Which findings suggest pediatric pharyngitis caused by group A beta-hemolytic streptococci (GABHS)?

Updated: Dec 11, 2018
  • Author: Harold K Simon, MD, MBA; Chief Editor: Russell W Steele, MD  more...
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Although no single finding or combination of physical findings distinguishes GABHS from a viral etiology, several findings are suggestive, including the following:

  • Enlarged tonsils

  • Pharyngeal erythema

  • Tonsillar exudates with necrotic crypts

  • Soft-palate petechiae

  • Tender cervical adenopathy

  • Scarlet fever rash (punctate erythematous macules and fine papules with reddened flexor creases and circumoral pallor), the so-called sandpaper rash

  • Conjunctivitis (more common with adenovirus infections)

GABHS pharyngitis is often associated with headache, pharyngeal exudate (see the image below), painful cervical adenopathy, gastrointestinal (GI) symptoms, chills, and high fever.

Posterior pharynx with petechiae and exudates in a Posterior pharynx with petechiae and exudates in a 12-year-old girl. Both the rapid antigen detection test and throat culture were positive for group A beta-hemolytic streptococci.

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