Abstract
OBJECTIVE: To assess the utility of clinical features for diagnosis of streptococcal pharyngotonsillitis in pediatrics.METHODS: A total of 335 children aged 1-18 years old and presenting clinical manifestations of acute pharyngotonsillitis (APT) were subjected to clinical interviews, physical examinations, and throat swab specimen collection to perform cultures and latex particle agglutination tests (LPATs) for group A streptococcus (GAS) detection. Signs and symptoms of patients were compared to their throat cultures and LPATs results. A clinical score was designed based on the multivariate logistic regression analysis and also was compared to throat cultures and LPATs results. Positive throat cultures and/or LPATs results were used as a reference standard to establish definitive streptococcal APT diagnosis.RESULTS: 78 children (23.4%) showed positivity for GAS in at least one of the two diagnostic tests. Coryza absence (odds ratio [OR]=1.80; p=0.040), conjunctivitis absence (OR=2.47; p=0.029), pharyngeal erythema (OR=3.99; p=0.006), pharyngeal exudate (OR=2.02; p=0.011), and tonsillar swelling (OR=2.60; p=0.007) were significantly associated with streptococcal pharyngotonsilitis. The highest clinical score, characterized by coryza absense, pharyngeal exudate, and pharyngeal erythema had a 45.6% sensitivity, a 74.5% especificity, and a likelihood ratio of 1.79 for streptococcal pharyngotonsilitis.CONCLUSIONS: Clinical presentation should not be used to confirm streptococcal pharyngotonsilitis, because its performance as a diagnostic test is low. Thus, it is necessary to enhance laboratory test availability, especially of LPATs that allow an acurate and fast diagnosis of streptococcal pharyngotonsilitis.
Highlights
Acute pharyngotonsillitis (APT) is a common health problem worldwide, especially in children, which is most often related to benign viral and self-limiting infections
A non-negligible number of these infections are of bacterial etiology, and in this case, the β-hemolytic group A streptococcus (GAS) is the main causative agent, which can lead to severe complications, with great individual, collective, social, and economic impact; the main complication is rheumatic fever (RF).[1]
This study was conducted in patients aged 18 or younger that presented with complaints of sore throat and/or pharyngeal and/or tonsillar erythema at admission in an emergency department and a pediatric outpatient clinic in the city of Belo Horizonte, state of Minas Gerais, Brazil, and was approved by the Ethics Committee of Universidade Federal de São João Del Rey (UFSJ) under number 05705112.6.0000.5545
Summary
Acute pharyngotonsillitis (APT) is a common health problem worldwide, especially in children, which is most often related to benign viral and self-limiting infections. A non-negligible number of these infections are of bacterial etiology, and in this case, the β-hemolytic group A streptococcus (GAS) is the main causative agent, which can lead to severe complications, with great individual, collective, social, and economic impact; the main complication is rheumatic fever (RF).[1]. RF is a non-suppurative complication of APT caused by GAS and is characterized by the appearance of inflammatory changes in the joints, skin, heart, and central nervous system, disclosing different combinations and degrees of severity. Considering its possible complications, it is essential to attain a correct diagnosis and adequate management of streptococcal APT, as its timely treatment (up to nine days of symptom onset) is effective in preventing both suppurative and non-suppurative complications.[3] The diagnosis is challenging, as studies show a large overlap between the clinical presentation of viral and streptococcal APT, with no clinical feature that, individually, can confirm or rule out the diagnosis of streptococcal APT.[4]
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