scholarly journals Group A streptococcal pharyngitis: A practical guide to diagnosis and treatment

2021 ◽  
Vol 26 (5) ◽  
pp. 319-319
Author(s):  
Laura Sauve ◽  
A Michael Forrester ◽  
Karina A Top
Keyword(s):  
Primary Care ◽  
Acute Rheumatic Fever ◽  
Throat Swab ◽  
Group A Streptococcus ◽  
Streptococcal Pharyngitis ◽  
Clinical Syndrome ◽  
Indigenous Populations ◽  
Diagnosis And Treatment ◽  
Group A ◽  
Disproportionate Burden

Abstract Group A Streptococcus (GAS) pharyngitis is a common clinical syndrome in primary care, yet controversy remains regarding the best approach to diagnosis and treatment, including the benefits of antibiotics. Children who are likely to have GAS pharyngitis based on history or physical examination should have a throat swab and, when positive, be treated with amoxicillin or penicillin. The disproportionate burden of acute rheumatic fever in Indigenous populations in Canada and special considerations for testing and treatment are discussed.

Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

2014 ◽  
Vol 35 (S3) ◽  
pp. S79-S85 ◽  
Author(s):  
Julie L. Fierro ◽  
Priya A. Prasad ◽  
A. Russell Localio ◽  
Robert W. Grundmeier ◽  
Richard C. Wasserman ◽  
...  
Keyword(s):  
Primary Care ◽  
Streptococcal Pharyngitis ◽  
Diagnosis And Treatment ◽  
Group A ◽  
Primary Care Pediatricians

scholarly journals Preceding group A streptococcus skin and throat infections are individually associated with acute rheumatic fever: evidence from New Zealand

2021 ◽  
Vol 6 (12) ◽  
pp. e007038
Author(s):  
Jane Oliver ◽  
Julie Bennett ◽  
Sally Thomas ◽  
Jane Zhang ◽  
Nevil Pierse ◽  
...  
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Throat Swab ◽  
Group A Streptococcus ◽  
Population Level ◽  
Gas Detection ◽  
Positive Skin ◽  
Group A ◽  
Dispensing Data

IntroductionAcute rheumatic fever (ARF) is usually considered a consequence of group A streptococcus (GAS) pharyngitis, with GAS skin infections not considered a major trigger. The aim was to quantify the risk of ARF following a GAS-positive skin or throat swab.MethodsThis retrospective analysis used pre-existing administrative data. Throat and skin swab data (1 866 981 swabs) from the Auckland region, New Zealand and antibiotic dispensing data were used (2010–2017). Incident ARF cases were identified using hospitalisation data (2010–2018). The risk ratio (RR) of ARF following swab collection was estimated across selected features and timeframes. Antibiotic dispensing data were linked to investigate whether this altered ARF risk following GAS detection.ResultsARF risk increased following GAS detection in a throat or skin swab. Māori and Pacific Peoples had the highest ARF risk 8–90 days following a GAS-positive throat or skin swab, compared with a GAS-negative swab. During this period, the RR for Māori and Pacific Peoples following a GAS-positive throat swab was 4.8 (95% CI 3.6 to 6.4) and following a GAS-positive skin swab, the RR was 5.1 (95% CI 1.8 to 15.0). Antibiotic dispensing was not associated with a reduction in ARF risk following GAS detection in a throat swab (antibiotics not dispensed (RR: 4.1, 95% CI 2.7 to 6.2), antibiotics dispensed (RR: 4.3, 95% CI 2.5 to 7.4) or in a skin swab (antibiotics not dispensed (RR: 3.5, 95% CI 0.9 to 13.9), antibiotics dispensed (RR: 2.0, 95% CI 0.3 to 12.1).ConclusionsA GAS-positive throat or skin swab is strongly associated with subsequent ARF, particularly for Māori and Pacific Peoples. This study provides the first population-level evidence that GAS skin infection can trigger ARF.

scholarly journals The feasibility of measuring calprotectin from a throat swab as a marker of infections caused by group A streptococcus: a case–control feasibility study

BJGP Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. bjgpopen20X101006
Author(s):  
Behnaz Schofield ◽  
Clive Gregory ◽  
Micaela Gal ◽  
David Gillespie ◽  
Gurudutt Naik ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthy Volunteers ◽  
Sore Throat ◽  
Throat Swab ◽  
Group A Streptococcus ◽  
Case Control ◽  
Antibiotic Prescribing ◽  
Group A ◽  
Primary Care Patients ◽  
Streptococcus A

BackgroundMost people with sore throat do not benefit from antibiotic treatment, but nearly three-quarters of those presenting in primary care are prescribed antibiotics. A test that is predictive of bacterial infection could help guide antibiotic prescribing. Calprotectin is a biomarker of neutrophilic inflammation, and may be a useful marker of bacterial throat infections.AimTo assess the feasibility of measuring calprotectin from throat swabs, and assess whether individuals with sore throats likely to be caused by streptococcal infections have apparently higher throat calprotectin levels than other individuals with sore throat and healthy volunteers.Design & settingA proof of concept case–control study was undertaken, which compared primary care patients with sore throats and healthy volunteers.MethodBaseline characteristics and throat swabs were collected from 30 primary care patients with suspected streptococcal sore throat, and throat swabs were taken from 10 volunteers without sore throat. Calprotectin level determination and rapid antigen streptococcal testing were conducted on the throat swab eluents. Calprotectin levels in the following groups were compared: volunteers without a sore throat; all patients with a sore throat; patients with a sore throat testing either negative or positive for streptococcal antigen; and those with lower and higher scores on clinical prediction rules for streptococcal sore throat.ResultsCalprotectin was detected in all throat swab samples. Mean calprotectin levels were numerically higher in patients with sore throat compared with healthy volunteers, and sore throat patients who had group A streptococci antigen detected compared with those who did not.ConclusionCalprotectin can be measured from throat swab samples and levels are consistent with the hypothesis that streptococcal infection leads to higher throat calprotectin levels. This hypothesis will be tested in a larger study.

scholarly journals Analysis of awareness of practical medicinal doctors on diagnosis and treatment of pharyngitis in children

2021 ◽  
pp. 20-35
Author(s):  
O.R. Boyarchuk ◽  
◽  
O.M. Mochulska ◽  
Keyword(s):  
Primary Care ◽  
Antibiotic Therapy ◽  
Sore Throat ◽  
Throat Swab ◽  
Tertiary Care ◽  
Streptococcal Pharyngitis ◽  
Hemolytic Streptococcus ◽  
Diagnosis And Management ◽  
Group A ◽  
Primary Care Pediatricians

Painful throat is the main symptom of pharyngitis and one of the most common reasons to refer to a primary care physician. In 60.0–70.0% of cases acute pharyngitis is caused by viruses, including rhinoviruses, adenoviruses, enteroviruses, coronaviruses and others. More then about 5.0–15.0% of pharyngitis cases in adults and around 20.0–30.0% of cases in children are caused by bacterial infections, among which group A β hemolytic Streptococcus. Among other causative agents of bacterial pharyngitis, group C and group G Streptococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae and Arcanobacterium haemolyticus are also reported, although much less frequently. Severe group A β-hemolytic Streptococcus-related diseases, such as acute rheumatic fever, rheumatic heart disease, post-streptococcal glomerulonephritis, and invasive infections are accountable for more than 517 000 deaths each year. Therefore, the issue of timely diagnosis and proper management of streptococcal pharyngitis is very important. Purpose — to study, evaluate and analyze the knowledge of pediatricians in diagnosis and management of sore throat in children and to identify further ways to raise their awareness. Matherials and methods. The poll among pediatricians on evaluation of diagnosis and management of pharyngitis in children were conducted. The study involved pediatricians of Ternopil region, Ukraine. In general 112 pediatricians were questioned. Among the participants 79 (70.5%) were the primary care pediatricians and 33 (29.5%) worked as the secondary and tertiary care pediatricians. Questionnaire and statistical research methods were used. Results. Overall, 70.5% of pediatricians prescribed a throat swab for patients with pharyngitis in selected cases. However, they rarely (20.0%) used Centor or McIsaak criteria to choose management strategy of sore throat. Amoxicillin as a first-line antibiotic for streptococcal pharyngitis was chosen by 66.1% of respondents and primary care pediatricians prescribed it more often than the secondary and tertiary care pediatricians (p=0.0006), but antibiotic therapy was prescribed for 10 days only by 52.7% of respondents. Less than half of the correct answers were to questions related to the prescribing of antibacterial therapy in healthy children, in which group A β-hemolytic Streptococcus is detected in throat swab (39.3%) and in cases of positive antistreptolysin-O (25.9%). Conclusions. The research showed a wide range of knowledge of pediatricians about the diagnosis and management of group A β-hemolytic Streptococcus pharyngitis — from satisfactory responses to the prescription of antibiotic therapy to low knowledge about the diagnosis and determination of strategies in healthy carriers. These data emphasize the need to improve knowledge about the strategies of group group A β-hemolytic Streptococcus pharingytis control. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: group A β-hemolytic Streptococcus, pharyngitis, diagnosis, treatment.

scholarly journals Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

2014 ◽  
Vol 35 (S3) ◽  
pp. S79-S85 ◽  
Author(s):  
Julie L. Fierro ◽  
Priya A. Prasad ◽  
A. Russell Localio ◽  
Robert W. Grundmeier ◽  
Richard C. Wasserman ◽  
...  
Keyword(s):  
Primary Care ◽  
Streptococcal Pharyngitis ◽  
Diagnosis And Treatment ◽  
Pediatric Primary Care ◽  
Antibiotic Prescribing ◽  
Acute Pharyngitis ◽  
Significant Variability ◽  
Group A ◽  
Care Practices ◽  
Primary Care Practices

Objective.To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.Design.Retrospective cohort study.Setting.All encounters to 25 pediatric primary care practices sharing an electronic health record.Methods.Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.Results.Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P < .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P ≤ .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.Conclusions.Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.

scholarly journals D8/17 and CD19 Expression on Lymphocytes of Patients with Acute Rheumatic Fever and Tourette's Disorder

2004 ◽  
Vol 11 (2) ◽  
pp. 330-336 ◽  
Author(s):  
Julie L. Weisz ◽  
William M. McMahon ◽  
Jill C. Moore ◽  
Nancy H. Augustine ◽  
John F. Bohnsack ◽  
...  
Keyword(s):  
B Cells ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Neuropsychiatric Disorders ◽  
Streptococcal Pharyngitis ◽  
Tourette’S Disorder ◽  
Compulsive Disorder ◽  
Tourette's Disorder ◽  
Group A ◽  
Normal Controls

ABSTRACT D8/17, an alloantigen found on B lymphocytes, has been reported to be elevated in patients susceptible to rheumatic fever and may be associated with autoimmune types of neuropsychiatric disorders. The pediatric-autoimmune-neuropsychiatric-disorders-associated-with-streptococci model is a putative model of pathogenesis for a group of children whose symptoms of obsessive-compulsive disorder and Tourette's disorder (TD) are abrupt and may be triggered by an infection with group A streptococci. As a test of this model, we have examined D8/17 levels on the B cells of patients with TD and acute rheumatic fever (ARF) along with those on the B cells of normal controls by flow cytometry. We have utilized several different preparations of D8/17 antibody along with a variety of secondary antibodies but have been unable to show an association with an elevated percentage of D8/17-positive, CD19-positive B cells in either ARF or TD. We did find, however, that the percentages of CD19-positive B cells in ARF and TD patients were significantly elevated compared to those in normal controls. Group A streptococcal pharyngitis patients also had an elevated percentage of CD19 B cells, however. These studies failed to confirm the utility of determining the percentage of B cells expressing the D8/17 alloantigen in ARF patients or our sample of TD patients. In contrast, the percentage of CD19-positive B cells was significantly elevated in ARF and TD patients, as well as group A streptococcal pharyngitis patients, suggesting a role for inflammation and/or autoimmunity in the pathogenesis of these disorders.

scholarly journals Value of rapid test for identification of beta hemolytic Streptococcus antigens in children with Streptococcal pharyngitis

2004 ◽  
Vol 132 (suppl. 1) ◽  
pp. 39-41 ◽  
Author(s):  
Branimir Nestorovic ◽  
Suzana Laban-Nestorovic ◽  
Veselinka Paripovic ◽  
Katarina Milosevic
Keyword(s):  
Group A Streptococcus ◽  
Rapid Test ◽  
Streptococcal Pharyngitis ◽  
Early Spring ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
Isolation And Identification ◽  
Cervical Lymph Nodes ◽  
Group A ◽  
Tract Infections

Beta-hemolytic group A streptococcus (Streptococcus pyogenes) is the most common bacterial agent associated with the upper respiratory tract infections in humans. The most frequently group A streptococcus-associated disease is pharyngitis. Males and females are equally affected by group A streptococcus. There is seasonal increase in the prevalence of group A streptococcus-associated pharyngitis. Streptococcal pharyngitis is most prevalent in winter and early spring with higher incidence of disease observed in crowded population such as school children. Early diagnosis and treatment of group A streptococcal pharyngitis has been shown to reduce the severity of symptoms and further complications such as rheumatic fever and glomerulonephritis. The conventional methods used for identification of group A streptococci depend on isolation and identification of the organism on blood agar plates. These methods usually require 18-24 hours of incubation at 37?C. Such delay in identifying the group A streptococcus has often made physicians to administer therapy without first disclosing the etiological agent. Development of immunologic tests, capable of detecting the group A streptococcal antigen directly from the throat swabs, produced rapid test results employed for better treatment of patients. STREP A test is a rapid immunochromatographic test for the detection of group A streptococci from throat swabs or culture. The accuracy of the test does not depend on the organism viability. Instead, group A strep antigen is extracted directly from the swab and identified using antibodies specific for the group A carbohydrates. We compared rapid test with conventional throat swab in 40 children, who met Centor criteria for streptococcal pharyngitis (absence of cough, high fever, purulent pharyngitis, enlarged and painful cervical lymph nodes). Overall congruence of rapid test and culture was 94%. Test is easy to perform and it is recommended as the first diagnostic test for management of children with streptococcal pharyngitis. In children with negative test, but with characteristics highly suggestive of streptococcal infection, throat culture should be performed.

scholarly journals Molecular Testing for Detection of Groups A, C, and G β-Hemolytic Streptococci in Pharyngeal Samples from Children

2018 ◽  
Vol 3 (3) ◽  
pp. 429-437 ◽  
Author(s):  
Tam T Van ◽  
Javier Mestas ◽  
Jennifer Dien Bard
Keyword(s):  
Group A Streptococcus ◽  
Improve Patient Care ◽  
Routine Care ◽  
Streptococcal Pharyngitis ◽  
Molecular Testing ◽  
Culture Methods ◽  
Rapid Antigen Detection Test ◽  
Large Colony ◽  
Group A ◽  
Improve Patient

Abstract Background Group A Streptococcus (GAS) and large colony-forming group C (GCS) and G (GGS) β-hemolytic streptococci are important causes of acute pharyngitis in children and adults. Rapid and accurate diagnosis of streptococcal pharyngitis can improve patient care and potentially reduce transmission. In this study, we evaluated the performance of the Lyra Direct Strep (LDS) assay for detection of GAS and GCS/GGS compared with traditional culture methods. Methods Pharyngeal samples obtained from 278 children presenting to the emergency department with initial negative GAS rapid antigen detection test (RADT) were used. All samples were cultured as part of routine care and tested in batches using the LDS assay. Results Of 278 pharyngeal samples with negative GAS RADT, 37 (13.3%) and 63 (22.7%) patients were positive for GAS by culture and LDS assay, respectively. Four (1.4%) patients were positive for GCS or GGS by culture or LDS assay. The LDS assay demonstrated sensitivity and specificity of 97.6% and 89.0%, respectively, compared with culture as the gold standard. Repeat culture and an alternate PCR showed that 85.7% (24 of 28) of discrepant samples agreed with findings of the LDS assay. Since implementation, the LDS assay shows a positivity rate of 21.0% (281 of 1340) compared with 11.7% (246 of 2110) by culture in the previous year. Conclusions We successfully implemented the LDS assay at our institution and have observed a significant increase in the positivity rate of GAS compared with culture. The LDS assay alone allowed for the elimination of β-streptococci screening by culture at our institution.

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