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Predictive value of clinical features in differentiating group A beta-hemolytic streptococcal pharyngitis in children
Meng-Hsun Lin1, Wen-Ki Fong, Pi-Feng Chang
1Department of Pediatrics, Cathay General Hospital-Neihu, Taipei, Taiwan, ROC. chumeng@cgh.org.tw
Insights
Accurate diagnosis of group A beta-hemolytic Streptococcus (GABHS) pharyngitis in children is challenging. While symptoms like sore throat and rash are associated with GABHS, clinical diagnosis alone is unreliable, making throat cultures essential.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Group A beta-hemolytic Streptococcus (GABHS) pharyngitis is common in children.
- Accurate identification of GABHS is crucial to prevent complications.
Purpose of the Study:
- To evaluate the predictive value of clinical symptoms and signs for GABHS pharyngitis in children.
- To determine the reliability of clinical diagnosis versus laboratory confirmation.
Main Methods:
- A study involving 442 children with pharyngeal erythema.
- Comparison of clinical features between children with positive and negative GABHS throat cultures.
Main Results:
- GABHS was identified in 27% of patients; prevalence was higher in children aged 5-10 years.
- Sore throat, tonsillar swelling, anterior cervical adenopathy, and scarlatiniform rash were significantly associated with GABHS.
- No single symptom or sign demonstrated both high sensitivity and specificity; positive predictive values were below 50%.
Conclusions:
- Clinical diagnosis of GABHS pharyngitis in children is unreliable.
- Certain symptoms aid in probability estimation but do not replace diagnostic testing.
- Throat cultures remain mandatory for suspected GABHS infections.
Abstract:
Identifying children with acute pharyngitis caused by group A beta-hemolytic Streptococcus (GABHS) is an important task for pediatricians. This study examined the value of certain clinical symptoms and signs in predicting a positive culture result. A total of 442 children who presented at the outpatient department with pharyngeal erythema were enrolled. The clinical features of patients with positive throat cultures for GABHS were compared to those with negative culture results. Throat cultures were positive for GABHS in 120 (27%) patients. Patients aged between 5 and 10 years had a higher prevalence of GABHS pharyngitis. Significant differences between the groups with and without GABHS pharyngitis were noted for the presence of sore throat (p < 0.001), tonsillar swelling (p < 0.001), anterior cervical adenopathy (p = 0.004), and scarlatiniform rash (p < 0.001), but not for the presence of fever, cough, rhinorrhea, abdominal pain, headache, tonsillar exudate, or palatal petechiae. Despite these strong associations, none of these symptoms or signs had both high sensitivity and specificity, and the positive predictive values of these individual findings were never greater than 50%. The results indicate that diagnosis based on clinical grounds alone is unreliable although there are certain individual symptoms and signs that are associated with GABHS pharyngitis. These symptoms and signs may be helpful in modifying estimates of probability of infection with GABHS. Throat cultures in suspected patients remain mandatory.