51
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Van TT, Mata K, Dien Bard J. Automated Detection of Streptococcus pyogenes Pharyngitis by Use of Colorex Strep A CHROMagar and WASPLab Artificial Intelligence Chromogenic Detection Module Software. J Clin Microbiol 2019; 57:e00811-19. [PMID: 31434725 PMCID: PMC6812993 DOI: 10.1128/jcm.00811-19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/14/2019] [Indexed: 01/08/2023] Open
Abstract
Colorex Strep A agar (CHROMagar, Paris, France) was evaluated with PhenoMATRIX chromogenic detection module (CDM) software (Copan Diagnostics Inc., Murrieta, CA) to detect group A Streptococcus (GAS) from throat specimens. The software results were compared to those of manual plate image reading. In addition, GAS PCR testing was performed on all specimens. True-positive specimens were defined as culture-positive (by either PhenoMATRIX CDM or manual reading) specimens confirmed as GAS by matrix-assisted laser desorption ionization-time of flight mass spectrometry plus any culture-negative specimens that were positive by both initial and repeat PCR testing. Of 480 specimens, 96 were considered true-positive specimens. Software reading of the chromogenic agar for suspected colonies detected 110 orange colonies, whereas technologist reading interpreted only 93/110 specimens (84.5%) as positive. None of the 361 cultures interpreted as negative by the PhenoMATRIX CDM software was positive by manual reading. In comparison with true-positive results, the sensitivity and specificity were 96.9% and 100% for PCR testing, 87.5% and 97.7% for technologist reading of chromogenic agar, 90.6% and 94.0% for software reading of chromogenic agar, 83.3% and 97.7% for technologist reading for β-hemolysis on blood agar, and 39.5% and 83.1% for technologist reading for β-hemolysis on blood agar accompanied by any zone of inhibition around a bacitracin-impregnated disk, respectively. The software had the most accurate results of the non-molecular testing methods, detecting all suspected colonies on the chromogenic agar and identifying 3 additional true-positive specimens that were missed by manual reading. The PhenoMATRIX CDM software and the Colorex Strep A agar can improve detection of GAS from throat specimens, and they compared favorably to molecular testing.
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Affiliation(s)
- Tam T Van
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, California, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, California, USA
| | - Kenneth Mata
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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52
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Vaduva C, Gómez JIT, Zaid DM, Rivera-Rodríguez T. [Acute infectious disease of otolaryngology focus]. Medicine (Baltimore) 2019; 12:5339-5351. [PMID: 32287913 PMCID: PMC7143590 DOI: 10.1016/j.med.2019.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infections are the most common cause of antibiotic prescription and one of the most frequent reasons for consultation in Primary Care. Among them, stand out acute media otitis and diffuse external otitis, acute pharyngitis and acute rhinosinusitis. Commonly they are viral and self-limited, so their complications are rare. Currently, the indiscriminate use of antibiotics have leaded to bacterial resistances; therefore antibiotic prescription should be more careful. Nowadays, several diagnostic strategies are available. In current updated etiological and pathophysiological factors of each infection, diagnostic and therapeutic strategy to be applied in Primary Care as well as the complications of each pathology and the referral indications to be assessed by specialists in the ENT area, will be reviewed.
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Affiliation(s)
- C Vaduva
- Servicio de Otorrinolaringología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - J I Tato Gómez
- Servicio de Otorrinolaringología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - D Mora Zaid
- Servicio de Otorrinolaringología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - T Rivera-Rodríguez
- Servicio de Otorrinolaringología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
- Universidad de Alcalá, Alcalá de Henares, Madrid, España
- Centro de Investigación Biomédica en Red (Ciber), Instituto de Salud Carlos III, Madrid, España
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53
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Van TT, Mestas J, Dien Bard J. Molecular Testing for Detection of Groups A, C, and G β-Hemolytic Streptococci in Pharyngeal Samples from Children. J Appl Lab Med 2019; 3:429-437. [DOI: 10.1373/jalm.2018.026104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/19/2018] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Group A Streptococcus (GAS) and large colony-forming group C (GCS) and G (GGS) β-hemolytic streptococci are important causes of acute pharyngitis in children and adults. Rapid and accurate diagnosis of streptococcal pharyngitis can improve patient care and potentially reduce transmission. In this study, we evaluated the performance of the Lyra Direct Strep (LDS) assay for detection of GAS and GCS/GGS compared with traditional culture methods.
Methods
Pharyngeal samples obtained from 278 children presenting to the emergency department with initial negative GAS rapid antigen detection test (RADT) were used. All samples were cultured as part of routine care and tested in batches using the LDS assay.
Results
Of 278 pharyngeal samples with negative GAS RADT, 37 (13.3%) and 63 (22.7%) patients were positive for GAS by culture and LDS assay, respectively. Four (1.4%) patients were positive for GCS or GGS by culture or LDS assay. The LDS assay demonstrated sensitivity and specificity of 97.6% and 89.0%, respectively, compared with culture as the gold standard. Repeat culture and an alternate PCR showed that 85.7% (24 of 28) of discrepant samples agreed with findings of the LDS assay. Since implementation, the LDS assay shows a positivity rate of 21.0% (281 of 1340) compared with 11.7% (246 of 2110) by culture in the previous year.
Conclusions
We successfully implemented the LDS assay at our institution and have observed a significant increase in the positivity rate of GAS compared with culture. The LDS assay alone allowed for the elimination of β-streptococci screening by culture at our institution.
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Affiliation(s)
- Tam T Van
- Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA
| | - Javier Mestas
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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54
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Homme JH. Acute Otitis Media and Group A Streptococcal Pharyngitis: A Review for the General Pediatric Practitioner. Pediatr Ann 2019; 48:e343-e348. [PMID: 31505007 DOI: 10.3928/19382359-20190813-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For pediatric practitioners, acute otitis media (AOM) and group A streptococcal pharyngitis are two of the most common infections seen in ambulatory practices. The purpose of this article is to review these conditions with the focus of highlighting evidence-based guidelines. AOM in children is a visual diagnosis and not one that can be made on history alone. The American Academy of Pediatrics (AAP) guidelines have clear criteria to aid clinicians in how to diagnose AOM. The pneumatic otoscope is the standard tool used to diagnose otitis media, and the AAP guidelines stress developing proficiency in distinguishing a normal tympanic membrane from otitis media with effusion or AOM. There are several components to appropriate management (treatment) of AOM including analgesia, education, antibiotics, and the option (for some) for observation. Group A streptococcal pharyngitis is the most common bacterial cause of sore throat in children but still only accounts for a minority of cases. History and physical examination help determine who should be tested. Testing is required to determine who to treat. Up to 15% of children in the United States are carriers, so indiscriminate testing can lead to inappropriate antibiotic use. If a patient's test is positive, treatment is recommended and penicillin or amoxicillin are appropriate for most cases. [Pediatr Ann. 2019;48(9):e343-e348.].
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55
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Li P, Jiang G, Shen X. Evaluation of 3-day azithromycin or 5-day cefaclor in comparison with 10-day amoxicillin for treatment of tonsillitis in children. Can J Physiol Pharmacol 2019; 97:939-944. [PMID: 31365280 DOI: 10.1139/cjpp-2019-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To evaluate the clinical efficacy of azithromycin, cefaclor, and amoxicillin in treatment of pediatric tonsillitis, a total of 256 children with Group A β-hemolytic streptococcus (GAS) tonsillitis were randomly divided into 3 groups. Only patients assessed with streptococcus-positive tonsillitis, considered to be compliant with treatment and complete clinical and microbiological evaluations at the end of therapy (day 14) and follow-up (day 30) were included in the efficacy analysis. Our study demonstrated that 96.4% of patients in the azithromycin group, 92.4% of patients in the cefaclor group, and 91.0% of patients in the amoxicillin group were recorded as clinical success at the end of therapy. Bacteriological eradication rates of the 3 groups at the end of therapy were 94.0%, 89.9%, and 88.5%, respectively. A pathogen recurrence rate was evaluated as 2.6%, 7.0%, and 5.9% at the follow-up. Treatment-stimulated adverse events occurred in 2.4% of patients in the azithromycin group, 11.3% in the cefaclor group, and 11.4% in the amoxicillin group. In summary, azithromycin showed an effective tendency for the treatment of pediatric tonsillitis with lower occurrence rate of adverse reactions, although there is no statistical significance for the clinical and bacteriological eradication efficacy between these 3 groups.
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Affiliation(s)
- Peng Li
- Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, Jiangsu, China
| | - Genqin Jiang
- Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, Jiangsu, China
| | - Xiaofei Shen
- Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, Jiangsu, China.,Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing 210008, Jiangsu, China
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56
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Takahashi K, Fujimoto T, Hanaoka N, Tamura M, Suzuki Y, Sugihara S. Useful manifestations to detect adenovirus in children with upper respiratory infections: A retrospective study. J Med Virol 2019; 94:582-586. [PMID: 31021428 DOI: 10.1002/jmv.25492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/27/2019] [Accepted: 04/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Approximately 1 million adenovirus immunochromatography (IC) kits are annually used in Japan. However, no practical strategies have been developed regarding their use for detecting adenovirus. The present study aims to verify the usefulness of clinical manifestations in making decisions regarding the use of adenovirus IC kits for children with upper respiratory infections (URI). METHODS The medical records of 825 pediatric cases tested by IC kits for adenovirus were extracted from clinical laboratory department database over a 3-year period at our hospital. Among them, 585 patients were suspected adenovirus URI, and their clinical manifestations were reviewed. After data cleaning, 10 types of clinical manifestations were statistically analyzed between adenovirus IC kit-positive and -negative groups. Multivariate analysis was performed to select significant clinical manifestations using adenovirus IC kit positivity as the objective variable. RESULTS Among 585 pediatric patients, the cases of 420 patients, with suitable data for whom no other pathogen was detected, were reviewed. Adenovirus was detected in 86 cases. Multivariate analysis identified a significant difference for three clinical manifestations: (1) fever ≥ 39.0°C, (2) rhinorrhea, and (3) tonsillar exudate. The negativity rate for the IC kit was 90% when none of the three manifestations was observed. CONCLUSIONS The results suggested that IC kits for adenovirus tend to give negative results in cases that lack all the three above mentioned clinical manifestations.
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Affiliation(s)
- Kenichiro Takahashi
- Department of Pediatrics, Shin Matsudo Central General Hospital, Chiba, Japan.,Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.,Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tsuguto Fujimoto
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Nozomu Hanaoka
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mariko Tamura
- Department of Pediatrics, Shin Matsudo Central General Hospital, Chiba, Japan
| | - Yoko Suzuki
- Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Shigetaka Sugihara
- Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Seifert G, Brandes-Schramm J, Zimmermann A, Lehmacher W, Kamin W. Faster recovery and reduced paracetamol use - a meta-analysis of EPs 7630 in children with acute respiratory tract infections. BMC Pediatr 2019; 19:119. [PMID: 31014293 PMCID: PMC6477747 DOI: 10.1186/s12887-019-1473-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/28/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Fever is a very common adaptive immune response in acute respiratory tract disorders during infancy. Antipyretic / analgesic drugs such as paracetamol (acetaminophen) are widely used to improve the comfort of the child but may cause medically unneeded antipyresis and rare but potentially serious side effects. We assess whether treatment with Pelargonium sidoides extract EPs 7630 reduces the administration of paracetamol in children with acute tonsillopharyngitis (ATP) or acute bronchitis (AB). DESIGN Meta-analysis of randomised, placebo-controlled clinical trials. METHODS We searched clinical trial registries (ISRCTN, ClinicalTrials.gov ) and medical literature (MEDLINE, EMBASE), for randomised, placebo-controlled trials investigating the administration of EPs 7630 to children with ATP or AB and reporting the co-administration of paracetamol. Based on the individual participant data of the eligible trials, study populations were characterized according to sex and age, and meta-analyses were performed for cumulative paracetamol use and ability to attend school at treatment end. RESULTS Six trials including a total of 523 children aged 6-10 years (EPs 7630: 265; placebo: 258) and suffering from non-β-hemolytic streptococcal ATP (3 trials) or from AB (3 trials) were identified and eligible. Children received EPs 7630 or placebo for 6 (ATP) or 7 days (AB). Compared to placebo, EPs 7630 reduced the cumulative dose of paracetamol in 5 out of the 6 trials, by an average of 244 mg (Hedges' g; - 0.28; 95% confidence interval: [- 0.53; - 0.02]; p < 0.03). At treatment end, 30.2% (EPs 7630) and 74.4% (placebo) of the children were still unable to attend school (risk ratio: 0.43; 95% confidence interval: [0.29; 0.65]; p < 0.001). CONCLUSIONS In children aged 6-10 years with AB or ATP, EPs 7630 alleviated the symptom burden and accelerated recovery. Although EPs 7630 has no known antipyretic effect, concomitant use of paracetamol was reduced.
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Affiliation(s)
- Georg Seifert
- Charité - Universitätsmedizin Berlin, Clinic for Paediatrics, Augustenburger Platz 1, 13353, Berlin, Germany.
| | | | - Andrea Zimmermann
- Clinical Research Department, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany
| | - Walter Lehmacher
- Emeritus -; University of Cologne, Institute of Medical Statistics, Informatics und Epidemiology, Cologne, Germany
| | - Wolfgang Kamin
- Clinic for Paediatrics, Evangelic Hospital Hamm, Hamm, Germany.,Faculty of Medicine, Pomeranian Medical University, Szczecin, Poland
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58
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Ghanchi A, James PT, Cerami C. Guts, Germs, and Iron: A Systematic Review on Iron Supplementation, Iron Fortification, and Diarrhea in Children Aged 4-59 Months. Curr Dev Nutr 2019; 3:nzz005. [PMID: 30891538 PMCID: PMC6416531 DOI: 10.1093/cdn/nzz005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/25/2018] [Accepted: 01/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The impact of iron supplements and iron fortification on diarrhea in children is controversial, with some studies reporting an increase and others reporting no effect. OBJECTIVE The aim of the study was systematically assess the published literature on oral iron supplementation and fortification to evaluate its impact on diarrhea incidence among children aged 4-59 mo. METHODS Randomized controlled trials of oral iron supplementation or iron fortification that reported diarrheal outcomes in children aged 4-59 mo were identified from a systematic search of 5 databases. RESULTS Of the 906 records identified, 19 studies were found to fit the inclusion criteria for this systematic review. However, variable case definitions for diarrhea made meta-analysis impossible. Of the 19 studies, 7 (37%) studies showed a significant increase, either in overall diarrhea incidence or within a specific subgroup of the population, between iron-supplemented and control groups. Subgroups included children who were iron-replete and children undergoing their first month of iron intervention. Two studies reported an increase in bloody diarrhea. The remaining 12 (63%) studies showed no difference between iron-supplemented and control groups. CONCLUSIONS Studies on iron supplementation and fortification use divergent case definitions for diarrhea. A number of studies (37%) showed an increase in overall diarrhea incidence or within a specific subgroup of the population, between iron-supplemented and control groups, but the majority (63%) did not. In addition, there was no clear relation between diarrhea and type of intervention or amount of iron administered observed. In future studies, we recommend that diarrhea be clearly defined and consistently recorded as a secondary outcome. Antibiotic status of participants receiving iron should also be collected to help assess possible drug interactions resulting in a "red stool effect." Finally, further microbiome research is required to better understand the effects of oral iron on specific bacterial species in the colon.
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Affiliation(s)
- Adnaan Ghanchi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom
| | - Philip T James
- Nutrition Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
| | - Carla Cerami
- Nutrition Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
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59
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Hwang S, Jung JY, Park JW, Kim DK, Kwak YH. Interexaminer reliability of pharyngeal injection and palatine tonsillar hypertrophy in a pediatric emergency department. Am J Emerg Med 2019; 37:1932-1935. [PMID: 30691864 DOI: 10.1016/j.ajem.2019.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To evaluate the interrater reliability of throat examinations in children according to the major and training stage. STUDY DESIGN We performed a prospective observational study of interrater reliability. The participants included physicians with various amounts of experience and majors who were working in an urban, tertiary hospital. We collected 20 photos of the throats of children who presented to the pediatric emergency department (ED) and performed 2 surveys (with or without medical history). The primary outcome was the interrater agreement for pharyngeal injection (PI) and palatine tonsillar hypertrophy (PTH), and the secondary outcome was the interrater agreement for PI and PTH in subgroups of examiners divided by major and duration of clinical experience. RESULTS Thirty-three examiners participated in this study. The overall percent agreement for PI was 0.669, and Fleiss' kappa was 0.296. The interrater reliability was similar before and after providing patients' medical history. The overall percent agreement for PTH was 0.408, and Kendall's W was 0.674. When the patients' medical history was provided, Kendall's W increased (0.692). In the subgroup analysis, Fleiss' kappa for PI ranged from 0.257 to 0.33, and Kendall's W for PTH ranged from 0.593 to 0.711. CONCLUSION Examiners' agreement for PTH was more reliable than that for PI when evaluating children who visited the ED. The interrater reliability did not improve with increased clinical experience. These findings should be considered in the examination of pharyngeal pathology.
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Affiliation(s)
- Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul 03080, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul 03080, Republic of Korea.
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul 03080, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul 03080, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro Jongno-Gu, Seoul 03080, Republic of Korea
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Ma SH, Choi WH, Park H, Kim S. Evaluation of the SD Bioline Strep A Ultra Test in Relation With Number of Colony Forming Units and Color Intensity. Ann Lab Med 2019; 39:31-35. [PMID: 30215227 PMCID: PMC6143457 DOI: 10.3343/alm.2019.39.1.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 06/14/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sang Hyuk Ma
- Department of Pediatrics, Changwon Fatima Hospital, Changwon, Korea
| | - Won-Hee Choi
- Department of Nursing Science, Kyungsung University, Busan, Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sunjoo Kim
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
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61
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Eryılmaz M, Acar Soykut E, Çetin D, Boyacı İH, Suludere Z, Tamer U. SERS-based rapid assay for sensitive detection of Group AStreptococcusby evaluation of the swab sampling technique. Analyst 2019; 144:3573-3580. [DOI: 10.1039/c9an00173e] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study combines the accuracy of the gold standard with the sensitivity of SERS for fast detection of Group AStreptococcus pyogenes.
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Affiliation(s)
- Merve Eryılmaz
- Department of Analytical Chemistry
- Gazi University
- Faculty of Pharmacy
- Ankara
- Turkey
| | - Esra Acar Soykut
- Division of Food Quality Control and Analysis
- Yeniçağa Yaşar Çelik Vocational School
- Abant Izzet Baysal University
- Bolu
- Turkey
| | - Demet Çetin
- Department of Mathematics and Science Education
- Gazi Faculty of Education
- Gazi University
- 06500 Ankara
- Turkey
| | - İsmail Hakkı Boyacı
- Department of Food Engineering
- Faculty of Engineering
- Hacettepe University
- Ankara
- Turkey
| | - Zekiye Suludere
- Department of Biology
- Faculty of Science
- Gazi University
- Ankara
- Turkey
| | - Uğur Tamer
- Department of Analytical Chemistry
- Gazi University
- Faculty of Pharmacy
- Ankara
- Turkey
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62
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Palm J, Fuchs K, Stammer H, Schumacher‐Stimpfl A, Milde J. Efficacy and safety of a triple active sore throat lozenge in the treatment of patients with acute pharyngitis: Results of a multi-centre, randomised, placebo-controlled, double-blind, parallel-group trial (DoriPha). Int J Clin Pract 2018; 72:e13272. [PMID: 30329199 PMCID: PMC6282512 DOI: 10.1111/ijcp.13272] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/15/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this multi-centre, randomised, double-blind, placebo-controlled trial was to compare the efficacy and safety of the fixed combination of 0.5 mg tyrothricin, 1.0 mg benzalkonium chloride, and 1.5 mg benzocaine (study drug marketed as Dorithricin® ) in repeat dosing for 3 days to match placebo lozenges in the treatment of acute pharyngitis in adults. METHODS Patients (pts, aged ≥18 years) with acute pharyngitis, ie, non-streptococcal sore throat and moderate-to-severe pain (intensity NRS ≥ 7; VAS ≥ 50) were assigned to study drug (n = 160) or matching placebo (n = 161). Efficacy was assessed by investigator for 2 hours post initial dose (p.i.d.), and 3 days later (Visit 2). Primary efficacy endpoint was the complete resolution of throat pain and difficulty in swallowing at Visit 2 (3 days p.i.d.). Safety and local tolerability were also assessed. RESULTS Seventy-two hours (p.i.d.), complete resolution of throat pain and difficulty in swallowing were achieved by 44.6% patients on study drug compared with 27.2% patients on placebo (difference 17.4% (CI [5.8%; 29.7%]; 64% improvement [GEE, P = 0.0022]). Until 2 hours p.i.d., reduction in symptoms was better with study drug (P < 0.005). Treatment satisfaction was higher with study drug (patients'/investigators' assessment (78.9%/78.9% vs 55.0%/55.6% for placebo) and was well tolerated, overall safety profile was comparable to placebo. CONCLUSION The strength of this randomised controlled trial lies in the endpoint of complete remission after 3 days p.i.d., especially in the light of other trials addressing acute pharyngitis. The results of this study show a significant benefit of the study drug over placebo in the treatment of acute pharyngitis. Local treatment with the fixed combination (0.5 mg tyrothricin, 1.0 mg benzalkonium chloride, and 1.5 mg benzocaine) provides a rapid analgesic effect and is effective in relieving both severe throat pain as well as difficulty in swallowing associated with acute pharyngitis leading to a 64% improved complete remission within 72 hours. The triple active combination is a suitable treatment option for patients in the self-management of acute pharyngitis and sore throat. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT03323528.
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Affiliation(s)
| | - Katharina Fuchs
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
| | - Holger Stammer
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
| | | | - Jens Milde
- Pharmalog Institut für klinische Forschung GmbHMunichGermany
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63
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Akhtar M, Van Heukelom PG, Ahmed A, Tranter RD, White E, Shekem N, Walz D, Fairfield C, Vakkalanka JP, Mohr NM. Telemedicine Physical Examination Utilizing a Consumer Device Demonstrates Poor Concordance with In-Person Physical Examination in Emergency Department Patients with Sore Throat: A Prospective Blinded Study. Telemed J E Health 2018; 24:790-796. [PMID: 29470127 PMCID: PMC6205037 DOI: 10.1089/tmj.2017.0240] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Telemedicine allows patients to connect with healthcare providers remotely. It has recently expanded to evaluate low-acuity illnesses such as pharyngitis by using patients' personal communication devices. The purpose of our study was to compare the telemedicine-facilitated physical examination with an in-person examination in emergency department (ED) patients with sore throat. MATERIALS AND METHODS This was a prospective, observational, blinded diagnostic concordance study of patients being seen for sore throat in a 60,000-visit Midwestern academic ED. A telemedicine and a face-to-face examination were performed independently by two advanced practice providers (APP), blinded to the results of the other evaluator. The primary outcome was agreement on pharyngeal redness between the evaluators, with secondary outcomes of agreement and inter-rater reliability on 14 other aspects of the pharyngeal physical examination. We also conducted a survey of patients and providers to evaluate perceptions and preferences for sore throat evaluation using telemedicine. RESULTS Sixty-two patients were enrolled, with a median tonsil size of 1.0. Inter-rater agreement (kappa) for tonsil size was 0.394, which was worse than our predetermined concordance threshold. Other kappa values ranged from 0 to 0.434, and telemedicine was best for detecting abnormal coloration of the palate and tender superficial cervical lymph nodes (anterior structures), but poor for detecting abnormal submandibular lymph nodes or asymmetry of the posterior pharynx (posterior structures). In survey responses, telemedicine was judged easier to use and more comfortable for providers than patients; however, neither patients nor providers preferred in-person to telemedicine evaluation. CONCLUSION Telemedicine exhibited poor agreement with the in-person physical examination on the primary outcome of tonsil size, but exhibited moderate agreement on coloration of the palate and cervical lymphadenopathy. Future work should better characterize the importance of the physical examination in treatment decisions for patients with sore throat and the use of telemedicine in avoiding in-person healthcare visits.
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Affiliation(s)
- Moneeb Akhtar
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Paul G. Van Heukelom
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Azeemuddin Ahmed
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Rachel D. Tranter
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Erinn White
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Nathaniel Shekem
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - David Walz
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Catherine Fairfield
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - J. Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Nicholas M. Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
- Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Ciccozzi M, Riva E, Vita S, Cella E, Fogolari M, Spoto S, Lopalco M, Ceccarelli G, Angeletti S. An acute febrile outbreak in a refugee community of an Italian asylum seeker center: lessons learned. Public Health 2018; 163:16-19. [PMID: 30031836 PMCID: PMC7111893 DOI: 10.1016/j.puhe.2018.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The management of infectious outbreaks in closed settings represents an important public health issue. An outbreak of acute febrile syndrome affecting 22 refugees resident at the Asylum Seekers Centre of Castelnuovo di Porto in Rome has been reported, and the preventive and control measures adopted have been described as an example of public health safety. METHODS Pharyngeal swab and whole-blood samples were collected from 22 cases observed and analyzed for standard bacterial cultures and respiratory and herpesviruses by qualitative CLART PneumoVir2 and Entherpex microarray. RESULTS A possible respiratory-transmitted etiology and a concomitant reactivation of multiple herpesviruses have been evidenced. The epidemiological investigation showed that the spread of the epidemic was promoted because patients were hosted in neighboring rooms or in the same room, facilitating the rapid spread of infectious disease. CONCLUSIONS The potential way of transmission was supposed, and preventive measures for infection control were adopted. The measures adopted are an example of best practice for outbreak management, and the microbiological surveillance is recommended for public health improvement.
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Affiliation(s)
- M Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - E Riva
- Unit of Virology, University Campus Bio-Medico of Rome, Italy
| | - S Vita
- Migrant and Global Health Research Organisation, Centro di Ricerca Sulla Salute Globale e Delle Popolazioni Mobili (Mi-Hero), Italy
| | - E Cella
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | - M Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy
| | - S Spoto
- Internal Medicine Department, University Campus Bio-Medico of Rome, Italy
| | - M Lopalco
- Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Rome, Italy; Auxilium Società Cooperativa Sociale, Senise (PZ), Italy
| | - G Ceccarelli
- Migrant and Global Health Research Organisation, Centro di Ricerca Sulla Salute Globale e Delle Popolazioni Mobili (Mi-Hero), Italy; Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto, Rome, Italy; Auxilium Società Cooperativa Sociale, Senise (PZ), Italy; Department of Public Health and Infectious Diseases, University of Rome Sapienza, Italy
| | - S Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Italy.
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Extra Dose of Vitamin C Based on a Daily Supplementation Shortens the Common Cold: A Meta-Analysis of 9 Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1837634. [PMID: 30069463 PMCID: PMC6057395 DOI: 10.1155/2018/1837634] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/30/2018] [Accepted: 06/12/2018] [Indexed: 12/13/2022]
Abstract
Aim To investigate whether vitamin C is effective in the treatment of the common cold. Method After systematically searching the National Library of Medicine (PubMed), Cochrane Library, Elsevier, China National Knowledge Infrastructure (CNKI), VIP databases, and WANFANG databases, 9 randomized placebo-controlled trials were included in our meta-analysis in RevMan 5.3 software, all of which were in English. Results In the evaluation of vitamin C, administration of extra therapeutic doses at the onset of cold despite routine supplementation was found to help reduce its duration (mean difference (MD) = -0.56, 95% confidence interval (CI) [-1.03, -0.10], and P = 0.02), shorten the time of confinement indoors (MD = -0.41, 95% CI [-0.62, -0.19], and P = 0.0002), and relieve the symptoms associated with it, including chest pain (MD = -0.40, 95% CI [-0.77, -0.03], and P = 0.03), fever (MD = -0.45, 95% CI [-0.78, -0.11], and P = 0.009), and chills (MD = -0.36, 95% CI [-0.65, -0.07], and P = 0.01). Conclusions Extra doses of vitamin C could benefit some patients who contract the common cold despite taking daily vitamin C supplements.
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Hernández EM, Díaz JP. Estudio Prospectivo Observacional: Determinar la Sensibilidad del Criterio Clínico usando la Escala de “Centor” versus el Test de Detección Rápida de Estreptococo para el diagnóstico de Faringitis Estreptocócica del Grupo A en el Centro de Salud Bárbara. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.37345/23045329.v1i25.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introducción: Las faringitis producidas por el estreptococo beta hemolítico del grupo A no se pueden distinguir clínicamente de las faringitis producidas por otros gérmenes, sin embargo la utilización de los criterios de Centor y el test de detección rápida de antígeno son de gran utilidad para determinar las probabilidades que estos sean causados por el estreptococo beta hemolítico del grupo A. En este estudio se comparó la sensibilidad entre ambos métodos. Objetivos: Se realizó un estudio para determinar la sensibilidad del criterio clínico en el diagnóstico de faringitis causada por Estreptococo en comparación a la sensibilidad del test de detección rápida de antígeno. Metodología: En el Centro de Salud Bárbara, se tomaron a los pacientes pediátricos que consultaron por dolor de garganta durante dos meses. Se puntuó según la escala de Centor y se tomó una muestra para el test de detección rápida de antígeno, luego, se comparó con el cultivo de orofaringe. Resultados: Se comparó la sensibilidad de ambos parámetros. Discusión: Un puntaje ≥ 3 puntos en la escala de Centor tuvo una sensibilidad de 81.8% y especificidad de 50%. Mientras que el RADT presentó una sensibilidad del 83.3% y especificidad de 84.2%.
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Abstract
BACKGROUND AND OBJECTIVES The importance of Streptococcus dysgalactiae subsp. equisimilis (SDSE) in causing sporadic pharyngitis in children remains controversial. The aims of this study were (1) to report the incidence and (2) to compare the epidemiologic and clinical features of patients with SDSE to those with Streptococcus pyogenes (SP). METHODS A prospective study was conducted on acute pharyngitis associated with SDSE in children over a 2-year period. SDSE was identified using a phenotypic method, M protein gene (emm) analysis and matrix-assisted laser desorption ionization-time of flight mass spectrometry. Patients with positive SDSE or SP cultures received cephalosporins for 5 days and were followed up. The emm genotyping and specific virulence genes analyses were performed. RESULTS From 3416 throat cultures, 67 isolates (2.0%) were identified as SDSE and 515 (15.1%) were identified as SP. The mean age of patients with SDSE (8.3 years) was older than those with SP (6.6 years; P < 0.01). There was minimal seasonal variation in the isolation rates of SDSE. The febrile patients' rates, gender distribution, cervical lymph node adenopathy rates, hospitalization rates, eradication and failure rates and the nonsuppurative sequelae between patients with SDSE and SP were similar. All SDSE isolates possessed important virulence genes. The emm genotyping of SDSE showed high strain diversity. CONCLUSIONS The incidence of acute pharyngitis associated with accurately identified SDSE was 2/15 of that with SP. Epidemiologic and clinical features of acute pharyngitis associated with SDSE are indistinguishable from those with SP, with the exception of age and seasonal variation.
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Pre-Clinical and Clinical Efficiency of Complexes of Oligoribonucleotides with D-Mannitol against Respiratory Viruses. Pharmaceutics 2018; 10:pharmaceutics10020059. [PMID: 29783756 PMCID: PMC6027485 DOI: 10.3390/pharmaceutics10020059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/30/2018] [Accepted: 05/14/2018] [Indexed: 11/17/2022] Open
Abstract
Oligoribonucleotides-D-mannitol (ORNs-D-M) complexes possess antiviral, anti-inflammatory, and immunomodulatory actions. The aim of the present study was to evaluated an antiviral effect of ORNs-D-M against parainfluenza virus type 3 (PIV3); influenza CA709, PR834; avian influenza virus H5N2 (AIV) in vitro by a TCID50; hemadsorption and neuraminidase activity assays; and clinical efficiency of ORNs-D-M in patients with acute respiratory infections (ARIs) of various etiologies by PCR assay and AmpliSens test systems. It was observed that ORNs-D-M have an antiviral activity against the influenza CA709, PR834, PIV3, and AIV in vitro. The injectable dosage form of ORNs-D-M was shown to have a stronger antiviral effect compared to capsule form. It was also detected that the injectable form of ORNs-D-M significantly reduced the neuraminidase activity of influenza PR834. A complex treatment of patients with ORNs-D-M had a positive effect on the course of the disease, it accelerated patients’ recovery. Treatment with ORNs-D-M caused eradication of adeno- and influenza viruses in patients with ARI. This drug contributed to significant decrease in duration of febrile period and cough. Comprehensive treatment with ORNs-D-M improved the disease clinical findings significantly. Collectively, these results suggested that ORNs-D-M may be used at co-infection with influenza and other respiratory viruses as a medical antiviral drug.
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Soderholm AT, Barnett TC, Korn O, Rivera-Hernandez T, Seymour LM, Schulz BL, Nizet V, Wells CA, Sweet MJ, Walker MJ. Group A Streptococcus M1T1 Intracellular Infection of Primary Tonsil Epithelial Cells Dampens Levels of Secreted IL-8 Through the Action of SpyCEP. Front Cell Infect Microbiol 2018; 8:160. [PMID: 29868516 PMCID: PMC5966554 DOI: 10.3389/fcimb.2018.00160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/26/2018] [Indexed: 11/22/2022] Open
Abstract
Streptococcus pyogenes (Group A Streptococcus; GAS) commonly causes pharyngitis in children and adults, with severe invasive disease and immune sequelae being an infrequent consequence. The ability of GAS to invade the host and establish infection likely involves subversion of host immune defenses. However, the signaling pathways and innate immune responses of epithelial cells to GAS are not well-understood. In this study, we utilized RNAseq to characterize the inflammatory responses of primary human tonsil epithelial (TEpi) cells to infection with the laboratory-adapted M6 strain JRS4 and the M1T1 clinical isolate 5448. Both strains induced the expression of genes encoding a wide range of inflammatory mediators, including IL-8. Pathway analysis revealed differentially expressed genes between mock and JRS4- or 5448-infected TEpi cells were enriched in transcription factor networks that regulate IL-8 expression, such as AP-1, ATF-2, and NFAT. While JRS4 infection resulted in high levels of secreted IL-8, 5448 infection did not, suggesting that 5448 may post-transcriptionally dampen IL-8 production. Infection with 5448ΔcepA, an isogenic mutant lacking the IL-8 protease SpyCEP, resulted in IL-8 secretion levels comparable to JRS4 infection. Complementation of 5448ΔcepA and JRS4 with a plasmid encoding 5448-derived SpyCEP significantly reduced IL-8 secretion by TEpi cells. Our results suggest that intracellular infection with the pathogenic GAS M1T1 clone induces a strong pro-inflammatory response in primary tonsil epithelial cells, but modulates this host response by selectively degrading the neutrophil-recruiting chemokine IL-8 to benefit infection.
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Affiliation(s)
- Amelia T. Soderholm
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Timothy C. Barnett
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Othmar Korn
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, QLD, Australia
| | - Tania Rivera-Hernandez
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Lisa M. Seymour
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Benjamin L. Schulz
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Victor Nizet
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Christine A. Wells
- Centre for Stem Cell Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew J. Sweet
- Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience and IMB Centre for Inflammation and Disease Research, University of Queensland, Brisbane, QLD, Australia
| | - Mark J. Walker
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, University of Queensland, Brisbane, QLD, Australia
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Taverniti V, Dalla Via A, Minuzzo M, Del Bo' C, Riso P, Frøkiær H, Guglielmetti S. In vitro assessment of the ability of probiotics, blueberry and food carbohydrates to prevent S. pyogenes adhesion on pharyngeal epithelium and modulate immune responses. Food Funct 2018; 8:3601-3609. [PMID: 28891576 DOI: 10.1039/c7fo00829e] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Group A streptococci (GAS) cause 20-30% of pediatric pharyngitis episodes, which are a major cause of ambulatory care visits. Therefore, a strategy to prevent GAS dissemination in children could significantly benefit public healthcare. Contextually, we assessed the possibility of employing alternative food-grade strategies to be used with the oral probiotic L. helveticus MIMLh5 for the prevention of pharyngeal infections. First, we demonstrated through an antagonism-by-exclusion assay that guaran may potentially prevent S. pyogenes adhesion on pharyngeal cells. Subsequently, we showed that an anthocyanin-rich fraction extracted from wild blueberry (BbE) exerts anti-inflammatory effects on the human macrophage cell line U937. Finally, we showed that BbE reduces interferon-β expression in MIMLh5-stimulated murine dendritic cells, resulting in a reduction in the pro-inflammatory cytokines IL-12 and TNF-α. In conclusion, this proof-of-concept study indicates that different food-grade strategies may be concomitantly adopted to potentially prevent GAS colonization and modulate local immune defences.
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Affiliation(s)
- Valentina Taverniti
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Italy.
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Streptococcal pharyngitis and rheumatic heart disease: the superantigen hypothesis revisited. INFECTION GENETICS AND EVOLUTION 2018. [PMID: 29530660 DOI: 10.1016/j.meegid.2018.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Streptococcus pyogenes is a human-specific and globally prominent bacterial pathogen that despite causing numerous human infections, this bacterium is normally found in an asymptomatic carrier state. This review provides an overview of both bacterial and human factors that likely play an important role in nasopharyngeal colonization and pharyngitis, as well as the development of acute rheumatic fever and rheumatic heart disease. Here we highlight a recently described role for bacterial superantigens in promoting acute nasopharyngeal infection, and discuss how these immune system activating toxins could be crucial to initiate the autoimmune process in rheumatic heart disease.
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Gottlieb M, Long B, Koyfman A. Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. J Emerg Med 2018. [PMID: 29523424 DOI: 10.1016/j.jemermed.2018.01.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pharyngitis is a common disease in the emergency department (ED). Despite a relatively low incidence of complications, there are many dangerous conditions that can mimic this disease and are essential for the emergency physician to consider. OBJECTIVE This article provides a review of the evaluation and management of group A β-hemolytic Streptococcal (GABHS) pharyngitis, as well as important medical conditions that can mimic this disease. DISCUSSION GABHS pharyngitis often presents with fever, sore throat, tonsillar exudates, and anterior cervical lymphadenopathy. History and physical examination are insufficient for the diagnosis. The Centor criteria or McIsaac score can help risk stratify patients for subsequent testing or treatment. Antibiotics may reduce symptom duration and suppurative complications, but the effect is small. Rheumatic fever is uncommon in developed countries, and shared decision making is recommended if antibiotics are used for this indication. Oral analgesics and topical anesthetics are important for symptom management. Physicians should consider alternate diagnoses that may mimic GABHS pharyngitis, which can include epiglottitis, infectious mononucleosis, Kawasaki disease, acute retroviral syndrome, Lemierre's syndrome, Ludwig's angina, peritonsillar abscess, retropharyngeal abscess, and viral pharyngitis. A focused history and physical examination can help differentiate these conditions. CONCLUSIONS GABHS may present similarly to other benign and potentially deadly diseases. Diagnosis and treatment of pharyngitis should be based on clinical evaluation. Consideration of pharyngitis mimics is important in the evaluation and management of ED patients.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Joseph P, Godofsky E. Outpatient Antibiotic Stewardship: A Growing Frontier-Combining Myxovirus Resistance Protein A With Other Biomarkers to Improve Antibiotic Use. Open Forum Infect Dis 2018; 5:ofy024. [PMID: 29479553 PMCID: PMC5815119 DOI: 10.1093/ofid/ofy024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022] Open
Abstract
Background The majority of oral antibiotics are prescribed in outpatient primary and urgent care clinics for acute respiratory infections. Effective antibiotic stewardship must include proper prescribing for outpatients as well as for those in a hospital or long-term care facility. Methods Major databases, including MEDLINE and the Cochrane Library, were searched for prospective human clinical studies, including children and/or adults published between January 1966 and November 2017 that evaluated Myxovirus resistance protein A (MxA) as a biomarker for diagnosing viral infections as well as both C-reactive protein (CRP) and procalcitonin (PCT) as potential biomarkers for identifying and differentiating true bacterial upper respiratory infection (URI) from colonization. Results Ten prospective human studies, totaling 1683 patients, were identified that evaluated MxA as a viral biomarker in children and/or adults. Both systematic review articles, meta-analyses, and randomized controlled clinical trials that examined CRP and/or PCT as a biomarker for identifying clinically significant bacterial infections and supporting antibiotic stewardship were identified. Conclusions Quick and accurate differentiation between a viral and bacterial respiratory infection is critical to effectively combat antibiotic misuse. MxA expression in peripheral blood is a highly specific marker for viral infection. Combining MxA with other inflammatory biomarkers to test for respiratory infections offers enhanced sensitivity and specificity, forming an excellent tool for antibiotic stewardship in the outpatient setting.
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Affiliation(s)
- Patrick Joseph
- Private Practice to California Infection Control Consultants, San Ramon, California
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Novel Genes Required for the Fitness of Streptococcus pyogenes in Human Saliva. mSphere 2017; 2:mSphere00460-17. [PMID: 29104937 PMCID: PMC5663985 DOI: 10.1128/mspheredirect.00460-17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 10/09/2017] [Indexed: 12/29/2022] Open
Abstract
Streptococcus pyogenes (group A streptococcus [GAS]) causes 600 million cases of pharyngitis each year. Despite this considerable disease burden, the molecular mechanisms used by GAS to infect, cause clinical pharyngitis, and persist in the human oropharynx are poorly understood. Saliva is ubiquitous in the human oropharynx and is the first material GAS encounters in the upper respiratory tract. Thus, a fuller understanding of how GAS survives and proliferates in saliva may provide valuable insights into the molecular mechanisms at work in the human oropharynx. We generated a highly saturated transposon insertion mutant library in serotype M1 strain MGAS2221, a strain genetically representative of a pandemic clone that arose in the 1980s and spread globally. The transposon mutant library was exposed to human saliva to screen for GAS genes required for wild-type fitness in this clinically relevant fluid. Using transposon-directed insertion site sequencing (TraDIS), we identified 92 genes required for GAS fitness in saliva. The more prevalent categories represented were genes involved in carbohydrate transport/metabolism, amino acid transport/metabolism, and inorganic ion transport/metabolism. Using six isogenic mutant strains, we confirmed that each of the mutants was significantly impaired for growth or persistence in human saliva ex vivo. Mutants with an inactivated Spy0644 (sptA) or Spy0646 (sptC) gene had especially severe persistence defects. This study is the first to use of TraDIS to study bacterial fitness in human saliva. The new information we obtained will be valuable for future translational maneuvers designed to prevent or treat human GAS infections. IMPORTANCE The human bacterial pathogen Streptococcus pyogenes (group A streptococcus [GAS]) causes more than 600 million cases of pharyngitis annually worldwide, 15 million of which occur in the United States. The human oropharynx is the primary anatomic site for GAS colonization and infection, and saliva is the first material encountered. Using a genome-wide transposon mutant screen, we identified 92 GAS genes required for wild-type fitness in human saliva. Many of the identified genes are involved in carbohydrate transport/metabolism, amino acid transport/metabolism, and inorganic ion transport/metabolism. The new information is potentially valuable for developing novel GAS therapeutics and vaccine research.
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Homme JH, Greenwood CS, Cronk LB, Nyre LM, Uhl JR, Weaver AL, Patel R. Duration of Group A Streptococcus PCR positivity following antibiotic treatment of pharyngitis. Diagn Microbiol Infect Dis 2017; 90:105-108. [PMID: 29150372 DOI: 10.1016/j.diagmicrobio.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/02/2017] [Accepted: 10/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Polymerase chain reaction (PCR) has high sensitivity and specificity for detection of group A streptococcus (GAS) in throat swabs and is routinely used for GAS pharyngitis diagnosis at our institution. Herein we defined the natural history of throat swab GAS PCR and culture positivity during and following treatment of GAS pharyngitis. METHODS Fifty children with a PCR positive GAS throat swab were recruited for participation. Four additional throat swabs were collected over 2 weeks following the initial positive PCR result (during and following a standard course of antibiotic therapy) and tested for GAS using rapid real-time PCR and culture. RESULTS After the initial positive swab, 45% had a positive PCR 2-4 days, 20% 5-7 days, 18% 8-10 days, 25% 11-13days, and 20% 14-18days later. The median time to a negative PCR was 4 days with the nadir in positive PCR results approximating the end of a typical 10-day treatment interval. Seven subjects remained persistently PCR positive. Culture results remained positive at a stable rate for each time interval, ranging from 5-10%. CONCLUSIONS If a patient presents with symptoms of GAS pharyngitis after previous positive GAS PCR testing and treatment with appropriate antibiotics, it is reasonable to use PCR testing for GAS pharyngitis testing beginning one week after initial testing. Further studies are warranted to determine if this time frame can be applied to PCR testing used to detect other infections.
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Affiliation(s)
- Jason H Homme
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
| | - Corryn S Greenwood
- Division of Neonatal-Perinatal Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital
| | | | - Lisa M Nyre
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James R Uhl
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
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Chang LY, Lai CC, Chen CJ, Cho CY, Luo YC, Jeng MJ, Wu KG. Recent trends in prescribing antibiotics for acute tonsillitis in pediatric ambulatory care in Taiwan, 2000–2009: A nationwide population-based study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:500-506. [DOI: 10.1016/j.jmii.2015.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/05/2015] [Accepted: 08/27/2015] [Indexed: 11/17/2022]
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77
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Kim JW, Kim SD, Cho KS. A pigmented lesion of the nasopharynx. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:435-436. [PMID: 28673656 DOI: 10.1016/j.anorl.2016.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Affiliation(s)
- J-W Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 179, Gudeok-Ro, Seo-gu, Busan 602-739, Republic of Korea
| | - S-D Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 179, Gudeok-Ro, Seo-gu, Busan 602-739, Republic of Korea
| | - K-S Cho
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, 179, Gudeok-Ro, Seo-gu, Busan 602-739, Republic of Korea.
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78
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Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc (2003) 2017; 57:464-473. [DOI: 10.1016/j.japh.2017.03.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/07/2017] [Accepted: 03/31/2017] [Indexed: 01/10/2023]
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79
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Corn CE, Klepser DG, Dering-Anderson AM, Brown TG, Klepser ME, Smith JK. Observation of a Pharmacist-Conducted Group A Streptococcal Pharyngitis Point-of-Care Test: A Time and Motion Study. J Pharm Pract 2017; 31:284-291. [PMID: 28553774 DOI: 10.1177/0897190017710518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute pharyngitis is among the most common infectious diseases encountered in the United States, resulting in 13 million patient visits annually, with group A streptococcus (GAS) being a common causative pathogen. It is estimated that annual expenditures for the treatment of adult pharyngitis will exceed US$1.2 billion annually. This substantial projection reinforces the need to evaluate diagnosis and treatment of adult pharyngitis in nontraditional settings. OBJECTIVE The objective of this research is to quantify the amount of pharmacist time required to complete a point-of-care (POC) test for a patient presenting with pharyngitis symptoms. METHODS A standardized patient with pharyngitis symptoms visited 11 pharmacies for POC testing services for a total of 33 patient encounters. An observer was present at each encounter and recorded the total encounter time, divided into 9 categories. Pharmacists conducted POC testing in 1 of 2 ways: sequence 1-pharmacists performed all service-related tasks; sequence 2-both pharmacists and pharmacist interns performed service-related tasks. RESULTS The average time for completion of a POC test for GAS pharyngitis was 25.3 ± 4.8 minutes. The average pharmacist participation time per encounter was 12.7 ± 3.0 minutes (sequence 1), which decreased to 2.6 ± 1.1 minutes when pharmacist interns were involved in the testing (sequence 2). CONCLUSION Although additional studies are required to further assess service feasibility, this study indicates that a GAS POC testing service could be implemented in a community pharmacy with limited disruption or change to workflow and staff.
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Affiliation(s)
- Carolyn E Corn
- 1 Outpatient Specialty Pharmacy, Nebraska Medicine, Omaha, NE, USA
| | - Donald G Klepser
- 2 College of Pharmacy (Pharmacy Practice), University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Terrence G Brown
- 2 College of Pharmacy (Pharmacy Practice), University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jaclyn K Smith
- 2 College of Pharmacy (Pharmacy Practice), University of Nebraska Medical Center, Omaha, NE, USA
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80
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Yu Z, Xu W, Wang H. Resveratrol treatment inhibits acute pharyngitis in the mice model through inhibition of PGE2/COX-2 expression. Saudi J Biol Sci 2017; 25:1468-1472. [PMID: 30505196 PMCID: PMC6251990 DOI: 10.1016/j.sjbs.2017.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/11/2017] [Accepted: 05/07/2017] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to investigate the effect of resveratrol on acute pharyngitis in the mice models induced by xylene and carrageenan treatment. The mice treated with various doses of resveratrol (5, 10, 15, 20 and 30 mg/kg) showed inhibition of edema in a dose dependent manner. The edema formation was reduced by 67% in the mice treated with 20 mg/kg of resveratrol compared to those in the control group. A significant (P < 0.02) reduction of paw swelling was observed in the mice treated with 20 mg/kg dose of resveratrol compared to the control group. The inhibition of paw swelling in mice was also caused by votalin by the extent of reduction was significantly (P < 0.02) lower compared to the resveratrol treatment. In the mice model of paw swelling, treatment with 20 mg/kg doses of resveratrol significantly (P < 0.02) reduced the expression of PGE2 compared to the control group. On the other hand, resveratrol played a vital role in the inhibition of carrageenan induced increase in the expression of COX-2 in mice. The inhibition in the COX-2 expression by 20 mg/kg doses of resveratrol was significantly higher compared to the known drug, votalin. Thus the current study revealed that resveratrol treatment inhibits acute pharyngitis in the mice model through inhibition of PGE2/COX-2 expression. Thus resveratrol can be used for the treatment of acute pharyngitis.
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Affiliation(s)
- Zhaoyan Yu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Wei Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
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81
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Klepser DG, Klepser ME, Smith JK, Dering-Anderson AM, Nelson M, Pohren LE. Utilization of influenza and streptococcal pharyngitis point-of-care testing in the community pharmacy practice setting. Res Social Adm Pharm 2017; 14:356-359. [PMID: 28479019 DOI: 10.1016/j.sapharm.2017.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/27/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND One way to reduce the complications and costs of influenza like illness and pharyngitis is to improve access to testing and treatment in early stages of infection. Pharmacy-based screening and treatment of group A streptococcus (GAS) infection and influenza has the potential to improve patient care and population health. OBJECTIVE To improve patient care and population health, the objective of this retrospective study was to assess if a previously validated service model could be implemented by pharmacy chains without mandated standardization. METHODS Researchers utilized a certificate program to provide initial training to pharmacists and shared templates from previous validated models. Pharmacy companies were responsible for navigation of all implementation within their company. Researchers analyzed the de-identified data from patients seeking point-of-care testing from the participating pharmacies. RESULTS Participating pharmacies reported 661 visits for adult (age 18 and over) patients tested for influenza for GAS pharyngitis. For the GAS patients, 91 (16.9%) tested positive. For the Influenza patients, 22.9% tested positive and 64 (77.1%) testing negative. Access to care was improved as patients presented to the visit outside normal clinic hours for 38% of the pharmacy visits, and 53.7% did not have a primary care provider. CONCLUSION A collaborative care model for managing patients with symptoms consistent with influenza or group A streptococcus can be successfully implemented, and improve access to care outside of normal clinic hours and for those without a regular primary care provider.
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Affiliation(s)
- Donald G Klepser
- University of Nebraska Medical Center, College of Pharmacy, Department of Pharmacy Practice, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA.
| | - Michael E Klepser
- Ferris State University, College of Pharmacy, 220 Ferris Drive, Big Rapids, MI, 49307, USA
| | - Jaclyn K Smith
- University of Nebraska Medical Center, College of Pharmacy, Department of Pharmacy Practice, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Allison M Dering-Anderson
- University of Nebraska Medical Center, College of Pharmacy, Department of Pharmacy Practice, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Maggie Nelson
- University of Nebraska Medical Center, College of Pharmacy, Department of Pharmacy Practice, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Lauren E Pohren
- University of Nebraska Medical Center, College of Pharmacy, Department of Pharmacy Practice, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA
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82
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Nonrheumatic myopericarditis post acute streptococcal pharyngitis: An uncommon cause of sore throat with ST segment elevation. Am J Emerg Med 2017; 35:806.e1-806.e3. [PMID: 27939516 DOI: 10.1016/j.ajem.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 12/06/2016] [Indexed: 11/21/2022] Open
Abstract
Nonrheumatic myopericarditis is an uncommon complication of acute pharyngitis caused by Group A Streptococcal infection (GAS). While the natural history of carditis complicating acute rheumatic fever is well established, the incidence, pathophysiology and clinical course of nonrheumatic myopericarditis are ill defined. Advances in rapid bedside testing for both myocardial injury and GAS pharyngitis have allowed for increasing recognition of this uncommon complication in patients presenting with a sore throat with associated chest discomfort. We describe a case of a 34years old man with GAS pharyngitis complicated by acute myopericarditis who presented with chest pain, ST segment elevation on electrocardiogram, and elevated cardiac biomarkers.
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83
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Zhao SR, Griffin MR, Patterson BL, Mace RL, Wyatt D, Zhu Y, Talbot HK. Risk Factors for Outpatient Use of Antibiotics in Children with Acute Respiratory Illnesses. South Med J 2017; 110:172-180. [PMID: 28257541 DOI: 10.14423/smj.0000000000000622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Antibiotics for acute respiratory illness (ARI) constitute most pediatric medication use and contribute to the emergence of antimicrobial resistance. We investigated antibiotic prescription risk factors for ARI in pediatric clinics and clinical follow-up in individuals prescribed and not prescribed antibiotics. METHODS In this observational study, we enrolled children ages 2 to 17 years old presenting with ARI with fever to two academic pediatric primary care outpatient clinics during influenza season 2013-2014. We collected information on demographics, initial symptoms, medical conditions, laboratory tests, discharge diagnoses, treatments, and 30 days of follow-up medical encounters. Factors associated with antibiotic prescription receipt were evaluated using logistic regression. RESULTS Of 206 consented and enrolled children, 59 (29%) were prescribed antibiotics, 51 of 59 (86%) for indicated diagnoses: 34 for streptococcal pharyngitis, 15 for acute otitis media (AOM), and 2 for pneumonia. Discharge diagnoses were the only factors independently associated with an antibiotic prescription. Of children prescribed/not prescribed an antibiotic, 17%/17% received follow-up telephone calls and 27%/17% had follow-up visits related to ARI within 30 days. Two children with AOM were prescribed a second antibiotic during follow-up, and one developed Clostridium difficile colitis. Eighteen of 206 (9%) additional children were prescribed antibiotics within 30 days for ARI symptoms, 17 for streptococcal pharyngitis, AOM, pneumonia, or sinusitis; one was prescribed antibiotics for influenza-like illness. CONCLUSIONS Among study children 2 to 17 years old with outpatient ARI, 29% were prescribed antibiotics at the initial visit and another 9% were prescribed antibiotics during the 30-day follow-up (most were for appropriate indications). Further decreasing antibiotic use in similar settings will likely require wider implementation of watchful waiting for AOM, a change in guidelines for pharyngitis management, and/or reductions in these diseases.
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Affiliation(s)
- Sophie R Zhao
- From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Marie R Griffin
- From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Barron L Patterson
- From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Rachel L Mace
- From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dayna Wyatt
- From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yuwei Zhu
- From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - H Keipp Talbot
- From the Departments of Medicine and Health Policy, Vanderbilt University Medical Center, the Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
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84
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Blair BM, Fischer PR, Libman M, Chen LH. Northern America. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Barbra M. Blair
- Division of Infectious Diseases; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
- Harvard Medical School; Boston Massachusetts USA
| | - Philip R. Fischer
- Department of Pediatric and Adolescent Medicine; Mayo Clinic; Rochester Minnesota USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases; Division of Infectious Diseases; and Department of Microbiology; McGill University; Montreal Quebec Canada
| | - Lin H. Chen
- Harvard Medical School; Boston Massachusetts USA
- Travel Medicine Center, Division of Infectious Diseases; Mount Auburn Hospital; Cambridge Massachusetts USA
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85
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Prevalence of Fusobacterium necrophorum in Children Presenting with Pharyngitis. J Clin Microbiol 2017; 55:1147-1153. [PMID: 28122872 DOI: 10.1128/jcm.02174-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/19/2017] [Indexed: 02/06/2023] Open
Abstract
Fusobacterium necrophorum, an obligate anaerobic bacterium, was recently reported to be an important cause of bacterial pharyngitis with a prevalence as high as that of group A Streptococcus (GAS) in adolescents and young adults. Importantly, F. necrophorum is the primary causative agent of the life-threatening Lemierre's syndrome, and screening of pharyngeal samples may be warranted for its early detection and prevention. The aim of this study was to determine the prevalences of F. necrophorum and groups A and C/G streptococci as agents of bacterial pharyngitis in children. Pharyngeal samples (n = 300) were collected from pediatric patients presenting to the emergency department with signs and symptoms of pharyngitis. Overall, 10 (3.3%), 79 (26.3%), and 4 (1.3%) patients were PCR positive for F. necrophorum, GAS, and group C/G streptococci, respectively. The prevalence of F. necrophorum was significantly higher in patients between the ages of 14 and 20 years at 13.5% than in patients aged 14 years and younger (1.9%, P < 0.001). All positive patients presented with signs and symptoms similar to GAS pharyngitis. Our data demonstrated a potential role for F. necrophorum as a pathogen of pharyngitis among young adults, but suggests that the prevalence of F. necrophorum is low in preadolescent patients.
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86
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Ivaska L, Niemelä J, Lempainen J, Österback R, Waris M, Vuorinen T, Hytönen J, Rantakokko-Jalava K, Peltola V. Aetiology of febrile pharyngitis in children: Potential of myxovirus resistance protein A (MxA) as a biomarker of viral infection. J Infect 2017; 74:385-392. [PMID: 28077283 PMCID: PMC7127312 DOI: 10.1016/j.jinf.2017.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022]
Abstract
Objectives Besides group A streptococcus (GAS), microbial causes of pharyngitis in children are not well known. We aimed to document the viral and bacterial aetiology of pharyngitis and to assess the pathogenic role of viruses by determining the myxovirus resistance protein A (MxA) in the blood as a marker of interferon response. Methods In this prospective observational study, throat swabs and blood samples were collected from children (age 1–16 years) presenting to the emergency department with febrile pharyngitis. Microbial cause was sought by bacterial culture, polymerase chain reaction, and serology. Blood MxA level was determined. Results A potential pathogen was detected in 88% of 83 patients: GAS alone in 10%, GAS and viruses in 13%, group C or G streptococci alone in 2% and together with viruses in 3%, and viruses alone in 59% of cases. Enteroviruses, rhinoviruses, and adenoviruses were the most frequently detected viruses. Blood MxA levels were higher in children with viral (880 [245–1250] μg/L; median [IQR]) or concomitant GAS-viral (340 [150–710] μg/L) than in those with sole GAS (105 [80–160] μg/L) infections. Conclusions Detection of respiratory viruses simultaneously with elevated blood MxA levels supports the causative role of viruses in the majority of children with pharyngitis. We evaluated the microbiological aetiology of febrile pharyngitis in 83 children. A potential pathogen could be detected in 88% and virus in 76% of patients. Blood myxovirus resistance protein A (MxA) levels were elevated in most of the patients with virus finding. MxA is a promising biomarker of virus infection.
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Affiliation(s)
- Lauri Ivaska
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland; Department of Emergency Services, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jussi Niemelä
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland; Department of Emergency Services, Turku University Hospital and University of Turku, Turku, Finland.
| | - Johanna Lempainen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland; Immunogenetics Laboratory, University of Turku, Turku, Finland.
| | - Riikka Österback
- Department of Clinical Virology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Matti Waris
- Department of Clinical Virology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Tytti Vuorinen
- Department of Clinical Virology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Jukka Hytönen
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; Department of Clinical Microbiology and Immunology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Kaisu Rantakokko-Jalava
- Department of Clinical Microbiology and Immunology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
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87
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Rhinosinusitis and Tonsillopharyngitis. Fam Med 2017. [PMCID: PMC7121430 DOI: 10.1007/978-3-319-04414-9_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sinusitis is characterized by mucosal inflammation of the sinuses which is almost always accompanied by inflammation of the nasal passages. Since nasal mucosa is contiguous with paranasal sinus mucosa, the term sinusitis is often used interchangeably with [1]; the latter term will be used in this chapter. Rhinosinusitis can be acute (less than 4 weeks’ duration), subacute (4–12 weeks), or chronic (greater than 12 weeks) [2].
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88
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Guibas GV, Papadopoulos NG. Viral Upper Respiratory Tract Infections. VIRAL INFECTIONS IN CHILDREN, VOLUME II 2017. [PMCID: PMC7121526 DOI: 10.1007/978-3-319-54093-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The upper respiratory system is one of the most common sites of infection for adults, but even more so for children. Several viruses, from variable families, cause upper respiratory infections which, although generally underestimated due to their typically self-limiting nature, underlie enormous healthcare resource utilization and financial burden. Such, otherwise “benign” infections, can have very significant sequelae both in the form of bringing about local complications but also inducing asthma attacks, thus greatly increasing morbidity. Their enormous prevalence also indicates that rigorous research should be undertaken in order to tackle them, in both the prevention and treatment field.
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89
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The role of Fusobacterium necrophorum in pharyngotonsillitis – A review. Anaerobe 2016; 42:89-97. [DOI: 10.1016/j.anaerobe.2016.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/26/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
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90
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Wu S, Peng X, Yang Z, Ma C, Zhang D, Wang Q, Yang P. Estimated burden of group a streptococcal pharyngitis among children in Beijing, China. BMC Infect Dis 2016; 16:452. [PMID: 27566251 PMCID: PMC5002216 DOI: 10.1186/s12879-016-1775-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 08/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burden of Group A streptococcus (GAS) pharyngitis is scarce in developing countries, still unknown in China. The objective of this study was to determine the incidence of clinical cases of pharyngitis and GAS culture-positive pharyngitis, and their outpatient visits among children aged 0-14 years in Beijing, the capital of China. METHODS Multiplier model was used to estimate the numbers of pharyngitis cases, based on reported numbers of clinical cases and GAS culture-positive rates from GAS surveillances in Beijing, consultation rate, population coverage of GAS surveillances, sampling success rate, and test sensitivity of GAS culture from previous studies, surveys and surveillances. RESULTS An average of 29804.6 (95 % CI: 28333.2-31276.0) clinical cases of pharyngitis per 100,000 person-years occurred among children aged 0-14 years, resulting in correspondingly 19519.0 (95 % CI: 18516.7-20521.2) outpatient visits per 100,000 person-years from 2012 to 2014 in Beijing. On average, there were 2685.1 (95 % CI: 2039.6-3330.6) GAS culture-positive cases of pharyngitis and 1652.7 (95 % CI: 1256.5-2049.0) outpatient visits per 100,000 person-years during the same period. The estimated burden of GAS pharyngitis was significantly higher than that of scarlet fever. Children aged 5-14 years had a higher burden of GAS pharyngitis than those aged 0-4 years. CONCLUSIONS The present data suggests that GAS pharyngitis is very common in children in China. Further studies and surveillances are needed to monitor trends and the effectiveness of control measures.
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Affiliation(s)
- Shuangsheng Wu
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No. 16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.,School of Public Health, Captial Medical University, Beijing, China
| | - Xiaomin Peng
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No. 16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.,School of Public Health, Captial Medical University, Beijing, China
| | - Zuyao Yang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR China
| | - Chunna Ma
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No. 16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.,School of Public Health, Captial Medical University, Beijing, China
| | - Daitao Zhang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No. 16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.,School of Public Health, Captial Medical University, Beijing, China
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No. 16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.,School of Public Health, Captial Medical University, Beijing, China
| | - Peng Yang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No. 16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China. .,School of Public Health, Captial Medical University, Beijing, China.
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91
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Kolukirik M, Yılmaz M, Ince O, Ketre C, Tosun AI, Ince BK. Development of a fast and low-cost qPCR assay for diagnosis of acute gas pharyngitis. Ann Clin Microbiol Antimicrob 2016; 15:46. [PMID: 27501688 PMCID: PMC4977885 DOI: 10.1186/s12941-016-0162-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/28/2016] [Indexed: 11/17/2022] Open
Abstract
Background Group A streptococci (GAS) are the most common bacterial cause of acute pharyngitis and account for 15–30 % of cases of acute pharyngitis in children and 5–10 % of cases in adults. In this study, a real-time quantitative PCR (qPCR) based GAS detection assay in pharyngeal swab specimens was developed. Methods The qPCR assay was compared with the gold standard bacterial culture and a rapid antigen detection test (RADT) to evaluate its clinical performance in 687 patients. The analytical sensitivity of the assay was 240 cfu/swab. Forty-five different potential cross-reacting organisms did not react with the test. Four different laboratories for the reproducibility studies were in 100 % (60/60) agreement for the contrived GAS positive and negative swab samples. Results The relative sensitivities of the RADT and the qPCR test were 55.9 and 100 %; and the relative specificities were 100 and 96.3 %, respectively. Duration of the total assay for 24 samples including pre-analytical processing and analysis changed between 42 and 55 min depending on the type of qPCR instrument used. A simple DNA extraction method and a low qPCR volume made the developed assay an economical alternative for the GAS detection. Conclusion We showed that the developed qPCR test is rapid, cheap, sensitive and specific and therefore can be used to replace both antigen detection and culture for diagnosis of acute GAS pharyngitis.
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Affiliation(s)
- Mustafa Kolukirik
- ENGY Environmental and Energy Technologies Biotechnology Research and Development Limited Company, Istanbul, Turkey.
| | - Mesut Yılmaz
- Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
| | - Orhan Ince
- Istanbul Technical University, Istanbul, Turkey
| | - Canan Ketre
- Istanbul Technical University, Istanbul, Turkey
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92
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Systematic review of factors contributing to penicillin treatment failure in Streptococcus pyogenes pharyngitis. Otolaryngol Head Neck Surg 2016; 137:851-857. [DOI: 10.1016/j.otohns.2007.07.033] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 07/06/2007] [Accepted: 07/25/2007] [Indexed: 11/21/2022]
Abstract
Objective Review the evidence for various explanations for microbiologic treatment failure following use of penicillin in group A streptococcal (GAS) tonsillopharyngitis. DATA SOURCE Systematic review of the literature based on Medline and EMBASE searches, and review of reference lists of included studies. RESULTS The explanations for penicillin treatment failure in GAS tonsillopharyngitis include 1) carrier state, 2) lack of compliance, 3) recurrent exposure, 4) in vivo copathogenicity of β-lactamase–producing normal pharyngeal flora, 5) in vivo bacterial coaggregation, 6) poor antibiotic penetration to tonsillopharyngeal tissue, 7) in vivo eradication of normal protective flora, 8) early initiation of antibiotic therapy resulting in suppression of an adequate host immune response, 9) intracellular localization of GAS, 10) GAS tolerance to penicillin, 11) contaminated toothbrushes or orthodontic appliances, and 12) transmission from the family pet. There is very little type I or II evidence to support any of the above-cited explanations for treatment failure in GAS tonsillopharyngitis; available studies are mostly observational (in patients) or laboratory-based without clinical confirmation. CONCLUSION Multiple explanations have been offered by investigators to explain penicillin treatment failures in GAS tonsillopharyngitis, but the evidence base to support the proposed explanations is generally weak by current standards. Further research is needed to better understand the mechanism(s) of penicillin treatment failure in GAS tonsillopharyngitis.
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93
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Fierro JL, Prasad PA, Localio AR, Grundmeier RW, Wasserman RC, Zaoutis TE, Gerber JS. Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians. Infect Control Hosp Epidemiol 2016; 35 Suppl 3:S79-85. [PMID: 25222902 DOI: 10.1086/677820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices. DESIGN Retrospective cohort study. SETTING All encounters to 25 pediatric primary care practices sharing an electronic health record. METHODS Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation. RESULTS Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P < .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P ≤ .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing. CONCLUSIONS Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.
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Affiliation(s)
- Julie L Fierro
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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94
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Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians. Infect Control Hosp Epidemiol 2016. [DOI: 10.1017/s0899823x00194036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective.To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.Design.Retrospective cohort study.Setting.All encounters to 25 pediatric primary care practices sharing an electronic health record.Methods.Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.Results.Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P < .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P ≤ .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.Conclusions.Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.
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95
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Klepser DG, Klepser ME, Dering-Anderson AM, Morse JA, Smith JK, Klepser SA. Community pharmacist-physician collaborative streptococcal pharyngitis management program. J Am Pharm Assoc (2003) 2016; 56:323-329.e1. [PMID: 27067554 DOI: 10.1016/j.japh.2015.11.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/11/2015] [Accepted: 11/30/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe patient outcomes associated with a community pharmacy-based, collaborative physician-pharmacist group A Streptococcus (GAS) management program. SETTING Fifty-five chain and independent community pharmacies in Michigan, Minnesota, and Nebraska. PRACTICE INNOVATION Pharmacists screened clinically stable adult patients who presented with signs and symptoms consistent with GAS pharyngitis from October 1, 2013, to August 1, 2014, by means of Centor criteria, and performed a physical assessment followed by a rapid antigen detection test (RADT) for eligible patients. Patients were treated according to a collaborative practice agreement (CPA) with a licensed prescriber or a physician consult site model. Pharmacists followed up with patients 24-48 hours after the encounter to assess patient status and possible need for further intervention. EVALUATION Number of patients screened, tested, and treated, and health care utilization. RESULTS Of 316 patients screened, 43 (13.6%) were excluded and referred for care. Of 273 patients (86.4%) eligible for testing, 48 (17.6%) had positive test results and 46 (16.8%) received amoxicillin or azithromycin per the CPA. Of those tested, 43.2% had no primary provider and 43.9% visited the pharmacy outside of traditional clinic office hours. CONCLUSION Pharmacists demonstrated the ability and capacity to provide care for patients seeking treatment for pharyngitis. The number of patients without a primary care provider and seen at the pharmacy outside of normal office hours highlights the improved access that community pharmacy-based care offers.
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96
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Jiang HL, She B, Liu W, Mao B, Zhang JY. Efficacy and safety of Qi-Wei-Qing-Yan aerosol in treatment of acute pharyngitis (lung-stomach excess-heat syndrome): study protocol for a randomized controlled trial. Trials 2016; 17:99. [PMID: 26896352 PMCID: PMC4759740 DOI: 10.1186/s13063-016-1217-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 02/05/2016] [Indexed: 02/05/2023] Open
Abstract
Background Acute pharyngitis accounts for an estimated 15 million patient visits in the United States. However, there is no proven effective and safe treatment. Although Chinese herbal medicine is widely used in the treatment of acute pharyngitis, there is a lack of evidence-based data. Despite several clinical trials conducted in this setting, no randomized placebo-controlled trial has been performed to date. This trial aims to investigate the efficacy and safety of Qi-Wei-Qing-Yan aerosol (QWQYA), a Chinese herbal prescription, compared with a placebo aerosol in the treatment of acute pharyngitis with lung-stomach excess-heat syndrome. Methods/design This is a prospective, multicenter, randomized, double-blinded, parallel-group, placebo-controlled trial. A total of 420 adult patients, of either sex, with acute pharyngitis will be enrolled from seven study sites across China. All patients will be randomly allocated to one of three parallel treatment groups: (1) QWQYA with the current propellant, (2) QWQYA with a previous propellant, and (3) the placebo aerosol with the current propellant. The study medication will be administered into the pharyngeal region in three sprays thrice daily for 5 consecutive days. The primary outcome measures are time to complete resolution of sore throat and relief rate of sore throat. Secondary outcome measures include resolution rate of sore throat, time to relief of sore throat, intensity of sore throat, and change of traditional Chinese medicine syndrome score and clinical signs score from baseline to post-treatment, as well as the occurrence of any adverse events. Discussion This will be the first clinical trial to investigate the efficacy and safety of QWQYA in the treatment of acute pharyngitis in an adult population in a multicenter, randomized, double-blinded, parallel-group, placebo-controlled manner. Not only might it establish the basis for the efficacy and safety of QWQYA in treating acute pharyngitis, but it might also provide evidence to support the use of Chinese herbal medicine in treating acute pharyngitis and thus support an alternative treatment option for management of acute pharyngitis. Trial registration Chinese Clinical Trial Registry ChiCTR-IPR-15005991.
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Affiliation(s)
- Hong-li Jiang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, Sichuan Province, China.
| | - Bin She
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, Sichuan Province, China.
| | - Wei Liu
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, Sichuan Province, China.
| | - Bing Mao
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, Sichuan Province, China.
| | - Ju-ying Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Sichuan University, No. 16 People's South Road, Chengdu, 610041, Sichuan Province, China.
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97
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Franco-Paredes C. Upper Airway Infections. CORE CONCEPTS IN CLINICAL INFECTIOUS DISEASES (CCCID) 2016. [PMCID: PMC7173413 DOI: 10.1016/b978-0-12-804423-0.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Infections of the upper respiratory tract represent an important source of morbidity and potentially of life-threatening complications. This group of infections represents one of the most frequent outpatient consultations; and includes a range of clinical syndromes that may go from a self-limited common cold, to acute rhinosinusitis, otitis media, to life threatening condition such as epiglottitis. Importantly, acute respiratory illness account for approximately 75% of the total number of antibiotic prescriptions per year; an often many of these conditions are of viral origin. When acute pharyngitis is caused by Streptococcus pyogenes, it is important to consider treatment to prevent transmission, reduce symptoms, and prevent its associated suppurative and nonsuppurative complications. Acute bacterial sinusitis can be associated with severe complications. Upper respiratory infection can also lead to life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck.
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98
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Oropharyngeal and Tonsillar Infections. HEAD, NECK, AND OROFACIAL INFECTIONS 2016. [PMCID: PMC7151798 DOI: 10.1016/b978-0-323-28945-0.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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99
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Weber NC, Klepser ME, Akers JM, Klepser DG, Adams AJ. Use of CLIA-waived point-of-care tests for infectious diseases in community pharmacies in the United States. Expert Rev Mol Diagn 2015; 16:253-64. [PMID: 26560318 DOI: 10.1586/14737159.2015.1116388] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Review of point-of-care (POC) testing in community pharmacies, availability and specifications of CLIA-waived infectious disease POC tests, and provide recommendations for future community pharmacy POC models in an effort to improve patient outcomes while reducing antibiotic resistance. PubMed and Medscape were searched for the following keywords: infectious disease, community pharmacy, rapid diagnostic tests, rapid assay, and POC tests. All studies utilizing POC tests in community pharmacies for infectious disease were included. Studies, articles, recommendations, and posters were reviewed and information categorized into general implementation of POC testing in community pharmacies, CLIA-waived tests available, Influenza, Group A Streptococcus pharyngitis, Helicobacter pylori, HIV and Hepatitis C. POC testing provides a unique opportunity for community pharmacists to implement collaborative disease management programmes for infectious diseases and reduce over-prescribing of antibiotics and improve patient outcomes through early detection, treatment and/or referral to a specialist.
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Affiliation(s)
- Natalie C Weber
- a Ferris State University College of Pharmacy , Kalamazoo , MI , USA
| | - Michael E Klepser
- a Ferris State University College of Pharmacy , Kalamazoo , MI , USA
| | - Julie M Akers
- b Washington State University College of Pharmacy , Spokane , WA , USA
| | - Donald G Klepser
- c University of Nebraska Medical Center School of Pharmacy , Omaha , NE , USA
| | - Alex J Adams
- d National Association of Chain Drug Stores , Arlington , VA , USA
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100
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Throat and nasal swabs for molecular detection of respiratory viruses in acute pharyngitis. Virol J 2015; 12:178. [PMID: 26511714 PMCID: PMC4625558 DOI: 10.1186/s12985-015-0408-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detection of specific respiratory viruses is important for surveillance programs, where nasopharyngeal or nasal swabs have traditionally been used. Our objective was to determine whether sampling with a throat swab provides incremental benefit-when used in conjunction with a nasal swab-to detect respiratory viruses among patients with acute pharyngitis in the outpatient setting. FINDINGS Among 83 university students with acute pharyngitis, we detected respiratory viruses with molecular assays on two samples collected per student: with a flocked nasal mid-turbinate swab and a rayon throat swab. Forty-eight (58 %) patients had virus-positive samples, with 49 virus positives detected by either swab (one patient had a dual viral co-infection). The most common viruses were rhinovirus, coronavirus, and influenza A virus. Specifically, 29 virus positives were detected by both swabs, 14 exclusively by the nasal swab, and six exclusively by the throat swab. The additional six virus positives detected by the throat swab corresponded to an absolute increase in viral detection of 7.1 % (95 % CI: 1.2-12.9 %); the specific viruses detected were four rhinoviruses and two coronaviruses. CONCLUSIONS The flocked nasal swab samples respiratory viruses well, even among patients whose primary complaint is a sore throat. The rayon throat swab has modest incremental value over and above using the flocked nasal mid-turbinate swab alone, which suggests that while throat swabs alone would not be adequate for respiratory viral surveillance, they may have value as a supplementary test.
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