A lethargic 22-month old black female was presented by her mother to the emergency room at 2:15 am on a Sunday. The child had a history of a runny nose, hoarse cough and low-grade fever (~99F) for the past 48 hours. The mother was concerned about the forced and noisy breathing of the child. The pediatrician examined the child and found cloudy eyes and mild inflammation of the ears, but no overt signs of bacterial infection (no significant changes in the eardrums). The throat of the child was red and coated with mucus. The larynx was swollen and raw.
The physician performed a rapid Strep Test*, and found it was negative. Throat swabs were taken for culture. The physician placed the child in a room with a warm vaponzer for about 30 minutes. This dramatically improved the breathing of the child.
rapid Strep test* is used in the diagnosis of bacterial pharyngitis caused by group A streptococci (GAS), sometimes termed strep throat.
Questions:
1. What is the presumptive diagnosis for this case?
2. Will the throat cultures likely show evidence of Streptococcus pyogenes? How about Staphylococcus aureus?
3. Do you believe that this is a bacterial or viral disease? Why?
4. What further treatment might be indicated for this case?