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Updated: May 7, 2026

A 1.5 Hour Procedure for Identification of Enterococcus Species Directly from Blood Cultures

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Published on: February 11, 2011

Streptococcal pharyngitis: diagnosis by gram stain

G Crawford, F Brancato, K K Holmes

Annals of Internal Medicine

|March 1, 1979

Summary

A Gram-stained smear is the most accurate method for early diagnosis of streptococcal pharyngitis, outperforming clinical algorithms. This rapid test aids in timely and effective patient treatment.

Area of Science:

Microbiology
Infectious Diseases
Diagnostic Medicine

Background:

Pharyngitis is a common condition, often caused by Group A beta-hemolytic streptococci (GABHS).
Accurate and timely diagnosis of streptococcal pharyngitis is crucial to prevent complications and guide treatment.

Purpose of the Study:

To evaluate the diagnostic accuracy of Gram-stained smears of pharyngeal secretions compared to clinical algorithms for identifying GABHS in patients with pharyngitis.

Main Methods:

Throat cultures for GABHS were performed on 472 patients presenting with pharyngitis.
Gram-stained smears of pharyngeal secretions were interpreted by multiple observers.
Diagnostic performance metrics (sensitivity, specificity, predictive value) were calculated for Gram-stained smears and a clinical algorithm.

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Main Results:

GABHS were isolated from 10.4% of patients.
The Gram-stained smear demonstrated a mean sensitivity of 73%, specificity of 96%, and positive predictive value of 71%.
The clinical algorithm showed lower performance with 45% sensitivity, 83% specificity, and 23% positive predictive value.

Conclusions:

Gram-stained smear of pharyngeal secretions is a highly accurate method for the early diagnosis of streptococcal pharyngitis.
This diagnostic approach is superior to clinical assessment alone for identifying GABHS infections.