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Group A Streptococcus Testing in Pediatrics: the Move to Point-of-Care Molecular Testing
Thomas Z Thompson1, Allison R McMullen2
1Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
Insights
Accurate diagnosis of pediatric pharyngitis caused by group A Streptococcus requires laboratory testing. Point-of-care assays improve diagnosis speed and antimicrobial stewardship by offering rapid results compared to traditional cultures.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Clinical diagnostics
Background:
- Pharyngitis is a common childhood illness, with group A Streptococcus (GAS) accounting for 15-30% of cases.
- Accurate diagnosis of GAS pharyngitis is crucial for treatment and preventing complications, as clinical suspicion alone is unreliable.
- Traditional culture methods for GAS diagnosis have lengthy turnaround times (18-48 hours), delaying treatment.
Purpose of the Study:
- To review current point-of-care testing (POCT) methods for group A streptococcal pharyngitis in children.
- To discuss diagnostic considerations, implementation strategies, and cost-effectiveness of POCT for GAS infections.
Main Methods:
- Review of existing literature on POCT for group A streptococcal pharyngitis.
- Description of rapid antigen detection tests (RADTs) and molecular-based assays.
- Analysis of diagnostic considerations, implementation, and institutional costs.
Main Results:
- POCT assays, including RADTs and molecular methods, offer faster results than traditional cultures.
- Molecular methods represent a newer, potentially more accurate approach to POCT for GAS.
- Cost analysis indicates differences between immunoassays and newer molecular methods.
Conclusions:
- Point-of-care testing significantly improves diagnostic turnaround time for pediatric pharyngitis.
- Choosing the appropriate POCT method involves balancing diagnostic accuracy, speed, and cost.
- Advancements in molecular POCT offer enhanced diagnostic capabilities for group A streptococcal infections.
Abstract:
Each year, there are an estimated 11 million visits to ambulatory care centers for pharyngitis in children between the ages of 3 and 18 years. While there are many causes of pediatric pharyngitis, group A streptococcal pharyngitis represents 15 to 30% of infections and is the only cause for which treatment is recommended. Unfortunately, clinical suspicion is insufficient for the accurate diagnosis of group A streptococcal pharyngitis, and laboratory testing for confirmation of Streptococcus pyogenes infection is required to prevent complications of infection. Traditionally, throat swabs are inoculated onto agar plates for isolation of the large-zone beta-hemolytic streptococcus. However, traditional culture methods present a potential delay in treatment due to turnaround times of 18 to 48 h. In order to improve turnaround times and enhance antimicrobial stewardship, multiple point-of-care assays have been developed. This review describes current point-of-care testing for group A streptococcal pharyngitis, including rapid antigen detection tests and more recent molecular methods. Additional attention is given to the diagnostic considerations when choosing a method for group A streptococcal point-of-care testing, implementation of molecular group A streptococcal testing, and the institutional cost of immunoassays compared to those of newer molecular methods.
