Efficacy of Rapid Antigen Test and McIsaac / Modified Centor Scores for Diagnosis of Streptococcal Tonsillopharyngitis in Children
Öz
Objective: We aimed to determine the efficacy of rapid antigen tests, clinical signs, and McIsaac / modified Centor clinical scoring systems in the diagnosis of Group A streptococcus (GAS) at children.
Materials and Methods: Subjects aged 3-14 years who presented with acute tonsillopharyngitis were questioned about their sociodemographic properties and symptoms. Their clinical signs and McIsaac / modified Centor scores were recorded. They underwent a rapid streptococcal antigen test and throat culture sampling.
Results: GAS proliferated in culture %11 of cases. The risk of culture positivity was 4.8 times greater in children aged 6 years or older. There was a significant correlation between culture positivity and muscle pain, tonsillar edema. Rapid strep test had a sensitivity of 75% and a specifity of 100% for the diagnosis of streptococcal tonsillopharyngitis. Rapid strep test showed a sensitivity of 80% and a specifity of 100% in children with a McIsaac / modified Centor score of 4-5.
Conclusions: Unnecessary antibiotic use for tonsillopharyngitis is an important problem. Therefore, it is ideal to order throat culture and act accordingly in every case suggesting GAS infection. However, when culture is not possible, rapid strep testing and McIsaac / modified Centor scoring are effective in guiding diagnosis and treatment.
Anahtar Kelimeler
Kaynakça
- Bisno AL. Acute pharyngitis. N Engl J Med. 2001;344(3):205-211.
- Regoli M, Chiappini E, Bonsignori F, Galli L, Martino de M. Update on the management of acute pharyngitis in children. Ital J Pediatr. 2011;37(1):10.
- Weber R. Pharyngitis. Prim Care Clin Office Pract. 2014;41(1):91-98.
- Ralph PA, Carapetis JR. Group A streptococcal diseases and their global burden. Curr Top Microbiol Immunol. 2013;368:1-27.
- Güler M, Laloğlu F, Olgun H, Ceviz N. Clinical characteristics of pediatric patients with first-attack acute rheumatic fever following the updated guideline. Turk Pediatri Ars. 2019;54(4):220-224.
- Narin N, Mutlu F, Argun M ve ark. Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998-2011.Cardiol Young. 2015;(4):745-751.
- Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239-246.
- McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with a sore throat. CMAJ. 1998;158(1):75-83.
- Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009;79(5):382-390.
- Anjos LM, Marcondes MB, Lima MF, Mandelli AL, Okoshi MP. Streptococcal acute pharyngitis. Rev Soc Bras Med Trop. 2014;47(4):409-413.
- Kalra MG, Higgins KE, Perez ED. Common questions about streptococcal pharyngitis. Am Fam Physician. 2016;94(1):24-31.
- Smeesters PR, Campos DJR, Melderen LV, Aguiar E, Vanderpas J, Vergison A. Pharyngitis in low-resources settings: A pragmatic clinical approach to reduce unnecessary antibiotic use. Pediatrics. 2006;118(6):1607-1611.
- Topyaka E, Yıldırım T, Arsan S. Isolation ratio, and T-serotyping group A streptococci from pediatric upper respiratory tract infections in Turkey. Anatol J Cardiol. 2005;5(4):302-304.
- Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126(3):557-564.
- Little P, Hobbs FD, Mant D, McNulty CA, Mullee M. Incidence, and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study. Br J Gen Pract. 2012;62 (604):787-794.
- Bhalla K, Bhardwaj P, Gupta A, Mehra S, Nehra D, Nanda S. Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice. J Family Med Prim Care. 2019;8(10):3130-3135.
- Attia M, Zaoutis T, Eppes S, Klein J, Meier F. Multivariate predictive models for group A beta-hemolytic streptococcal pharyngitis in children. Acad Emerg Med. 1999;6(1):8-13.
- Tesfaw G, Kibru G, Mekonnen D, Abdissa A. Prevalence of group A β-hemolytic streptococcus among children with pharyngitis in Jimma town, Southwest Ethiopia. Egyptian Journal of Ear, Nose, Throat, and Allied Sciences. 2015;16(1):35-40.
- Júnior ARB, Oliveira CDL, Fontes MJF, Lasmar LMLBF, Camargos PAM. Diagnosis of streptococcal pharyngotonsillitis in children and adolescents: clinical picture limitations. Rev Paul Pediatr. 2014;32(4):285-291.
- Cohen JF, Bertille N, Cohen R, Chalumeau M. Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database of Systematic Reviews. 2016. doi: 10.1002/14651858.CD010502.pub2
- Fine AM, Nizet V, Mandi KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med. 2012;172(11):847-852.
- Saddik, IAB, Munibari AA, Alhilali AM ve ark. Prevalence of group A beta-hemolytic streptococcus isolated from children with acute pharyngotonsillitis in Aden, Yemen. Trop Med Int Health. 2014;19(4):431-439.
- Cohen JF, Chalumeau M, Levy C ve ark. Spectrum and inoculum size effect of a rapid antigen detection test for group A streptococcus in children with pharyngitis. PLoS One. 2012;7(6):39085
Çocuklarda Streptokoksik Tonsillofarenjit Tanısında Hızlı Antijen Testi ile McIsaac / Modifiye Centor Skorlamalarının Etkinliği
Öz
Amaç: Bu çalışmada çocuklarda grup A streptokok (GAS) infeksiyonlarını saptamada hızlı antijen testi, klinik bulgular ile McIsaac / modifiye Centor klinik skorlamalarının etkinliğinin saptanması amaçlandı.
Materyal ve Metot: Çalışmada akut tonsillofarenjitle başvuran 3-14 yaş arası olgular sosyodemografik ve semptomlar yönünden sorgulandı. Klinik bulguları ve McIsaac / modifiye Centor skorlamaları kaydedildi. Olguların tümüne hızlı streptokok antijen testi uygulandı ve boğaz kültürü çalışıldı.
Bulgular: Olguların % 11 inde GAS kültürde üredi. Altı yaş ve üzeri çocuklarda kültür pozitifliği riski 4.8 kat daha fazla saptandı. Kas ağrısı ve tonsiller ödem ile kültür pozitifliği arasında istatiksel anlamlı ilişki mevcuttu Hızlı antijen testi streptokok tonsillofarenjiti tanısında %75 duyarlılığa, %100 özgüllüğe sahip olarak bulundu. McIsaac / modifiye Centor skoru 4-5 olan çocuklarda hızlı antijen testi streptokok tonsillofarenjiti tanısında %80 duyarlılık, %100 özgüllük gösterdi.
Sonuç: Akut tonsillofarenjitte gereksiz antibiyotik kullanımı önemli bir sorundur. Bu nedenle GAS infeksiyonunu düşündüren her olguda boğaz kültürünün istenmesi ve ona göre hareket edilmesi ideal olandır. Ancak kültürün yapılamadığı durumlarda tanı ve tedaviyi yönlendirmede hızlı strep testi ve McIsaac / modifiye Centor skorlaması etkilidir.
Anahtar Kelimeler
Kaynakça
- Bisno AL. Acute pharyngitis. N Engl J Med. 2001;344(3):205-211.
- Regoli M, Chiappini E, Bonsignori F, Galli L, Martino de M. Update on the management of acute pharyngitis in children. Ital J Pediatr. 2011;37(1):10.
- Weber R. Pharyngitis. Prim Care Clin Office Pract. 2014;41(1):91-98.
- Ralph PA, Carapetis JR. Group A streptococcal diseases and their global burden. Curr Top Microbiol Immunol. 2013;368:1-27.
- Güler M, Laloğlu F, Olgun H, Ceviz N. Clinical characteristics of pediatric patients with first-attack acute rheumatic fever following the updated guideline. Turk Pediatri Ars. 2019;54(4):220-224.
- Narin N, Mutlu F, Argun M ve ark. Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998-2011.Cardiol Young. 2015;(4):745-751.
- Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239-246.
- McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with a sore throat. CMAJ. 1998;158(1):75-83.
- Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician. 2009;79(5):382-390.
- Anjos LM, Marcondes MB, Lima MF, Mandelli AL, Okoshi MP. Streptococcal acute pharyngitis. Rev Soc Bras Med Trop. 2014;47(4):409-413.
- Kalra MG, Higgins KE, Perez ED. Common questions about streptococcal pharyngitis. Am Fam Physician. 2016;94(1):24-31.
- Smeesters PR, Campos DJR, Melderen LV, Aguiar E, Vanderpas J, Vergison A. Pharyngitis in low-resources settings: A pragmatic clinical approach to reduce unnecessary antibiotic use. Pediatrics. 2006;118(6):1607-1611.
- Topyaka E, Yıldırım T, Arsan S. Isolation ratio, and T-serotyping group A streptococci from pediatric upper respiratory tract infections in Turkey. Anatol J Cardiol. 2005;5(4):302-304.
- Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126(3):557-564.
- Little P, Hobbs FD, Mant D, McNulty CA, Mullee M. Incidence, and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study. Br J Gen Pract. 2012;62 (604):787-794.
- Bhalla K, Bhardwaj P, Gupta A, Mehra S, Nehra D, Nanda S. Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice. J Family Med Prim Care. 2019;8(10):3130-3135.
- Attia M, Zaoutis T, Eppes S, Klein J, Meier F. Multivariate predictive models for group A beta-hemolytic streptococcal pharyngitis in children. Acad Emerg Med. 1999;6(1):8-13.
- Tesfaw G, Kibru G, Mekonnen D, Abdissa A. Prevalence of group A β-hemolytic streptococcus among children with pharyngitis in Jimma town, Southwest Ethiopia. Egyptian Journal of Ear, Nose, Throat, and Allied Sciences. 2015;16(1):35-40.
- Júnior ARB, Oliveira CDL, Fontes MJF, Lasmar LMLBF, Camargos PAM. Diagnosis of streptococcal pharyngotonsillitis in children and adolescents: clinical picture limitations. Rev Paul Pediatr. 2014;32(4):285-291.
- Cohen JF, Bertille N, Cohen R, Chalumeau M. Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database of Systematic Reviews. 2016. doi: 10.1002/14651858.CD010502.pub2
- Fine AM, Nizet V, Mandi KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med. 2012;172(11):847-852.
- Saddik, IAB, Munibari AA, Alhilali AM ve ark. Prevalence of group A beta-hemolytic streptococcus isolated from children with acute pharyngotonsillitis in Aden, Yemen. Trop Med Int Health. 2014;19(4):431-439.
- Cohen JF, Chalumeau M, Levy C ve ark. Spectrum and inoculum size effect of a rapid antigen detection test for group A streptococcus in children with pharyngitis. PLoS One. 2012;7(6):39085
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Aralık 2020 |
| Gönderilme Tarihi | 13 Temmuz 2020 |
| Kabul Tarihi | 20 Ekim 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 5 Sayı: 4 |
