Faringotonsillite streptococcica: Confronto tra diagnosi clinica e microbiologica

Translated title of the contribution: Streptococcal tonsillopharyngitis: Clinical vs. microbiological diagnosis

Antonio Boccazzi, Matteo Garotta, Sara Pontari, Carlo Virgilio Agostoni

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

This study aimed to evaluate the role of clinical diagnosis vs. rapid antigen detection tests (RADT) in identifying streptococcal vs. non-streptococcal cases of acute pharyngitis (AP) with respect to a scoring schedule. The Breese scoring system, modified by eliminating the count of peripheral WBC, was used in the study. At enrolment, cases of AP observed by office-based pediatricians were judged on a clinical basis as possibly of streptococcal or of non-streptococcal origin and a clinical score recorded. At the end of the visit and following completion of the clinical score to documentthe presence/absence of a group A beta haemolytic streptococcus (GABHS), a confirmatory RADT was performed. In RADT negative cases a standard throat swab and culture were performed. In all, 629 children presenting with AP were enrolled in the study. A correct clinical diagnosis was predicted on the basis of the clinical observation in 74.2% of cases (with a sensitivity of 81.1% and specificity of 70.5%). In cases judged as 'streptococcal', a mean score of 27.6 was recorded both in those patients with a positive or negative RADT/throat swab for GABHS. By contrast, among cases considered of non-streptococcal aetiology, negative RADT/culture had a mean score of 24.3 (±SD 2.5) compared to a mean score of 25 (±2.5) in those with a positive RADT/culture. Intragroup score differences were not significant, while intergroup differences were highly significant. Optimization of AP treatment requires careful identification of streptococcal cases, avoiding unnecessary antibiotic treatment which would contribute to enhancing antibiotic resistance and increase medical treatment costs. We document that clinical observation alone, although performed by skilled pediatricians, will misdiagnose a sizeable percentage of cases. As indicated by this study, scores may suffer from a subjective interpretative bias in grading the severity of signs and symptoms.

Original languageItalian
Pages (from-to)100-105
Number of pages6
JournalInfezioni in Medicina
Volume19
Issue number2
Publication statusPublished - Jun 2011

Fingerprint

Pharyngitis
Antigens
Pharynx
Streptococcus
Observation
Microbial Drug Resistance
Diagnostic Errors
Health Care Costs
Signs and Symptoms
Appointments and Schedules
Anti-Bacterial Agents
Sensitivity and Specificity
Therapeutics
Pediatricians

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Faringotonsillite streptococcica : Confronto tra diagnosi clinica e microbiologica. / Boccazzi, Antonio; Garotta, Matteo; Pontari, Sara; Agostoni, Carlo Virgilio.

In: Infezioni in Medicina, Vol. 19, No. 2, 06.2011, p. 100-105.

Research output: Contribution to journalArticle

Boccazzi, Antonio ; Garotta, Matteo ; Pontari, Sara ; Agostoni, Carlo Virgilio. / Faringotonsillite streptococcica : Confronto tra diagnosi clinica e microbiologica. In: Infezioni in Medicina. 2011 ; Vol. 19, No. 2. pp. 100-105.
@article{74a991d161534c86884bf6717a3178dc,
title = "Faringotonsillite streptococcica: Confronto tra diagnosi clinica e microbiologica",
abstract = "This study aimed to evaluate the role of clinical diagnosis vs. rapid antigen detection tests (RADT) in identifying streptococcal vs. non-streptococcal cases of acute pharyngitis (AP) with respect to a scoring schedule. The Breese scoring system, modified by eliminating the count of peripheral WBC, was used in the study. At enrolment, cases of AP observed by office-based pediatricians were judged on a clinical basis as possibly of streptococcal or of non-streptococcal origin and a clinical score recorded. At the end of the visit and following completion of the clinical score to documentthe presence/absence of a group A beta haemolytic streptococcus (GABHS), a confirmatory RADT was performed. In RADT negative cases a standard throat swab and culture were performed. In all, 629 children presenting with AP were enrolled in the study. A correct clinical diagnosis was predicted on the basis of the clinical observation in 74.2{\%} of cases (with a sensitivity of 81.1{\%} and specificity of 70.5{\%}). In cases judged as 'streptococcal', a mean score of 27.6 was recorded both in those patients with a positive or negative RADT/throat swab for GABHS. By contrast, among cases considered of non-streptococcal aetiology, negative RADT/culture had a mean score of 24.3 (±SD 2.5) compared to a mean score of 25 (±2.5) in those with a positive RADT/culture. Intragroup score differences were not significant, while intergroup differences were highly significant. Optimization of AP treatment requires careful identification of streptococcal cases, avoiding unnecessary antibiotic treatment which would contribute to enhancing antibiotic resistance and increase medical treatment costs. We document that clinical observation alone, although performed by skilled pediatricians, will misdiagnose a sizeable percentage of cases. As indicated by this study, scores may suffer from a subjective interpretative bias in grading the severity of signs and symptoms.",
keywords = "Acute tonsillopharyngitis, Aetiological diagnosis, Clinical diagnosis, Rapid antigen test, Score",
author = "Antonio Boccazzi and Matteo Garotta and Sara Pontari and Agostoni, {Carlo Virgilio}",
year = "2011",
month = "6",
language = "Italian",
volume = "19",
pages = "100--105",
journal = "Infezioni in Medicina",
issn = "1124-9390",
publisher = "EDIMES Edizioni Medico Scientifiche",
number = "2",

}

TY - JOUR

T1 - Faringotonsillite streptococcica

T2 - Confronto tra diagnosi clinica e microbiologica

AU - Boccazzi, Antonio

AU - Garotta, Matteo

AU - Pontari, Sara

AU - Agostoni, Carlo Virgilio

PY - 2011/6

Y1 - 2011/6

N2 - This study aimed to evaluate the role of clinical diagnosis vs. rapid antigen detection tests (RADT) in identifying streptococcal vs. non-streptococcal cases of acute pharyngitis (AP) with respect to a scoring schedule. The Breese scoring system, modified by eliminating the count of peripheral WBC, was used in the study. At enrolment, cases of AP observed by office-based pediatricians were judged on a clinical basis as possibly of streptococcal or of non-streptococcal origin and a clinical score recorded. At the end of the visit and following completion of the clinical score to documentthe presence/absence of a group A beta haemolytic streptococcus (GABHS), a confirmatory RADT was performed. In RADT negative cases a standard throat swab and culture were performed. In all, 629 children presenting with AP were enrolled in the study. A correct clinical diagnosis was predicted on the basis of the clinical observation in 74.2% of cases (with a sensitivity of 81.1% and specificity of 70.5%). In cases judged as 'streptococcal', a mean score of 27.6 was recorded both in those patients with a positive or negative RADT/throat swab for GABHS. By contrast, among cases considered of non-streptococcal aetiology, negative RADT/culture had a mean score of 24.3 (±SD 2.5) compared to a mean score of 25 (±2.5) in those with a positive RADT/culture. Intragroup score differences were not significant, while intergroup differences were highly significant. Optimization of AP treatment requires careful identification of streptococcal cases, avoiding unnecessary antibiotic treatment which would contribute to enhancing antibiotic resistance and increase medical treatment costs. We document that clinical observation alone, although performed by skilled pediatricians, will misdiagnose a sizeable percentage of cases. As indicated by this study, scores may suffer from a subjective interpretative bias in grading the severity of signs and symptoms.

AB - This study aimed to evaluate the role of clinical diagnosis vs. rapid antigen detection tests (RADT) in identifying streptococcal vs. non-streptococcal cases of acute pharyngitis (AP) with respect to a scoring schedule. The Breese scoring system, modified by eliminating the count of peripheral WBC, was used in the study. At enrolment, cases of AP observed by office-based pediatricians were judged on a clinical basis as possibly of streptococcal or of non-streptococcal origin and a clinical score recorded. At the end of the visit and following completion of the clinical score to documentthe presence/absence of a group A beta haemolytic streptococcus (GABHS), a confirmatory RADT was performed. In RADT negative cases a standard throat swab and culture were performed. In all, 629 children presenting with AP were enrolled in the study. A correct clinical diagnosis was predicted on the basis of the clinical observation in 74.2% of cases (with a sensitivity of 81.1% and specificity of 70.5%). In cases judged as 'streptococcal', a mean score of 27.6 was recorded both in those patients with a positive or negative RADT/throat swab for GABHS. By contrast, among cases considered of non-streptococcal aetiology, negative RADT/culture had a mean score of 24.3 (±SD 2.5) compared to a mean score of 25 (±2.5) in those with a positive RADT/culture. Intragroup score differences were not significant, while intergroup differences were highly significant. Optimization of AP treatment requires careful identification of streptococcal cases, avoiding unnecessary antibiotic treatment which would contribute to enhancing antibiotic resistance and increase medical treatment costs. We document that clinical observation alone, although performed by skilled pediatricians, will misdiagnose a sizeable percentage of cases. As indicated by this study, scores may suffer from a subjective interpretative bias in grading the severity of signs and symptoms.

KW - Acute tonsillopharyngitis

KW - Aetiological diagnosis

KW - Clinical diagnosis

KW - Rapid antigen test

KW - Score

UR - http://www.scopus.com/inward/record.url?scp=79960409654&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960409654&partnerID=8YFLogxK

M3 - Articolo

C2 - 21753249

AN - SCOPUS:79960409654

VL - 19

SP - 100

EP - 105

JO - Infezioni in Medicina

JF - Infezioni in Medicina

SN - 1124-9390

IS - 2

ER -