{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:50:41Z","timestamp":1790268641716,"version":"4.1.0"},"reference-count":90,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The accurate differentiation between asymptomatic carriage with group A streptococcus (GAS) and active streptococcal pharyngitis is a complex task with important clinical and public health implications. This work aims to highlight the key strategies necessary for optimizing the diagnostic and therapeutic management of pediatric pharyngitis. Clinical scores are essential tools for improving diagnostic accuracy. When combined with laboratory tests such as throat cultures and rapid antigen detection tests, these systems enable effective risk stratification of patients, supporting more precise treatment decisions. In addition to diagnostic strategies, the article underscores the importance of patient-centered communication, particularly with the families of pediatric patients. Clear, empathetic discussions about the condition, diagnostic rationale, and treatment plan help foster trust, enhance adherence to medical recommendations, and reduce anxiety related to potential complications. A critical outcome of these combined strategies is the reduction of unnecessary antibiotic use, which plays a pivotal role in preventing both overdiagnosis and overprescription. This, in turn, mitigates the growing threat of antimicrobial resistance, one of the most significant global health challenges. By integrating clinical expertise, standardized protocols, and effective communication, healthcare providers can promote judicious and effective management of streptococcal pharyngitis or asymptomatic carriage, contributing to improved individual and population health outcomes.<\/jats:p>","DOI":"10.3390\/microorganisms13030529","type":"journal-article","created":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T05:13:58Z","timestamp":1740633238000},"page":"529","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Role of Physical Examination and Clinical Scores in Distinguishing Streptococcal Colonization from Pharyngitis in Pediatric Patients: Insights from a Common Clinical Scenario"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2318-5365","authenticated-orcid":false,"given":"Victor Daniel","family":"Miron","sequence":"first","affiliation":[{"name":"Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doina Anca","family":"Ple\u0219ca","sequence":"additional","affiliation":[{"name":"Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Children\u2019s Clinical Hospital Dr. Victor Gomoiu, 022102 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu\u021ba","family":"Bila\u0219co","sequence":"additional","affiliation":[{"name":"Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudiu","family":"Filimon","sequence":"additional","affiliation":[{"name":"Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Emergency Clinical Hospital, 014461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid","family":"Covaci","sequence":"additional","affiliation":[{"name":"Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca Cristina","family":"Dr\u0103g\u0103nescu","sequence":"additional","affiliation":[{"name":"Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"National Institute for Infectious Diseases \u201cProf. Dr. Matei Bal\u0219\u201d, 021105 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mercadante, S., Ficari, A., Romani, L., De Luca, M., Tripiciano, C., Chiurchiu, S., Calo Carducci, F.I., Cursi, L., Di Giuseppe, M., and Krzysztofiak, A. (2024). The Thousand Faces of Invasive Group A Streptococcal Infections: Update on Epidemiology, Symptoms, and Therapy. Children, 11.","DOI":"10.3390\/children11040383"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.pcl.2005.02.004","article-title":"Diagnosis and treatment of pharyngitis in children","volume":"52","author":"Gerber","year":"2005","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101458","DOI":"10.1016\/j.eclinm.2022.101458","article-title":"The global burden of sore throat and group A Streptococcus pharyngitis: A systematic review and meta-analysis","volume":"48","author":"Miller","year":"2022","journal-title":"EClinicalMedicine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"154","DOI":"10.4103\/jgid.jgid_59_21","article-title":"Streptococcal Pharyngitis in Children: A Tertiary Pediatric Hospital in Bucharest, Romania","volume":"13","author":"Miron","year":"2021","journal-title":"J. Glob. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1542\/peds.2007-0484","article-title":"Burden and economic cost of group A streptococcal pharyngitis","volume":"121","author":"Pfoh","year":"2008","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Miller, K.M., Barnett, T.C., Cadarette, D., Bloom, D.E., Carapetis, J.R., and Cannon, J.W. (2023). Antibiotic consumption for sore throat and the potential effect of a vaccine against group A Streptococcus: A systematic review and modelling study. EBioMedicine, 98.","DOI":"10.1016\/j.ebiom.2023.104864"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Di Pietro, G.M., Marchisio, P., Bosi, P., Castellazzi, M.L., and Lemieux, P. (2024). Group A Streptococcal Infections in Pediatric Age: Updates about a Re-Emerging Pathogen. Pathogens, 13.","DOI":"10.3390\/pathogens13050350"},{"key":"ref_8","unstructured":"National Institute for Public Health (Romania) (2025, February 19). Calendarul Na\u021bional de Vaccinare, Available online: https:\/\/insp.gov.ro\/wp-content\/uploads\/2022\/08\/Calendar-de-vaccinare-2022.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1001\/jama.291.13.1587","article-title":"Empirical validation of guidelines for the management of pharyngitis in children and adults","volume":"291","author":"McIsaac","year":"2004","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"vii","DOI":"10.3310\/hta18060","article-title":"PRImary care Streptococcal Management (PRISM) study: In vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study","volume":"18","author":"Little","year":"2014","journal-title":"Health Technol. Assess."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S1473-3099(19)30039-8","article-title":"Macrolide resistance in Streptococcus spp.","volume":"19","author":"Tsuzuki","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jgar.2017.05.026","article-title":"Distribution of macrolide resistance mechanisms in Bulgarian clinical isolates of Streptococcus pyogenes during the years of 2013\u20132016","volume":"10","author":"Muhtarova","year":"2017","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lu, B., Fang, Y., Fan, Y., Chen, X., Wang, J., Zeng, J., Li, Y., Zhang, Z., Huang, L., and Li, H. (2017). High Prevalence of Macrolide-resistance and Molecular Characterization of Streptococcus pyogenes Isolates Circulating in China from 2009 to 2016. Front. Microbiol., 8.","DOI":"10.3389\/fmicb.2017.01052"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Plesca, V.S., Streinu-Cercel, A., Sandulescu, O., Draganescu, A.C., Hainarosie, R., and Plesca, A.D. (2024). Incidence and Characteristics of Pediatric Patients with Acute Otitis Hospitalized in a Romanian Infectious Diseases Hospital. Children, 11.","DOI":"10.3390\/children11070832"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1099\/jmm.0.001158","article-title":"Changes in epidemiologic characteristics and antimicrobial resistance of Streptococcus pyogenes isolated over 10 years from Japanese children with pharyngotonsillitis","volume":"69","author":"Ubukata","year":"2020","journal-title":"J. Med. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/j.jmii.2023.04.010","article-title":"High-level levofloxacin-resistant emm12 group A Streptococcus, 2012\u20132018: A multicenter study in Taiwan","volume":"56","author":"Huang","year":"2023","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.2147\/IDR.S261975","article-title":"Is There Emergence of beta-Lactam Antibiotic-Resistant Streptococcus pyogenes in China?","volume":"13","author":"Yu","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jcma.2016.01.002","article-title":"Isolation of Streptococcus pyogenes from children with pharyngitis and emm type analysis","volume":"79","author":"Khosravi","year":"2016","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2783","DOI":"10.2147\/IDR.S418143","article-title":"Comment on: \u201cPrevalence, Antibiotic Susceptibility Profile and Associated Factors of Group A Streptococcal Pharyngitis Among Pediatric Patients with Acute Pharyngitis in Gondar, Northwest Ethiopia\u201d [Letter]","volume":"16","author":"Miron","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.2147\/IDR.S402292","article-title":"Prevalence, Antibiotic Susceptibility Profile and Associated Factors of Group A Streptococcal pharyngitis Among Pediatric Patients with Acute Pharyngitis in Gondar, Northwest Ethiopia","volume":"16","author":"Tadesse","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"351","DOI":"10.18683\/germs.2021.1271","article-title":"\u201cRed throat\u201d or acute pharyngitis-challenges in real life clinical practice","volume":"11","author":"Miron","year":"2021","journal-title":"Germs"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"363","DOI":"10.18683\/germs.2021.1273","article-title":"Diagnosis and management of pharyngitis in children: A survey study in Ukraine","volume":"11","author":"Boyarchuk","year":"2021","journal-title":"Germs"},{"key":"ref_23","first-page":"CD010502","article-title":"Rapid antigen detection test for group A streptococcus in children with pharyngitis","volume":"7","author":"Cohen","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Sharif, M.R., Aalinezhad, M., Sajadian, S.M., and Haji Rezaei, M. (2016). Streptococcal Pharyngitis in a Two-Month-Old Infant: A Case Report. Jundishapur J. Microbiol., 9.","DOI":"10.5812\/jjm.32630"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/S0735-6757(00)90032-9","article-title":"Group A streptococcal pharyngitis and scarlatiniform rash in an 8-week-old infant","volume":"18","author":"Macaset","year":"2000","journal-title":"Am. J. Emerg. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/2230-8229.97929","article-title":"A study of group a streptococcal bacteria isolation from children less than 12 years with acute tonsillitis, pharyngitis and healthy primary school children","volume":"9","author":"Telmesani","year":"2002","journal-title":"J. Fam. Community Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e557","DOI":"10.1542\/peds.2009-2648","article-title":"Prevalence of streptococcal pharyngitis and streptococcal carriage in children: A meta-analysis","volume":"126","author":"Shaikh","year":"2010","journal-title":"Pediatrics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"ofw243","DOI":"10.1093\/ofid\/ofw243","article-title":"High Incidence of Invasive Group A Streptococcal Infections in Remote Indigenous Communities in Northwestern Ontario, Canada","volume":"4","author":"Bocking","year":"2017","journal-title":"Open Forum Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1097\/INF.0b013e3182a5c32a","article-title":"Group A streptococcal emm type prevalence among symptomatic children in Cape Town and potential vaccine coverage","volume":"33","author":"Engel","year":"2014","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/INF.0000000000000677","article-title":"Comparative epidemiology of Streptococcus pyogenes emm-types causing invasive and noninvasive infections in French children by use of high-resolution melting-polymerase chain reaction","volume":"34","author":"Bidet","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5285","DOI":"10.1128\/JCM.41.11.5285-5287.2003","article-title":"Prevalence of group A streptococcal carriers in asymptomatic children and clonal relatedness among isolates in Malatya, Turkey","volume":"41","author":"Durmaz","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tartof, S.Y., Reis, J.N., Andrade, A.N., Ramos, R.T., Reis, M.G., and Riley, L.W. (2010). Factors associated with Group A Streptococcus emm type diversification in a large urban setting in Brazil: A cross-sectional study. BMC Infect. Dis., 10.","DOI":"10.1186\/1471-2334-10-327"},{"key":"ref_33","first-page":"1178","article-title":"Upper respiratory tract infection in Thai adults: Prevalence and prediction of bacterial causes, and effectiveness of using clinical practice guidelines","volume":"89","author":"Treebupachatsakul","year":"2006","journal-title":"J. Med. Assoc. Thai"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1542\/peds.2006-3368","article-title":"Burden of acute sore throat and group A streptococcal pharyngitis in school-aged children and their families in Australia","volume":"120","author":"Danchin","year":"2007","journal-title":"Pediatrics"},{"key":"ref_35","first-page":"76","article-title":"Epidemiological survey of beta-hemolytic streptococci isolated from acute pharyngitis in a private pediatric practice","volume":"54","author":"Karasawa","year":"2001","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_36","first-page":"20499361221132101","article-title":"Seasonal variations and risk factors of Streptococcus pyogenes infection: A multicenter research network study","volume":"9","author":"Kennis","year":"2022","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s00484-015-1072-0","article-title":"Effects of meteorologic factors and schooling on the seasonality of group A streptococcal pharyngitis","volume":"60","author":"Hervas","year":"2016","journal-title":"Int. J. Biometeorol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1093\/fampra\/cmx072","article-title":"Signs and symptoms of Group A versus Non-Group A strep throat: A meta-analysis","volume":"35","author":"Thai","year":"2018","journal-title":"Fam. Pract."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.wjorl.2021.05.005","article-title":"The treatment of streptococcal tonsillitis\/pharyngitis in young children","volume":"7","author":"Norton","year":"2021","journal-title":"World J. Otorhinolaryngol. Head Neck Surg."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Draganescu, A.C., Miron, V.D., Sandulescu, O., Bilasco, A., Streinu-Cercel, A., Sandu, R.G., Marinescu, A., Gunsahin, D., Hoffmann, K.I., and Horobet, D.S. (2023). Omicron in Infants-Respiratory or Digestive Disease?. Diagnostics, 13.","DOI":"10.3390\/diagnostics13030421"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1093\/cid\/cis629","article-title":"Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America","volume":"55","author":"Shulman","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"38","DOI":"10.18683\/germs.2024.1416","article-title":"Occurrence of acute otitis and sinusitis in patients hospitalized for influenza","volume":"14","author":"Plesca","year":"2024","journal-title":"Germs"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1007\/s00431-020-03861-8","article-title":"Reducing antibiotic prescriptions in children is not associated with higher rate of complications","volume":"180","author":"Gagliotti","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_44","first-page":"l5337","article-title":"Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: Randomised controlled, open label, non-inferiority study","volume":"367","author":"Tyrstrup","year":"2019","journal-title":"BMJ"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1097\/INF.0000000000004111","article-title":"A Longitudinal Study of Group A Streptococcal Colonization and Pharyngitis in US Children","volume":"42","author":"Frenck","year":"2023","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_46","first-page":"169","article-title":"Study on carrier rate of Streptococcus pyogenes among the school children and antimicrobial susceptibility pattern of isolates","volume":"14","author":"Prajapati","year":"2012","journal-title":"Nepal. Med. Coll. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"392","DOI":"10.3126\/kumj.v7i4.2760","article-title":"Asymptomatic throat carriage rate and antimicrobial resistance pattern of Streptococcus pyogenes in Nepalese school children","volume":"7","author":"Dumre","year":"2009","journal-title":"Kathmandu Univ. Med. J."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Othman, A.M., Assayaghi, R.M., Al-Shami, H.Z., and Saif-Ali, R. (2019). Asymptomatic carriage of Streptococcus pyogenes among school children in Sana\u2019a city, Yemen. BMC Res. Notes, 12.","DOI":"10.1186\/s13104-019-4370-5"},{"key":"ref_49","unstructured":"Ali Al Shamisi, F.H. (2016). The Prevalence of Streptococcus pyogenes and Its Emm Gene Types Among School Children in AI Ain, UAE. [Master\u2019s Thesis, United Arab Emirates University]. Available online: https:\/\/scholarworks.uaeu.ac.ae\/all_theses\/466\/."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"471","DOI":"10.4103\/apc.apc_280_20","article-title":"Prevalence and predicting factors of Group A beta-hemolytic Streptococcus carrier state in primary schoolchildren","volume":"14","author":"Rahmadhany","year":"2021","journal-title":"Ann. Pediatr. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"727","DOI":"10.31128\/AJGP-07-23-6897","article-title":"Carrier rates of group A streptococci in Australian wet tropics and their impact on the clinical usefulness of throat swabs","volume":"53","author":"Gunnarsson","year":"2024","journal-title":"Aust. J. Gen. Pract."},{"key":"ref_52","unstructured":"Murugami, M.W. (2025, January 29). Prevalence and Factors Associated with Group a Streptococcal Pharyngeal Carriage Among Primary School Children in Bomet County. Thesis Faculty of Health Sciences, University of Nairobi. Available online: https:\/\/erepository.uonbi.ac.ke\/handle\/11295\/160885."},{"key":"ref_53","first-page":"36","article-title":"Group A beta hemolytic streptococcal carriage and antibiotic sensitivity among school going children in Mardan, Pakistan","volume":"35","author":"Akram","year":"2021","journal-title":"J. Postgrad. Med. Inst."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Barsenga, S., Mitiku, H., Tesfa, T., and Shume, T. (2022). Throat carriage rate, associated factors, and antimicrobial susceptibility pattern of group A Streptococcus among healthy school children in Jigjiga City, Eastern Ethiopia. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03294-2"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Anja, A., Beyene, G., S\/Mariam, Z., and Daka, D. (2019). Asymptomatic pharyngeal carriage rate of Streptococcus pyogenes, its associated factors and antibiotic susceptibility pattern among school children in Hawassa town, southern Ethiopia. BMC Res. Notes, 12.","DOI":"10.1186\/s13104-019-4601-9"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Gashaw, Y., Getaneh, A., Kasew, D., Tigabie, M., and Gelaw, B. (2025). Streptococcus pyogenes carriage rate, associated factors and antimicrobial susceptibility profiles among urban and rural schoolchildren at Gondar city, Northwest Ethiopia. Sci. Rep., 15.","DOI":"10.1038\/s41598-024-82009-2"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"127","DOI":"10.3961\/jpmph.15.073","article-title":"Throat Carriage Rate and Antimicrobial Resistance of Streptococcus pyogenes in Rural Children in Argentina","volume":"50","author":"Delpech","year":"2017","journal-title":"J. Prev. Med. Public. Health"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Nayiga, I., Okello, E., Lwabi, P., and Ndeezi, G. (2017). Prevalence of group a streptococcus pharyngeal carriage and clinical manifestations in school children aged 5\u201315 yrs in Wakiso District, Uganda. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2353-5"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1097\/INF.0000000000000745","article-title":"Group A Streptococcal Carriage and Seroepidemiology in Children up to 10 Years of Age in Australia","volume":"34","author":"Marshall","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/INF.0000000000002293","article-title":"Highly Sensitive Molecular Assay for Group A Streptococci Over-identifies Carriers and May Impact Outpatient Antimicrobial Stewardship","volume":"38","author":"Tanz","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_61","first-page":"446","article-title":"The prevalence of group a streptococci carriers among asymptomatic school children","volume":"7","author":"Vijaya","year":"2013","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1128\/JCM.00422-08","article-title":"Epidemiology of severe Streptococcus pyogenes disease in Europe","volume":"46","author":"Lamagni","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Avire, N.J., Whiley, H., and Ross, K. (2021). A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control. Pathogens, 10.","DOI":"10.3390\/pathogens10020248"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1080\/07853890252953464","article-title":"Molecular mechanisms of adhesion, colonization, and invasion of group A streptococci","volume":"34","author":"Courtney","year":"2002","journal-title":"Ann. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1093\/oxfordjournals.aje.a113495","article-title":"Type-specific immunity and pharyngeal acquisition of group A Streptococcus","volume":"116","author":"Guirguis","year":"1982","journal-title":"Am. J. Epidemiol."},{"key":"ref_66","unstructured":"Weckel, A. (2018). Molecular Mechanisms of Streptococcus pyogenes Tissue Colonization and Invasion. [Theses in Microbiology and Parasitology, Universit\u00e9 Sorbonne]. (In English)."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1542\/peds.2004-0133","article-title":"Group A streptococci among school-aged children: Clinical characteristics and the carrier state","volume":"114","author":"Martin","year":"2004","journal-title":"Pediatrics"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.micpath.2011.03.009","article-title":"Biofilm formation or internalization into epithelial cells enable Streptococcus pyogenes to evade antibiotic eradication in patients with pharyngitis","volume":"51","author":"Ogawa","year":"2011","journal-title":"Microb. Pathog."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"163","DOI":"10.17305\/bjbms.2013.2356","article-title":"Evaluation of emm gene types, toxin gene profiles and clonal relatedness of group A streptococci","volume":"13","author":"Mengeloglu","year":"2013","journal-title":"Bosn. J. Basic. Med. Sci."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/S0140-6736(97)12452-7","article-title":"Prevalence of internalisation-associated gene, prtF1, among persisting group-A streptococcus strains isolated from asymptomatic carriers","volume":"352","author":"Neeman","year":"1998","journal-title":"Lancet"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1128\/CMR.13.3.470","article-title":"Pathogenesis of group A streptococcal infections","volume":"13","author":"Cunningham","year":"2000","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1086\/375589","article-title":"Internalization-associated proteins among Streptococcus pyogenes isolated from asymptomatic carriers and children with pharyngitis","volume":"37","author":"Musumeci","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.micinf.2004.11.015","article-title":"Presence of fibronectin-binding protein gene prtF2 in invasive group A streptococci in tropical Australia is associated with increased internalisation efficiency","volume":"7","author":"Gorton","year":"2005","journal-title":"Microbes Infect."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/0002-9343(51)90274-4","article-title":"Effect in penicillin and aureomycin on the natural course of streptococcal tonsillitis and pharyngitis","volume":"10","author":"Brink","year":"1951","journal-title":"Am. J. Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/0002-9343(54)90219-3","article-title":"The role of the streptococcus in the pathogenesis of rheumatic fever","volume":"17","author":"Catanzaro","year":"1954","journal-title":"Am. J. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1172\/JCI104510","article-title":"Studies of the carrier state following infection with group A streptococci. 1. Effect of climate","volume":"41","author":"Krause","year":"1962","journal-title":"J. Clin. Investig."},{"key":"ref_77","unstructured":"Ferretti, J.J., Stevens, D.L., and Fischetti, V.A. (2022). The Carrier State of Streptococcus pyogenes. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, University of Oklahoma Health Sciences Center. [2nd ed.]."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1056\/NEJM199608223350803","article-title":"Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group","volume":"335","author":"Davies","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2147\/CLEP.S12977","article-title":"The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease","volume":"3","author":"Seckeler","year":"2011","journal-title":"Clin. Epidemiol."},{"key":"ref_80","unstructured":"Kimberlin, D., Brady, M., Jackson, M., and Long, S. (2015). Red Book, American Academy of Pediatrics. [30th ed.]."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jcv.2014.11.018","article-title":"Blood MxA protein as a marker for respiratory virus infections in young children","volume":"62","author":"Toivonen","year":"2015","journal-title":"J. Clin. Virol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"e985","DOI":"10.1542\/peds.2014-1946","article-title":"Diagnosis of viral infections using myxovirus resistance protein A (MxA)","volume":"135","author":"Engelmann","year":"2015","journal-title":"Pediatrics"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"13053","DOI":"10.1128\/JVI.02220-13","article-title":"The human interferon-induced MxA protein inhibits early stages of influenza A virus infection by retaining the incoming viral genome in the cytoplasm","volume":"87","author":"Xiao","year":"2013","journal-title":"J. Virol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s00439-019-02092-8","article-title":"Mx genes: Host determinants controlling influenza virus infection and trans-species transmission","volume":"139","author":"Haller","year":"2020","journal-title":"Hum. Genet."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s13052-021-01055-y","article-title":"Prevention and contrast of child abuse and neglect in the practice of European paediatricians: A multi-national pilot study","volume":"47","author":"Nigri","year":"2021","journal-title":"Ital. J. Pediatr."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"S190","DOI":"10.1093\/infdis\/jiae416","article-title":"Review: Diagnostic Potential for Collaborative Pharyngitis Biomarkers","volume":"230","author":"Ledeboer","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"232","DOI":"10.18683\/germs.2024.1435","article-title":"Vitamin D and COVID-19: Comparative analysis with other respiratory infections and impact of comorbidities","volume":"14","author":"Constantin","year":"2024","journal-title":"Germs"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"294","DOI":"10.18683\/germs.2020.1220","article-title":"COVID-19 in the pediatric population and parental perceptions","volume":"10","author":"Miron","year":"2020","journal-title":"Germs"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"468","DOI":"10.18683\/germs.2021.1283","article-title":"COVID-19: The Pseudo-Environment and the Need for a Paradigm Change","volume":"11","author":"Stein","year":"2021","journal-title":"Germs"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Miron, V.D., Toma, A.R., Filimon, C., Bar, G., and Craiu, M. (2022). Optional Vaccines in Children-Knowledge, Attitudes, and Practices in Romanian Parents. Vaccines, 10.","DOI":"10.3390\/vaccines10030404"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/3\/529\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:43:15Z","timestamp":1760028195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/13\/3\/529"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,27]]},"references-count":90,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["microorganisms13030529"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms13030529","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,27]]}}}