Group A Beta-hemolytic Streptococcal Pharyngitis Research Articles

The Epidemiology of Influenza Virus Infection and Group A Streptococcal Pharyngitis in Children Between 2011 and 2018 in an Outpatient Pediatric Clinic.

Background The frequency of influenza virus infections and group A beta-hemolytic streptococcus (GAS) pharyngitis varies according to populations. We aimed to investigate the frequency of influenza virus and streptococcal pharyngitis infections in a pediatric outpatient cohort with many pediatric admissions in Istanbul. Materials and methods Children with upper respiratory tract infection (URTI) symptoms between 2011 and 2018 who underwent rapid diagnostic tests for influenza virus or streptococcal infection were evaluated retrospectively. Results Thetotal number of pediatric cases admitted between 2011 and 2018 was 185,228, of which 119,928 were under five years oldand 66,300 were children over five years old. The mean frequency of the influenza virus was 1,283 per 100,000 children, and the mean frequency of streptococcal pharyngitis was 1,764 per 100,000 children. The frequency of influenza has increased over the years. The frequency of streptococcal infection is higher in children over five years of age, and its frequency has decreased in this group. Conclusions Thefrequency of influenza virus infection and GAS pharyngitis varies according to years and seasons. Winter and spring were the seasons with the most frequent positive influenza virus and GAS pharyngitis. Although influenza frequency increased annually, this phenomenon was not observed in the frequency of GAS pharyngitis.

Respiratory microorganisms in acute pharyngitis patients: Identification, antibiotic prescription patterns and appropriateness, and antibiotic resistance in private primary care, central Malaysia.

Acute pharyngitis (AP) is a common reason for private primary care consultations, thus providing an avenue for widespread antibiotic intake among the community. However, there is limited data on the antibiotic prescription appropriateness and resistance information in the Malaysian private primary care setting, therefore, this study aimed to investigate the prevalence of isolated viruses and bacteria, antibiotic resistance patterns, antibiotic prescription patterns and appropriateness by general practitioners (GPs) and factors affecting antibiotic resistance and antibiotic prescription patterns. To investigate, a cross-sectional study was conducted among 205 patients presenting with AP symptoms at private primary care clinics in central Malaysia from 3rd January 2016 to 30th November 2016. Throat swabs were collected from 205 AP patients for two purposes: (i) the detection of four common respiratory viruses associated with AP via reverse-transcription real-time PCR (qRT-PCR); and (ii) bacterial identification using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Bacterial isolates were then subjected to antibiotic susceptibility screening and McIsaac scoring was calculated post-prescription based on GP selection of criteria. Generalized estimating equations analysis with multiple logistic regression was conducted to identify factors associated with presence of virus and antibiotic prescription. The results showed that 95.1% (195/205) of patients had at least one of the four viruses, with rhinovirus (88.5%) being the most prevalent, followed by adenovirus (74.9%), influenza A virus (4.6%) and enterovirus (2.1%). A total of 862 non-repetitive colonies were isolated from the culture of throat swabs from 205 patients who were positive for bacteria. From a total of 22 genera, Streptococcus constitutes the most prevalent bacteria genus (40.9%), followed by Neisseria (20%), Rothia (13.0%), Staphylococcus (11%) and Klebsiella (4.9%). Only 5 patients carried group A beta-hemolytic streptococci (GABHS). We also report the presence of vancomycin-resistant S. aureus or VRSA (n = 9, 10.1%) among which one isolate is a multidrug-resistant methicillin-resistant S. aureus (MDR-MRSA), while 54.1% (n = 111) were found to carry at least one antibiotic-resistant bacteria species. Application of the McIsaac scoring system indicated that 87.8% (n = 180) of patients should not be prescribed antibiotics as the majority of AP patients in this study had viral pharyngitis. The antibiotic prescription appropriateness by applying post-prescription McIsaac scoring was able to rule out GABHS pharyngitis in this sample with a GABHS culture-positive sensitivity of 40% (n = 2/5) and specificity of 90% (180/200). In conclusion, antibiotic-resistant throat isolates and over-prescription of antibiotics were observed and McIsaac scoring system is effective in guiding GPs to determine occurrences of viral pharyngitis to reduce unnecessary antibiotic prescription.

Rapid strep testing in children with recently treated streptococcal pharyngitis.

ImportanceThe use of the rapid antigen‐detection test (RADT) has become the standard of care in the early diagnosis of group A beta‐hemolytic Streptococcus (GAS) pharyngitis. Concern has been expressed over increased false positives when the child had been treated recently for GAS pharyngitis, resulting in over use of antibiotics.ObjectiveTo determine if the false positive rate for RADT is increased in children recently treated for GAS pharyngitis.MethodsWe conducted a prospective study to evaluate 300 children from a private practice with acute pharyngitis who were treated for GAS pharyngitis within the preceding 28 days (study group) compared to 306 children of comparable age who had not been previously treated (control group). RADT and throat culture were performed on all children presenting with signs and symptoms of acute pharyngitis. The false positive and false negative rates were determined and compared in both groups.ResultsThe false positive rate of 11.5% (23/200) in the study group was significantly higher than the false positive rate of 0 in the control group. False positives were more likely to occur in younger children.InterpretationThese data would indicate that while RADT is reliable in most children, it can lead to over treatment in children who have been recently treated for GAS. In children treated in the preceding 28 days for GAS pharyngitis, the presence of infection should be determined with a throat culture only. Treatment based on a positive RADT should be reserved for children not recently treated for GAS pharyngitis.

Analysis of the tonsillar microbiome in young adults with sore throat reveals a high relative abundance of Fusobacterium necrophorum with low diversity.

Fusobacterium necrophorum (Fn), a gram-negative anaerobe, is increasingly implicated as an etiologic agent in older adolescents and young adults with sore throat. Inadequately treated Fn pharyngitis may result in suppurative complications such as peritonsillar abscess and Lemierre’s syndrome. Data from the literature suggest that the incidence of life-threating complications in these age groups from Fn pharyngitis (Lemierre’s syndrome) in the United States exceeds those associated with group A beta-hemolytic streptococcal (GAS) pharyngitis (acute rheumatic fever). Using real-time PCR, we previously reported about a 10% prevalence of Fn in asymptomatic medical students and about 20% in students complaining of sore throat at a university student health clinic (p = 0.009). In this study, a comprehensive microbiome analysis of the same study samples confirms that Fn pharyngitis was more common than GAS pharyngitis. Eighteen patients were found to have Fn OTU values exceeding an arbitrary cutoff value of 0.1, i.e. greater than 10% of total sequences, with five subjects reaching values above 0.7. By contrast only 9 patients had GAS OTU values greater than 0.1 and none exceeded 0.6. When the data were analyzed using five separate assessments of alpha diversity, in each case for Fn there were statistically significant differences between Fn positive_high (OTU abundance > 0.1) vs control, Fn positive_high vs Fn negative (OTU abundance = 0), Fn positive_high vs Fn positive_low (OTU abundance > 0 and < 0.1). When the data were analyzed using three beta diversity indexes (Bray-Curtis, weighted unifrac, and unweighted unifrac), there were statistically significant differences between Fn positive_high (OTU abundance ≥ 0.1) vs control for all three. Statistically significant differences remained if we chose somewhat different OTU abundance cutoffs of 0.05 or 0.15. We conclude that Fn appears to play a dominant role in bacterial pharyngitis in the older adolescent and young adult age groups and that the development of a productive mucosal infection with Fn is linked to a significant decrease in the diversity of the associated tonsillar microbiome.

Diagnosis and management of group A beta-hemolytic streptococcal pharyngitis

Viral and Group A beta-hemolytic streptococcal (GAS) pharyngitis have overlapping signs and symptoms, but distinguishing between the two is critical to proper treatment. Antibacterial therapy is appropriate for GAS pharyngitis and may help prevent complications.

Rheumatic Heart Disease: Progress and Challenges in India

Rheumatic heart disease, a neglected disease, continues to be a burden in India and other developing countries. It is a result of an autoimmune sequalae in response to group A beta hemolytic streptococcus (GAS) infection of the pharynx. Acute rheumatic fever (RF), a multisystem inflammatory disease, is followed by rheumatic heart disease (RHD) and has manifestations of joints, skin and central nervous system involvement. A review of epidemiological studies indicates unchanged GAS pharyngitis and carrier rates in India. The apparent decline in RHD rates in India as indicated by the epidemiological studies has to be taken with caution as methodological differences exist among studies. Use of echocardiography increases case detection rates of RHD in population surveys. However, the significance of echo based diagnosis of carditis needs further evaluation to establish the significance. Research in this area through prospective follow up studies will have to be undertaken by the developing countries as the interest of developed countries in the disease has waned due the declined burden in their populations. Prevention of RHD is possible through treatment of GAS pharyngitis (primary prophylaxis) and continued antibiotic treatment for number of years in patients with history of RF to prevent recurrences (secondary prophylaxis). The cost effectiveness and practicality of secondary prophylaxis is well documented. The challenge to any secondary prophylaxis program for prevention of RF in India will be the availability of benzathine penicillin G and dissipation of fears of allergic reactions to penicillin among practitioners, general public and policy makers. The authors review here the progress and challenges in epidemiology, diagnosis and primary and secondary prevention of RF and RHD.

Variation in Clinical Presentation of Childhood Group A Streptococcal Pharyngitis in Four Countries

We conducted a cross-sectional study from September 2001 to August 2003 during which children between 2 and 12 years of age presenting with complaint of sore throat were recruited from urban pediatric clinics in Brazil, Croatia, Egypt and Latvia. The objective of the study was to compare clinical signs and symptoms of children presenting to urban pediatric clinics with sore throat in and between countries and to identify common clinical criteria predicting group A beta hemolytic streptococcal (GAS) pharyngitis. Using a single standard protocol in all four sites, clinical data were recorded and throat swabs obtained for standard GAS culture in 2040 children. Signs and symptoms were tested for statistical association with GAS positive/negative pharyngitis, and were compared using chi(2) tests, ANOVA and Odds Ratios. Clinical signs of GAS pharyngitis in children presenting to clinics varied significantly between countries, and there were few signs or symptom that could statistically be associated with GAS pharyngitis in all four countries, though several were useful in two or three countries. Our results indicate that the clinical manifestations of pharyngitis in clinics may vary by region. It is therefore critical that clinical decision rules for management of pharyngitis should have local validation.

Group A Beta-Hemolytic Streptococcal Pharyngitis in Inmates

An initial attack of group A beta-hemolytic streptococcal (GAS) pharyngitis is observed in approximately 5% to 26% of adults in the late teens or early 20s. Correctional professionals need to understand the pathophysiology of the disease, signs and symptoms, diagnostic data and treatment protocols, and compliance issues to prevent the transfer of infection among inmates. Spread of the bacteria can occur through direct contact with mucus from the nose or throat and can be prevented through good hand washing. This article presents a classic case of an inmate presenting with GAS pharyngitis and the interventions employees of correctional facilities can practice.

Efficacy of Tonsillectomy in Treatment of Recurrent Group A β‐Hemolytic Streptococcal Pharyngitis

The objective of this study was to determine whether children with tonsillectomies experienced fewer recurrent group A beta-hemolytic streptococcal (GABHS) infections after surgery compared with children who did not receive tonsillectomies. The authors conducted a retrospective cohort study of 290 children 4 to <16 years who experienced three or more episodes of group A beta-hemolytic streptococcal pharyngitis at least 1 month apart in 12 months. Children without tonsillectomy were 3.1 times (95% confidence interval, 1.9-4.9; P < .001) more likely to develop a subsequent group A beta-hemolytic streptococcal pharyngitis infection during follow up than children who underwent tonsillectomy after adjusting for the number of group A beta-hemolytic streptococcal pharyngitis infections per patient within the previous year and the presence of preexisting conditions. Among the children who developed a subsequent group A beta-hemolytic streptococcal pharyngitis infection, the children without a tonsillectomy developed a group A beta-hemolytic streptococcal pharyngeal infection sooner (median, 0.6 vs. 1.1 years). Tonsillectomy is associated with a decrease in the number of group A beta-hemolytic streptococcal pharyngitis infections in children with a history of recurrent groups A beta-hemolytic streptococcal pharyngitis infection. Tonsillectomy also increased the amount of time before development of further GABHS pharyngitis.

Diagnosis and management of adults with pharyngitis. A cost-effectiveness analysis.

Rheumatic fever has become uncommon in the United States while rapid diagnostic test technology for streptococcal antigens has improved. However, little is known about the effectiveness or cost-effectiveness of various strategies for managing pharyngitis caused by group A beta-hemolytic streptococcus (GAS) in U.S. adults. To examine the cost-effectiveness of several diagnostic and management strategies for patients with suspected GAS pharyngitis. Cost-effectiveness analysis. Published literature, including systematic reviews where possible. When costs were not available in the literature, we estimated them from our institution and Medicare charges. Adults in the general U.S. population. 1 year. Societal. Five strategies for the management of adult patients with pharyngitis: 1) observation without testing or treatment, 2) empirical treatment with penicillin, 3) throat culture using a two-plate selective culture technique, 4) optical immunoassay (OIA) followed by culture to confirm negative OIA test results, or 5) OIA alone. Cost per lost quality-adjusted life-days (converted to life-years where appropriate) and incremental cost-effectiveness. Empirical treatment was the least effective strategy at a GAS pharyngitis prevalence of 10% (resulting in 0.41 lost quality-adjusted life-day). Although the other four strategies had similar effectiveness (all resulted in about 0.27 lost quality-adjusted life-day), culture was the least expensive strategy. Results were sensitive to the prevalence of GAS pharyngitis: OIA followed by culture was most effective when GAS pharyngitis prevalence was greater than 20%. Observation was least expensive when prevalence was less than 6%, and empirical treatment was least expensive when prevalence was greater than 71%. The effectiveness of strategies was also very sensitive to the probability of anaphylaxis: When the probability of anaphylaxis was about half the baseline probability, OIA/culture was most effective; when the probability was 1.6 times that of baseline, observation was most effective. Only at an OIA cost less than half of baseline did the OIA alone strategy become less expensive than culture. Results were not sensitive to other variations in probabilities or costs of diagnosis or treatment of GAS pharyngitis. Observation, culture, and two rapid antigen test strategies for diagnostic testing and treatment of suspected GAS pharyngitis in adults have very similar effectiveness and costs, although culture is the least expensive and most effective strategy when the GAS pharyngitis prevalence is 10%. Empirical treatment was not the most effective or least expensive strategy at any prevalence of GAS pharyngitis in adults, although it may be reasonable for individual patients at very high risk for GAS pharyngitis as assessed by a clinical decision rule.

Clinical score card for diagnosis of group A streptococcal sore throat.

Group A beta hemolytic streptococcus (GAS) sore throat primarily occurs among children in 5-15 years age group, and if not treated appropriately causes rheumatic fever/rheumatic heart disease (RF/RHD). Present study was aimed at validation of a clinical scoring system for diagnosis of GAS. Five hundred and thirty six children in 5-15 years age group were enrolled by systematic random selection of households from a peri-urban slum of Chandigarh. They were visited fortnightly at their home for one year to record signs and symptoms of cough and cold. Throat swabs were collected in 918 episodes, of which 123 (13.4%) were GAS culture positive. Significant association of GAS was found with pain in the throat, enlarged tonsils, pharyngeal erythema and tender cervical lymphadenopathy. According to the percentage positivity of GAS culture, weighted scores were assigned to age of the child, season of occurrence, fever, size of tonsil, pharyngeal erythema and exudate, lymphadenopathy and pain in throat. Combinations of various symptoms and signs gave sensitivity of 86-89% and specificity of 83-89% whereas clinical score of 15 or more had 91% sensitivity and 98% specificity for diagnosis of GAS pharyngitis. As the level of clinical acumen and prevalence of GAS may differ in different primary care settings of the country, the proposed scoring system should be validated and adapted to suit local conditions before establishing it in the primary prophylaxis strategy to prevention of RF/RHD.

The Impact of a Rapid Screen for Streptococcal Pharyngitis on Clinical Decision Making in the Emergency Department

The impact of a rapid streptococcal screening test (RSS) on clinical decision making in the management of patients with acute pharyngitis was evaluated. Physicians managing 95 ambulatory patients with the complaint of sore throat were asked to estimate the probability of group A beta-hemolytic streptococcal pharyngitis (GRABS) in each patient and whether they intended to treat with antibiotics both before and after the results of the RSS were known. Simultaneous throat cultures were obtained for 80 patients at the discretion of the treating physicians. Regression analysis revealed that the RSS result was an important independent predictor for the posttest decision to treat with antibiotics and for the estimated probability of disease. The mean absolute log-likelihood ratio was used to quantify the effect of the RSS on diagnostic certainty; a greater contribution to diagnostic certainty occurred when the RSS was positive. Physicians would have prescribed an antibiotic 49 times without the benefit of the RSS and prescribed an antibiotic 48 times given the RSS result. Without the RSS, the treatment decision contradicted the throat culture result in 25 cases. With the RSS, this occurred in 26 cases. The RSS, while influencing decision making, especially when positive, did not decrease the use of antibiotics.