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Cureus 2021 Apr 29;13(4):e14749. Epub 2021 Apr 29.

Internal Medicine, Hospital De Cascais Dr. José De Almeida, Lisbon, PRT.

We report the case of a 28-year-old male, with a past history of recurrent pharyngitis and tonsillectomy, who presented to the emergency department with fever, pharyngitis, and cervical adenitis. Inflammatory markers were elevated and the patient was initially started on ceftriaxone with remission after four days. However, the symptoms recurred three weeks later and an autoinflammatory disease was suspected. Read More

Int J Pediatr Otorhinolaryngol 2021 Jul 13;146:110759. Epub 2021 May 13.

Division of Infectious Diseases, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at 1515 Holcombe Blvd, Houston, TX, 77030, USA; Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA. Electronic address:

Introduction: Arcanobacterium haemolyticum causes pharyngotonsillitis in children and young adults. It is rarely isolated in pharyngeal swabs as testing for it is not routine. Data on complications, management, and antibiotic susceptibility testing is limited. Read More

BMC Infect Dis 2021 May 21;21(1):463. Epub 2021 May 21.

Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Background: Streptococcus pyogenes causes a profound global burden of morbidity and mortality across its diverse clinical spectrum. To support a new controlled human infection ('challenge') model seeking to accelerate S. pyogenes vaccine development, we aimed to develop an accurate and reliable molecular method for quantifying bacterial load from pharyngeal swabs collected during experimental human pharyngitis. Read More

Clin Rheumatol 2021 May 20. Epub 2021 May 20.

Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr Qarib St, Keshavarz Blvd, 14194, Tehran, Iran.

Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is an autoinflammatory disorder with an uncertain origin. PFAPA manifestations occur in the form of regular attacks accompanied by a rise in inflammatory markers. Regarding the family clustering of PFAPA and its similarities with other autoinflammatory disorders such as familial Mediterranean fever, a genetic basis is suggested for the disease. Read More

Clin Exp Immunol 2021 May 18. Epub 2021 May 18.

Section of Clinical and Laboratory Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.

Lymphadenopathies can be part of the clinical spectrum of several primary immunodeficiencies, including diseases with immune dysregulation and autoinflammatory disorders, as the clinical expression of benign polyclonal lymphoproliferation, granulomatous disease or lymphoid malignancy. Lymphadenopathy poses a significant diagnostic dilemma when it represents the first sign of a disorder of the immune system, leading to a consequently delayed diagnosis. Additionally, the finding of lymphadenopathy in a patient with diagnosed immunodeficiency raises the question of the differential diagnosis between benign lymphoproliferation and malignancies. Read More

Lancet Glob Health 2021 Jul 10;9(7):e957-e966. Epub 2021 May 10.

Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA; Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Partners In Health, Boston, MA, USA. Electronic address:

Background: Despite declines in deaths from rheumatic heart disease (RHD) in Africa over the past 30 years, it remains a major cause of cardiovascular morbidity and mortality on the continent. We present an investment case for interventions to prevent and manage RHD in the African Union (AU).

Methods: We created a cohort state-transition model to estimate key outcomes in the disease process, including cases of pharyngitis from group A streptococcus, episodes of acute rheumatic fever (ARF), cases of RHD, heart failure, and deaths. Read More

Clin Microbiol Infect 2021 May 6. Epub 2021 May 6.

Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, Paris, France; Necker-Enfants malades Hospital, APHP, Université de Paris, Department of General Paediatrics and Paediatric Infectious Diseases, Paris, France. Electronic address:

Background: Acute pharyngitis is one of the most common conditions in outpatient settings and an important source of inappropriate antibiotic prescribing. Rapid antigen detection tests (RADTs) offer diagnosis of group A streptococcus at the point of care but have limited sensitivity. Rapid nucleic acid tests (RNATs) are now available; a systematic review of their accuracy is lacking. Read More

J Med Microbiol 2021 May;70(5)

Department of Microbiology, Seth G S Medical College and King Edward Memorial Hospital, Mumbai, India.

Group A streptococci can trigger autoimmune responses that lead to acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Some autoantibodies generated in ARF/RHD target antigens in the S2 subfragment region of cardiac myosin. However, little is known about the kinetics of these antibodies during the disease process. Read More

BMC Microbiol 2021 May 3;21(1):135. Epub 2021 May 3.

Department of Medical laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box: 79, Bahir Dar, Ethiopia.

Background: Streptococcus pyogenes (S. pyogenes) is a Gram positive bacterium which is a leading cause of pharyngitis, skin and soft tissue infection and post streptococcal syndromes. Due to lack of β-lactamase enzyme production, it was considered universally susceptible to penicillin group and later generation of β-lactam antibiotics. Read More

PLoS One 2021 29;16(4):e0248201. Epub 2021 Apr 29.

Division of Infectious Diseases, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America.

Streptococcus pyogenes or group A Streptococcus (GAS) is a leading cause of bacterial pharyngitis, skin and soft tissue infections, life-threatening invasive infections, and the post-infectious autoimmune syndromes of acute rheumatic fever and post-streptococcal glomerulonephritis. Genetic manipulation of this important pathogen is complicated by resistance of the organism to genetic transformation. Very low transformation efficiency is attributed to recognition and degradation of introduced foreign DNA by a type I restriction-modification system encoded by the hsdRSM locus. Read More

J Paediatr Child Health 2021 06 20;57(6):797-802. Epub 2021 Apr 20.

Department of Public Health, University of Otago, Wellington, New Zealand.

Rheumatic heart disease (RHD) is a large, preventable, global public health burden. In New Zealand (NZ), acute rheumatic fever (ARF) and RHD rates are highest for Māori and Pacific children. This structured review explores the evidence for primary prevention interventions to diagnose and effectively treat group A Streptococcus (GAS) pharyngitis and skin infections to reduce rates of ARF and RHD. Read More

BMJ Case Rep 2021 Apr 13;14(4). Epub 2021 Apr 13.

Pediatrics, Yokohama Minami Kyosai Hospital, Yokohama, Japan.

A previously healthy 16-year-old adolescent was admitted to our hospital with fever, sore throat, diarrhoea, strawberry tongue, rashes on lower extremities, and pain in the neck, abdomen and joints. He was initially diagnosed with IgA vasculitis triggered by acute pharyngitis. Despite antibiotic treatment, he gradually developed multiorgan failure and cardiac shock. Read More

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021 Apr;56(4):387-389

Department of Neurology, Capital Institute of Pediatrics Children's Hospital, Beijing 100020, China.

Drugs Context 2021 26;10. Epub 2021 Mar 26.

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

The goal of this narrative review of pharyngitis is to summarize the practical aspects of the management of sore throat in children in high- and middle-income countries. A traditional review of the literature was performed. Most cases of pharyngitis are viral and self-limited, although rarely viral pharyngitis due to Epstein-Barr leads to airway obstruction. Read More

BMC Infect Dis 2021 Apr 7;21(1):322. Epub 2021 Apr 7.

Department of Paediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain.

Background: Despite a notable decrease in acute rheumatic fever (ARF) incidence in the past few decades, there are still cases in our setting. Sydenham chorea (SC) may be the initial manifestation for this condition in childhood in a significant proportion of children. We report two cases of choreoathetosis in children as the first manifestation of ARF. Read More

Saudi Med J 2021 Apr;42(4):391-398

From the Department of Pediatrics (Alnajjar, Dohain, Abdelmohsen, Alahmadi, Zaher, Abdelgalil), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; and from the Department of Pediatrics (Dohain, Abdelmohsen, Abdelgalil), Cairo University, Cairo, Egypt.

Objectives: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection.

Methods: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Results: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14. Read More

Benef Microbes 2021 Apr 1;12(2):137-145. Epub 2021 Apr 1.

Centre for Translational Research on Mother and Child Health, Hospital GEA, Calzada de Tlalpan 4800, 14080, Mexico City, Mexico.

Pharyngitis and tonsillitis are the most common acute respiratory infections (ARIs) in children aged ≤5 years. The analysis of published data showed that some probiotics could decrease the frequency and number of days with ARIs. This study evaluated the safety and efficacy of ATCC PTA 5289 and DSM 17938 to reduce the duration and severity of ARI symptoms. Read More

Acad Pediatr 2021 Mar 16. Epub 2021 Mar 16.

Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.

Objective: Regulatory and payment changes associated with COVID-19 facilitated wide-spread use of telehealth within pediatric primary care starting in March 2020. Given prior quality concerns about antibiotic management for children during telemedicine visits outside of primary care, we sought to examine acute respiratory tract infection (ARTI) visit volume and antibiotic management for children via telemedicine integrated within pediatric primary care.

Methods: Using electronic health record data from 47 practices within a large pediatric primary care network, we identified visits for ARTI from April to September 2020. Read More

BMJ Case Rep 2021 Mar 18;14(3). Epub 2021 Mar 18.

Pediatrics Department, Centro Hospitalar de Setubal EPE, Setubal, Portugal.

The Epstein-Barr virus (EBV) is highly prevalent throughout the population. Although in most cases, the infection has a good prognosis, it can cause severe complications. We report a case of a healthy child with a primary EBV infection that evolved with two rare complications. Read More

Trials 2021 Mar 18;22(1):216. Epub 2021 Mar 18.

Department of Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, No. 88 Changling Street, Xiqing District, Tianjin, 300193, China.

Background: Acute pharyngitis and tonsillitis are common respiratory diseases for which children seek medical care. Their main clinical manifestation is sore throat which interferes with patients' quality of life. However, there is no proven effective or safe method to treat it. Read More

J Paediatr Child Health 2021 03;57(3):459

Department of General Paediatrics, Children's Hospital at Westmead, Sydney, New South Wales, Australia.

Int J Pediatr Otorhinolaryngol 2021 May 10;144:110674. Epub 2021 Mar 10.

Department of Biostatistics, Faculty of Medicine, Near East University, Nicosia, Cyprus.

Introduction: Tonsillar microenvironment is thought to contribute to innate immune dysregulation responsible for the periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) because of beneficial effects of tonsillectomy on treatment of the syndrome. Accordingly previous studies reported altered lymphocyte frequency, cytokine level and microbial composition in PFAPA tonsils. The aim of our study is to monitor expression levels of pro-inflammatory cell surface Toll-like receptors (TLRs) which have important role in induction of inflammation and maintaining tissue haemostasis. Read More

Br J Biomed Sci 2021 Jul 14;78(3):107-116. Epub 2021 Apr 14.

Department of Biological Sciences, Munster Technological University, Bishopstown, Cork, Ireland.

EBV is the sole causative agent of the acute illness in humans described either as infectious mononucleosis (IM), or glandular fever. IM, when not clinically silent, can present in patients with at least two of the classic triad of symptoms of fever, pharyngitis, and lymphadenopathy. Challenges for the clinician arise when atypical cases present. Read More

Rheumatol Int 2021 Mar 11. Epub 2021 Mar 11.

Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.

Differentiating PFAPA (periodic fever, aphthosis, pharyngitis, and adenitis) syndrome from familial Mediterranean fever (FMF) could be challenging in some cases. Galectin-3 is a lectin with regulatory functions in apoptosis and inflammation. We aimed to test whether galectin-3 could be a biomarker for differentiating PFAPA syndrome from FMF. Read More

Clin Immunol 2021 05 24;226:108697. Epub 2021 Feb 24.

Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of California-San Diego, La Jolla, CA, United States of America; Rady Children's Foundation, Rady Children's Hospital, San Diego, CA, United States of America. Electronic address:

Autoinflammatory disorders of the innate immune system present with recurrent episodes of inflammation often beginning in early childhood. While there are now more than 30 genetically-defined hereditary fever disorders, many patients lack a clear diagnosis. Many pediatric patients are often grouped with patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome despite failing to meet diagnostic criteria. Read More

Laryngoscope 2021 07 25;131(7):E2149-E2152. Epub 2021 Feb 25.

PEDEGO Research Unit, Medical Research Center, University of Oulu, Oulu, Finland.

Objectives/hypothesis: Tonsillectomy is an effective treatment for periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome, but the role of adenoidectomy, as well as later tonsillar regrowth, is unclear. To find out if the volume of lymphoid tissue is pivotal to the efficacy, we analyzed the association between the relapse of the symptoms of PFAPA syndrome and regrowth of tonsillar tissue after tonsillectomy or adenotonsillectomy.

Study Design: Prospective cohort study of operated PFAPA pateints. Read More

Front Cell Infect Microbiol 2020 27;10:616814. Epub 2021 Jan 27.

PEDEGO Research Unit, University of Oulu, Oulu, Finland.

Periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome (PFAPA) is the most common periodic fever syndrome in children with unknown etiology, effectively treated with tonsillectomy. Earlier we have shown that tonsil microbiome is different in patients with PFAPA as compared to that in controls. Recently, fungal microbiome, mycobiome, has been linked to the pathogenesis of inflammatory diseases. Read More

Artif Intell Med 2021 02 15;112:102018. Epub 2021 Jan 15.

Department of Pediatrics, Faculty of Medicine, University of Toronto, Department of Newborn and Developmental Pediatrics, Sunnybrook Health Science Centre, Canada.

Background And Objective: The novel coronavirus disease 2019 (COVID-19) is considered a pandemic by the World Health Organization (WHO). As of April 3, 2020, there were 1,009,625 reported confirmed cases, and 51,737 reported deaths. Doctors have been faced with a myriad of patients who present with many different symptoms. Read More

IDCases 2021 22;23:e01036. Epub 2021 Jan 22.

Medical College of Wisconsin, Infectious Disease Department, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, United States.

Group C Streptococcus (GCS) is part of the normal commensal flora of the upper airway, as well as frequently colonizes the skin, gastrointestinal tract, and female genital tract. It can also be implicated in mono- and polymicrobial infections of the skin and soft tissue, pharyngitis, bacteremia, endocarditis, septic arthritis, osteomyelitis, and meningitis. Our case study features a previously healthy 65-year-old male, who retired as a veterinarian one month prior, with Group C Streptococcus bacteremia complicated by septic polyarthritis, native mitral valve endocarditis, and lumbar discitis/osteomyelitis. Read More

Eur J Pediatr 2021 Jun 2;180(6):1867-1874. Epub 2021 Feb 2.

Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland.

Group A Streptococcus has been associated with a perianal infection. We conducted a systematic review of the literature on childhood streptococcal perianitis in three databases: Excerpta Medica, National Library of Medicine, and Web of Science. The main purposes were to document the clinical features, the tendency to recur, the association with an asymptomatic streptococcal throat carriage, the accuracy of rapid streptococcal tests, and the mechanism possibly underlying the acquisition of this infection. Read More