The accuracy of diagnosis of beta streptococcal infections on clinical grounds

Breese, Burtis B.; Disney, Frank A.

doi:10.1016/s0022-3476(54)80008-4

Cited by 172 publications

(41 citation statements)

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“…This meant that the majority of patients with pharyngitis would have been given antibiotics unnecessarily while almost half of the patients with GAS pharyngitis would have been denied antibiotic treatment and left with the possibility of developing its non-suppurative sequelae. Similar findings were also reported in other studies (Breese & Disney, 1954;Kaplan, 1980;McCracken, 1982;Stollerman, 1975;Wannmaker, 1958). The SADST would help diagnosis since it is easy to perform and suitable for use in primary care clinics, physicians' offices and clinical laboratories.…”

Section: Discussionsupporting

confidence: 92%

“…Clinically, it is difficult to differentiate GAS from other aetiologies of pharyngitis (Breese & Disney, 1954;Kaplan, 1980;McCracken, 1982;Stollerman, 1975;Wannamaker, 1958). A previous study from the same primary-care clinic reported a high false-positive (76 %) and false-negative (46 %) diagnosis of GAS pharyngitis based on clinical findings alone (El-Batish, Mark & Majeed, 1985).…”

Section: Discussionmentioning

confidence: 99%

“…The clinical diagnosis of GAS pharyngitis and its differentiation from other etiologies is difficult and unreliable (Breese & Disney, 1954; El-Batish, Mark & Majeed, 1985; Kaplan, 1980;McCracken, 1982). Therefore, throat swabs have been performed on patients with pharyngitis to confirm or exclude the presence of GAS by different methods.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a two-minute strep A direct swab test (SADST) on patients with pharyngitis at a primary care clinic

Araj

Majeed

1986

J. Hyg.

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SUMMARYA two-minute strep A direct swab test (SADST) was used to detect the presence of Lancefield group A streptococci (GAS) from the throats of 207 patients with pharyngitis at a primary-care clinic. The results were compared with a standard culture method. Fifty-one specimens were positive and 156 specimens were negative for GAS by culture. The SADST had a sensitivity of 96 % (49 of 51) and specificity of 98-7 % (154 of 156). The predictive values of a positive and negative SADST, for GAS, were 96 % and 98-7 % respectively. The SADST showed negative reactions with five specimens containing beta-haemolytic streptococci other than GAS and 34 known stock cultures other than GAS. Our results indicate that SADST is a rapid, simple, convenient and reliable test to use for diagnosis of GAS pharyngitis at primary care clinics, physicians' offices and clinical laboratories.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Evaluation of a two-minute strep A direct swab test (SADST) on patients with pharyngitis at a primary care clinic

Araj

Majeed

1986

J. Hyg.

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“…Figure III shows past history of symptoms in carriers of GAS. The antibiotic sensitivity pattern of the isolates is indicated in [18][19][20][21][22][23][24][25][26] According to seasonal distribution, maximum number of cases were noted in the months of November (12), December (14) and January (10) contributing to 19.7%, 23% and 16.4% respectively. The samples were not collected during the months of April and May when the children had vacation.…”

Section: Resultsmentioning

confidence: 99%

4. Pharyngeal carriage of Group A streptococci among school children

Mukundan¹,

Vijayakumar²

2017

JIMD

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Abstract:Objectives: The aims of the study were to determine the pharyngeal carriage rate of Group A streptococci among school children at Thrissur, Kerala and to determine the antibiotic sensitivity pattern of the above isolates. Materials and methods: Throat swabs were collected from a total of 260 asymptomatic children(130 each from rural and urban areas) of eighth and ninth standard classes during a period between July 2012 and July 2013. Presumptively identified Group A Streptococci (GAS/Streptococcus pyogenes) were serogrouped by agglutination tests using specific antisera. Antibiotic sensitivity was performed by disc diffusion method following CLSI guidelines. Results: The GAS carriage rate noted in the study was 23.1%. Carriage distribution was found to be independent of age, sex and locality with more number of cases during winter season. All the isolates were found to be sensitive to Penicillin and Vancomycin. Five isolates each were found to be resistant to Erythromycin and Clindamycin respectively. Inducible Clindamycin resistance was demonstrated in three of them. GAS was isolated from the throat swab of one child with past history of joint pains and another child with past history of skin infection-both of them presently had findings of heart disease. Conclusion: When screened and appropriately treated with antibiotics, carriers can be prevented from spreading streptococcal infections in the school environment and the community. Combined efforts by clinicians, community health personnel and clinical microbiologists are required for the early detection and control of streptococcal infections. .

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“…Generally, clinicians tend to overdiagnose this condition. 7 Since the early 1950s, the common approach to suspected GABHS pharyngi-tis is to obtain a throat culture 8,9 and more recently, rapid antigen test 8 if available. Laboratory diagnosis of GABHS has many limitations.…”

mentioning

confidence: 99%

Multivariate Predictive Models for Group A Beta‐hemolytic Streptococcal Pharyngitis in Children

Attia

Zaoutis

Eppes

et al. 1999

Academic Emergency Medicine

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Abstract. Objectives:To create predictive models for the clinical diagnosis of group A beta-hemolytic streptococcal (GABHS) pharyngitis in children. Methods: Patients aged 6 months to 18 years presenting to a pediatric ED with suspected GABHS pharyngitis were prospectively enrolled in the study. Clinicians recorded pertinent clinical information using a standardized form and obtained a throat swab to culture GABHS using a reference standard method. Twelve demographic and clinical features of patients with positive throat cultures were compared with the features of patients with negative throat cultures. Significantly different features were entered in a stepwise logistic regression analysis to create predictive models for the diagnosis. Results: Eighty-five patients (29%) were culture-positive and 212 (71%) were culture-negative for GABHS. Respective mean ages were 6.2 years and 6.1 years in the two groups. Univariate chi-square analysis of the 12 features identified six variables that were significantly associated with GABHS. All significant features were initially included in a stepwise logistic regression analysis. In model I, four independent variables were identified: moderate to severe presentation of tonsillar swelling, moderate to severe tenderness and enlargement of cervical lymph nodes, the presence of scarlatiniform rash, and the absence of moderate to severe coryza, yielding a 95% probability for GABHS. Excluding the rare scarlatiniform rash, the remaining variables were used in the second regression analysis. In model II, three independent variables were identified: moderate to severe tonsillar swelling, moderate to severe tenderness and enlargement of cervical lymph nodes, and absence of moderate to severe coryza, yielding a probability of 65% for the diagnosis. A probability of <15% was observed in the absence of scarlatiniform rash, the absence of moderate to severe tenderness and enlargement of cervical lymph nodes, and the presence of moderate to severe coryza. Conclusions: In children with moderate to severe presentation of tonsillar swelling, tenderness and enlargement of cervical lymph nodes, and the absence of coryza, the probability of a positive throat culture is >65%. Conversely, in the absence of a moderate to severe presentation of tonsillar swelling, enlargement of cervical nodes, and the presence of coryza, the probability of a positive throat culture is <15%. If prospectively validated, these models could be integrated into a consistent treat, test, and no treatment/no testing approach to the clinical management of childhood pharyngitis.

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The accuracy of diagnosis of beta streptococcal infections on clinical grounds

Cited by 172 publications

References 1 publication

Evaluation of a two-minute strep A direct swab test (SADST) on patients with pharyngitis at a primary care clinic

Evaluation of a two-minute strep A direct swab test (SADST) on patients with pharyngitis at a primary care clinic

4. Pharyngeal carriage of Group A streptococci among school children

Multivariate Predictive Models for Group A Beta‐hemolytic Streptococcal Pharyngitis in Children

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