Acute Pharyngotonsillitis Research Articles

Molecular Study of (Mycoplasma Pneumoniae, Streptococcus Pneumoniae) in Respiratory Infections Patients in Thiqar Province

The high death and hospitalization rates caused by bacterial respiratory infections make them a major worldwide health problem. Acute otitis media, bacterial rhinosinusitis, pharyngotonsillitis, bronchitis, and community-acquired pneumonia are among the common respiratory tract illnesses caused by common bacterial respiratory infections, which include Streptococcus pneumoniae, Mycobacterium tuberculosis, Haemophilus influenzae, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila. The study aimed to detect uncultivated bacteria in respiratory infections patients (Mycoplasma pneumoniae) and Streptococcus pneumoniae that caused respiratory infections and determined if it caused this infection. The study included 140 patients (67males and 73 females) who were suffering from respiratory infections, ages ranging from 10-80 years, in a period from 1 September 2023 to 1 February 2024, all of the 140 samples collected from Nasiriyah Teaching Hospital, Center for Chest Diseases and Respiratory Diseases in Nasiriyah, Souq Al-Shuyoukh General Hospital, Alhussein Teaching Hospital, Private Clinics in Shatrah. Specimens included a sputum sample and oropharyngeal swab for direct detecting by polymerase chain reaction (pcr) Diagnosis is based on the presence of the (16s rRNA) gene to detect (Mycoplasma pneumoniae, Streptococcus pneumoniae) patients had with un-cultivated bacteria where 3\140(2.14%) of patients had infection with Mycoplasma pneumoniae and 6\140(4.28%) with Streptococcus pneumoniae. The present study was conducted that the most detected bacterial in female group 6 (75.0%), while in the male group 2 (25.0%), in addition, the most isolated bacteria in female group were both M. pneumoniae 3 (50.0%), and S. pneumoniae 3 (50%),whil in age groups in first group 3, while non-detected bacteria in both fourth and seventh age group 0, fever and headache are the most abundant symptoms patients, followed by myalgia (90.6%), chill (66%), cough (59%), and dyspnea (36.6%).

Patterns and outcomes of Emergency Pediatric Unit admissions in Usmanu Danfodiyo University Teaching Hospital in Sokoto State, Nigeria: a five-year review

Children are susceptible to illnesses that often require urgent medical attention, with attendant high mortality rates, especially in resource-constrained settings. Periodic audits in tertiary care facilities can guide preventive and therapeutic policies. The aim was to determine the admissions pattern and outcome over five years in the Emergency Paediatric Unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, a major tertiary facility in North Western Nigeria. This was a retrospective study between January 2017 and December 2021. The admission records of children aged >1 month to 15 years were retrieved, relevant information extracted, and entered into a study proforma. Data was analyzed using SPSS version 23. There were 6088 admissions. Under-fives constituted 4448 (73.1%), and males were 3558 (58.4%). The median age was 24.0 months (Interquartile Range, IQR, 12, 60). Top admissions were severe malaria (1100; 18.1%), acute diarrhoeal disease (631; 10.4%), Sickle Cell Disease (SCD) (624; 10.2%), pneumonia (547;9.0%), Severe Acute Malnutrition (SAM) (438;7.2%), febrile convulsions (421;6.9%), pharyngotonsillitis (402;6.6%) and sepsis (398;6.5%). Total discharges were 2483 (40.8%), 2635 (43.3%) were transferred, and mortalities were 679 (11.2%). Case fatality rates of the top admissions were sepsis (19.6%), SAM (19.4%), severe malaria (13.7%), pneumonia (10.6%), febrile convulsions (5.0%), acute diarrhoeal disease (4.9%), pharyngotonsillitis (2.5%) and SCD (2.1%). SCD was the most common non-infectious morbidity and responsible for most re-admissions. Malaria was the top cause of mortality in all age groups except infancy, where sepsis and pneumonia predominated. In conclusion, malaria and other infectious diseases accounted for most admissions. Non-communicable diseases, like SCD, also constitute significant morbidity. Hence, policymakers need to scale up targeted preventive measures.

Adecuación de las prescripciones médicas en faringitis estreptocócicas y otitis media aguda a las guías terapéuticas

Background and objective: to analyze the degree of adequacy to consensus therapeutic guidelines in acute pharyngotonsillitis and acute otitis media of primary care pediatricians. Material and Methods: retrospective observational study with data collection from electronic medical records of patients with suppurative AOM and streptococcal AAF in patients from 0 to 14 years of age residing in Araba, in an 18-month period study. Results: in the group of patients with suppurative AOM, 238 episodes have been evaluated, with a degree of therapeutic adequacy of 56.7%, being underdosing the main cause of inadequacy. In the group of patients with streptococcal AAF, 1721 episodes have been evaluated, with a degree of therapeutic adequacy of 57%, being the main causes of inadequacy overdose and short-duration regimens. Conclusion: in both suppurative AOM and streptococcal AAF, the degree of therapeutic adequacy is somewhat lower than in other analysed studies. To achieve a correct treatment in these processes in primary care settings is of vital importance due to its high frequency of diagnosis. It is also important to improve the quality of registered data in medical records of all patients.

Faringoamigdalitis y estreptococo, ¿enemigo o colonizador?

Introduction: the main etiology of acute pharyngotonsillitis (AAT) is viral, and among the bacterial etiology, Streptococcus pyogenes is a non-negligible colonizer of the healthy pediatric population. The aim of this study is to know how the rapid streptococcal diagnostic test (RDT) is used in pediatric emergency departments in order to optimize its use, reduce the overdiagnosis of streptococcal AAP and the prescription of antibiotics. Material and methods: we collected retrospective information on the number of RDTs performed on patients seen in the Pediatric Emergency Department of a tertiary hospital, from January 2022 to January 2023 (both inclusive). Information was also collected on the number of patients who underwent more than one RDT and the time elapsed. Results: during the 13 months studied, a total of 1610 TDRs were performed (43% in < 5 years). More than one TDR was performed in 89 patients (53% in < 5 years) and 40% of these were performed in the first 40 days. Discussion: microbiological tests for Streptococcus pyogenes are not able to differentiate between active infection and healthy carrier state. According to the results of our study there seems to be an inadequate use of RDTs; most tests are performed in < 5 years, where streptococcal etiology is less frequent and healthy carrier status predominant. This leads to overdiagnosis of FAAE, antibiotic overtreatment, occurrence of adverse effects and bacterial resistance.

AN OVERVIEW OF SIDDHA POLYHERBAL FORMULATION: MILAGU LEGIYAM

Milagu Legiyam is a polyherbal Siddha formulation mentioned in the Siddha literature "Aathmaratchamirtham". It indicates silethumam 96. In the Siddha system of medicine, the clinical presentation of acute pharyngotonsillitis is described under "virana silethumam". Vitiation of kabam is responsible for the virana silethumam. According to modern medicine, this occurs due to the viruses and beta?hemolytic group A streptococci. Nowadays, this is a common illness in children that often leads patients to consult paediatricians. The hot potency of the ingredients of Milagu Legiyam plays the leading role in the management of virana silethumam. Hence, this review highlights the fields of research conducted on the ingredients of Milagu Legiyam. The data was collected from the scientific databases and various textbooks. This review revealed the presence of antimicrobial, antiviral, antioxidant, anti-inflammatory, analgesic, antipyretic, anthelmintic and anticancer activities.

Isolation and Characterization of Streptococcus pyogenes from Iraqi Children with Pharyngotonsillitis

Background: Streptococcus pyogenes known as group A streptococci (GAS) is the main causative agent of pharyngotonsillitis in children younger than 12 years old. The infection appears mostly in winter and spring. Signs and symptoms of patients with a beta-hemolytic GAS infection, include tonsillar exudate, fever, painful anterior cervical adenopathy, and the lack of a cough. Penicillin and ampicillin are the preferred clinical therapy choice for GAS pharyngitis treatment. Objectives: Isolate and identify GAS in throat swabs among children suffering from acute pharyngotonsillitis to estimate the prevalence rate of bacterial isolates associated with age, sex, and months variation of GAS infection. Also, it is to determine the antibiotic sensitivity patterns such as penicillin, ampicillin, erythromycin, azithromycin, ofloxacin, clindamycin, and rifampicin, which are used for the treatment of GAS associated with the acute pharyngotonsillitis in children. Materials and Methods: Four hundred and ten throat swabs have been obtained from patients who were clinically diagnosed as having acute pharyngotonsillitis of age ranging from (1–12) years of both sexes were admitted to various hospitals and enrolled in a sequential manner from November 2021 to April 2022 in two Governorates (Baghdad and Babylon), Iraq. These throat swabs were exposed to the bacterial culturing, and some other tests. Streptococcus pyogenes isolates were identified depending on the colony properties, beta-hemolysis on sheep blood agar plate, Gram’s stain, catalase production test, in addition to a sensitivity to bacitracin and Pyrrolidinyl arylamidase test to confirm the identification of GAS. Results: The prevalence of identifying GAS isolates was 140 (34.1%) out of 410 samples. GAS strains can cause acute pharyngotonsillitis in children of all ages, but it most frequently occurred between 1 and 6 year age groups, and it was more in men 80 (57.1%) than in women 60 (42.9%). Likewise, it was found that GAS associated with acute pharyngotonsillitis with a high incidence in winter and in early spring, in which the peak of GAS infection has been seen in January (30.7%). On the other hand, some antibiotics were used to show their effect on these GAS isolates. The findings revealed that all isolates were sensitive (100%) to penicillin and ampicillin, and (83.6%) of isolates were sensitive to clindamycin, whereas some isolates shown a lesser degree of sensitivity (75% and 60%) to rifampicin and ofloxacin. However, only 49.3% of the isolates were sensitive to erythromycin, and (46.4%) were sensitive to azithromycin. Conclusion: GAS strains can cause acute pharyngotonsillitis in children of all ages, but it most frequently occurred in the age groups (1–6) year, and more predominant in men than in women. High percentage of infections with GAS have been noticed in winter and spring to reach its peak in January. Additionally, penicillin and ampicillin are preferred antibiotic for treatment, whereas in the most serious cases clindamycin was added to the treatment plan.

Thrombosis of the internal jugular vein, a rare entity

Rationale: Thrombosis of the internal jugular vein is an infrequent and underdiagnosed pathology due to the absence of symptoms. If present, the symptoms are frequently manifested as a sensation of pain and cervical tension. Its etiology is variable, including trauma, central catheterization, and hypercoagulable states, among others. Patient’s Concern: A 41-year-old female, previously healthy, was admitted to the emergency room for worsening pain in the left cervical area of 5 d. Previously, she was treated for suspected acute pharyngotonsillitis yet without improvement. Diagnosis: Physical examination revealed a 2 cm in length cervical mass of hard consistency that was painful on palpation and non-fluctuating. Ultrasound study showed thrombosis of the left internal jugular vein. A computed tomography scan revealed that the thrombosis occurred at the cervical portion of the left internal jugular vein as well as the left transverse sinus. Interventions: Hospital admission and treatment with low molecular weight heparin at a dose of 1.5 mg/kg every 24 h. Outcomes: The patient was discharged after 3 d of treatment with vitamin K antagonists. Lessons: Venous thrombosis at the level of the internal jugular vein is an infrequent entity. Clinical suspicion is necessary for the diagnosis given the possibility of absence of symptoms.

Bactericidal effect of lascufloxacin on HEp-2 cell-internalized group A Streptococcus

IntroductionAlthough amoxicillin (AMPC) is recommended as first-line therapy for acute pharyngotonsillitis caused by group A streptococci (GAS), it often fails to eradicate infections. Internalization and subsequent intracellular survival of GAS are considered major mechanisms for penicillin therapeutic failure. It is, therefore, desirable to administer drugs that exert bactericidal effects on extracellular and intracellular GAS. In this study, we aim to investigate the bactericidal effects of lascufloxacin (LSFX) on internalized GAS in HEp-2 cells. Materials and methodsThe GAS strain M1 and clinical isolate strain #2 were used in this study. Following treatment of GAS-infected human pharyngeal carcinoma epithelial HEp-2 cells with LSFX or AMPC, internalized GAS cells were recovered. The concentrations of LSFX and AMPC were equivalent to 1 × and 2 × MIC for strain M1. Culture medium was used as a control. Time-lapse and fluorescence images of GAS invading HEp-2 cell were obtained. LIVE/DEAD fluorescence staining was used to confirm the viability of internalized GAS. ResultsLSFX significantly reduced the number of cell-internalized M1 and #2 GAS strains compared to the control (p < 0.01) in a dose-dependent manner. However, AMPC did not reduce this in both strains. Both live and dead intracellular GAS were confirmed in HEp-2 cells exposed to LSFX. In contrast, intracellular GAS survived in HEp-2 cells exposed to AMPC and in the control. ConclusionLSFX elicits significant bactericidal effects on cell-internalized GAS, hence it may represent a potent therapeutic option for patients with acute pharyngotonsillitis in whom AMPC treatment has failed.

Diagnosis and management of acute pharyngotonsillitis among pediatric patients at Ribat Teaching Hospital: a prospective audit (2021-2022).

Diagnosis of pharyngotonsillitis is challenging due to the wide range of symptoms and signs. Sudan Federal Ministry of Health and Sudanese Association of Paediatricians, along with Sudan Heart Society reached a consensus about the clinical prediction rule which aids in diagnosing and managing bacterial pharyngotonsillitis. This audit aimed to assess doctors' knowledge and practice regarding diagnosis and management of bacterial pharyngotonsillitis at Ribat Teaching Hospital, Khartoum, Sudan. This audit was done at Pediatric Department, Ribat Teaching Hospital, and data collection was done over 2 weeks either in the first or the second cycle. Inclusion criteria were children who presented at the emergency room and were diagnosed with acute pharyngotonsillitis. The criteria used in this audit were from Sudan guidelines for prevention, diagnosis and management of rheumatic heart disease. Regular training sessions were done between the first and second cycles. There were 19 patients in the first cycle, 17 of them (89.4%) were diagnosed clinically with bacterial pharyngotonsillitis, and 8 of these 17 (47%) were fitting the criteria. Regarding the management of bacterial pharyngotonsillitis, no patient was given the recommended antibiotics in the guidelines (0.00%). In the second cycle, there were 21 patients, of whom 11 patients were diagnosed clinically with bacterial pharyngotonsillitis (52%). Of those 11, 8 patients were fitting the criteria (72.7%), and the recommended antibiotics were given in 9 of them (82%). The current practice toward acute pharyngotonsillitis management revealed a lack of doctors' knowledge about local guidelines which can be improved by simple ways such as posters, lectures, and focused group discussions.

Retrospective study on the effectiveness and safety of the shortened 5- to 7-day antibiotic regimen for acute streptococcal pharyngotonsillitis compared to the classic 10-day regimen

IntroductionAntibiotherapy regimens for management of acute streptococcal pharyngitis traditionally last 10 days, but the development of resistance to different antimicrobials has motivated the exploration of shorter courses. Material and methodsWe selected patients given a diagnosis of streptococcal pharyngitis in 2 paediatric caseloads of 1 primary care centre between June 2016 and April 2020. We compared outcomes in patients treated with 8- to 10-day courses versus 5- to 7-day courses. ResultsThe analysis included 350 care episodes (252 patients). Sixty-four percent were managed with 8- to 10-day courses of antibiotherapy (group 1) and 36% with 5- to 7-day courses (group 2). There were no significant differences in the incidence of streptococcal pharyngitis or scarlet fever in the 3 months that followed (OR, 0.98; 95% confidence interval [CI], 0.46–2.03), with similar percentages in both groups (9.8% vs 9.5%). Overall, without differentiating based on the type of infection (streptococcal pharyngitis, scarlet fever or other streptococcal infections), we found similar outcomes (OR, 0.81; 95% CI, 0.41–1.59): 13.4% in group 1 and 11.1% in group 2. We also found no differences in the frequency of adverse events documented in the health records (OR, 0.29; 95% CI, 0.04–2.44): 2.7% in group 1 and 0.8% in group 2. ConclusionsIn our experience, a shorter antibiotic course (5–7 days) is not less effective or more unsafe for management of acute streptococcal pharyngitis than the traditional 10-day course.

Septic Thrombophlebitis of the Internal Jugular Vein in an Immunocompromised Patient with Lemierre Syndrome: A Case Report

Lemierre syndrome is a rare complication of oropharyngeal infection, especially acute pharyngotonsillitis, associated with septicemia and thrombophlebitis of the internal jugular vein (IJV). We present the case of a 52-year-old patient who underwent liver transplantation and returned with symptoms of pain, redness and left cervical bulging 1 month after surgery. After investigation, the diagnosis of septic thrombophlebitis of the IJV was made. The patient responded well to treatment with antibiotic therapy and full anticoagulation. To the best of our knowledge, the present report is the first report of Lemierre syndrome in a post-liver transplant patient.

Severe acute pharyngotonsillitis due to herpes simplex virus type 2 in an homosexual man – Report of A case and review of the literature

Severe acute pharyngotonsillitis due to herpes simplex virus type 2 in an homosexual man – Report of A case and review of the literature

The High Necessity of Rapid Antigen Detection Test (RADT) use to Guide Antibiotic Prescribing Pattern for Acute Pharyngotonsillitis in Syria

The objectives of this study were to assess the percentage of the inappropriate antibiotics prescribing for clinically diagnosed Group A β-hemolytic streptococcus (GABHS) caused acute pharyngotonsillitis (APT), and to investigate factors influencing this prescribing and the possibility and necessity of routine usage of RADT for rational treatment of APT in different primary care facilities in Latakia, Syria. Throat swabs were collected from 80 patients, ≥ 5 years old, seen in urban or rural pharmacies, otolaryngology clinic or emergency unit of University Tishreen hospital over a period of 6 months, who were diagnosed and treated for APT depending on clinical findings. RADT was applied and McIsaac score (MIS) was recorded for all patients. Throat cultures were done only for negative RADT cases seen in the hospital. The chi square (χ2) statistical test was used for comparing categorical variables. A P value of &lt;0.05 was considered significant. Antibiotics were prescribed for 59 patients (74%) among them RADT results were positive for only 9 patients (15.25%) with a percentage of inappropriate antibiotic prescribing of (84.75%). Cultures were GABHS negative for all negative RADT cases. The most frequently prescribed antibiotic was azithromycin (50.8%). Antibiotics prescribing was significantly influenced by the presence of fever (P=0.041), anterior cervical adenitis (P=0.0003), and MIS≤0 (P=0.0001). We found a significance association of the presence of tonsillar exudate (P=0.013) and MIS≥4 (P=0.002) with positive RADT results. There was no significant difference in antibiotic prescribing according to age, sex or place of consultation. Our findings highlight the great need to use RADT in clinical practice as important adjuvant tool in APT diagnosis to reduce the percentage of antibiotic prescribing and so limiting of bacterial resistance.

Antibiotic stewardship in direct-to-consumer telemedicine consultations leads to high adherence to best practice guidelines and a low prescription rate

ObjectiveTo analyze the antibiotic prescription rate in low-risk patients evaluated at a telemedicine program that adopts antibiotic stewardship protocols. MethodsAdult patients who accessed a single direct-to-consumer telemedicine center (Jan/2019–Feb/2020) were retrospectively enrolled. Diseases amenable to antimicrobial treatment were classified under five diagnostic groups: upper respiratory tract infection (URI), acute pharyngotonsillitis (PT), acute sinusitis (AS), urinary tract infection (UTI), and acute diarrhea (AD). Physicians were trained on and advised to strictly follow the current guideline recommendations supported by institutional antibiotic stewardship protocols, readily available online during consultations. We analyzed the antibiotic prescription rate among patients, referral rate, and antibiotic class through descriptive statistics. ResultsA total of 2328 patients were included in the study. A total of 2085 (89·6%) patients were discharged with usual recommendations, medication (if needed), and instructions about red flags, while 243 (10·4%) were referred to a face-to-face consultation. Among the discharged patients, the antibiotic prescription rates by the diagnostic group were URI — 2·5%, PT — 35·0%, AS — 51·8%, UTI — 91.6%, and AD — 1·6%. In most cases, prescribed antibiotics were in line with institutional stewardship protocols. ConclusionsLow prescription rate of antibiotics can be achieved using antibiotic stewardship protocols at direct-to-consumer telemedicine consultations, showing high adherence to international guidelines. These results reinforce telemedicine as a cost-effective and safe strategy for the initial assessment of acute non-urgent symptoms.

重症急性咽頭・扁桃炎におけるレボフロキサシン（500 mg） 1日 1 回投与の有用性

重症急性咽頭・扁桃炎におけるレボフロキサシン（500 mg） 1日 1 回投与の有用性

Diagnosis-linked antibiotic prescribing in Swedish primary care - a comparison between in-hours and out-of-hours

BackgroundThe rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. However, no study has compared the out-of-hours treatment of infections to in-hours treatment within the same population.MethodsThis retrospective, descriptive study was based on data retrieved from the Kronoberg Infection Database in Primary Care (KIDPC), which consists of all visits to primary care with an infection diagnosis or prescription of antibiotics during 2006–2014. The purpose was to study the trends in antibiotic prescribing and to compare consultations and prescriptions between in-hours and out-of-hours.ResultsThe visit rate for all infections was 434 visits per 1000 inhabitants per year. The visit rate was stable during the study period, but the antibiotic prescribing rate decreased from 266 prescriptions per 1000 inhabitants in 2006 to 194 prescriptions in 2014 (mean annual change − 8.5 [95% CI − 11.9 to − 5.2]). For the out-of-hours visits (12% of the total visits), a similar reduction in antibiotic prescribing was seen. The decrease was most apparent among children and in respiratory tract infections.When antibiotic prescribing during out-of-hours was compared to in-hours, the unadjusted relative risk of antibiotic prescribing was 1.37 (95% CI 1.36 to 1.38), but when adjusted for age, sex, and diagnosis, the relative risk of antibiotic prescribing was 1.09 (95% CI 1.08 to 1.10). The reduction after adjustment was largely explained by a higher visit rate during out-of-hours for infections requiring antibiotics (acute otitis media, pharyngotonsillitis, and lower urinary tract infection). The choices of antibiotics used for common diagnoses were similar.ConclusionsAlthough the infection visit rate was unchanged over the study period, there was a significant reduction in antibiotic prescribing, especially to children and for respiratory tract infections. The higher antibiotic prescribing rate during out-of-hours was small when adjusted for age, sex, and diagnosis. No excess prescription of broad-spectrum antibiotics was seen. Therefore, interventions selectively aiming at out-of-hours centres seem to be unmotivated in a low-prescribing context.

A study of guidelines for respiratory tract infections and their references from Swedish GPs: a qualitative analysis

Background: National guidelines are important instruments in reducing inappropriate antibiotic prescriptions. Low adherence to guidelines is an acknowledged problem that needs to be addressed.Method: We evaluated established characteristics for guidelines in the guidelines for lower respiratory tract infection, acute otitis media and pharyngotonsillitis in primary care. We studied how doctors used these guidelines by analysing interviews with 29 general practitioners (GPs) in Sweden.Results: We found important between-guidelines differences, which we believe affects adherence. The GPs reported persistent preconceptions about diagnosis and treatment, which we believe reduces their adherence to the guidelines.Conclusion: To increase adherence, it is important to consider doctors’ preconceptions when creating new guidelines.

Diagnostic accuracy of QuickVue\xae Dipstick Strep A\xa0test and its effect on antibiotic prescribing in children in the United Arab Emirates

BackgroundUnnecessary antibiotic prescription to patients with upper respiratory tract infections (URTIs) has led to the increase in antibiotics resistant bacteria rates. In this study, we evaluated the diagnostic accuracy of QuickVue® Dipstick Strep A test (QV-SAT) in children presenting with acute pharyngotonsillitis and its effect on antibiotic prescribing.MethodsA single-gated diagnostic accuracy study of children with fever, runny nose, and tonsillitis presenting to a paediatric clinic between March 2016 and September 2018. Paired throat swabs for QV-SAT and culture were collected. None of the children received antibiotics prior to sample collection. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the test were calculated.ResultsTwo hundred four children were included in this study. 111 (54.4%) were boys and 146 (71.6%) were under the age of 5 years. QV-SAT was positive in 44 (21.6%) and throat culture was positive for Group A β- haemolytic Streptococcus (GAS) in 42 (20.6%) of the children. The results of QV-SAT were highly consistent with culture results: only 2 (0.9%) children with negative results had a positive throat culture. The sensitivity of the QV-SAT in the identification of GAS infection was 100% (95% CI 91.6%, 100%) and the NPV was 100% (95% CI 99.9%, 100%). Only 42 children ( 20.6%) were given antibiotics, while 162 (79.4%) were not.ConclusionThe QV-SAT is a quick and reliable test that can help dramatically reduce antibiotic prescriptions to children presenting with fever and acute pharyngotonsillitis.

Are there effects of lunar cycle on pediatric febrile seizure?: A single-center retrospective study (2005-2018).

Several studies have reported an association between seizure and the lunar cycle; however, results are conflicting. Thus, we investigated whether emergency department (ED) visits due to febrile seizure (FS) or FS plus were affected by lunar cycle. We reviewed the medical records of patients who were admitted to the ED with a main diagnosis of FS or FS plus from January 1, 2005 to August 31, 2018 (13 years 8 months), a period of 4991 days with 169 lunar cycles. During that period, we collected weather data such as mean temperature, average atmospheric pressure (AP), and humidity according to lunar phase (new moon, first quarter, full moon, and third or last quarter). A total of 1979 patients were identified. We found male predominant with a mean age of 2.62 ± 2.09 years. Acute pharyngotonsillitis was the most common cause of fever, generalized tonic-clonic seizure was the most common type of seizure, and the mean peak body temperature was 38.77 ± 0.81 °C. The lunar cycle did not affect the onset or frequency of FS after adjustment; however, several factors, including season, O3 and NO2 concentrations, and holidays, were associated with FS. We did not find an association between lunar cycle and FS or FS plus. However, several factors, including season, O3, NO2, and holidays were associated with FS or FS plus.

Pilot study to explore the prophylactic efficacy of oral probiotic Streptococcus salivarius K12 in preventing recurrent pharyngo-tonsillar episodes in pediatric patients.

Background: In the pediatric population, acute pharyngo-tonsillitis represents one of the most frequent causes of access to outpatient treatment and use of antibiotics. In frequent tonsillitis, the pharmacological approach is no longer effective, and, therefore, surgery becomes the treatment of choice.Methods: This study compares the prophylactic efficacy of Streptococcus salivarius K12 (Bactoblis®) in children with recurrent pharyngo-tonsillitis treated vs untreated, with a 12 -month follow-up. The primary objectives are: The incidence of recurrence of pharyngo-tonsillar episodes and the concomitant use of other drugs. Secondary objectives are: tolerability of the treatment, the effectiveness in terms of clinical improvement, days of absence from school, reduction of the use of standard therapies, and cancellation from the surgical planning list.Results: Patients belonging to group A (treated with K12 for 90 days) were 24 males and 26 females, mean age 6.6 years (SD=1.57), those belonging to group B (untreated) were 23 males and 27 females, average age 6.8 years (SD=1.72). In the follow-up, group A reported 26 inflammatory pharyngo-tonsillary episodes in the first trimester, unlike group B, who reported 72 in the second trimester. This has shown a lower incidence (3.38%) of the disease compared to group B (6.66%), for a total of 169 inflammatory pharyngo-tonsillary episodes in group A against 333 in group B. A reduction in days of school absence of 429 days in group A and 927 days in the control group (P<0.01) was also noted. Finally, 14 children of group A (28%) underwent adenotonsillectomy, against the whole group B. No adverse events were reported.Conclusion: The efficacy of K12 on the prevention of pharyngo-tonsillar infections, the decrease in the use of antibiotics and the improvement of the overall quality-of-life was confirmed, with a decreased number of absences from school and fewer patients undergoing surgery.