Efficiency of Rapid Antigen Test in Diagnosis of Acute Streptococcal Tonsillopharyngitis

Year 2019, Volume: 9 Issue: 3, 241 - 245, 30.09.2019

Tarik Acar Birsen Ertekin Abdullah Sadik Girisgin Esma Ozturk Serpil Bilgi

https://doi.org/10.33808/clinexphealthsci.600033

Abstract

Objective: Group A beta hemolytic streptococcus (GABHS) is the most common bacterial cause of acute tonsillopharyngitis. Cases with bacterial infection suspicion should undergo rapid antigen test (RAT) and/or throat culture test in addition to clinical criteria, since it may lead to serious complications.

Method: A total of 220 adult and pediatric patients admitted to the emergency department between April-May 2016 with complaints of fever and sore throat, and diagnosed as acute tonsillopharyngitis were prospectively enrolled to the study. All participants had Centor score ≥2 and they underwent RAT. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RAT results of both groups were compared. Throat culture was considered as gold standard method.

Results: Mean age of the study population was 22,5±16,9 (1-72) years. 57% (n=61) of the pediatric group, and 42.5% (n=48) of adult group were male. Sensitivity of RAT in adults and pediatric group was 62% vs. 57%, and specificity of the test was 96% vs. 97%, PPV was 55% vs. 80%, and NPV was 97% vs. 93%, respectively.

Conclusion: We found low sensitivity and PPV values of RAT. Also, low levels of sensitivity decrease the possibility of RAT to be a diagnostic tool for the diagnosis of GABHS.

Keywords

Pharyngitis, streptococci, emergency care, rapid antigen test, culture

References

• 1. Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2006. Natl Health Stat Report. 2008;(8):1-29.
• 2. Barnett ML, Linder JA. Antibiotic prescribing to adults with sore throat in the United States, 1997–2010. JAMA Intern Med. 2014;174(1):138-40.
• 3. Alcaide ML, Bisno AL. Pharyngitis and epiglottitis. Infect Dis Clin North Am. 2007;21(2):449-69.
• 4. B. Spellerberg, C. Brandt. Streptococcus. In: P.T. Murray, E.J. Baron, J.H. Jorgensen, eds. Manual of Clinical Microbiology. ASM Press,Washington;2007:412–429.
• 5. Aaron M. Harris, Lauri A. Hicks, Amir Qaseem. Appropriate antibiotic use for acute respiratory tract ınfection in adults. Ann Intern Med. 2016;165(9):674. 6. 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(3):239-46.
• 7. 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.
• 8. Bisno AL, Gerber MA, Gwaltney Jr JM, Kaplan EL, Schwartz RH. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis. 2002;35(2):113-25.
• 9. M.J. Fontes, F.B. Bottrel, M.T. Fonseca, L.B. Lasmar, R.Diamante, P.A. Camargos. Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test. J Pediatr (Rio J). 2007;83(5):465-70.
• 10. R.D. Sheeler, P. Little. Rapid streptococcal testing for sore throat and antibiotic resistance. Clin Microbiol Infect. 2006; 12 (9): 3–7.
• 11. Cardoso DM, Gilio AE, Hsin SH, Machado BM, de Paulis M, Lotufo JP, Martinez MB, Grisi SJ. Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a pediatric emergency room. Rev Paul Pediatr. 2013;31(1):4-9.
• 12. Maltezou H.C, Tsagris V, Antoniadou A, Galani L, Douros C, Katsarolis I. Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription. J Antimicrob Chemother. 2008;62(6):1407-12.
• 13. York MK, Traylor MM, Hardy J, Henry M. Biochemical tests for the identification of aerobic bacteria. PYR (L-Pyrrolidonyl-ß-Naphthylamide) Test. In: Garcia LS (editor in chief). Clinical Microbiology Procedures Handbook. 3rd ed. update, ASM Press, Washington D.C. 2010, p. 3.17.41.1 - 3.17.41.3.
• 14. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev. 2004; 17(3): 571–80.
• 15. L.K. Pickering. 2000 Red Book: Report of Committee on Infectious Diseases. 25nd ed. Elk GroveVillage; 2000.
• 16. Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices:implications for management of pharyngitis. Pediatrics. 2009;123(2):437–44.
• 17. Dimatteo LA, Lowenstein SR, Brimhall B, Reiquam W, Gonzales R. The relationship between the clinical features of pharyngitis and the sensitivity of a rapid antigen test: evidence of spectrum bias. Ann Emerg Med 2001;38(6):648–52.
• 18. Rimoin A.W, Walker C.L, Hamza H.S, Elminawi N, Ghafar H.A, Vince A. The utility of rapid antigen detection testing for the diagnosis of streptococcal pharyngitis in low-resource settings. Int J Infect Dis. 2010;14(12):1048-53.
• 19. Santos AG, Berezin EN. Comparative analysis of clinical and laboratory methods for diagnosing streptococcal sore throat. J Pediatr (Rio J) 2005;81(1):23-8.
• 20. Gurol Y, Akan H, Izbırak G, Tekkanat ZT, Gunduz TS, Hayran O. The sensitivity and the specifity of rapid antigen test in streptococcal upper respiratory tract infections. Int J Pediatr Otorhinolaryngol. 2010;74(6):591-3.
• 21. Camurdan A.D, Camurdan O.M, Ok I, Sahin F, Ilhan M. N, Beyazova U. Diagnostic value of rapid antigen detection test for streptococcal pharyngitis in a pediatric population. Int J Pediatr Otorhinolaryngol. 2008;72(8):1203-6.
• 22. Araujo Filho BC, Imamura R, Sennes LU, Sakae FA. Role of rapid antigen detection test for the diagnosis of group-A beta-hemolytic streptococcus in patients with pharyngotonsillitis. Braz J Otorhinolaryngol. 2006;72(1):12-5.
• 23. Mayes T.M, Pichichero M.E. Are follow-up throat cultures necessary when rapid antigen detection tests are negative for group A streptococci? Clin Pediatr (Phila). 2001;40(4):191-5.
• 24. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the ınfectious diseases society of america. Clin Infect Dis. 2012;55(10):1279-82.
• 25. Darrow DH, Siemens C. Indications for tonsillectomy and adenoidectomy. Laryngoscope. 2002;112(100): 6-10.
• 26. Matthys J, De Meyere M, van Driel ML, De Sutter A. Differences among international pharyngitis guidelines: not just academic. Ann Fam Med. 2007;5(5):436–43. 27. Rimoin A.W, Walker C.L, Hamza H.S, Elminawi N, Ghafar H.A, Vince A. The utility of rapid antigen detection testing for the diagnosis of streptococcal pharyngitis in low-resource settings. Int J Infect Dis. 2010;14(12):1048-53