A Study to Determine if Addition of Palatal Petechiae to Centor Criteria Adds More Significance to Clinical Diagnosis of Acute Strep Pharyngitis in Children

Abstract

Objective. A study to determine if addition of palatal petechiae to Centor criteria adds more value for clinical diagnosis of acute strep pharyngitis in children. Hypothesis. In children, Centor Criteria does not cover all the symptoms and signs of acute strep pharyngitis. We hypothesize that addition of palatal petechiae to Centor Criteria will increase the possibility of clinical diagnosis of group A streptococcal pharyngitis in children. Methods. One hundred patients with a complaint of sore throat were enrolled in the study. All the patients were examined clinically using the Centor Criteria. They were also examined for other signs and symptoms like petechial lesions over the palate, abdominal pain, and skin rash. All the patients were given rapid strep tests, and throat cultures were sent. No antibiotics were given until culture results were obtained. Results. The sample size was 100 patients. All 100 had fever, sore throat, and erythema of tonsils. Twenty of the 100 patients had tonsillar exudates, 85/100 had tender anterior cervical lymph nodes, and 86/100 had no cough. In total, 9 out of the 100 patients had positive throat cultures. We observed that petechiae over the palate, a very significant sign, is not included in the Centor Criteria. Palatal petechiae were present in 8 out of the 100 patients. Six out of these 8 with palatal petechiae had positive throat culture for strep (75%). Only 7 out of 20 with exudates had positive strep culture. Sixteen out of the 100 patients had rapid strep test positive. Those 84/100 who had negative rapid strep also had negative throat culture. Statistics. We used Fisher’s exact test, comparing throat culture positive and negative versus presence of exudates and palatal hemorrhages with positive and negative throat cultures and the resultant P value <.0001. Conclusion. Our study concludes that addition of petechiae over the palate to Centor Criteria will increase the possibility of diagnosing acute group A streptococcal pharyngitis in children.

Nasopharyngeal Isolates from a Cohort of Medical Students with or without Pharyngitis

“…These findings confirm observations from previous reports and suggests that the specificity and sensitivity of this cut-off score for S. pyogenes pharyngitis may be much lower in other populations. 16 , 24 , 25 Moreover, this measure may give false-positive results with pathogens other than S. pyogenes . Therefore, the authors propose that the Centor cut-off score should not be relied upon to initiate penicillin therapy in the Emirati population, although further studies are necessary to confirm these findings.…”

In pediatric patients, what role does palatal petechiae have in the diagnosis of GAS pharyngitis?

“…A 2016 prospective, nonrandomized observational study (n5100) evaluated whether the addition of palatal petechiae to the Centor criteria improved accuracy of clinical diagnosis of acute strep pharyngitis in children and adolescents 4 to 17 years old. 2 All patients presented with complaints of sore throat and were examined clinically using the Centor criteria (fever, anterior cervical lymphadenopathy, tonsillar exudate, and absence of cough) as well as the presence of palatal petechiae, abdominal pain, and rash. Those who tested positive with a rapid strep test confirmed with throat culture were compared with those without positive laboratory tests.…”

“…A newer but much smaller 2012 retrospective case series of 108 infertile couples in Canada measured the effectiveness of natural procreative technology by tracking live birth rates. 2 Women included had a mean age of 35 years old and a prior mean time of attempted conception of 3.2 years before enrollment. ART had previously been used for some couples including 22% who received previous intrauterine insemination and 8% who received previous in vitro fertilization.…”

Evaluation of Symptoms and Findings in Children with Tonsillopharyngitis Reflecting The Presence of Beta Hemolytic Streptococcal Infection

“…Hastaların %20 sinde BHS enfeksiyonu tanısı konuldu. Bu oranın yüksek olduğu düşünülmekle birlikte Belçikada Roggen ve arkadaşları tarafından yapılan benzer yaş grubunu içeren bir çalışmada BHS sıklığı %32, Nibhanipudi ve arkadaşlarının çalışmasında da bu oran %9 olarak belirlenmiştir 9,10 . Ülkemizden yapılan çalışmalarda ise boğaz kültüründe BHS üreme sıklığı %18,50 ve % 25,73 olarak bildirilmiştir 11,12 .…”

“…Birçok çalışmada belirti ve bulguların bakteriyel tanıyı tahminde yeterli olup olmadığı üzerinde durulmuş skorlamalar geliştirilmiş ancak net bir sonuç elde edilememiştir [6][7][8][9][10] . Bu çalışma öykü ve fizik muayenedeki son dönemdeki bulgularının bakteriyel tanıyı belirlemedeki değerlerinin belirlenmesi ve bu sayede birinci basamak sağlık hizmeti veren ünitelerde boğaz kültürünün yapılamaması durumunda antibiyotik tedavisi gerektirecek hastanın tespit edilerek tedaviye gecikmeden başlanmasına katkıda bulunmak amacıyla yapıldı.…”