Bacterial Pharyngitis Research Articles

Trends in the use of antibiotics for pharyngitis in Saudi Arabia.

Pharyngitis is one of the most common diagnoses for antibiotic prescriptions worldwide. Antibiotics should be prescribed for bacterial pharyngitis to reduce its complications. The aims of this study were to assess antibiotic prescriptions for pharyngitis cases, and their relationship with physicians' knowledge regarding its diagnosis and management. A cross-sectional study was conducted. First, prescriptions for pharyngitis cases using the modified Centor criteria was evaluated at primary care centers in Saudi Arabia. Second, physicians' knowledge of the modified Centor score and the diagnosis and management of pharyngitis was assessed using a self-administered questionnaire. Out of 104 pharyngitis cases, 79% (n = 82) were prescribed antibiotics, of which 28% were evidence-based prescriptions. First-line antibiotics were prescribed in 34% of patients, and second-line (broad-spectrum) antibiotics such as amoxicillin/clavulanate were prescribed in half of the patients. The main significant predictors of antibiotic prescriptions were age < 3 years (odds ratio, 0.13; 95% CI, 0.02 to 0.97), tonsillar exudate (odds ratio, 21.14; 95% CI, 2.88 to 155.09), and throat erythema (odds ratio, 9.30; 95% CI, 1.18 to 73.41). Overall, physicians (n = 29) had adequate knowledge about the modified Centor score and the management of pharyngitis. Most prescribed antibiotics for pharyngitis were unnecessarily prescribed; the majority being broad-spectrum antibiotics. Despite physicians' adequate knowledge of the modified Centor score and the management of pharyngitis, their practice failed to demonstrate that. Induction of the Saudi Antimicrobial Stewardship Program in the primary care centers, accessibility to diagnostic tools, and educational programs may help in reducing unnecessary antibiotic prescriptions.

Paediatrics: how to manage pharyngitis in an era of increasing antimicrobial resistance.

The goal of this narrative review of pharyngitis is to summarize the practical aspects of the management of sore throat in children in high- and middle-income countries. A traditional review of the literature was performed. Most cases of pharyngitis are viral and self-limited, although rarely viral pharyngitis due to Epstein–Barr leads to airway obstruction. Bacterial pharyngitis is usually due to group A streptococcus (GAS), occurs primarily in children aged 5–15 years, and presents as sore throat in the absence of rhinitis, laryngitis or cough. Again, most cases are self-limited; antibiotics hasten recovery by only 1–2 days. Guidelines vary by country, but antibiotics are commonly recommended for proven GAS pharyngitis as they may prevent rare but severe complications, in particular rheumatic fever (RF). In this era of antimicrobial stewardship, it should be extremely rare that antibiotics are prescribed for presumed GAS pharyngitis until GAS has been detected. Even with proven GAS pharyngitis, it is controversial whether children at low risk for RF should routinely be prescribed antibiotics as the number needed to treat to prevent one case of RF is undoubtedly very large. When treatment is offered, the antibiotics of choice are penicillin or amoxicillin as they are narrow spectrum and resistance resulting in clinical failure is yet to be documented. A 10-day oral course is recommended as shorter courses appear to be less likely to clear carriage of GAS. However, the evidence that one needs to clear carriage to prevent RF is low quality and indirect.

Clinical Practice Guideline: Sore Throat.

Sore throat is a common reason for consultation of primary care physicians, pediatricians, and ENT specialists. The updated German clinical practice guideline on sore throat provides evidence-based recommendations for treatment in the German healthcare system. Guideline revision by means of a systematic search of the literature for international guidelines and systematic reviews. All recommendations resulted from interdisciplinary cooperation and were agreed by formal consensus. The updated guideline applies to patients aged 3 years and over. In the absence of red flags such as immunosuppression, severe comorbidity, or severe systemic infection, acute sore throat is predominantly self-limiting. The mean duration is 7 days. Chronic sore throat usually has noninfectious causes. Laboratory tests are not routinely necessary. Apart from non-pharmacological self-management, ibuprofen and naproxen are recommended for symptomatic treatment. Scores can be used to assess the risk of bacterial pharyngitis: one point each is assigned for tonsil lesions, palpable cervical lymph nodes, patient age, disease course, and elevated temperature. If the risk is low (<3 points), antibiotics are not indicated; if at least moderate (3 points), delayed prescribing is recommended; if high (>3 points), antibiotics can be taken immediately. Penicillin remains the first choice, with clarithromycin as an alternative for those who do not tolerate penicillin. The antibiotic should be taken for 5-7 days. After the exclusion of red flags, antibiotic treatment is unnecessary in many cases of acute sore throat. If administration of antibiotics is still considered in spite of consultation on the usual course of tonsillopharyngitis and the low risk of complications, a risk-adapted approach using clinical scores is recommended.

English

Pharyngitis is an inflammation or irritation of the pharynx or palatine tonsil. The etiology is usually viruses which cause the majority of the pharyngitis but most bacterial cases are attributed to group A Streptococci (GAS). This study aimed to identify the frequency of bacterial pharyngitis especially GAS of children, according to epidemiological factors. Symptoms present and signs for each patient were recorded, following which a throat swab was collected. There were 237 cases of&nbsp; children aged between 1 and 14 years with inflammation; out of 394 cases that visited the ENT primary care at &nbsp;Souk Al-Kameess during the 12 months study period. From the incidence of 394 sore throat cases,&nbsp; GAS was observed in 237 cases (60.15%). Of these 110 (46.41%) were girls and 127 (53.59%) were boys. A higher proportion of children were found with GAS pharyngitis aged 5-9 and the lowest incidence of sore throat occurrence was 3-4 years. The highest incidence of children pharyngitis was recorded in January (Winter) and September (Autmn). The following factors showed independent positive correlation with GAS sore throat infection; patients visiting, months, year season, tonsillectomy, culture result, catalase test result and bacitracin test result with significant value of P&lt;0.01, whereas sex, age and gram stain results with P˃ 0.01. In conclusion, the results of this study found that cases of bacterial sore throat were higher than non-bacterial sore throat. The main cause of bacterial pharyngitis was GAS. Therefore, this study suggested that&nbsp;the use of the effectiveness of antibiotics and recommended anti-bacterial pharyngitis therapy to prevent initial rheumatic fever and its complications. &nbsp; Key words: Pharyngitis, tonsillitis, epidemiological factors, Streptococcus, children.

Clinical features of gingivostomatitis due to primary infection of herpes simplex virus in children

BackgroundPrimary herpetic gingivostomatitis (PHGS) in children, though usually self-limited, might mimic bacterial and enteroviral pharyngitis clinically. We conducted a study to define the clinical features of PHGS in children.MethodsBetween January 2012 and December 2016, 282 inpatients aged less than 19 years with cell culture-confirmed herpes simplex virus (HSV) infection in a medical center were identified from the virologic laboratory logbook. Clinical data were retrospectively collected.ResultsAmong the 282 inpatients, 185 cases were considered as PHGS and were included for analysis. Fever was present in 99.5%. The mean duration of fever was 5.11 days (±2.24) with the longest being 17 days. Common oral manifestations included oral ulcers (84.3%), which equally resided in the anterior and posterior part of the oral cavity (65.4% vs. 63.2%), gum swelling and/or bleeding (67.6%), and exudate coated tonsils (16.8%). Leukocytosis (WBC count > 15,000/uL3) was noted in 52 patients (28.1%) and a serum C-reactive protein level > 40 mg/L in 55 patients (29.7%). Fixty-five patients (35%) were diagnosed with PHGS on admission and were significantly more likely to have ulcers over the anterior oral cavity (76.1% vs. 26.7%) and gum swelling/bleeding (76.2% vs. 7.5%, p-value all < 0.001) on admission and were significantly less likely to receive antibiotic treatment (16.9 vs. 36.7%, p-value < 0.01) than others. Forty-six patients (25%) undiagnosed as PHGS on discharge were significantly more likely to have exudate coated on the tonsils, to receive antibiotic treatment and significantly less likely to have gum swelling/bleeding and oral ulcers (all p-values < 0.01).ConclusionsMeticulously identifying specific oral manifestations of gum swelling/bleeding and ulcers over the anterior oral cavity in children can help making the diagnosis of PHGS earlier and subsequently reduce unnecessary prescription of antibiotics.

Comparison and Recommendation of Diagnostic Tools for Bacterial Pharyngitis at Primary Care Clinics

Comparison and Recommendation of Diagnostic Tools for Bacterial Pharyngitis at Primary Care Clinics

Extensive Deep Tissue Involvement in Nicolau Syndrome and Below-Knee Amputation: A Case Report and Literature Review.

Nicolau syndrome (NS) is a rare cutaneous drug reaction in response to injections administered via any route. Based on the available studies in the medical literature, NS presents as skin and subcutaneous fat necrosis, and typically, it does not cause severe complications such as acute limb ischemia or death. In this study, we report the case of a 6-year-old boy who received an intramuscular injection of benzathine penicillin G for the treatment of bacterial pharyngitis, and subsequently developed a severe case of NS, which eventually led to below-knee amputation of the right lower limb. Although a few approaches have been suggested for the management of NS, they might not be effective under certain circumstances. Early detection, close monitoring, and consistent interventions, such as surgical fasciotomy and debridement procedures, might be necessary in severe cases of NS.

Multicenter Clinical Evaluation of the Revogene Strep A Molecular Assay for Detection of Streptococcus pyogenes from Throat Swab Specimens.

Group A streptococcus (GAS) species cause bacterial pharyngitis in both adults and children. Early and accurate diagnosis of GAS is important for appropriate antibiotic therapy to prevent GAS sequalae. The Revogene Strep A molecular assay (Meridian Bioscience Canada Inc, Quebec City, QC, Canada) is an automated real-time PCR assay for GAS detection from throat swab specimens within approximately 70 min. This multicenter prospective study evaluated the performance of the Revogene Strep A molecular assay compared to that of bacterial culture. Dual throat swab specimens in either liquid Amies or Stuart medium were collected from eligible subjects (pediatric population and adults) enrolled across 7 sites (USA and Canada). Revogene Strep A and reference testing was performed within 7 days and 48 h of sample collection, respectively. Of the 604 evaluable specimens, GAS was detected in 154 (25.5%) samples by the reference method and in 175 (29%) samples by the Revogene Strep A assay. Revogene Strep A assay sensitivity and specificity were reported to be 98.1% (95% confidence interval [CI], 94.4 to 99.3) and 94.7% (95% CI, 92.2 to 96.4), respectively. The positive predictive value was 86.3% (95% CI, 80.4 to 90.6), negative predictive value was 99.3% (95% CI, 98.0 to 99.8) with a 1.0% invalid rate. Discrepant analysis with alternative PCR/bidirectional sequencing was performed for 24 false-positive (FP) and 3 false-negative (FN) specimens. Concordant results were reported for 17 (FP only) of 27 discordant specimens. The Revogene Strep A assay had high sensitivity and specificity for GAS detection and provides a faster alternative for GAS diagnosis.

The effect of group A streptococcal carrier on the epidemic model of acute rheumatic fever

BackgroundGroup A streptococcus (GAS) is the most frequent cause of bacterial pharyngitis in school-aged children. The postinfection sequel as acute rheumatic fever (ARF) and rheumatic heart disease that cause morbidity and mortality among young people is public health concerns in several developing countries. Asymptomatic carriage state of GAS is not fully understood in terms of host and bacterial factors. Although the ability of transmitting GAS of the asymptomatic carriers is relatively low, they may present the reservoir of the epidemic. A fraction of GAS carriers is difficult to estimate in practice and may greatly vary between populations. Understanding the role of carriage on the transmission dynamic of GAS is important for assessing the public health impact of the ARF.MethodThis study investigates the effect of GAS carriers on both the transmission and dynamic of ARF cases by using a mathematical model.ResultWe derive the sufficient conditions for which the GAS can spread or extinct from the naive population under the variation of the fraction of symptomatic cases over the incidence of GAS. The threshold is possible to occur in general, but the last condition which is rather restrictive and involves parameter uncertainty. The increasing of carriers in the endemic state leads to the reduction in magnitude of the reproduction number and the number of ARF patients. We demonstrate that the adjustment of parameters can be carried out by the use of endemic state and some specific data.ConclusionWe show theoretically that the presence of asymptomatic carriers may induce the epidemic threshold and reduce the virulence of GAS and the prevalence of ARF.

Randomised Controlled Trial of Salt Solution (Sodium Chloride) Mouth Wash vs Thymol Glycerine Usage in Sore Throat with Non Bacterial Pharyngitis

Backgrounds: Sore throat is one of the most common reasons for visits to the hospital. While most patients with sore throat have an infectious cause (pharyngitis), either bacterial or viral infection, fewer than 20 per cent have a clear indication for antibiotic therapy.&#x0D; Objective: The aim of this study is to investigate the patient’s clinical outcome after using a salt solution (sodium chloride) and thymol glycerine mouth wash in the evaluation of sore throat patient with non bacterial pharyngitis.&#x0D; Methods: This was a randomized clinical trial, in which 100 patients who had non-bacterial pharyngitis were divided into two groups: those who gargled a salt solution (sodium chloride 3%) and those who gargled a thymol solution. A sore throat questionnaire was filled out 1 week later.&#x0D; Results: Demographically, the results showed that there were significant differences between the two groups with regard to gender. However, there was no significant difference in age of the patients. A significant difference was observed between the two groups in term of sore throat pain scale, difficulty swallowing scale and swollen throat scale. All p-value are &lt;0.001.&#x0D; Conclusion: Gargling a salt solution, a natural, and harmless substance, can reduce the pain and other symptom of sore throat in patients with non-bacterial pharyngitis.

Prevalence and long-term persistence of beta-haemolytic streptococci throat carriage among children and young adults.

Introduction. Among beta-haemolytic streptococci, Streptococcus pyogenes (GAS) is the prototype agent of bacterial pharyngitis and causes other human infections. Streptococcus dysgalactiae subsp. equisimilis (SDSE) causes GAS-like infections, while Streptococcus agalactiae (GBS) is a common neonate pathogen that is rarely associated with pharyngitis.Aim. To determine the prevalence and persistence of beta-haemolytic streptococci throat carriage and type the bacterial population.Methods. Throat swabs were collected from 121 children and 127 young adult volunteers and cultured. Colonized volunteers were screened quarterly, for up to 1 year, while beta-haemolytic streptococci could be detected. Isolates were identified and submitted to antimicrobial susceptibility testing and epidemiological typing.Results. Carriage was detected in 34 (13.7 %) volunteers. Seventeen children carried GAS (14 %), while 17 young adults carried SDSE (8, 6.3 %), GBS (4, 3.1 %), GAS (3, 2.4 %) and the Streptococcus anginosus group (2, 1.6 %). Persistent carriage was detected for up to 6 months in two children and for up to 1 year in three young adults. Three new emm subtypes were found, emm87.16 and emm90.9 (GAS) and stC36.11 (SDSE). While the GAS population among children was unexpectedly clonal, substantial genetic diversity was found among the isolates recovered from young adults. Resistance to erythromycin, clindamycin and tetracycline was detected in GAS, GBS and SDSE recovered from young adults.Conclusions. Prevalence was slightly greater among children, but persistent carriage was greater among young adults, with SDSE being the species most associated with persistence. Few sources seemed to disseminate GAS among children, since only two clonal types were found. The volunteers hosted pathogenic streptococci persistently, including macrolide-resistant strains.

Rapid Antigen Detection Test for Diagnosis of Bacterial Pharyngitis

Pharyngitis is a prevalent disease of the upper respiratory tract that requires treatment with an antibiotic. Group A streptococci (GAS) are the most frequent etiologic agents of bacterial pharyngitis. Because GAS are susceptible to penicillin, routine antibiotic susceptibility testing is not needed. Generally, patients with bacterial pharyngitis have high fever, cervical lymphadenopathy and tenderness, and tonsillar exudative discharge without symptoms of the common cold (e.g., cough, rhinorrhea, and sneezing). However, differentiating bacterial pharyngitis from viral pharyngitis based only on their clinical manifestations is problematic. Therefore, a bacterial culture or a rapid antigen detection test (RADT) is required for the diagnosis of bacterial pharyngitis. Although bacterial culture is the gold standard for diagnosis of bacterial pharyngitis, its accuracy is affected by the technical expertise of the technician, and there is a delay of 1-2 days before the results become available. In contrast, the sensitivity of RADT has increased to over 90%, making them suitable for screening purposes. The result of a RADT is available within 5-10 minutes, obviating the need for a second visit to obtain the results of culture. Use of a RADT would enable the optimal antibiotic to be administered earlier, reducing the overuse of antibiotics. Keywords: Pharyngitis; Immunological tests; Drug resistance 중심 단어: 인두염; ë©´ì—­í•™ì  검사; ì•½ì œ 내성

Predominance of emm4 and antibiotic resistance of Streptococcus pyogenes in acute pharyngitis in a southern region of Korea.

Streptococcus pyogenes is the most common cause of bacterial pharyngitis. Genotyping of emm is useful for molecular epidemiological survey of S. pyogenes. Antibiotic resistance data are needed for empirical treatments. In total, 358 children in Changwon, Korea who had pharyngitis symptoms were subjected to throat cultures to isolate S. pyogenes in 2017. emm genotyping was performed by direct sequencing. An antibiotic susceptibility test was performed using the disk diffusion method for erythromycin (ERY), clindamycin (CLI), tetracycline (TET) and ofloxacin (OFX). Screening for macrolide resistance phenotype and its determinants was performed for the ERY-resistant strains. A total of 190 strains (53.1 %) of S. pyogenes were isolated from 358 children. The most frequent emm genotype was emm4 (53.2 %), followed by emm89 (12.6 %), emm28 (11.6 %) and emm1 (10 %). Antibiotic resistance rates to ERY, CLI, TET and OFX were 3.2 %, 2.6 %, 1.1 % and 2.6%, respectively. There were five isolates of the cMLSB phenotype having the ermB gene and one M phenotype harbouring the mefA gene. The distribution of emm genotypes was quite different from those previously reported in Korea. emm4 accounted for more than 50 % of the genotypes. Macrolide resistance rates remained very low, but five of six ERY-resistant strains displayed the cMLSB phenotype.

Antagonistic effects of Streptococcus and Lactobacillus probiotics in pharyngeal biofilms.

Direct antagonism towards pathogens including Streptococcus pyogenes is a proposed mechanism of pharyngeal probiosis but off-target effects on the symbiotic microbiota of the throat are possible and may be beneficial, harmful or neutral. We have assessed the bacteriological effects of two candidate Lactobacillus probiotics and the established pharyngeal probiotic Streptococcus salivarius K12. Antagonism towards S. pyogenes and potential off-target effects were determined using sessile monospecies biofilms and pharyngeal microcosms, respectively. The candidate probiotics were antagonistic towardsS. pyogenes (rank order of increasing potency, Lactobacillus acidophilus<Lactobacillus plantarum<Streptococcus salivarius) in the absence of significant acidification or cell-cell contact. Streptococcus salivarius and L. plantarum caused significant reductions in viable counts of streptococci in pharyngeal microbiotas, whilst S. salivarius also caused reductions in staphylococci. In contrast, changes in pharyngeal eubacterial DNA profiles were limited overall. In summary, the three candidate probiotics suppressed axenic Streptococcus pyogenes biofilms by mechanisms that did not depend on cell-cell contact or acidification and did not markedly destabilize complex pharyngeal microbiotas derived from healthy individuals. SIGNIFICANCE AND IMPACT OF THE STUDY: Candidate probiotic bacteria deployed to prevent or treat bacterial pharyngitis will interact with the target bacteria such as Streptococcus pyogenes as well as with the microbiota of the throat, where off-target effects are possible. Three candidate probiotics Lactobacillus acidophilus, Lactobacillus plantarum and Streptococcus salivarius reduced viability within extant S. pyogenes biofilms through the elaboration of diffusible factors other than fermentation acids but did not markedly disrupt ex situ pharyngeal microcosms. This work demonstrates the application of invitro pharyngeal models in the preclinical testing of the safety and efficacy of candidate pharyngeal probiotics.

Safety of Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Liver Metastases from Ocular Melanoma Using the Delcath Systems\u2019 Second-Generation Hemofiltration System: A Prospective Non-randomized Phase II Trial

PurposeTo investigate the safety and toxicity of percutaneous hepatic perfusion with melphalan (M-PHP) with the Delcath Systems’ second-generation (GEN 2) filter and compare the outcomes with historical data from studies using the first-generation filter.Materials and MethodsA prospective, single-arm, single-center phase II study was carried out including 35 patients with unresectable, histologically confirmed liver metastases from ocular melanoma between February 2014 and June 2017. Main exclusion criteria were extrahepatic disease and age > 75 years. M-PHP was performed with melphalan 3 mg/kg (maximum dose 220 mg). Safety and toxicity were assessed according to the Common Terminology Criteria for Adverse Events version 4.03.ResultsA total of 67 M-PHPs were performed in 35 patients (median 2 procedures). Although hematologic grade 3/4 events were seen in the majority of patients (thrombocytopenia 54.5%, leukopenia 75.6%, neutropenia 66.7%, anemia (only grade 3) 18.1%), these were all well manageable or self-limiting. Of the non-hematologic grade 3 events (n = 14), febrile neutropenia (n = 3), pulmonary emboli (n = 2) and post-procedural hemorrhage (n = 2) were most common. A case of sepsis with bacterial pharyngitis was the only non-hematologic grade 4 event. Prior therapy for liver metastases was found to be a predictor of late grade 3/4 neutropenia with an odds ratio of 5.5 (95% CI 1.4–21.7).ConclusionsM-PHP using the GEN 2 filter has an acceptable safety and toxicity profile, and seems to reduce hematologic toxicity when compared to M-PHP with a first-generation filter. Prior therapy of liver metastases is a possible predictive factor in developing grade 3/4 hematologic toxicity.

Community Awareness of Sore Throat and Rheumatic Heart Disease in Northern Ethiopia

Background: Rheumatic heart disease (RHD) remains the leading cardiovascular disease in Ethiopian children and adults. Early treatment of bacterial sore throat is important in primary prevention of acute rheumatic fever (ARF). In Ethiopian population knowledge about RHD and its prevention strategies is expected to be limited but few studies have been done. Methods: To determine awareness of RHD prevention in the community in Northern Ethiopia a descriptive cross-sectional study was conducted in three districts of Tigray, Northern Ethiopia. Using structured questionnaire, adults > 18 years selected by systematic random sampling were interviewed. Findings: A total of 1298 participants were included, 1004 (77·4%) were from rural areas, 978 (75·3%) were female and 823 (60·1%) had no formal education. Only 34 (2·6%) of the participants responded that the cause of sore throat is due to bacteria or virus and 6·2 % knew that there is a relation between sore throat and heart disease. Of the respondents, 43·3% would take children with sore throat to traditional healers, 71·6% had history of uvulectomy in their children or themselves. Only 7·8% answered that penicillin injection is useful in children with sore throat as primary prophylaxis and 8·1% answered that regular penicillin injection is useful as secondary prevention in RHD. Interpretation: These results can help understand the beliefs and practices about sore throat in Northern Ethiopia. We conclude that the community awareness on the cause and the link between bacterial pharyngitis and ARF/RHD is almost non-existent. Funding: Klinikpartnerschaften, Germany, supported the study. Declaration of Interest: None. Ethical Approval: An ethical approval for this study was obtained from Mekelle University Ethical Review Committee of the College of Health Sciences, Northern Ethiopia. A letter of permission was issued from the Tigray Regional Health Bureau and the district health authorities. Verbal informed consent from the household heads was obtained.

2293. Evaluation of Three Rapid Molecular Assays for the Detection of Group A Streptococcus

BackgroundGroup A Streptococcus (GAS), the primary causative agent of bacterial pharyngitis, is most commonly diagnosed with a rapid antigen test performed at the point of care followed by bacterial culture, if negative. Final test results may not be available for 24–72 hours, which can delay the time to therapy and cause patients to miss additional work or school days. Recently, rapid molecular tests, including some that are CLIA-waived, have become available allowing providers to obtain results within a timeframe similar to rapid antigen tests, but with accuracies comparable to traditional culture. The purpose of this study was to evaluate the performance of the Alere™i Strep A test, Roche cobas® Strep A test, and the Cepheid Xpert Xpress Strep A Test (RUO Version) compared with the OSOM Group A Streptococcus rapid antigen test and traditional bacterial culture. All molecular tests are either currently or in the process of obtaining CLIA-Waived status and can be completed in less than 25 minutes.MethodsThe current testing process in our healthcare system (AdvocateAuroraHealth) is to collect oropharyngeal swabs with both a traditional swab and an ESwab (Copan). The traditional swab is used for rapid antigen testing and the ESwab is submitted to the microbiology laboratory for bacterial culture, if indicated. Residual ESwab specimens were de-identified, cultured, and tested using the Alere and Roche molecular assays (at the time of de-identification the result of the GAS rapid antigen test that was performed on the same patient at the time of ESwab collection was noted). Following testing, ESwab specimens were frozen and tested on the Cepheid molecular assay within 6 months. In total 194 specimens were compared.ResultsSpecimens positive by culture or in two of three molecular assays were considered true positives. The results can be seen in the Table below. ConclusionAll molecular tests were more sensitive than antigen testing and culture and could be completed in a timeframe similar to the rapid antigen test. Replacing traditional GAS diagnosis with rapid GAS molecular assays will allow providers to make definitive clinical decisions in near real-time. Acknowledgements. Molecular testing reagents and equipment were provided by Roche, Alere, and Cepheid.Disclosures All authors: No reported disclosures.

Spectrum of bactericidal action of amylmetacresol/2,4-dichlorobenzyl alcohol lozenges against oropharyngeal organisms implicated in pharyngitis.

PurposePharyngitis is commonly caused by a self-limiting upper respiratory tract infection (URTI) and symptoms typically include sore throat. Antibiotics are often inappropriately used for the treatment of pharyngitis, which can contribute to antimicrobial resistance, therefore non-antibiotic treatments which have broad antiseptic effects may be more appropriate. Amylmetacresol (AMC) and 2,4-dichlorobenzyl alcohol (DCBA) are present in some antiseptic lozenges and have established benefits in providing symptomatic relief and some in vitro antiviral action.MethodsSeven bacterial species associated with pharyngitis, namely Streptococcus pyogenes, Fusobacterium necrophorum, Streptococcus dysgalactiae subspecies equisimilis, Moraxella catarrhalis, Haemophilus influenza, Arcanobacterium haemolyticum and Staphylococcus aureus, were exposed to an AMC/DCBA lozenge dissolved in artificial saliva. In vitro bactericidal activity was measured as a log reduction in colony-forming units (CFUs).ResultsBactericidal activity was recorded against all organisms after 1 minute. Greater than 3 log10 reductions in CFUs were observed at 1 minute for S. pyogenes (log10 reduction CFU/mL ± SD, 5.7±0.1), H. influenza (6.1±0.1), A. haemolyticum (6.5±0.0) and F. necrophorum (6.5±0.0), at 5 minutes for S. dysgalactiae (6.3±0.0) and M. catarrhalis (5.0±0.9) and at 10 minutes for S. aureus (3.5±0.1).ConclusionAn AMC/DCBA lozenge demonstrated a greater than 99.9% reduction in CFUs against all tested species within 10 minutes, which is consistent with the time a lozenge remains in the mouth. Patients with uncomplicated bacterial pharyngitis may benefit from the antibacterial action of antiseptic AMC/DCBA lozenges. Furthermore, AMC/DCBA lozenges may be more relevant and appropriate than antibiotics for pharyngitis associated with a self-limiting viral URTI.

Simple or Complex? A Not so Straightforward Manifestation of Herpes Simplex Virus

Esophagitis presents with odynophagia and/or dysphagia and diagnosed based endoscopic ulcerations and biopsy pathology. Etiology for esophagitis is either noninfectious or infectious; noninfectious causes such as gastroesophageal reflux disease (GERD) are most common. Herpes simplex virus (HSV) esophagitis is a well described infectious cause in immunocompromised hosts, but rarely seen in immunocompetent individuals. This is a 28 year old male with no past medical history who presented to his PCP with a chief complaint of sore throat which was presumed to be benign. Eight weeks later he presented to urgent care with persistent sore throat, and started on amoxicillin for bacterial pharyngitis. The next day he was seen in the emergency department for fevers and odynophagia. He was started on pantoprazole for GERD and continued on amoxicillin. He was seen by gastroenterology five days later for further evaluation of odynophagia. He also reported severe heartburn, which improved slightly with pantoprazole, and inability to eat due to pain. He reported no prior surgeries, social alcohol use, and no pertinent family history. Physical exam revealed an enlarged left tonsil without exudate and lab work was unremarkable. On endoscopic evaluation he had LA grade D erosive esophagitis with circumferential severe ulcerations in the distal esophagus and scattered mid esophageal ulcerations. Biopsies of esophageal ulcerations showed rare multinucleated and nuclear viral inclusions and immunohistochemical stains were positive for HSV1 and HSV2, consistent with herpes simplex esophagitis. Additional lab work revealed an HSV1/2 IgM of 4.08, an HSV 1 IgG of >8.0, a negative HSV 2 IgG. He was noted to have a negative HIV test and a normal CD4 count. He was started on a Valtrex with rapid improvement of symptoms. Although HSV is an uncommon cause of esophagitis in immunocompetent hosts, it is an important differential in patients who do not respond to conservative therapy for a noninfectious cause. Herpes simplex esophagitis is usually self-limited in immunocompetent hosts, but can also manifest with significant esophageal ulceration and erosion, as shown in this case. Untreated herpes simplex esophagitis can result in weight loss and malnutrition due odynophagia, worsening of esophageal ulcerations, and even esophageal perforation. These patients respond well to antiviral therapy and early definitive diagnosis can lead to early treatment and improved patient outcomes.1741_A Figure 1. Distal esophagus with LA grade D erosive esophagitis and severe circumferential ulcerations1741_B Figure 2. Scattered ulcerations in the mid esophagus1741_C Figure 3. Multinucleated cell at single arrow; cells showing margination of chromatin at double arrows

Clinical Impact of a Rapid Streptococcal Antigen Test on Antibiotic Use in Adult Patients

IntroductionAdult pharyngitis is rarely attributable to group A streptococci. Utilization of a rapid streptococcal antigen test (RADT) may improve appropriate prescribing for bacterial pharyngitis. MethodsClinic 1 performed RADTs with subsequent Group A DNA probe test (GADNA) from November 2014-March 2015 and November 2015-March 2016 while Clinic 2 was the control clinic, then implemented the RADT with a GADNA from November 2015-March 2016. All GADNA results were obtained for each clinic from October 2013-March 2016. ResultsAt Clinic 1, 22.2% versus 8.5% of patients received inappropriately prescribed antibiotics for a GADNA or RADT result, respectively (p=0.048). For Clinic 2, 51.1% compared to 21.4% of patients were inappropriately prescribed antibiotic for a GADNA or RADT result, respectively (p=0.038). Overall, the total GADNA without RADT testing or RADTs with subsequent GADNA testing, 41.6% versus 11% of patients were inappropriately prescribed antibiotics, respectively (p=<0.0001). ConclusionUtilizing the RADT prevented unnecessary prescribing of antibiotics in adults.