Diagnostic methods for group A Streptococcus associated with sore throat in Cameroon

BACKGROUND The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. OBJECTIVE We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. METHODS This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. RESULTS There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. CONCLUSIONS McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.

Download Full-text

Evaluation of Rapid Antigen Detection Test for Group A Streptococci Pharyngitis among Children in an Out-Patient Clinic in Malaysia

Sains Malaysiana ◽

10.17576/jsm-2021-5011-18 ◽

2021 ◽

Vol 50 (11) ◽

pp. 3345-3354

Author(s):

Zaili Zaki ◽

Asrul Abdul Wahab ◽

Ramliza Ramli ◽

Afaaf Esa ◽

Ezura Madiana Md. Monoto

Keyword(s):

Sore Throat ◽

Sensitivity And Specificity ◽

Throat Swab ◽

Group A Streptococcus ◽

Antigen Detection ◽

Preschool Age ◽

Throat Culture ◽

Care Clinic ◽

Rapid Antigen Detection Test ◽

Group A

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement between RADT whereby BIONEXIA® Strep A Plus (BioMérieux, France) kit was used and throat culture in the diagnosis of GAS pharyngitis in children presented with a sore throat. One hundred and ten children from a primary health care clinic with sore throat were included in this study. All children were evaluated based on McIsaac scoring and throat swab samples were taken for both throat culture and RADT testing. The prevalence of GAS pharyngitis by RADT in this study was 7.3% over one year. A higher incidence of GAS pharyngitis was noted in the school-aged children than the preschool-age children. There was no correlation between cough, lymph node enlargement, and tonsillar enlargement in predicting GAS pharyngitis. The sensitivity and specificity of RADT were 100% and 98%, respectively, when taking throat culture as a gold standard. A good agreement between RADT and throat culture was achieved (k=0.848). McIsaac scoring was noted to have good predictability for GAS pharyngitis with AUC=0.82. In conclusion, the rapid streptococcal antigen detection test showed excellent sensitivity and specificity and detecting GAS from the throat swab samples. Thus, it can be used to aid in the diagnosis of group A Streptococcal pharyngitis and could reduce the overuse of antibiotics. McIsaac score has also proven to be useful as a screening tool for bacterial pharyngitis.

Download Full-text

010 / GROUP A STREPTOCOCCUS DIAGNOSTIC METHODS AND VIRAL CO-INFECTIONS IN PHARYNGITIS

10.26226/morressier.5ad774e0d462b80296ca6d77 ◽

2018 ◽

Author(s):

Lauri Ivaska

Keyword(s):

Group A Streptococcus ◽

Diagnostic Methods ◽

Group A

Download Full-text

USE OF EXPRESS TESTS IN THE PRACTICE OF FAMILY DOCTORS AND PEDIATRICIANS

Ukrainian Scientific Medical Youth Journal ◽

10.32345/usmyj.1(121).2021.51-64 ◽

2021 ◽

Vol 121 (1) ◽

pp. 51-64

Author(s):

Liudmyla Gospodarenko ◽

Tetiana Klets ◽

Ganna Gnyloskurenko ◽

Roman Terletskyi ◽

Diana Kononenko

Keyword(s):

Primary Care ◽

Medical Care ◽

Outpatient Clinic ◽

Secondary Care ◽

Group A Streptococcus ◽

Rapid Test ◽

Diagnostic Methods ◽

C Reactive Protein ◽

Reactive Protein ◽

Group A

Rapid diagnosis significantly reduces the patient's expectation of effective medical care. As a result, rapid or POC-tests are becoming increasingly important in the world. However, the frequency of their use, the availability of tests in medical facilities, the awareness of physicians about diagnostic capabilities and the need for them are currently unclear. The aim of our study was to determine the level of awareness of physicians about the use of rapid tests for influenza, RS-virus, ꞵ-hemolytic group A streptococcus and laboratory markers of inflammation in the form of POC-tests in daily practice. The study was conducted by interviewing 78 pediatricians and family physicians in Kyiv and Kyiv region who work at the primary and secondary levels of medical care. A questionnaire from EAPRASnetT (European Academy of Pediatric Research in the network of outpatient settings) was used for the survey. Our research has shown that hospital physicians are more informed about the use of rapid diagnostics and are more willing to use it in the treatment and diagnostic process. A rapid antigen test for influenza is available to the vast majority of inpatients (78%) and only half of outpatients (46.3%). Half of primary care physicians (56.1%) and the vast majority of secondary care professionals (73%) are willing to use this test in practice if it is available. The results of our study also showed a higher adherence to this rapid test of inpatients, as only 2.7% of them would like to confirm the results of POC-tests by laboratory tests (compared to 22% of outpatients). Most doctors in both outpatient clinics (61%) and inpatients (75.7%) are ready to use a rapid test for respiratory syncytial virus. Only 2.7% of hospital doctors would like to have a laboratory version, and outpatients would be completely satisfied with a quick test. However, due to the lack of trust in 14.6% of cases, they would like to confirm its results by laboratory testing. About a third of physicians (39%) use the rapid test for ꞵ-hemolytic group A streptococcus in the outpatient clinic, but half (51.2%) stated the need for this test and its unavailability. In the hospital, the data obtained were the opposite: half of doctors already use this test (59.5%), and another third would like to have it (35.1%). Rapid C-reactive protein testing is poorly used by physicians in both health care settings (12.2% in the outpatient setting and 29.7% in the inpatient setting) due to low security and lack of awareness. This is confirmed by the fact that 75.6% of primary and 64.9% of secondary care physicians stated that the test is not available, but they are ready to use this test if available. POC-test for C-reactive protein is used more in the hospital than in the outpatient clinic. At the outpatient stage, 12.2% of physicians do not consider it appropriate to use C-reactive protein in the diagnosis of diseases, in the hospital of such physicians 5%. About 10% of doctors in both groups expressed distrust in the rapid CRP-test, as they would like to use only the laboratory version. Doubts about the accuracy of almost twice as many outpatients, as more often would like to check it with a laboratory version (19.5% vs. 10.8% of inpatients). Therefore, one in five physicians in the outpatient clinic would use both the laboratory and POC versions. The rapid test for procalcitonin is used by every 5th doctor in the hospital and only 7% of the primary care, which can be attributed to the low availability of the test in medical practice, poor provision of medical institutions with POC-tests, as 62.2% and 78% of doctors the hospital and the clinic replied that they would use it if it was available. As for the complete general analysis of blood with leukocyte formula, only 17.1% and 35.5% of doctors of the polyclinic and hospital would like to use its POC version. Interviewed physicians would prefer a laboratory version of the test.It is necessary to raise awareness of physicians, especially primary care, about modern diagnostic methods, namely the practice of POC-tests and make them more accessible, which would significantly improve the diagnosis and treatment of patients, would have a positive impact on public health and significant economic effect.

Download Full-text

Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study

Journal of Medical Internet Research ◽

10.2196/25899 ◽

2021 ◽

Vol 23 (12) ◽

pp. e25899

Author(s):

Jennifer L Pecina ◽

Leah M Nigon ◽

Kristine S Penza ◽

Martha A Murray ◽

Beckie J Kronebusch ◽

...

Keyword(s):

Retrospective Study ◽

Observational Study ◽

Sore Throat ◽

Scoring System ◽

Group A Streptococcus ◽

Streptococcal Pharyngitis ◽

Future Studies ◽

Face To Face ◽

Geographic Barriers ◽

Group A

Background The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.

Download Full-text

Etiologic predictive value of a rapid immunoassay for the detection of group A Streptococcus antigen from throat swabs in patients presenting with a sore throat

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2016.02.002 ◽

2016 ◽

Vol 45 ◽

pp. 32-35 ◽

Cited By ~ 4

Author(s):

Ulrich Orda ◽

Ronny Gunnarsson ◽

Sabine Orda ◽

Mark Fitzgerald ◽

Geoff Rofe ◽

...

Keyword(s):

Sore Throat ◽

Predictive Value ◽

Group A Streptococcus ◽

Group A

Download Full-text

Should Routine Throat Cultures Be Done in Hospital Personnel Complaining of a Sore Throat?

Infection Control ◽

10.1017/s0195941700061385 ◽

1985 ◽

Vol 6 (5) ◽

pp. 183-185 ◽

Cited By ~ 5

Author(s):

Chatrchai Watanakunakorn

Keyword(s):

Sore Throat ◽

Teaching Hospital ◽

High Probability ◽

Group A Streptococcus ◽

Streptococcal Pharyngitis ◽

Adult Patients ◽

Hospital Personnel ◽

Group A ◽

Community Teaching

AbstractIn a 750-bed community-teaching hospital with 3,200 employees, throat cultures were routinely done in hospital personnel complaining of a sore throat. During a 3-month period, 323 employees had throat cultures; only 20 (6.2%) of these throat cultures grew group A streptococcus. The prevalence of positive throat cultures was similarly low in employees (6.2%) and adult patients (7.3%). There was no evidence that employees either had higher prevalence of group A streptococcal pharyngitis or that they spread the infection to patients. It is concluded that routine throat cultures are not warranted in employees complaining of a sore throat, and that throat cultures should be done only selectively in hospital personnel with a high probability of group A streptococcal pharyngitis.

Download Full-text

The feasibility of measuring calprotectin from a throat swab as a marker of infections caused by group A streptococcus: a case–control feasibility study

BJGP Open ◽

10.3399/bjgpopen20x101006 ◽

2020 ◽

Vol 4 (2) ◽

pp. bjgpopen20X101006

Author(s):

Behnaz Schofield ◽

Clive Gregory ◽

Micaela Gal ◽

David Gillespie ◽

Gurudutt Naik ◽

...

Keyword(s):

Primary Care ◽

Healthy Volunteers ◽

Sore Throat ◽

Throat Swab ◽

Group A Streptococcus ◽

Case Control ◽

Antibiotic Prescribing ◽

Group A ◽

Primary Care Patients ◽

Streptococcus A

BackgroundMost people with sore throat do not benefit from antibiotic treatment, but nearly three-quarters of those presenting in primary care are prescribed antibiotics. A test that is predictive of bacterial infection could help guide antibiotic prescribing. Calprotectin is a biomarker of neutrophilic inflammation, and may be a useful marker of bacterial throat infections.AimTo assess the feasibility of measuring calprotectin from throat swabs, and assess whether individuals with sore throats likely to be caused by streptococcal infections have apparently higher throat calprotectin levels than other individuals with sore throat and healthy volunteers.Design & settingA proof of concept case–control study was undertaken, which compared primary care patients with sore throats and healthy volunteers.MethodBaseline characteristics and throat swabs were collected from 30 primary care patients with suspected streptococcal sore throat, and throat swabs were taken from 10 volunteers without sore throat. Calprotectin level determination and rapid antigen streptococcal testing were conducted on the throat swab eluents. Calprotectin levels in the following groups were compared: volunteers without a sore throat; all patients with a sore throat; patients with a sore throat testing either negative or positive for streptococcal antigen; and those with lower and higher scores on clinical prediction rules for streptococcal sore throat.ResultsCalprotectin was detected in all throat swab samples. Mean calprotectin levels were numerically higher in patients with sore throat compared with healthy volunteers, and sore throat patients who had group A streptococci antigen detected compared with those who did not.ConclusionCalprotectin can be measured from throat swab samples and levels are consistent with the hypothesis that streptococcal infection leads to higher throat calprotectin levels. This hypothesis will be tested in a larger study.

Download Full-text

2179. Detection of Group A Streptococcus in the Saliva of Children Presenting With Pharyngitis Using the cobas®LIAT® PCR System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1859 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S739-S740

Author(s):

Gregory P DeMuri ◽

Ellen R Wald

Keyword(s):

Sore Throat ◽

Group A Streptococcus ◽

Point Of Care ◽

Poor Quality ◽

Small Pilot Study ◽

Point Of Care Test ◽

Group A ◽

Pharynx Swab ◽

Scientific System ◽

Posterior Pharynx

Abstract Background CLIA waived polymerase chain reaction (PCR) has recently become available as a point of care test for Group A Streptococci (GAS) in individuals presenting with pharyngitis, enabling rapid and accurate diagnosis. However, swabbing the pharynx results in discomfort and is often dreaded by young children which may result in poor quality sampling. Objective In order to assess the viability of saliva as a sample specimen for GAS, this study compared saliva samples with pharynx swabs of children with sore throat, using swabs inoculated by children sucking on them as they would a lollipop in the context of newly available very sensitive techniques. Methods We enrolled children ages 5–15 years presenting with sore throat and known to have a positive rapid streptococcal antigen detection test (RADT) performed on a posterior pharyngeal swab, at the discretion of the primary care provider. The RADT used was the SureVue® (Fisher Scientific) system. A second swab was obtained by having the child suck on the swab in the anterior mouth for 30 seconds and a third swab was obtained from the posterior pharynx. PCR was performed on these two additional swabs using the cobas®LIAT® (Roche) system according to the manufacturer’s instructions. Results Seventeen children were enrolled in the study between January and April 2019. The mean age of enrollment was 9.6 years (range 6–15). By design all children were known to have a positive RADT for GAS. The LIAT posterior pharynx swab was positive in all 17 subjects. In addition, the LIAT saliva swab was positive in all 17 subjects. Conclusion In this small pilot study, there was 100% concordance between the RADT for GAS and both the posterior pharyngeal and saliva swab using the cobas®LIAT® PCR system. Performing saliva swabs will result in less discomfort and distress to children who are tested for GAS. Further study is needed to determine the sensitivity and specificity of saliva swabs for the detection of GAS in children presenting with acute pharyngitis. Disclosures All authors: No reported disclosures.

Download Full-text