pursue other types of bacterial throat infections to treat them. So Why do we or should we for Strep just becaue a rapid swab is readily available? 


Marty
Martin Herman, M.D.
Pediatric Emergency Medicine 
Sacred Heart Children's Hospital
FSU @ Sacred Heart, Division of Pediatrics
5153 N. 9th Ave, 6th Floor Nemours Bldg
Pensacola, FL 32504
Ph: 850 416 7658(office)
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Date: Mon, 20 Feb 2012 16:51:35 -0500
Subject: Re: question about strep
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Marty beat me to this posting. I was going to ask the group about this.

Last week I received a call from a local pediatric group (a decent one). They wanted me to QI a case. We had seen an 8 month old with a fever of 105 and some diarrhea and dehydration and provided IVFs. But we didn't do any testing and therefore "missed" the fact that the child had strep.

I really have no idea how to respond to this other than to say that I believe strep was not the cause and that nothing was "missed". But I think that this only results in a he said - she said discussion where the community physicians and ED physicians each think that the other is wrong.

Does anyone believe that strep can cause high fevers in infants less than a year of age? Who should be swabbed?

(I am not questioning the treatment of a positive strep swab. I think that once you do the test and get a positive, you are stuck).

Thanks

Rick Place


On Mon, Feb 20, 2012 at 3:18 PM, Marty Herman <[log in to unmask]> wrote:

SO for years I have been puzzled why folks swab for strep in kids less than 2. When I read the Red Book it says testing for Strep in kids 2-3 is marginally indicated. They say typically 3 and up. According to what I have been told Rheumatic Fever doesn't occur in kids < 2, and is rare anyway and so if the reason we swab for strep is to prevent RF by early intervention, then why waste the money in kids < 2?If it's to limit the symptoms, avoid spreading contagion especially to daycare classmates,  and or to allow parents to return to work sooner, why don't we screen for other causes of treatable bacterial infections like Eikenella, or arcanybacterium or mycoplasma? Studies done looking at the treatment with Penicillin and cephalosporins excluded kids under 3 ( Pediatric Annals May 1998 . the entire issue is dedicated to Group A Strep Infections. ). SO how do we know that treating kids <2 is actually worthwhile?  SO do you see patients who have been diagnosed with "Strep" pharyngitis that are < 2? Do you swab and treat kids < 2 if positive?

Marty
Martin Herman, M.D.

Pediatric Emergency Medicine
Sacred Heart Children's Hospital
FSU @ Sacred Heart, Division of Pediatrics
5153 N. 9th Ave, 6th Floor Nemours Bldg
Pensacola, FL 32504
Ph: 850 416 7658(office)
Ph: 901 219 9202 ( cell)
Fx: 850 416 7677
Email: [log in to unmask]

CONFIDENTIALITY NOTICE:
This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege.



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-- 
Rick Place, MD
Department of Emergency Medicine
Inova Fairfax Hospital for Children
3300 Gallows Road
Falls Church, VA 22042
 		 	   		  
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