Objective.The sensitivity of a rapid antigen-detection test(RADT)for group A streptococcal(GAS)pharyngitis is critical to whether the test is cost-effe ctive and to whether a confirmatory throat culture is needed.We e...Objective.The sensitivity of a rapid antigen-detection test(RADT)for group A streptococcal(GAS)pharyngitis is critical to whether the test is cost-effe ctive and to whether a confirmatory throat culture is needed.We evaluated a second-generation RADT to determine if its sensitivity varies across the broa d clinical spectrum of patients tested for GAS in pediatric outpatient practice.Methods.We used laboratory logbooks from a single pediatric clinic to identify 1184 consecutive patient visits at which an RADT was performed.In a blinded ch art review,we calculated McIsaac scores to separately estimate the pretest clin ical likelihood of GAS pharyngitis for visits at which the RADT result was posit ive(n = 384)and for visits at which the result proved to be false-negative(n = 65).Positive RADT results were assumed to be true positives,and test sensit ivity was estimated by dividing the number of positive results by the sum of pos itives and false-negatives.Results.As the clinical likelihood of GAS increase d,there were stepwise increases in RADT sensitivity(from 0.67 to 0.88).Sensit ivity was low(0.73;95%confidence interval [CI]:0.62-0.86)in patients clini cally unlikely to have GAS(McIsaac score ≤2)and high(0.94;95%CI:0.89-0.9 9)in patients < 15 years old who had tonsillar exudate and no cough.False-neg ative RADT results were associated with lighter growth of GAS than found on spec imens obtained from a random sample of clinic patients who had only primary thro at cultures ordered.Conclusions.For pediatric patients who are clinically unli kely to have GAS pharyngitis,as indicated by a McIsaac score ≤2,the sensitivi ty of a second-generation RADT may drop below thresholds reported for cost-eff ectiveness.For children who have tonsillar exudate and no cough,the test may b e sensitive enough to meet current pediatric practice guidelines for stand-alon e testing.展开更多
Aims: To prospectively assess the WHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS)-pharyngitis in three countries. Methods: A prospective, observational cohort study in urban outpatie...Aims: To prospectively assess the WHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS)-pharyngitis in three countries. Methods: A prospective, observational cohort study in urban outpatient clinics in Rio de Janeiro, Cairo, and Zagreb. There were 2225 children aged 2-12 years with cough, rhinorrhoea, red or sore throat; 1810 of these with sore throat were included in the analysis. Results: The proportion of children presenting with sore throat and found to have GABHS pharyngitis ranged from 24.6% (Brazil) to 42.0% (Croatia). WHO CDR sensitivity was low for all sites in both age groups. In children age 5 or older, sensitivity ranged from 3.8% in Egypt to 10.8% in Brazil. In children under 5, sensitivity was low(0.0-4.6% ) Specificity was high in both age groups in all countries (93.8-97.4% ). Conclusions: In these populations, the current WHO CDR has high specificity, but low sensitivity; it did not detect up to 96.0% of children who have laboratory confirmed GABHS pharyngitis. A CDR with higher sensitivity should be developed for use in regions where rheumatic fever and rheumatic heart disease are still major health problems.展开更多
Background.Rapid antigen detection testing (RADT) is often performed for diagnosis of group A β-hemolytic streptococcal (GABHS) pharyngitis among children.Among adults, the sensitivity of this test varies on the basi...Background.Rapid antigen detection testing (RADT) is often performed for diagnosis of group A β-hemolytic streptococcal (GABHS) pharyngitis among children.Among adults, the sensitivity of this test varies on the basis of disease severity (spectrum bias).A similar phenomenon may occur when this test is used in a pediatric population, which may affect the need for culture confirmation of all negative RADT results.Objectives.To assess the performance of a clinical scoring system and to determine whether RADT spectrum bias is present among children who are evaluated for GABHS pharyngitis.Methods.Laboratory and clinical records for a consecutive series of pediatric patients who underwent RADT at the Marshfield Clinic between January 2002 and March 2002 were reviewed retrospectively.Patients were stratified according to the number of clinical features present by using modified Centor criteria, ie, history of fever, absence of cough, presence of pharyngeal exudates, and cervical lymphadenopathy.The sensitivity of the RADT was defined as the number of patients with positive RADT results divided by the number of patients with either positive RADT results or negative RADT results but positive throat culture results.Results.RADT results were positive for 117 of 561 children (21%), and culture results were positive for 35 of 444 children (8%) with negative RADT results.The over-all prevalence of GABHS pharyngitis was 27%(95%confidence interval: 23-31%).The prevalence of GABHS pharyngitis was 18%among patients with 0 Centor criteria, 16%among those with 1 criterion, 32%among those with 2 criteria, and 50%among those with 3 or 4 criteria.Spectrum bias was present, inasmuch as RADT sensitivity increased with Centor scores, ie, 47%sensitivity among children with 0 Centor criteria, 65%among those with 1 criterion, 82%among those with 2 criteria, and 90%among those with 3 or 4 criteria.Conclusions.The sensitivity of RADT for GABHS pharyngitis is not a fixed value but varies with the severity of disease.However, even among pediatric patients with ≥3 Centor criteria for GABHS pharyngitis, the sensitivity of RADT is still too low to support the use of RADT without culture confirmation of negative results.展开更多
Background: There is a high degree of professional consensus that children dia gnosed with pharyngitis should only receive antibiotics if they have a positive test for group A streptococcus (GAS). Objectives: To devel...Background: There is a high degree of professional consensus that children dia gnosed with pharyngitis should only receive antibiotics if they have a positive test for group A streptococcus (GAS). Objectives: To develop and test the validity of a quality of care performance measure that examines GAS testing ra tes in children diagnosed with pharyngitis and prescribed an antibiotic. Design: The measure developed examines the annual rate of GAS testing in children aged 2 to 18 years with an episode of pharyngitis who were prescribed antibiotics. Th e measure was tested for feasibility of implementation and validity in 5 health plans in the United States. Health plan administrative data were used to identif y episodes of pharyngitis using International Classification of Diseases, Ninth Revision (ICD-9) codes 462, 463, and 034.0. Pharmacy data (National Drug Codes) were used to determine if antibiotics were prescribed for the pharyngitis episo de. Laboratory claims data (Current Procedural Terminology codes) were used to d etermine whether a GAS test was performed. Rates of GAS testing in children with pharyngitis who received antibiotics were calculated for each health plan. Medi cal record abstractions were performed on a random sample (n = 465) of cases to assess percent agreement with laboratory claims data for GAS testing. Sensitivit y of the administrative data for accurately identifying when GAS tests were perf ormed was also assessed. Results: Of the 120 158 children aged 2 to 18 years who had at least 1 episode of pharyngitis during the measurement year, 51172 (43%) received antibiotics. Group A streptococcal testing rates for patients who were prescribed antibiotics varied widely among the participating health plans (59% -83%of cases; P<.05). Percent agreement between administrative and medical rec ords data for GAS tests was 86%. The sensitivity of the administrative data for accurately identifying when GAS tests were performed was 85%. Conclusions: Thi s quality measure is feasible to implement at the health plan level and validly assesses GAS testing rates using administrative data. The participating health p lans are not performing GAS tests as indicated by current expert practice guidel ines in a substantial proportion of cases. Improvements in adhering to these gui delines are warranted given the current levels of antibiotic overuse and antibio tic resistance nationally.展开更多
Background: Most of the world’s children live in regionswhere laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians’decisions on antibiotic therapy fo...Background: Most of the world’s children live in regionswhere laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians’decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis. Methods: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture. Results: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92%sensitivity and 38%specificity in these children. Conclusions: The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90%of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.展开更多
A 7- y- old girl presented with prolonged fever, arrhythmia and cardiomegaly during the treatment course of group A β - haemolytic streptococcal pharyngitis. The isolated rheumatogenic strain M1 suggested the diagnos...A 7- y- old girl presented with prolonged fever, arrhythmia and cardiomegaly during the treatment course of group A β - haemolytic streptococcal pharyngitis. The isolated rheumatogenic strain M1 suggested the diagnosis of rheumatic fever. However, serous pericardial effusion contained high levels of Epstein- Barr virus (EBV) DNA. Clonally proliferating EBV+ T cells were determined in the circulation. The atypical carditis without valvitis was then complicated by coronary artery dilatations. Four months after the start of prednisolone plus antiviral/bacterial therapy, EBV+ T- cell lymphoma developed in the thigh. Conclusion: Atypical carditis may be a notable and life- th- reatening presentation of chronic active EBV infection to be differentiated from rheumatic fever.展开更多
July 1,2016·Common Questions About Streptococcal Pharyngitis链球菌性咽炎常见问题·Cardiac Rehabilitation：Improving Function and Reducing Risk心脏康复：改善功能和降低风险·Diagnosis and Management of Vert...July 1,2016·Common Questions About Streptococcal Pharyngitis链球菌性咽炎常见问题·Cardiac Rehabilitation：Improving Function and Reducing Risk心脏康复：改善功能和降低风险·Diagnosis and Management of Vertebral Compression Fractures椎体压缩性骨折的诊断和管理·FDA Implements New Labeling for Medications Used During Pregnancy and Lactation美国食品药品监督管理局落实孕期哺乳期药物使用新标签，展开更多
美国食品药品管理局(FDA)已批准治疗呼吸道和皮肤感染的一种新抗生素。 Abbott实验室大环内酯类药物的制造厂临床研究主任J Carl Craft说:在临床试验中,一种口服大环内酯类抗生素Clarithro-mycin,在治疗特殊类型感染时与其它药物同样有...美国食品药品管理局(FDA)已批准治疗呼吸道和皮肤感染的一种新抗生素。 Abbott实验室大环内酯类药物的制造厂临床研究主任J Carl Craft说:在临床试验中,一种口服大环内酯类抗生素Clarithro-mycin,在治疗特殊类型感染时与其它药物同样有效。在治疗链球菌性咽炎和扁桃体炎时。展开更多
文摘Objective.The sensitivity of a rapid antigen-detection test(RADT)for group A streptococcal(GAS)pharyngitis is critical to whether the test is cost-effe ctive and to whether a confirmatory throat culture is needed.We evaluated a second-generation RADT to determine if its sensitivity varies across the broa d clinical spectrum of patients tested for GAS in pediatric outpatient practice.Methods.We used laboratory logbooks from a single pediatric clinic to identify 1184 consecutive patient visits at which an RADT was performed.In a blinded ch art review,we calculated McIsaac scores to separately estimate the pretest clin ical likelihood of GAS pharyngitis for visits at which the RADT result was posit ive(n = 384)and for visits at which the result proved to be false-negative(n = 65).Positive RADT results were assumed to be true positives,and test sensit ivity was estimated by dividing the number of positive results by the sum of pos itives and false-negatives.Results.As the clinical likelihood of GAS increase d,there were stepwise increases in RADT sensitivity(from 0.67 to 0.88).Sensit ivity was low(0.73;95%confidence interval [CI]:0.62-0.86)in patients clini cally unlikely to have GAS(McIsaac score ≤2)and high(0.94;95%CI:0.89-0.9 9)in patients < 15 years old who had tonsillar exudate and no cough.False-neg ative RADT results were associated with lighter growth of GAS than found on spec imens obtained from a random sample of clinic patients who had only primary thro at cultures ordered.Conclusions.For pediatric patients who are clinically unli kely to have GAS pharyngitis,as indicated by a McIsaac score ≤2,the sensitivi ty of a second-generation RADT may drop below thresholds reported for cost-eff ectiveness.For children who have tonsillar exudate and no cough,the test may b e sensitive enough to meet current pediatric practice guidelines for stand-alon e testing.
文摘Aims: To prospectively assess the WHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS)-pharyngitis in three countries. Methods: A prospective, observational cohort study in urban outpatient clinics in Rio de Janeiro, Cairo, and Zagreb. There were 2225 children aged 2-12 years with cough, rhinorrhoea, red or sore throat; 1810 of these with sore throat were included in the analysis. Results: The proportion of children presenting with sore throat and found to have GABHS pharyngitis ranged from 24.6% (Brazil) to 42.0% (Croatia). WHO CDR sensitivity was low for all sites in both age groups. In children age 5 or older, sensitivity ranged from 3.8% in Egypt to 10.8% in Brazil. In children under 5, sensitivity was low(0.0-4.6% ) Specificity was high in both age groups in all countries (93.8-97.4% ). Conclusions: In these populations, the current WHO CDR has high specificity, but low sensitivity; it did not detect up to 96.0% of children who have laboratory confirmed GABHS pharyngitis. A CDR with higher sensitivity should be developed for use in regions where rheumatic fever and rheumatic heart disease are still major health problems.
文摘Background.Rapid antigen detection testing (RADT) is often performed for diagnosis of group A β-hemolytic streptococcal (GABHS) pharyngitis among children.Among adults, the sensitivity of this test varies on the basis of disease severity (spectrum bias).A similar phenomenon may occur when this test is used in a pediatric population, which may affect the need for culture confirmation of all negative RADT results.Objectives.To assess the performance of a clinical scoring system and to determine whether RADT spectrum bias is present among children who are evaluated for GABHS pharyngitis.Methods.Laboratory and clinical records for a consecutive series of pediatric patients who underwent RADT at the Marshfield Clinic between January 2002 and March 2002 were reviewed retrospectively.Patients were stratified according to the number of clinical features present by using modified Centor criteria, ie, history of fever, absence of cough, presence of pharyngeal exudates, and cervical lymphadenopathy.The sensitivity of the RADT was defined as the number of patients with positive RADT results divided by the number of patients with either positive RADT results or negative RADT results but positive throat culture results.Results.RADT results were positive for 117 of 561 children (21%), and culture results were positive for 35 of 444 children (8%) with negative RADT results.The over-all prevalence of GABHS pharyngitis was 27%(95%confidence interval: 23-31%).The prevalence of GABHS pharyngitis was 18%among patients with 0 Centor criteria, 16%among those with 1 criterion, 32%among those with 2 criteria, and 50%among those with 3 or 4 criteria.Spectrum bias was present, inasmuch as RADT sensitivity increased with Centor scores, ie, 47%sensitivity among children with 0 Centor criteria, 65%among those with 1 criterion, 82%among those with 2 criteria, and 90%among those with 3 or 4 criteria.Conclusions.The sensitivity of RADT for GABHS pharyngitis is not a fixed value but varies with the severity of disease.However, even among pediatric patients with ≥3 Centor criteria for GABHS pharyngitis, the sensitivity of RADT is still too low to support the use of RADT without culture confirmation of negative results.
文摘Background: There is a high degree of professional consensus that children dia gnosed with pharyngitis should only receive antibiotics if they have a positive test for group A streptococcus (GAS). Objectives: To develop and test the validity of a quality of care performance measure that examines GAS testing ra tes in children diagnosed with pharyngitis and prescribed an antibiotic. Design: The measure developed examines the annual rate of GAS testing in children aged 2 to 18 years with an episode of pharyngitis who were prescribed antibiotics. Th e measure was tested for feasibility of implementation and validity in 5 health plans in the United States. Health plan administrative data were used to identif y episodes of pharyngitis using International Classification of Diseases, Ninth Revision (ICD-9) codes 462, 463, and 034.0. Pharmacy data (National Drug Codes) were used to determine if antibiotics were prescribed for the pharyngitis episo de. Laboratory claims data (Current Procedural Terminology codes) were used to d etermine whether a GAS test was performed. Rates of GAS testing in children with pharyngitis who received antibiotics were calculated for each health plan. Medi cal record abstractions were performed on a random sample (n = 465) of cases to assess percent agreement with laboratory claims data for GAS testing. Sensitivit y of the administrative data for accurately identifying when GAS tests were perf ormed was also assessed. Results: Of the 120 158 children aged 2 to 18 years who had at least 1 episode of pharyngitis during the measurement year, 51172 (43%) received antibiotics. Group A streptococcal testing rates for patients who were prescribed antibiotics varied widely among the participating health plans (59% -83%of cases; P<.05). Percent agreement between administrative and medical rec ords data for GAS tests was 86%. The sensitivity of the administrative data for accurately identifying when GAS tests were performed was 85%. Conclusions: Thi s quality measure is feasible to implement at the health plan level and validly assesses GAS testing rates using administrative data. The participating health p lans are not performing GAS tests as indicated by current expert practice guidel ines in a substantial proportion of cases. Improvements in adhering to these gui delines are warranted given the current levels of antibiotic overuse and antibio tic resistance nationally.
文摘Background: Most of the world’s children live in regionswhere laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians’decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis. Methods: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture. Results: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92%sensitivity and 38%specificity in these children. Conclusions: The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90%of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.
文摘A 7- y- old girl presented with prolonged fever, arrhythmia and cardiomegaly during the treatment course of group A β - haemolytic streptococcal pharyngitis. The isolated rheumatogenic strain M1 suggested the diagnosis of rheumatic fever. However, serous pericardial effusion contained high levels of Epstein- Barr virus (EBV) DNA. Clonally proliferating EBV+ T cells were determined in the circulation. The atypical carditis without valvitis was then complicated by coronary artery dilatations. Four months after the start of prednisolone plus antiviral/bacterial therapy, EBV+ T- cell lymphoma developed in the thigh. Conclusion: Atypical carditis may be a notable and life- th- reatening presentation of chronic active EBV infection to be differentiated from rheumatic fever.
文摘July 1,2016·Common Questions About Streptococcal Pharyngitis链球菌性咽炎常见问题·Cardiac Rehabilitation：Improving Function and Reducing Risk心脏康复：改善功能和降低风险·Diagnosis and Management of Vertebral Compression Fractures椎体压缩性骨折的诊断和管理·FDA Implements New Labeling for Medications Used During Pregnancy and Lactation美国食品药品监督管理局落实孕期哺乳期药物使用新标签，
