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 Evaluation of Rapid Antigen Detection Test for Group A Streptococci Pharyngitis among Children in an Out-Patient Clinic in Malaysia

2021 ◽  
Vol 50 (11) ◽  
pp. 3345-3354
Author(s):  
Zaili Zaki ◽  
Asrul Abdul Wahab ◽  
Ramliza Ramli ◽  
Afaaf Esa ◽  
Ezura Madiana Md. Monoto
Keyword(s):  
Sore Throat ◽  
Sensitivity And Specificity ◽  
Throat Swab ◽  
Group A Streptococcus ◽  
Antigen Detection ◽  
Preschool Age ◽  
Throat Culture ◽  
Care Clinic ◽  
Rapid Antigen Detection Test ◽  
Group A

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement between RADT whereby BIONEXIA® Strep A Plus (BioMérieux, France) kit was used and throat culture in the diagnosis of GAS pharyngitis in children presented with a sore throat. One hundred and ten children from a primary health care clinic with sore throat were included in this study. All children were evaluated based on McIsaac scoring and throat swab samples were taken for both throat culture and RADT testing. The prevalence of GAS pharyngitis by RADT in this study was 7.3% over one year. A higher incidence of GAS pharyngitis was noted in the school-aged children than the preschool-age children. There was no correlation between cough, lymph node enlargement, and tonsillar enlargement in predicting GAS pharyngitis. The sensitivity and specificity of RADT were 100% and 98%, respectively, when taking throat culture as a gold standard. A good agreement between RADT and throat culture was achieved (k=0.848). McIsaac scoring was noted to have good predictability for GAS pharyngitis with AUC=0.82. In conclusion, the rapid streptococcal antigen detection test showed excellent sensitivity and specificity and detecting GAS from the throat swab samples. Thus, it can be used to aid in the diagnosis of group A Streptococcal pharyngitis and could reduce the overuse of antibiotics. McIsaac score has also proven to be useful as a screening tool for bacterial pharyngitis.

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.

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.

Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test

2021 ◽  
pp. 001857872110323
Author(s):  
Preeyaporn Sarangarm ◽  
Timothy A. Huerena ◽  
Tatsuya Norii ◽  
Carla J. Walraven
Keyword(s):  
Group A Streptococcus ◽  
Intervention Group ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Care Clinic ◽  
Rapid Antigen Detection Test ◽  
Appropriate Prescribing ◽  
Icd 10 ◽  
Group A

Background: Group A Streptococcus (GAS) pharyngitis is the most common bacterial cause of acute pharyngitis and is often over treated with unnecessary antibiotics. The purpose was to evaluate if implementation of a rapid antigen detection test (RADT) for GAS would reduce the number of inappropriately prescribed antibiotics for adult patients presenting with symptoms of pharyngitis. Methods: This was a retrospective cohort study of adult urgent care clinic patients pre- and post-implementation of a GAS RADT. We included patients who had a diagnosis of GAS identified via ICD-10 codes and either a throat culture, GAS RADT, or antibiotic prescribed for GAS. Antibiotic prescribing was assessed as appropriate or inappropriate based on testing and IDSA guideline recommendations. Thirty-day follow-up visits related to pharyngitis or the prescribed antibiotics was also evaluated. Results: A total of 1734 patients were included; 912 and 822 in the pre- and post-implementation groups, respectively. Following implementation of the GAS RADT, there was an increase in the number of antibiotics prescribed for GAS (43.4% vs 59.1%, P < .001) as well as an increase in appropriate prescribing (67.6% vs 77.5%, P < .001). More 30-day pharyngitis-related follow-up visits were seen in the pre-intervention group (12.5% vs 9.3%, P = .03). Conclusion: Implementation of a RADT for GAS pharyngitis was associated with an increase in both the overall number of antibiotic prescriptions for GAS and the proportion of appropriately prescribed antibiotics. There was also a reduction in follow up visits related to GAS pharyngitis, however educational efforts to further increase appropriate prescribing is needed.

scholarly journals The most common causative bacteria in maternal sepsis-related deaths in Japan were group A Streptococcus: A nationwide survey

2019 ◽  
Vol 25 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Hiroaki Tanaka ◽  
Shinji Katsuragi ◽  
Junichi Hasegawa ◽  
Kayo Tanaka ◽  
Kazuhiro Osato ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Nationwide Survey ◽  
Group A ◽  
Maternal Sepsis ◽  
Streptococcus A

scholarly journals Biofilm formation by group A Streptococcus: a role for the streptococcal regulator of virulence (Srv) and streptococcal cysteine protease (SpeB)

Microbiology ◽  
2009 ◽  
Vol 155 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Christopher D. Doern ◽  
Amity L. Roberts ◽  
Wenzhou Hong ◽  
Jessica Nelson ◽  
Slawomir Lukomski ◽  
...  
Keyword(s):  
Cysteine Protease ◽  
Biofilm Formation ◽  
Group A Streptococcus ◽  
Immunoblot Analysis ◽  
Wild Type ◽  
Flow Conditions ◽  
Group A ◽  
Streptococcus A ◽  
Insight Into ◽  
Western Immunoblot Analysis

Recently, biofilms have become a topic of interest in the study of the human pathogen group A Streptococcus (GAS). In this study, we sought to learn more about the make-up of these structures and gain insight into biofilm regulation. Enzymic studies indicated that biofilm formation by GAS strain MGAS5005 required an extracellular protein and DNA component(s). Previous results indicated that inactivation of the transcriptional regulator Srv in MGAS5005 resulted in a significant decrease in virulence. Here, inactivation of Srv also resulted in a significant decrease in biofilm formation under both static and flow conditions. Given that production of the extracellular cysteine protease SpeB is increased in the srv mutant, we tested the hypothesis that increased levels of active SpeB may be responsible for the reduction in biofilm formation. Western immunoblot analysis indicated that SpeB was absent from MGAS5005 biofilms. Complementation of MGAS5005Δsrv restored the biofilm phenotype and eliminated the overproduction of active SpeB. Inhibition of SpeB with E64 also restored the MGAS5005Δsrv biofilm to wild-type levels.

scholarly journals C-reactive protein testing reduces antibiotics prescription in a community setting

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703313
Author(s):  
Abdus Burahee ◽  
Owen Hibberd ◽  
Aneja Malladi
Keyword(s):  
Primary Care ◽  
Sore Throat ◽  
Clinical Decision Making ◽  
Respiratory Illness ◽  
Antibiotic Prescribing ◽  
C Reactive Protein ◽  
Health Seeking ◽  
Retrospective Case ◽  
Reactive Protein ◽  
The Impact

BackgroundOveruse of antimicrobials and the threats posed by resistance are concerning. Most patients in primary care with respiratory tract symptoms are prescribed antibiotics, amounting between 80–90% of all prescriptions. The National Institute for Health and Care Excellence (NICE) recommends point-of-care (POC) testing of C-reactive protein (CRP) where there is uncertainty about prescribing antibiotics. Studies evaluating the use of POC CRP to reduce antibiotic prescribing for self-limiting respiratory illness in primary care have demonstrated heterogeneity in their results.AimTo evaluate the impact of POC CRP testing on antibiotic prescribing.MethodA retrospective case analysis was undertaken at a GP practice. Alere Afinion AS100 was used for POC CRP testing. Data were collected on patients presenting with cough or sore throat who had POC CRP testing used in their clinical decision making. Eighty-four cases were selected for inclusion. NICE clinical guideline CG191 was used as a standard comparator for antibiotic prescribing and patients were followed up over a 2-month period.ResultsPatients presented with cough (n = 56) and sore throat (n = 28). At initial presentation 23/84 (27.4%) of patients were prescribed antibiotics. Over the 2-month follow-up period 15/84 (17.8%) of patients had at least one further consultation related to their initial respiratory complaint with 6/84 (7.1%) being prescribed antibiotics. The overall effect was a reduction of antibiotic prescriptions by 65.5%.ConclusionThe use of POC CRP testing helped GPs reduce the rate of antibiotic prescription and improve antimicrobial stewardship by being an addition to their diagnostic armoury. It has also shown potential role in patient reassurance and modifying health seeking behaviour.

scholarly journals Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study (Preprint)

2020 ◽  
Author(s):  
Jennifer L Pecina ◽  
Leah M Nigon ◽  
Kristine S Penza ◽  
Martha A Murray ◽  
Beckie J Kronebusch ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Observational Study ◽  
Sore Throat ◽  
Scoring System ◽  
Group A Streptococcus ◽  
Streptococcal Pharyngitis ◽  
Future Studies ◽  
Face To Face ◽  
Geographic Barriers ◽  
Group A

BACKGROUND The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. OBJECTIVE We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. METHODS This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. RESULTS There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. CONCLUSIONS McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.

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