Comparação entre métodos clínicos e laboratoriais no diagnóstico das faringotonsilites estreptocócicas

Abstract

Objectives: Diagnosis and correct treatment of group A streptococcal sore throat is important particularly to prevent non-suppurative sequelae. Clinical findings continue to be used to differentiate streptococcal infection from viral sore throat. The American Academy of Pediatrics recommends that streptococcal sore throat diagnosis should always be performed by microbiological identification methods. The aim of this study is to evaluate the accuracy of clinical diagnosis in comparison with culture and rapid test.Methods: Children aged 2 to 13 years who had received a clinical diagnosis of sore throat and sought treatment at the pediatric emergency unit of São Paulo Santa Casa were evaluated and those with clinical signs or viral infection were excluded. Clinical findings were recorded and swabs were taken for group A Streptococcus cultures and a Streptococcus rapid test. Results:The culture was positive in 96 (24.4%) of the 376 children evaluated. The presence of petechiae, purulent exudate and painful tonsils were more likely to occur in children with positive streptococcus cultures, however they exhibited low diagnostic accuracy. The doctors subjective evaluation failed to identify 21% of positive cases and antibiotics were prescribed in 47% of negative cases, compared with 3 and 6%, respectively, for the rapid test.Conclusions: A microbiologic method is necessary for the correct prescription of antibiotics in children with streptococcal sore throat.

Recomendação do Departamento de Infectologia da Sociedade Brasileira de Pediatria para conduta de crianças e adolescentes com faringoamigdalites agudas

“…This regimen is advantageous because of the convenient posology. 7 For patients who are allergic to penicillin, but without immediate hypersensitivity, the first generation cephalosporins erythromycin and clindamycin are treatment options, however, cephalosporins are contraindicated for allergic patients with immediate hypersensitivity. 8 Erythromycin can be used, specifically for the treatment of streptococcal AP in children, at doses of 40 mg/kg/day in two parts at 12 hour intervals.…”

“…The international code for the classification of diseases recognizes these two nosological entities. 6 Nasopharyngitis was excluded from the acute pharyngitis study published in the Jornal de Pediatria, 7 and I have did the same in the editorial. 2 In the letter above, in the article by Bisno et al, 3 in common with others, 8 acute pharyngitis is not defined, however, it is clear from the text that the denomination includes nasopharyngitis.…”

Management of patients with acute pharyngitis

“…4 A abrangência da investigação etiológica depende de objetivos a serem alcançados frente aos recursos técni-cos e financeiros disponíveis. Deve ser observado que 20% das crianças com faringite estreptocócica (5% do total de casos de faringite aguda) têm clínica pouco exuberante e potencial de complicações tardias [1][2][3][4] . De fato, uma parcela dos casos de doença reumática não registra antecedente de faringite importante 5 .…”

“…Isso também foi observado no estudo da Santa Casa de Misericórdia de São Paulo, onde os pediatras prescreveram 55% de antibióticos para um grupo de crianças com Outros aspectos relativos ao diagnóstico e à conduta frente a uma criança com faringite aguda Quem é trazido ao pediatra é um paciente com febre, como se verifica no perfil clínico descrito pelos autores 1 . A febre estava presente em 93% dos casos e indicava, em cada um, a natureza da doença aguda, mas não o(s) foco(s).…”

“…Na verdade, há um paciente com faringite, e não uma faringite. Estudos americanos mostram que, após a realização de teste faríngeo com resultado negativo, apenas metade dos médicos suspende o antibió-tico em utilização 1 . Isso pode ser visto como um erro de conduta, mas também como uma precaução frente à suspeita de infecção bacteriana não-estreptocócica da via aérea adjacente ou da corrente sangüínea.…”