Group A Streptococcal Pharyngitis in Young Children

The American Academy of Pediatrics notes that Group A streptococcal pharyngitis predominantly affects school-age children (5-15 years) and occurs most commonly during winter and early spring in temperate climates 1, 2
The American Academy of Pediatrics also states that Group A streptococcus is an uncommon cause of pharyngitis in preschool children, though outbreaks in childcare settings have been documented 1, 2
The Infectious Diseases Society of America recommends that the low prevalence of Group A streptococcal pharyngitis in children <3 years of age limits the usefulness of diagnostic testing in this age group 3, 4

Clinical Presentation

The American Academy of Pediatrics notes that infants with Group A streptococcal upper respiratory tract infections may present with excoriated nares or purulent nasal discharge rather than classic pharyngitis 1, 2
The Infectious Diseases Society of America states that Group A streptococcal infection in children <3 years old is often associated with fever, mucopurulent rhinitis, excoriated nares, and diffuse adenopathy 3, 4
The American Academy of Pediatrics also notes that exudative pharyngitis is rare in this age group 3, 4

The American Heart Association reports that acute rheumatic fever in children <3 years of age is very rare 3, 4
The American Heart Association also notes that repeated exposures to Group A streptococcus or priming of the immune system may be necessary before an immune response develops that can lead to rheumatic fever 3, 4

The Infectious Diseases Society of America recommends that routine testing for Group A streptococcal pharyngitis in a 2-month-old is generally not warranted given the very low prevalence in this age group 3, 4
The American Academy of Pediatrics notes that if pharyngitis symptoms occur in an infant this young, viral etiologies are far more likely, and other serious bacterial infections appropriate to this age group should be considered first 5
The American Academy of Pediatrics also states that the most common serious bacterial infection in febrile 2-month-old infants is urinary tract infection (17.9%), followed by bacteremia (2%) and bacterial meningitis (0.9%), with E. coli being the leading pathogen 5