Interest of the Rapid Diagnostic Test in the Management of Streptotoccic Angina in Children

Abstract

The objective of this work was to evaluate the interest of RDT compared to the scores of clinical presumptions (McIsaac, PCIE, WHO) in the management of angina with SBHGA of the child while referring to the bacteriological culture. We have managed a prospective analytical study carried out over 8 months between July 2012 and February 2013 in the pediatric emergency department of the Mohammed VI UHC in Marrakech in collaboration with four pediatric practices in the liberal sector, in partnership with a Swiss medical research team from the Lausanne childhood Hospital. For each child consulting for acute angina, a clinical information sheet was completed, an RDT was carried out by the examining doctor, then a throat sample used for the classic bacteriological examination was carried out and treated by the microbiology laboratory of the Mohamed VI UHC of Marrakech. 124 children with strong suspicion of strep throat were included in the study. The average age was 6 years and 4 months with a sex ratio of 1.4 in favor of boys. The bacteriological culture demonstrated the group A hemolytic β streptococcus in=45 (36,9%). The analysis of the established clinical scores revealed the a very good sensitivity reaching 100% but with a mediocre specificity not exceeding 7,7% any score combined without notable superiority of one compared to the others. Mc Isaac's score was more positive ≥ 4 since RDT and culture were positive. The RDT showed a sensitivity of 62,2% and a specificity of 96,15% compared to the bacterial culture which is the reference examination. We retained a strong resistance to erythromycin reaching 69% associated with co-resistance to lyncomicin and spiramycinin 30% of cases. The bacterial origin to SBHG A acute angina in children from the city of Marrakech represented a third of the cases. RDT, by its sensitivity, its high specificity, its speed and its reproducibility, offers a very good means of diagnostic and therapeutic orientation and allows initiating early targeted antibiotic treatment to avoid the appearance of complications in the short, medium and long term and remedy the alarming situation of resistance to macrolides in Marrakech.