What is the role of viral testing in the workup of pediatric pharyngitis?

Updated: Dec 11, 2018
  • Author: Harold K Simon, MD, MBA; Chief Editor: Russell W Steele, MD  more...
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If Epstein-Barr virus (EBV) is considered, obtain a complete blood count (CBC) to detect atypical cells in the white blood cell (WBC) differential, along with a Monospot test (or another rapid heterophile antibody test). EBV can also produce a subclinical hepatitis with a slightly elevation in aminotransferases.

Monospot findings are often negative in children younger than 6 years with EBV infections and in the first week of symptoms. In adolescents, Monospot testing detects approximately 90% of positive cases ultimately diagnosed with EBV-specific serologies.

Other viral pathogens usually do not call for further diagnostic testing, but viral cultures can be obtained. Viruses can be cultured in special media.

During viral outbreaks (eg, H1N1 influenza), if associated symptoms of the outbreak virus may initially include sore throat, one may opt to screen for streptococcal infection immediately or may elect to screen later, if symptoms persist, in order to rule out Streptococcus as the primary cause of the fever and sore throat.

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