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

Year 2019, Volume: 19 Issue: 2, 226 - 231, 28.06.2019

Şamil Hızlı , Filiz Meryem Altay

https://doi.org/10.17098/amj.575478

Cited By: 1

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

References

• Pallon J, Sundqvist M, Hedin KA 2-year follow-up study of patients with pharyngotonsillitis. BMC Infect Dis 2018;18:3.
• Andre M, Vernby A, Odenholt I, et al. Diagnosis-prescribing surveys in 2000, 2002 and 2005 in Swedish general practice: consultations, diagnosis, diagnostics and treatment choices. Scand J Infect Dis 2008;40:648-54.
• Group ESTG, Pelucchi C, Grigoryan L, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012;18(Suppl 1):1-28.
• Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981;1:239-46.
• Roggen I, van Berlaer G, Gordts F, Pierard D, Hubloue I. Centor criteria in children in a paediatric emergency department: for what it is worth. BMJ Open 2013;3:e002712.
• Hossain P, Kostiala A, Lyytikäinen O, Kurki S. Clinical features of district hospital paediatric patients with pharyngeal group A streptococci. Scand J Infect Dis 2003;35:77-9.
• Sahin F, Ulukol B, Aysev D, Suskan E. The validity of diagnostic criteria for streptococcal pharyngitis in Integrated Management of Childhood Illness (IMCI) guidelines. J Trop Pediatr 2003;49:377-9.
• Fischer Walker C, Rimoin A, Hamza H, Steinhoff MC. Comparison of clinical prediction rules for management of pharyngitis in settings with limited resources. J Pediatr 2006;149:64-71.
• Regoli M, Chiappini E, Bonsignori F, Galli L, de Martino M. Update on the management of acute pharyngitis in children. Ital J Pediatr 2011;37:10.
• Nibhanipudi KV. A study to Determine if Addition of Palatal Petechiae to Centor Criteria Adds More Significance to Clinical Diagnosis of Acute Strep Pharyngitis in Children. Glob Pediatr Health. 2016 Jul 5;3:2333794X16657943. eCollection 2016.
• Mistik S, Gokahmetoglu S, Balci E, Onuk FA.. Sore throat in primary care project: a clinical score to diagnose viral sore throat. Fam Pract 2015;32:263-8.
• Uysal A, Durak Y, Akın D. Boğaz Kültürlerinden İzole Edilen Beta-Hemolitik Streptokokların İdentifikasyonu, Tiplendirilmesi Ve Antibiyotik Ve Eritromisin Direnç Profillerinin Belirlenmesi. Selçuk Üniversitesi Fen Fakültesi Fen Dergisi. (2014), 39: 10-20
• Dodd M, Adolphe A, Parada A, Brett M, Culbreath K, Mercier RC. Clinical Impact of a Rapid Streptococcal Antigen Test on Antibiotic Use in Adult Patients. Diagn Microbiol Infect Dis. 2018 pii: S0732-8893(18)30111-1.
• Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev 2013;(11):CD000023.
• Shaikh N, Swaminathan N, Hooper E. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. J Pediatr 2012;160:487-93.