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FIGURE 74.4 Diagnostic approach when findings are clinically suggestive for mononucleosis.
WBC, white blood cell; IM, infectious mononucleosis; EBV, Epstein–Barr virus.

Ultimately, most children will have a mildly to moderately inflamed pharynx
but no specific etiologic diagnosis based solely on the history and physical
examination. The local, recent incidence of group A streptococcal pharyngitis is
an important predictor of strep throat among symptomatic patients. Integration of
real-time biosurveillance data with the electronic health record has the potential
to facilitate improved diagnosis of strep throat. Although certain symptoms and
signs favor streptococcal infection, none is conclusive. Thus, obtaining a rapid
test (latex agglutination or optical immunoassay) for group A streptococci,
followed by a culture, if negative, is prudent. Rapid tests are most helpful when a
positive result is obtained because specificity of the tests is high; however, a
negative test result does not exclude streptococcal infection reliably, although
some authorities would be satisfied with a negative optical immunoassay alone.
About 10% to 20% of children are carriers of group A streptococci. Testing these