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J Pediatr Infect Dis 2016; 11(04): 126-130
DOI: 10.1055/s-0036-1597697
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Use of Streptococcal Tonsillopharyngitis Diagnostic Tests in Children

Raziye Dut
1   Department of Pediatric, Süleymaniye Gynecologic-Obstetrics and Children Training and Research Hospital, Zeytinburnu, İstanbul
,
Sesin Kocagöz
2   Division of Infectious Diseases, Acıbadem University, İstanbul
› Author Affiliations
Further Information

Publication History

18 September 2016

29 November 2016

Publication Date:
29 December 2016 (online)

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Abstract

Objectives Group A β hemolytic streptococcus (GABHS) is the main bacterial case of tonsillopharyngitis in children, but most cases of tonsillopharyngitis are viral. Rapid diagnosis and early antibiotherapy of GABHS infections are important to help prevent suppurative and nonsuppurative complications. This retrospective study investigated the using of the rapid streptococcal antigen detection test and traditional throat culture in diagnosing tonsillopharyngitis in children.

Materials and Methods Retrospectively, the laboratory results of throat culture and rapid strep A test (optic immunoassay) of 1,654 children were compared.

Results Of the 1,654 subjects, the rapid test was performed in 1,110 (67.1%), and throat culture was performed in 930 (56.2%). Both tests were performed in 479 (31.1%) patients and the correlation between the tests was 87.2%. The power of the correlation between the two tests was 0.6 (p < 0.001). The sensitivity of the rapid strep test was 50.0%. Its specificity was 97.6%. It had a positive predictive value of 85.2% and a negative predictive value of 87.6%.

Conclusion The rapid strep A testing is more practical and quick to detect GABHS. This can be an important strategy to reduce unnecessary antibiotic use. Throat culture should be used to confirm the negative findings of the rapid test.

Keywords

β hemolytic - children - test
 

  • References

  • 1 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 (4) 924-926
    CrossrefPubMedGoogle Scholar
  • 2 Morais S, Teles A, Ramalheira E, Roseta J. [Streptococcal pharyngitis: clinical suspicion versus diagnosis]. Acta Med Port 2009; 22 (6) 773-778
    PubMedGoogle Scholar
  • 3 Al-Najjar FY, Uduman SA. Clinical utility of a new rapid test for the detection of group A streptococcus and discriminate use of antibiotics for bacterial pharyngitis in an outpatient setting. Int J Infect Dis 2008; 12 (3) 308-311
    CrossrefPubMedGoogle Scholar
  • 4 Ayanruoh S, Waseem M, Quee F, Humphrey A, Reynolds T. Impact of rapid streptococcal test on antibiotic use in a pediatric emergency department. Pediatr Emerg Care 2009; 25 (11) 748-750
    CrossrefPubMedGoogle Scholar
  • 5 Linder JA, Bates DW, Lee GM, Finkelstein JA. Antibiotic treatment of children with sore throat. JAMA 2005; 294 (18) 2315-2322
    CrossrefPubMedGoogle Scholar
  • 6 Martin JM, Green M, Barbadora KA, Wald ER. Group A streptococci among school-aged children: clinical characteristics and the carrier state. Pediatrics 2004; 114 (5) 1212-1219
    CrossrefPubMedGoogle Scholar
  • 7 Pichichero ME. Group A streptococcal tonsillopharyngitis: cost-effective diagnosis and treatment. Ann Emerg Med 1995; 25 (3) 390-403
    CrossrefPubMedGoogle Scholar
  • 8 Leung AK, Kellner JD. Group A beta-hemolytic streptococcal pharyngitis in children. Adv Ther 2004; 21 (5) 277-287
    CrossrefPubMedGoogle Scholar
  • 9 Schroeder BM. Diagnosis and management of group A streptococcal pharyngitis. Am Fam Physician 2003; 67 (4) 880 , 883–884
    PubMedGoogle Scholar
  • 10 Gerber MA. Treatment failures and carriers: perception or problems?. Pediatr Infect Dis J 1994; 13 (6) 576-579
    CrossrefPubMedGoogle Scholar
  • 11 Pichichero ME, Marsocci SM, Murphy ML, Hoeger W, Green JL, Sorrento A. Incidence of streptococcal carriers in private pediatric practice. Arch Pediatr Adolesc Med 1999; 153 (6) 624-628
    CrossrefPubMedGoogle Scholar
  • 12 Sarrell EM, Giveon SM. Streptococcal pharyngitis: a prospective study of compliance and complications. ISRN Pediatr 2012; 2012: 796389
    PubMedGoogle Scholar
  • 13 Cardoso DM, Gilio AE, Hsin SH , et al. Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a pediatric emergency room. Rev Paul Pediatr 2013; 31 (1) 4-9
    CrossrefPubMedGoogle Scholar
  • 14 Lin MH, Fong WK, Chang PF, Yen CW, Hung KL, Lin SJ. Predictive value of clinical features in differentiating group A beta-hemolytic streptococcal pharyngitis in children. J Microbiol Immunol Infect 2003; 36 (1) 21-25
    PubMedGoogle Scholar
  • 15 Robertson KA, Volmink JA, Mayosi BM. Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovasc Disord 2005; 5 (1) 11
    CrossrefPubMedGoogle Scholar
  • 16 Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev 2006; (4) CD000023
    PubMedGoogle Scholar
  • 17 Macknin M, Hall G, Rutherford I, Imrie R, Shapiro D. Three simultaneously obtained throat cultures for beta-hemolytic group A streptococcus. Pediatr Infect Dis J 1987; 6 (6) 575-576
    CrossrefPubMedGoogle Scholar
  • 18 Gerber MA, Tanz RR, Kabat W , et al. Optical immunoassay test for group A beta-hemolytic streptococcal pharyngitis. An office-based, multicenter investigation. JAMA 1997; 277 (11) 899-903
    CrossrefPubMedGoogle Scholar
  • 19 Bisno AL, Gerber MA, Gwaltney Jr JM, Kaplan EL, Schwartz RH ; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis 2002; 35 (2) 113-125
    CrossrefPubMedGoogle Scholar
  • 20 Gerber MA. Diagnosis of group A streptococcal pharyngitis. Pediatr Ann 1998; 27 (5) 269-273
    CrossrefPubMedGoogle Scholar
  • 21 Corneli HM. Rapid detection and diagnosis of group A streptococcal pharyngitis. Curr Infect Dis Rep 2004; 6 (3) 181-186
    CrossrefPubMedGoogle Scholar
  • 22 Ehrlich JE, Demopoulos BP, Daniel Jr KR, Ricarte MC, Glied S. Cost-effectiveness of treatment options for prevention of rheumatic heart disease from group A streptococcal pharyngitis in a pediatric population. Prev Med 2002; 35 (3) 250-257
    CrossrefPubMedGoogle Scholar
  • 23 Araujo Filho BC, Imamura R, Sennes LU, Sakae FA. Role of rapid antigen detection test for the diagnosis of group-A β-hemolytic streptococcus in patients with pharyngotonsillitis. Rev Bras Otorrinolaringol (Engl Ed) 2006; 72 (1) 12-15
    CrossrefPubMedGoogle Scholar
  • 24 Mayes T, Pichichero ME. Are follow-up throat cultures necessary when rapid antigen detection tests are negative for group A streptococci?. Clin Pediatr (Phila) 2001; 40 (4) 191-195
    CrossrefPubMedGoogle Scholar
  • 25 Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev 2004; 17 (3) 571-580
    CrossrefPubMedGoogle Scholar
  • 26 Camurdan AD, Camurdan OM, Ok I, Sahin F, Ilhan MN, Beyazova U. Diagnostic value of rapid antigen detection test for streptococcal pharyngitis in a pediatric population. Int J Pediatr Otorhinolaryngol 2008; 72 (8) 1203-1206
    CrossrefPubMedGoogle Scholar
  • 27 Araujo Filho BC, Imamura R, Sennes LU, Sakae FA. Role of rapid antigen detection test for the diagnosis of group A beta-hemolytic streptococcus in patients with pharyngotonsillitis. Rev Bras Otorrinolaringol (Engl Ed) 2005; 71 (2) 168-171
    CrossrefPubMedGoogle Scholar
  • 28 Brook I. Antibacterial therapy for acute group a streptococcal pharyngotonsillitis: short-course versus traditional 10-day oral regimens. Paediatr Drugs 2002; 4 (11) 747-754
    CrossrefPubMedGoogle Scholar
  • 29 Darrow DH, Siemens C. Indications for tonsillectomy and adenoidectomy. Laryngoscope 2002; 112 (8 Pt 2, suppl 100): 6-10
    PubMedGoogle Scholar
  • 30 Gurol Y, Akan H, Izbirak G , et al. The sensitivity and the specifity of rapid antigen test in streptococcal upper respiratory tract infections. Int J Pediatr Otorhinolaryngol 2010; 74 (6) 591-593
    CrossrefPubMedGoogle Scholar
  • 31 Küçük O, Biçer S, Giray T , et al. Validity of rapid antigen detection testing in group A beta-hemolytic streptococcal tonsillopharyngitis. Indian J Pediatr 2014; 81 (2) 138-142
    PubMedGoogle Scholar
  • 32 Gonzales R, Bartlett JG, Besser RE , et al; Centers for Disease Control and Prevention. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Emerg Med 2001; 37 (6) 720-727
    CrossrefPubMedGoogle Scholar
  • 33 American Academy of Pediatrics. Committee on Infectious Diseases. Red Book for PDA. Elk Grove Village, IL: American Academy of Pediatrics; 2003
    Google Scholar
  • 34 Pelucchi C, Grigoryan L, Galeone C , et al; ESCMID Sore Throat Guideline Group. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012; ;(18, suppl 1): 1-28
    PubMedGoogle Scholar
  • 35 Maltezou HC, Tsagris V, Antoniadou A , et al. Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription. J Antimicrob Chemother 2008; 62 (6) 1407-1412
    CrossrefPubMedGoogle Scholar
  • 36 Attia MW, Zaoutis T, Klein JD, Meier FA. Performance of a predictive model for streptococcal pharyngitis in children. Arch Pediatr Adolesc Med 2001; 155 (6) 687-691
    CrossrefPubMedGoogle Scholar
  • 37 Nawaz H, Smith DS, Mazhari R, Katz DL. Concordance of clinical findings and clinical judgment in the diagnosis of streptococcal pharyngitis. Acad Emerg Med 2000; 7 (10) 1104-1109
    CrossrefPubMedGoogle Scholar
  • 38 McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004; 291 (13) 1587-1595
    Google Scholar
  • 39 Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M. Update on the management of acute pharyngitis in children. Ital J Pediatr 2011; 37: 10
    Google Scholar
  • 40 Roggen I, van Berlaer G, Gordts F, Pierard D, Hubloue I. Centor criteria in children in a paediatric emergency department: for what it is worth. BMJ Open 2013; 3 (4) e002712
    CrossrefPubMedGoogle Scholar
  • 41 Anjos LM, Marcondes MB, Lima MF, Mondelli AL, Okoshi MP. Streptococcal acute pharyngitis. Rev Soc Bras Med Trop 2014; 47 (4) 409-413
    CrossrefPubMedGoogle Scholar
  • 42 Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics 2009; 123 (2) 437-444
    CrossrefPubMedGoogle Scholar