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Abuzeid N, Ahmed E, Groun EA, Almugadam B. Performance of clinical features as predictor of streptococcal tonsillitis and macrolides resistance. BIOMEDICAL AND BIOTECHNOLOGY RESEARCH JOURNAL (BBRJ) 2022. [DOI: 10.4103/bbrj.bbrj_237_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Khan A, Davis D, Brown L. A Comparison of Diagnostic Accuracy of a Rapid Antigen Detection Test in Screening for Group A Streptococcal Throat Infection Between 3- to 10-Year-Old (Children and Preadolescents) and 11- to 21-Year-Old (Adolescents). Cureus 2021; 13:e14840. [PMID: 33968544 PMCID: PMC8098778 DOI: 10.7759/cureus.14840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction Pharyngitis is one of the most common childhood diseases worldwide. We intended to compare the performance of one such rapid antigen detection test (RADT) using lateral flow immunoassay technique, between 3- to 10-year-old (children and preadolescent) and 11- to 21-year-old (adolescents). Methods Children and adolescents attending the pediatric ED with complaints of throat pain and signs of pharyngeal and tonsillar inflammation were tested by both the RADT and throat culture (TC) directed towards group A streptococcal (GAS) between April and June of 2016. The prevalence, sensitivity (SN), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) were calculated against throat culture, the gold standard for the diagnosis of GAS pharyngitis. Comparisons between the two age groups were made using the Chi-square test Results Of 202 patients, 123 (61%) patients were between 3-11 and 79 (39%) between 11-21 years of age. A positive throat culture was recorded in 56 patients yielding an overall prevalence of GAS pharyngitis at 28%. For the whole sample, the screening RADT had an SN, SP, PPV and NPV of 79%, 90%, 75%, and 92%, respectively. Also, there was no statistically significant difference between the two groups in terms of SN, SP, PPV and NPV. Conclusion The RADT in use at our institution, performed comparable to studies reported in the literature using a similar technique in both preadolescent and adolescent age groups.
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Affiliation(s)
- Abdullah Khan
- Pediatric Emergency Medicine, Loma Linda University Medical Center, Loma Linda, USA.,Pediatric Emergency Medicine, Dignity Health - St. Rose Dominican Hospital, Siena Campus, Henderson, USA
| | - Drew Davis
- Pediatric Emergency Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Lance Brown
- Pediatric Emergency Medicine, Loma Linda University Medical Center, Loma Linda, USA
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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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Cohen JF, Bertille N, Cohen R, Chalumeau M. Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database Syst Rev 2016; 7:CD010502. [PMID: 27374000 PMCID: PMC6457926 DOI: 10.1002/14651858.cd010502.pub2] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Group A streptococcus (GAS) accounts for 20% to 40% of cases of pharyngitis in children; the remaining cases are caused by viruses. Compared with throat culture, rapid antigen detection tests (RADTs) offer diagnosis at the point of care (within five to 10 minutes). OBJECTIVES To determine the diagnostic accuracy of RADTs for diagnosing GAS in children with pharyngitis. To assess the relative diagnostic accuracy of the two major types of RADTs (enzyme immunoassays (EIA) and optical immunoassays (OIA)) by indirect and direct comparison. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, Web of Science, CDSR, DARE, MEDION and TRIP (January 1980 to July 2015). We also conducted related citations tracking via PubMed, handsearched reference lists of included studies and relevant review articles, and screened all articles citing included studies via Google Scholar. SELECTION CRITERIA We included studies that compared RADT for GAS pharyngitis with throat culture on a blood agar plate in a microbiology laboratory in children seen in ambulatory care. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance, assessed full texts for inclusion, and carried out data extraction and quality assessment using the QUADAS-2 tool. We used bivariate meta-analysis to estimate summary sensitivity and specificity, and to investigate heterogeneity across studies. We compared the accuracy of EIA and OIA tests using indirect and direct evidence. MAIN RESULTS We included 98 unique studies in the review (116 test evaluations; 101,121 participants). The overall methodological quality of included studies was poor, mainly because many studies were at high risk of bias regarding patient selection and the reference standard used (in 73% and 43% of test evaluations, respectively). In studies in which all participants underwent both RADT and throat culture (105 test evaluations; 58,244 participants; median prevalence of participants with GAS was 29.5%), RADT had a summary sensitivity of 85.6%; 95% confidence interval (CI) 83.3 to 87.6 and a summary specificity of 95.4%; 95% CI 94.5 to 96.2. There was substantial heterogeneity in sensitivity across studies; specificity was more stable. There was no evidence of a trade-off between sensitivity and specificity. Heterogeneity in accuracy was not explained by study-level characteristics such as whether an enrichment broth was used before plating, mean age and clinical severity of participants, and GAS prevalence. The sensitivity of EIA and OIA tests was comparable (summary sensitivity 85.4% versus 86.2%). Sensitivity analyses showed that summary estimates of sensitivity and specificity were stable in low risk of bias studies. AUTHORS' CONCLUSIONS In a population of 1000 children with a GAS prevalence of 30%, 43 patients with GAS will be missed. Whether or not RADT can be used as a stand-alone test to rule out GAS will depend mainly on the epidemiological context. The sensitivity of EIA and OIA tests seems comparable. RADT specificity is sufficiently high to ensure against unnecessary use of antibiotics. Based on these results, we would expect that amongst 100 children with strep throat, 86 would be correctly detected with the rapid test while 14 would be missed and not receive antibiotic treatment.
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Affiliation(s)
- Jérémie F Cohen
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes UniversityObstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)ParisFrance
- Necker Hospital, AP‐HP and Paris Descartes UniversityDepartment of PediatricsParisFrance
| | - Nathalie Bertille
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes UniversityObstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)ParisFrance
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val‐de‐Marne (ACTIV)27 Rue InkermannSaint‐Maur‐des‐FossésFrance
- Centre Hospitalier Intercommunal de Créteil (CHIC)Department of Microbiology40 avenue de VerdunCréteilFrance94010
| | - Martin Chalumeau
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes UniversityObstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé)ParisFrance
- Necker Hospital, AP‐HP and Paris Descartes UniversityDepartment of PediatricsParisFrance
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Microbiologic Diagnosis of Lung Infection. MURRAY AND NADEL'S TEXTBOOK OF RESPIRATORY MEDICINE 2016. [PMCID: PMC7152380 DOI: 10.1016/b978-1-4557-3383-5.00017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada CA, Centor RM. Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis. PLoS One 2014; 9:e111727. [PMID: 25369170 PMCID: PMC4219770 DOI: 10.1371/journal.pone.0111727] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022] Open
Abstract
Background Pharyngitis management guidelines include estimates of the test characteristics of rapid antigen streptococcus tests (RAST) using a non-systematic approach. Objective To examine the sensitivity and specificity, and sources of variability, of RAST for diagnosing group A streptococcal (GAS) pharyngitis. Data Sources MEDLINE, Cochrane Reviews, Centre for Reviews and Dissemination, Scopus, SciELO, CINAHL, guidelines, 2000–2012. Study Selection Culture as reference standard, all languages. Data Extraction and Synthesis Study characteristics, quality. Main Outcome(s) and Measure(s) Sensitivity, specificity. Results We included 59 studies encompassing 55,766 patients. Forty three studies (18,464 patients) fulfilled the higher quality definition (at least 50 patients, prospective data collection, and no significant biases) and 16 (35,634 patients) did not. For the higher quality immunochromatographic methods in children (10,325 patients), heterogeneity was high for sensitivity (inconsistency [I2] 88%) and specificity (I2 86%). For enzyme immunoassay in children (342 patients), the pooled sensitivity was 86% (95% CI, 79–92%) and the pooled specificity was 92% (95% CI, 88–95%). For the higher quality immunochromatographic methods in the adult population (1,216 patients), the pooled sensitivity was 91% (95% CI, 87 to 94%) and the pooled specificity was 93% (95% CI, 92 to 95%); however, heterogeneity was modest for sensitivity (I2 61%) and specificity (I2 72%). For enzyme immunoassay in the adult population (333 patients), the pooled sensitivity was 86% (95% CI, 81–91%) and the pooled specificity was 97% (95% CI, 96 to 99%); however, heterogeneity was high for sensitivity and specificity (both, I2 88%). Conclusions RAST immunochromatographic methods appear to be very sensitive and highly specific to diagnose group A streptococcal pharyngitis among adults but not in children. We could not identify sources of variability among higher quality studies. The present systematic review provides the best evidence for the wide range of sensitivity included in current guidelines.
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Affiliation(s)
- Emily H. Stewart
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Brian Davis
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - B. Lee Clemans-Taylor
- The University of Alabama at Birmingham, Huntsville Campus, Huntsville, Alabama, United States of America
| | | | - Carlos A. Estrada
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Birmingham Veterans Affairs Medical Center and Veterans Affairs Quality Scholar Program, Birmingham, Alabama, United States of America
- * E-mail:
| | - Robert M. Centor
- The University of Alabama at Birmingham, Huntsville Campus, Huntsville, Alabama, United States of America
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Cohen J, Levy C, Chalumeau M, Bidet P, Cohen R. Tests de diagnostic rapide dans les angines de l’enfant. Arch Pediatr 2014; 21 Suppl 2:S78-83. [DOI: 10.1016/s0929-693x(14)72265-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lean WL, Arnup S, Danchin M, Steer AC. Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis. Pediatrics 2014; 134:771-81. [PMID: 25201792 DOI: 10.1542/peds.2014-1094] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Effective management of group A streptococcal (GAS) pharyngitis is hindered by impracticality of the gold standard diagnostic test: throat culture. Rapid antigen diagnostic tests (RADTs) are a promising alternative, although concerns about their sensitivity and specificity, and variation between test methodologies, have limited their clinical use. The objective of this study was to perform a systematic review with meta-analysis of the diagnostic accuracy of RADTs for GAS pharyngitis. METHODS Medline and Embase from 1996 to 2013 were used as data sources. Of 159 identified studies, 48 studies of diagnostic accuracy of GAS RADTs using throat culture on blood agar as a reference standard were selected. Bivariate random-effects regression was used to estimate sensitivity and specificity with 95% confidence intervals (CIs). Additional meta-analyses were performed for pediatric data. RESULTS A total of 60 pairs of sensitivity and specificity from 48 studies were included. Overall summary estimates for sensitivity and specificity of RADTs were 0.86 (95% CI 0.83 to 0.88) and 0.96 (95% CI 0.94 to 0.97), respectively, and estimates for pediatric data were similar. Molecular-based RADTs had the best diagnostic accuracy. Considerable variability exists in methodology between studies. There were insufficient studies to allow meta-regression/subgroup analysis within each test type. CONCLUSIONS RADTs can be used for accurate diagnosis of GAS pharyngitis to streamline management of sore throat in primary care. RADTs may not require culture backup for negative tests in most low-incidence rheumatic fever settings. Newer molecular tests have the highest sensitivity, but are not true point-of-care tests.
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Affiliation(s)
- Wei Ling Lean
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Sarah Arnup
- Clinical Epidemiology and Biostatistics Unit
| | - Margie Danchin
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; Group A Streptococcal Research Group, and Vaccine and Immunisation Research Group, Murdoch Children's Research Institute, Melbourne, Australia; and
| | - Andrew C Steer
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; Group A Streptococcal Research Group, and Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Cardoso DM, Gilio AE, Hsin SH, Machado BM, de Paulis M, Lotufo JPB, Martinez MB, Grisi SJE. Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a pediatric emergency room. REVISTA PAULISTA DE PEDIATRIA 2014; 31:4-9. [PMID: 23703037 DOI: 10.1590/s0103-05822013000100002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 10/08/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. METHODS This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. CONCLUSIONS The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.
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Affiliation(s)
- Débora Morais Cardoso
- Pronto-Socorro de Pediatria, Enfermaria de Pediatria, Hospital Universitário, USP, São Paulo, SP, Brasil
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Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, Verheij T. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012; 18 Suppl 1:1-28. [PMID: 22432746 DOI: 10.1111/j.1469-0691.2012.03766.x] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat. In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use. The Centor scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection. In patients with high likelihood of streptococcal infections (e.g. 3-4 Centor criteria) physicians can consider the use of rapid antigen test (RAT). If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci. To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms. Zinc gluconate is not recommended to be used in sore throat. There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat. Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0-2 Centor criteria to relieve symptoms. Modest benefits of antibiotics, which have been observed in patients with 3-4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs. The prevention of suppurative complications is not a specific indication for antibiotic therapy in sore throat. If antibiotics are indicated, penicillin V, twice or three times daily for 10 days is recommended. At the present, there is no evidence enough that indicates shorter treatment length.
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Management of Acute Pharyngitis in Children: Summary of the Italian National Institute of Health Guidelines. Clin Ther 2012; 34:1442-1458.e2. [DOI: 10.1016/j.clinthera.2012.04.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/24/2012] [Accepted: 05/01/2012] [Indexed: 11/15/2022]
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Pharyngitis. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7151797 DOI: 10.1016/b978-1-4377-2702-9.00027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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A comparison between the Strep A Rapid Test Device and conventional culture for the diagnosis of streptococcal pharyngitis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 17:221-3. [PMID: 18382631 DOI: 10.1155/2006/696018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 06/20/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rapid antigen detection tests are frequently used to diagnose pharyngitis due to Streptococcus pyogenes. Because a large number of kits are available commercially, performance characteristics may vary considerably. The present study evaluated one such kit currently in use in Canadian laboratories for which published evaluations are not available. OBJECTIVE To evaluate the performance characteristics of the Strep A Rapid Test Device (SARTD) (Nova Century Scientific Inc, Canada). METHODS Pharyngeal swabs from 818 patients with suspected streptococcal pharyngitis were tested. Swabs were initially inoculated onto the surface of a blood agar plate and then used to perform the rapid antigen test. The test was performed in accordance with the product monograph. Beta-hemolytic colonies were identified as S pyogenes using conventional means. RESULTS Four hundred ninety specimens were obtained from children and 328 from adults. S pyogenes was recovered from 171 (21%) patients. The SARTD detected S pyogenes antigens in 123 of 171 specimens from which S pyogenes was isolated on culture; the screen was negative in 610 of 647 specimens from which cultures were negative. The positive and negative predictive values of the SARTD were 76.9% and 92.7%, respectively. CONCLUSIONS The SARTD was much less sensitive (72%) than was suggested in the product monograph (90%). Laboratories should vigorously evaluate such products in-house, optimize specimen collection and transport, and choose more sensitive kits for use.
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Affiliation(s)
- Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Ruiz-Aragón J, Rodríguez López R, Molina Linde JM. [Evaluation of rapid methods for detecting Streptococcus pyogenes. Systematic review and meta-analysis]. An Pediatr (Barc) 2010; 72:391-402. [PMID: 20346743 DOI: 10.1016/j.anpedi.2009.12.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 10/15/2009] [Accepted: 12/18/2009] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Streptococcal pharyngitis is one of the most frequent reasons for consultations in primary and paediatric care. An inadequate treatment could cause adverse effects and bacterial resistance. The rapid antigen tests are an important advance, enabling the diagnosis of infection by Streptococcus pyogenes to be diagnosed in a few minutes. The aim of this review is to assess the rapid antigen-detection test in the diagnosis of S. pyogenes from throat samples. MATERIAL AND METHODS Systematic review and meta-analysis (2000-09). Source database: MedLine, Embase, Cochrane Library, Cinahl, CRD, ECRI, Hayes and HTA's agencies. The quality of included studies was measured according to Quadas's criteria. The diagnostic validity indices have been calculated. A meta-analysis was performed in order to synthesize the results of the different evaluated studies. RESULTS Twenty four studies were included. The quality was moderate. The sensitivity ranged between 65.6% and 96.4%; specificity from 68.7%-99.3%; the positive predictive value was between 59.4%-97.4%; and the negative predictive value from 87.8%-98%. The meta-analysis determined an overall sensitivity of 0.85 [95% CI, 0.84-0.87], specificity was 0.96 [95% CI, 0.96-0.97], likelihood ratio (+) 22.21 [95% CI, 15.12-32.63], and likelihood ratio (-) 0.15 [95% CI, 0.13-0.18]. The rapid antigen-detection test demonstrated a good diagnostic performance. CONCLUSIONS Rapid tests offer good accuracy for use as diagnostic method, however, these devices have to be complemented with the microbiological culture, because there are false positive and negative results.
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Affiliation(s)
- J Ruiz-Aragón
- Agencia de Evaluación de Tecnología Sanitaria de Andalucía (AETSA), Sevilla, España.
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Infectious diseases and the use of antibiotics in outpatients at the emergency department of the University Hospital of León, Nicaragua. Int J Infect Dis 2008; 13:349-54. [PMID: 18955005 DOI: 10.1016/j.ijid.2008.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 06/25/2008] [Accepted: 07/15/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In order to develop guidelines for the use of antimicrobial agents, it is necessary to obtain detailed information on the prevalence of infectious diseases and antibiotic usage. METHODS A retrospective study was conducted among outpatients with acute infections visiting the emergency department of the University Hospital of León, Nicaragua. RESULTS Over the course of one month, 2027 patients visited the emergency department. Seven hundred and thirty-two patients (36.1%) had an infection, with a total of 799 acute infections. The majority of patients (55.9%) were children. Respiratory tract infections (43.4%), urogenital infections (29.5%), and diarrhea or gastroenteritis of presumed infectious origin (8.8%) were the most frequent infections. Among respiratory tract infections, the most frequent diagnoses were community-acquired pneumonia (CAP; 31.4%), acute tonsillitis (28.2%), and the common cold (17.6%). CAP was treated with procaine benzylpenicillin in 70.6% of cases, whereas 84.0% of patients with acute tonsillitis were treated with a single dosage of benzathine benzylpenicillin intramuscularly. Among urogenital infections, the most frequent diagnosis was acute uncomplicated urinary tract infection (24.2%). Approximately a quarter of patients with uncomplicated urinary tract infections did not receive treatment according to the local guidelines. Of the patients with acute diarrhea, 27.1% were treated with antibiotics, while only a minority had leukocytes in Wright stain of the feces. CONCLUSIONS In conclusion our study shows that the use of antimicrobial agents is not optimal. Antibiotics were prescribed too often and not according to the local guidelines. This will further exacerbate the resistance problem in Nicaragua.
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Abstract
Acute pharyngitis, or the complaint of a sore throat, is one of the most common illnesses for which both adult and pediatric patients seek medical care from primary care physicians. In the USA, acute pharyngitis accounts for 1-2% of all visits to outpatient departments, physician offices and emergency departments. There are multiple etiologic agents that can cause pharyngitis, and strategies for diagnosis and treatment should be directed at identifying those causes of pharyngitis that require antimicrobial therapy. In some cases, the decision as to which patients to treat with antibiotics remains difficult. This article reviews some of the various causes of pharyngitis and the available therapeutic options.
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Affiliation(s)
- Tina Q Tan
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60614, USA.
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Van Limbergen J, Kalima P, Taheri S, Beattie TF. Streptococcus A in paediatric accident and emergency: are rapid streptococcal tests and clinical examination of any help? Emerg Med J 2006; 23:32-4. [PMID: 16373800 PMCID: PMC2564123 DOI: 10.1136/emj.2004.022970] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Rapid streptococcal tests (RSTs) for streptococcal pharyngitis have made diagnosis at once simpler and more complicated. The American Academy of Pediatrics recommends that all RSTs be confirmed by a follow up throat culture unless local validation has proved the RST to be equally sensitive. AIMS To evaluate (a) RST as a single diagnostic tool, compared with RST with or without throat culture; (b) clinical diagnosis and the relative contribution of different symptoms. METHODS The study included 213 patients with clinical signs of pharyngitis. Throat swabs were analysed using Quickvue+ Strep A Test; negative RSTs were backed up by throat culture. Thirteen clinical features commonly associated with strep throat were analysed using backward stepwise logistic regression. RESULTS Positive results (RST or throat culture) were obtained in 33 patients; RST correctly identified 21. Eleven samples were false negative on RST. At a strep throat prevalence of 15.9%, sensitivity of RST was 65.6% (95% CI 46.8% to 81.4%) and specificity 99.4% (96.7% to 99.9%). Sensitivity of clinical diagnosis alone was 57% (34% to 78%) and specificity 71% (61% to 80%). Clinically, only history of sore throat, rash, and pyrexia contributed to the diagnosis of strep throat (p<0.05). CONCLUSION The high specificity of RST facilitates early diagnosis of strep throat. However, the low sensitivity of RST does not support its use as a single diagnostic tool. The sensitivity in the present study is markedly different from that reported by the manufacturer. Clinical examination is of limited value in the diagnosis of strep throat. It is important to audit the performance of new diagnostic tests, previously validated in different settings.
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Affiliation(s)
- J Van Limbergen
- Department of Paediatric Emergency Care, Royal Hospital for Sick Children, Edinburgh, UK.
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Jager D, Mintz ML. Pharyngitis. DISORDERS OF THE RESPIRATORY TRACT 2006. [PMCID: PMC7121935 DOI: 10.1007/978-1-59745-041-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Davignon L, Walter EA, Mueller KM, Barrozo CP, Stenger DA, Lin B. Use of resequencing oligonucleotide microarrays for identification of Streptococcus pyogenes and associated antibiotic resistance determinants. J Clin Microbiol 2005; 43:5690-5. [PMID: 16272506 PMCID: PMC1287778 DOI: 10.1128/jcm.43.11.5690-5695.2005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Group A streptococci (GAS) are responsible for a wide variety of human infections associated with considerable morbidity and mortality. Ever since the first systematic effort by Lancefield to group Streptococcus species by M protein variants, the detection and characterization of Streptococcus by different methods have been an evolving process. The ideal assay for GAS identification not only would provide quick and accurate diagnostic results but also would reveal antibiotic resistance patterns and genotype information, aiding not only in treatment but in epidemiologic assessment as well. The oligonucleotide microarray is a promising new technology which could potentially address this need. In this study, we evaluated the usefulness of oligonucleotide resequencing microarrays for identifying GAS and its associated antibiotic resistance markers. We demonstrated an assay platform that combines the use of resequencing DNA microarrays with either random nucleic acid amplification or multiplex PCR for GAS detection. When detecting Streptococcus pyogenes from coded clinical samples, this approach demonstrated an excellent concordance with a more established culture method. To this end, we showed the potential of resequencing microarrays for efficient and accurate detection of GAS and its associated antibiotic resistance markers with the benefit of sequencing information from microarray analysis.
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Affiliation(s)
- Louis Davignon
- Malcolm Grow Medical Center, Andrews Air Force Base, Maryland 20762, USA
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24
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Abstract
Acute pharyngitis is one of the most common illnesses for which children visit primary care physicians. Most cases of acute pharyngitis in children are caused by viruses and are benign and self-limited. Group A beta-hemolytic streptococcus is the most important of the bacterial causes of acute pharyngitis. Strategies for diagnosis and treatment of acute pharyngitis are directed at distinguishing children with viral pharyngitis, who would not benefit from antimicrobial therapy, from children with group A beta-hemolytic streptococcal pharyngitis, for whom antimicrobial therapy would be beneficial. Making this distinction is crucial in attempting to minimize the unnecessary use of antimicrobial agents in children.
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Affiliation(s)
- Michael A Gerber
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
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25
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Keitzer R. Akutes rheumatisches Fieber (ARF) und Poststreptokokken reaktive Arthritis (PSRA)—. Z Rheumatol 2005; 64:295-307. [PMID: 15965814 DOI: 10.1007/s00393-005-0749-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Accepted: 05/02/2005] [Indexed: 11/30/2022]
Abstract
Betahemolytic strains of streptococcus A are able to induce a spectrum of immunologically induced diseases, depending on the immunogenic M structure of the bacteria as well as on the genetic determined reaction of the host. In acute rheumatic fever (ARF) the Jones criteria, revised and modified several times and updated in 1992, remain the diagnostic standard. Echocardiography, still not included in the Jones criteria, has become a very important diagnostic tool, especially as half of the ARF induced carditis cases are clinically inapparent. Diagnosis may be very difficult if arthritis is the only major sign, especially if not occurring in the typical migrating pattern, a fact frequently reported from countries with a high risk of ARF. Poststreptococcal reactive arthritis (PSRA) has been described as a different entity as well as a part of rheumatic fever. There is a lack of validated diagnostic criteria to establish a reliable diagnosis. There are no accepted recommendations for antibiotic prophylaxis in PSRA.
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Affiliation(s)
- R Keitzer
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie und Immunologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin.
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26
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Liu D, Hollingshead S, Swiatlo E, Lawrence ML, Austin FW. Rapid identification of Streptococcus pyogenes with PCR primers from a putative transcriptional regulator gene. Res Microbiol 2005; 156:564-7. [PMID: 15862455 DOI: 10.1016/j.resmic.2005.01.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2004] [Revised: 10/12/2004] [Accepted: 01/06/2005] [Indexed: 11/27/2022]
Abstract
Streptococcus pyogenes (GAS) is a common bacterial pathogen that has emerged as an increasingly important health concern in many parts of the world. Although GAS may appear harmless in healthy individuals, the ability of this bacterium to take advantage of a weakened or compromised host defense system is extraordinary. Following the recent publication of the genome sequences of several S. pyogenes strains, we undertook an investigation of a specialized gene group in GAS that encodes transcriptional regulators. By screening S. pyogenes transcriptional regulator genes from the complete genome of M1 strain SF370 against other DNA sequences at GenBank by BLAST searches, we identified a gene (i.e., Spy1258) that is uniquely present in the bacterium. Application of PCR primers (spy1258F and spy1258R) derived from this gene facilitated amplification of a 407-bp DNA fragment from S. pyogenes only, but not from other species of the genus Streptococcus and common bacteria. Apart from offering an additional target for specific confirmation of GAS, further analysis of the putative transcriptional regulator gene Spy1258 and its related protein product may lead to new insights into the molecular mechanisms of S. pyogenes maintenance and pathogenicity.
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Affiliation(s)
- Dongyou Liu
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762, USA.
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27
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Edmonson MB, Farwell KR. Relationship between the clinical likelihood of group a streptococcal pharyngitis and the sensitivity of a rapid antigen-detection test in a pediatric practice. Pediatrics 2005; 115:280-5. [PMID: 15687433 DOI: 10.1542/peds.2004-0907] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The sensitivity of a rapid antigen-detection test (RADT) for group A streptococcal (GAS) pharyngitis is critical to whether the test is cost-effective and to whether a confirmatory throat culture is needed. We evaluated a second-generation RADT to determine if its sensitivity varies across the broad clinical spectrum of patients tested for GAS in pediatric outpatient practice. METHODS We used laboratory logbooks from a single pediatric clinic to identify 1184 consecutive patient visits at which an RADT was performed. In a blinded chart review, we calculated McIsaac scores to separately estimate the pretest clinical likelihood of GAS pharyngitis for visits at which the RADT result was positive (n = 384) and for visits at which the result proved to be false-negative (n = 65). Positive RADT results were assumed to be true positives, and test sensitivity was estimated by dividing the number of positive results by the sum of positives and false-negatives. RESULTS As the clinical likelihood of GAS increased, there were stepwise increases in RADT sensitivity (from 0.67 to 0.88). Sensitivity was low (0.73; 95% confidence interval [CI]: 0.62-0.86) in patients clinically unlikely to have GAS (McIsaac score < or =2) and high (0.94; 95% CI: 0.89-0.99) in patients <15 years old who had tonsillar exudate and no cough. False-negative RADT results were associated with lighter growth of GAS than found on specimens obtained from a random sample of clinic patients who had only primary throat cultures ordered. CONCLUSIONS For pediatric patients who are clinically unlikely to have GAS pharyngitis, as indicated by a McIsaac score < or =2, the sensitivity of a second-generation RADT may drop below thresholds reported for cost-effectiveness. For children who have tonsillar exudate and no cough, the test may be sensitive enough to meet current pediatric practice guidelines for stand-alone testing.
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Affiliation(s)
- M Bruce Edmonson
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin, USA.
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28
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Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev 2004; 17:571-80, table of contents. [PMID: 15258094 PMCID: PMC452552 DOI: 10.1128/cmr.17.3.571-580.2004] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although commercial rapid antigen detection tests (RADTs) are more expensive than blood agar plate (BAP) cultures, the advantage they offer is the speed with which they provide results. Rapid identification and consequent prompt treatment of patients with pharyngitis due to group A beta-hemolytic streptococci (GABHS) can reduce the risk of spread of GABHS, can allow patients to return to school or work sooner, and may reduce the acute morbidity of this illness. In most studies, RADTs have been compared with BAP cultures as the criterion standard. However, these comparisons are complicated by the fact that there is no universally accepted procedure for performing a BAP culture. The great majority of the RADTs that are currently available have a high specificity (i.e., 95% or greater) and a sensitivity of between 70 and 90% compared with BAP cultures. Few published studies have compared the performance of various RADTs to each other or examined the performance of various RADTs in the office setting. There is also relatively little published information about how physicians in practice actually use RADTs, but the available information suggests that many physicians do not follow recommended guidelines. While the development of easy-to-perform RADTs for the diagnosis of GABHS pharyngitis has altered clinical practice substantially, only limited data about cost-effectiveness are currently available.
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Affiliation(s)
- Michael A Gerber
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MC5019, Cincinnati, OH 45229-3039, USA.
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29
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Armengol CE, Schlager TA, Hendley JO. Sensitivity of a rapid antigen detection test for group A streptococci in a private pediatric office setting: answering the Red Book's request for validation. Pediatrics 2004; 113:924-6. [PMID: 15060248 DOI: 10.1542/peds.113.4.924] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In the office laboratory of our private practice, the sensitivity of a single rapid antigen detection (RAD) test for group A streptococci (compared with backup throat culture) was examined over 3 winter periods. When cultures were held only 24 hours, the sensitivity was 92%; in the second period, when cultures were held to 48 hours, the sensitivity declined significantly to 86%; when the cultures were read without knowledge of the RAD test result, the sensitivity was 85%. As the Red Book Committee has suggested, physician office laboratories should validate the sensitivity of their RAD test against culture onto blood agar before abandoning the backup throat culture.
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Affiliation(s)
- Carlos E Armengol
- Pediatric Associates of Charlottesville, Charlottesville, Virginia 22902, USA.
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30
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Gieseker KE, Roe MH, MacKenzie T, Todd JK. Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing. Pediatrics 2003; 111:e666-70. [PMID: 12777583 DOI: 10.1542/peds.111.6.e666] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The American Academy of Pediatrics recommends that all negative rapid diagnostic tests for Streptococcus pyogenes pharyngitis be backed up by culture, which creates a dilemma for clinicians who must make treatment decisions without complete diagnostic information at the time of visit. The use of a follow-up serial rapid antigen test instead of a follow-up culture would provide a more timely result. METHODS Two swabs were collected from children who were suspected of having S pyogenes pharyngitis. Each swab was used for a culture and an OSOM Ultra Strep A Test rapid antigen test. The gold standard of comparison was defined as the identification of S pyogenes on either of the 2 culture plates. Three diagnostic strategies were evaluated: a single rapid antigen test, a rapid antigen test with follow-up rapid antigen test (rapid-rapid), and a rapid antigen test with follow-up culture (rapid-culture). RESULTS A total of 210 (23.7%) of 887 throat cultures with matched data were identified with S pyogenes. A single rapid antigen test had a sensitivity of 87.6% (95% confidence interval [CI]: 83.2%-92.1%), the sensitivity of the rapid-rapid follow-up was 91.4% (95% CI: 87.6%-95.2%), and the sensitivity of the rapid-culture follow-up was 95.7% (95% CI: 93.0%-98.5%), which was significantly higher than the others. As shown in Fig 1, when these test strategies were evaluated on a subgroup with clinical symptoms commonly associated with S pyogenes pharyngitis, the sensitivities all increased and were no longer significantly different. None of the strategies reliably exceeded a 95% sensitivity threshold. CONCLUSIONS The American Academy of Pediatrics strategy for S pyogenes detection in children with pharyngitis, requiring a backup culture for those with negative antigen tests, was not exceeded by any other test strategy; however, a rapid-rapid diagnostic strategy may approximate it with the use of judicious clinical selection of patients.
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Affiliation(s)
- Karen E Gieseker
- Department of Epidemiology, University of Colorado Health Sciences Center, Denver, Colorado, USA
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