It is important to differentiate GABHS infections in chil- dren. The antibiotic therapy should be started within 9 days after the onset of infection to prevent potential cardiac and renal complications. It is not possible to make a diagnosis of GABHS infection by clinical examination alone. Throat swabs are necessary to identify Streptococcus (Fig. 3.1.1). Gener- ally, a cherry red tongue and perioral pallor suggest GABHS infection. In infectious mononucleosis, the cervical lymph nodes are enlarged and petechial hemorrhages may be seen on the palate. In some patients, hepatosplenomegaly may be palpable. A positive Paul-Bunnell test result or identi cation of atypical lymphocytes in the peripheral blood is diagnostic for infectious mononucleosis.
