Correlation between symptoms and Centor/McIsaac score in the diagnosis of tonsillopharyngitis

Purpose: Group A beta hemolytic streptococcus (GABHS) is identified in 20-40% of cases of childhood pharyngitis. The Centor/McIsaac score is an important scoring method used in the early diagnosis of patients presenting with symptoms of Group A beta hemolytic streptococcus (GABHS) pharyngitis. In this study, we aimed to determine the relationship between Centor / McIsaac score and patients’ symptoms, and to investigate any conformity between Rapid Antigen Test positivity and high Centor/McIsaac score. Materials and methods: Data were obtained retrospectively by scanning the files of patients (age 2 to 18 years) diagnosed with GAData were obtained retrospectively by scanning the files of patients (age 2 to 18 years) diagnosed with GABHS who were hospitalized between May and December 2017. Inclusion criteria were, being between the ages of 2 and 18 years and to be diagnosed with group A beta hemolytic streptococcal pharyngitis. Receiving antibiotic treatment within the last 14 days, being under 2 years of age and over 18 years of age are exclusion criteria. Daily clinical findings and test results (complete blood count, neutrophil and lymphocyte percentages, rapid antigen test, throat culture) were collected from medical records. The Centor/ McIsaac scores calculated according to symptoms and rapid antigen test results used for GABHS antigen detection from throat swab samples, used for the initiation of effective treatment and to shorten hospitalization, were recorded from patient files. Student's t test was used to analyze the data that showed normal distribution among independent groups. The chi-square test was used for the analysis of categorical variables. P

Tonsillofarenjit tanısında semptomlar ve Centor/Mclsaac skoru arasındaki korelasyon

Amaç: A grubu beta hemolitik streptokok (GABHS) çocukluk çağı farenjit vakalarının %20-40’ında tanımlanır. Centor/McIsaac skoru A grubu beta hemolitik streptokok farenjiti semptomları ile başvuran hastaların erken tanısında kullanılan önemli bir skorlama yöntemidir. Bu çalışmada, Centor/McIsaac skor ile hastaların semptomları arasındaki ilişkiyi saptamayı ve Hızlı Antijen Test pozitifliği ile yüksek Centor/McIsaac skoru arasındaki herhangi bir uygunluğu incelemeyi amaçladık. Gereç ve yöntem: Mayıs ile Aralık 2017 arasında hastanede yatmış olan GABHS tanısı alan hastaların (2 ila 18 yaş) dosyaları taranarak retrospektif olarak veriler elde edildi. Dahil edilme kriterleri 2 ve 18 yaş arasında olmak, A grubu beta hemolitik streptokok farenjit tanısı almasıdır. Son 14 gün içinde antibiyotik tedavisi almak, 2 yaş altında ve 18 yaş üstünde olmak dışlanma kriterleridir. Günlük klinik bulguları ve test sonuçları (tam kan sayımı, nötrofil ve lenfosit yüzdeleri, Hızlı antijen test, boğaz kültür) tıbbi kayıtlardan toplandı. Boğaz sürüntü örneklerinden GABHS antijeninin saptanması, etkin tedavi başlanması ve hastanede kalış süresinin kısaltılması için kullanılan; semptomlar ve hızlı antijen test sonuçlarına göre hesaplanan Centor/McIsaac skorları hasta dosyalarından kaydedildi. Bağımsız gruplar arasında normal dağılım gösteren verilerin analizinde Student t test kullanıldı. Kategorik değişkenlerin analizi için kikare testi kullanıldı. P

PDF

___

1. Küçük Ö, Biçer S, Giray T, et al. Validity of rapid antigen detection testing in group a beta-hemolytic streptococcal tonsillopharyngitis. Indian J Pediatr 2014;81:138-142. https://doi.org/10.1007/s12098-013- 1067-y
2. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics 2010;126:557- 564. https://doi.org/10.1542/peds.2009-2648
3. Borchardt RA. Diagnosis and management of group a beta hemolytic streptococcal pharyngitis. JAAPA 2013;26:53-54. https://doi.org/10.1097/01. jaa.0000433876.39648.52
4. Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group a streptococcal pharyngitis: 2012 update by the infectious diseases society of America. Clin Infect Dis 2012;55:86-102. https://doi.org/10.1093/cid/cis629
5. Lindbaek M, Hoiby EA, Lermark G, Steinsholt MI, Hjortdahl P. Which is the best method to trace group a streptococci in sore throat patients: culture or GAS antigen test? Scand J Prim Health Care 2004;22:233- 238. https://doi.org/10.1080/02813430410006675
6. Fontes MJ, Bottrel FB, Fonseca MT, Lasmar LB, Diamante R, Camargos PA. Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test. J Pediatr (Rio J) 2007;83:465-470. https://doi.org/10.2223/JPED.1695
7. Hryniewicz W, Albrecht P, Radzikowski A. Guidelines for the management of community acquired-respiratory tract infection. Recommendations of approach in respiratory tract infections. In National Program of Antibiotics Protection. National Medicines Institute 2016. Available at: https://www.antybiotyki.edu.pl/ Rekomendacje2016.pdf. Accessed May 9, 2019
8. Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981;1:239-246. https://doi.org/10.1177/0272989X8100100304
9. McIsaac WJ, Goel V, To T, Low DE. The validity of a sore throat score in family practice. CMAJ 2000;163:811- 815.
10. El Ghany SMA, Abdelmaksoud AA, Saber SM, Abd El Hamid DH. Group a beta-hemolytic streptococcal pharyngitis and carriage rate among egyptian children: a case-control study. Ann Saudi Med 2015;35:377-382. https://doi.org/10.5144/0256-4947.2015.377
11. Telmesani AM, Ghazi HO. A study of group a streptococcal bacteria isolation from less than 12 years with acute tonsillitis, pharyngitis and healthy primary school chidren. J Family Community Med 2002;9:23- 26.
12. Ba Saddik IA, Munibari AA, Alhilali AM, et al. Prevalance of group a beta hemolytic streptococcus isolated from children with acute pharyngotonsillitis in Aden, Yemen. Trop Med Int Health 2014;19:431-439. https://doi. org/10.1111/tmi.12264
13. Stefaniuk E, Bosacka K, Wanke Rytt M, Hryniewicz W. The use of rapid test quikread go strep a in bacterial pharyngotonsillitis diagnosing and therapeutic decisions. Eur J Clin Microbiol Infect Dis 2017;36:1733- 1738. https://doi.org/10.1007/s10096-017-2986-8
14. Fine AM, Nizet V, Mandl KD. Large-scale validation of the centor and mcisaac scores to predict group a streptococcal pharyngitis. Arch Intern Med 2012;172:847-852. https://doi.org/10.1001/ archinternmed.2012.950
15. Felsenstein S, Faddoul D, Sposto R, Battoon K, Polanco CM, Dien Bard J. Molecular and clinical diagnosis of group a streptococcal pharyngitis in children. J Clin Microbiol 2014;52:3884-3889. https:// doi.org/10.1128/JCM.01489-14
16. Dimatteo LA, Lowenstein SR, Brimhall B, Reiquam W, Gonzales R. The relationship between the clinical features of pharyngitis and the sensitivity of a rapid antigen test: evidence of spectrum bias. Ann Emerg Med 2001;38:648-652. https://doi.org/10.1067/ mem.2001.119850
17. Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics 2009;123:437-444. https://doi.org/10.1542/peds.2008- 0488
18. Çamurdan AD, Çamurdan OM, Ok I, Sahin F, Ilhan MN, Beyazova U. Diagnostic value of rapid antigen detection test for streptococcal pharyngitis in a pediatric population. Int J Pediatr Otorhinolaryngol 2008;72:1203-1206. https://doi.org/10.1016/j. ijporl.2008.04.008