“Mommy, my throat is on fire!”
History of Present Illness
JT is a 7-year-old Chinese American female, accompanied by her mother, who presents to the community pharmacy with complaints of sore throat and fever, looking for medications to take to relieve her symptoms. She is fussy and describes the pain when she swallows as feeling if her throat is “on fire.” Her symptoms began yesterday morning, and she has only tried drinking a pei pa koa syrup containing medicinal herbs (main active herb is elm bark) and honey to relieve the sore throat. This provided some relief but the pain has been getting worse. She did not have a temperature taken, but her forehead was hot to the touch. She was not given any medications to relieve the fever. She was dressed with additional clothing and blankets to “sweat the fever out,” but the fever still persisted. She reports that there may have been other sick classmates. She denies a prior history of sore throat.
Attention-deficit disorder, recurrent otitis media (resolved)
Amoxicillin (throat swelling, difficulty breathing)
Methylphenidate ER 18 mg PO daily
Temp 101.9°F (oral), Ht 4′4″, Wt 29.55 kg
Appears uncomfortable, tired, grimacing when swallowing
Anterior cervical lymph nodes enlarged and tender; tonsils moist, red, with white exudates
Point-of-Care GAS Rapid Antigen Detection Test
1. What is the most common pathogen responsible for acute bacterial pharyngitis in children?
A. Corynebacterium diphtheriae
2. What signs and symptoms in this patient definitely discriminate between GAS pharyngitis rather than viral pharyngitis?
A. Tonsils with white exudates
3. If GAS is suspected, what age range is typically excluded for testing for GAS?