Evaluation of Symptoms and Findings in Children with Tonsillopharyngitis Reflecting The Presence of Beta Hemolytic Streptococcal Infection

Abstract

Objectives: The administration of antibiotic is used to be indicated, based on the incidence of nonsuppurative complications (post-streptococcal glomerulonephritis and acute rheumatic fever) after streptococcal pharyngitis and also suppurative complications. History and physical examination findings distinguishing between GABHS and non-GABHS pharyngitis is valuable in order to start antibiotics at right time and at right dose.

Material and Methods: A prospective study was performed on a cohort of children with acute tonsillopharyngitis (n = 300).  The smymptoms at application and signs in physical examination were recorded and analyzed in relation to throat swab culture results at inclusion. Mean age was 67.70 ± 40 months (14-168 mo),  % 45.33 (n=136) were female, the others were male. Age, sore throat, fever, headache, swallowing difficulty, myalgia, skin eruptions, abdominal pain, nausea, vomiting, family history, the number of people in house, the duration of symptoms of disease findings before admission asked and tonsillar hypertrophy, presence of cryptitis and cervical lymph node sensitivity recorded. Throat swab culture had taken from all of the patients.

Results: Throat swab culture results were as follows; 20%(n=60) beta hemolytic streptococci(BHS) and 83.33% of them(n=50) were Group A. The mean age of BHS group (85.81± 39 mo) was higher than non BHS group (63.13 ± 39 mo) (p<0.001).  Headache(p<0.001), myalgia(p<0,001), difficulty in swallowing(p=0.040), skin eruptions(p=0.011) were significantly related with BHS infection. The other findings were not statistically significant.

Conclusion: The findings of this study would be usefull to determine the decision of antibiotic treatment in clinical conditions where the throat culture is not available in the clinic. 

Keywords

• Child,Tonsillopharnygitis,Beta Hemolytic Streptococci,Symptom,Sign,Throat culture

Akut Tonsillofarenjitli Çocuklarda Beta Hemolitik Streptokok Varlığını Gösteren Belirti ve Bulguların Değerlendirilmesi

Abstract

Amaç: Streptokoksik tonsillofarenjitte erken ve uygun antibiyotik tedavisi semptomları azaltıp bulaşıcılık süresinin kısaltılmasında, akut glomerülonefrit ve akut romatizmal ateş gibi poststreptokokkal komplikasyonların önlenmesinde önemlidir. Öykü ve fizik muayene bulgularından etiyolojiye ışık tutanların belirlenmesi tedavinin erken ve uygun antibiyotikle başlanmasını sağlayabilir.

Materyal ve Metot: Bu çalışmada üst solunum yolu enfeksiyonu belirtileri ile başvuran ve klinik olarak akut tonsillofarenjit tanısı alan 300 vaka prospektif olarak değerlendirildi. Hastaların yaş ortalaması 67,70 ± 40 ay (14-168 ay) olup 136’sı (% 45,33) kız; 164’ü (% 54,66) erkekti. Hastalar yaş, akut boğaz ağrısı, ateş, başağrısı, yutma güçlüğü, myalji, döküntü, karın ağrısı, bulantı, kusma, aile öyküsü, evdeki fert sayısı, başvuru öncesi hastalık süresi açısından sorgulandı, fizik muayenedeki tonsil hipertrofisi, kript, servikal lenf bezi hassasiyeti kaydedildi. Tüm hastalardan boğaz kültürü alındı.

Bulgular: Boğaz kültürü sonuçlarına göre 60(%20) hastada beta hemolitik streptokok(BHS) izole edilirken, bunlardan 50(%83,33)’si A grubu olarak gruplandı. BHS izole edilen ve BHS izole edilmeyen vakalar karşılaştırıldığında yaş ortalamaları BHS grubunda 85,81±39, BHS üremeyen grupta 63,13±39 ay(p<0,001) bulundu. Öyküde başağrısı(p<0,001), myalji(p<0,001), yutma güçlüğü (p=0,040) ve döküntü(p=0,011) varlığı ile BHS izolasyonu arasında istatistiksel olarak anlamlı bir ilişki bulundu. Diğer veriler anlamlı değildi. 

Sonuç: Hastaların bakteriyolojik olarak değerlendirilmesinin mümkün olmadığı durumlarda öykü ve klinik bulgulardan spesifik olanların değerlendirilmesi çocuk hastalarda gelişene tonsillofarenjitin ampirik tedavisinde yol gösterici olacaktır.

Keywords

• Çocuk,Tonsillofarenjit,Beta Hemolitik Streptokok,Belirti,Bulgu,Boğaz kültürü

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