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.
Highlights
Acute tonsillitis is one of the leading causes of pediatric consultation and it is estimated that several million prescriptions are written every day around the world to treat them
The objective of our work is to highlight the interest of rapid diagnostic tests (RDT) compared to clinical scores and its reliability compared to conventional culture techniques in the demonstration of group A betahemolytic streptococcus (GABHS) for a more rational antibiotic therapy
During the period of our study, 124 children with an oropharyngeal infection with strong suspicion of acute angina, consulting the pediatric emergency department of UHC Mohammed VI or in private settings, were examined and benefited from a throat swab which used to carry out a rapid diagnostic test for group A beta-hemolytic streptococcus (GABHS)
Summary
Acute tonsillitis is one of the leading causes of pediatric consultation and it is estimated that several million prescriptions are written every day around the world to treat them. 9 million tonsillitis are treated in France [1]. Diagnostic tools; clinical such as the Mc Isaac score, the WHO criteria for the treatment of strep throat described in Maryam Mouamin et al.: Interest of the Rapid Diagnostic Test in the Management of Streptotoccic Angina in Children the strategy for integrated management of the child (IBD) or biological, namely rapid diagnostic tests (RDT) of the betahemolytic group A streptococcus, improve the etiological distinction between viral and bacterial angina in everyday practice and condition the therapeutic attitude. The objective of our work is to highlight the interest of RDT compared to clinical scores and its reliability compared to conventional culture techniques in the demonstration of GABHS for a more rational antibiotic therapy
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