Correlation between symptoms and Centor/McIsaac score in the diagnosis of tonsillopharyngitis.

Abstract

Objective: Group A beta hemolytic streptococcus (GABHS) is identified in 20-40% of cases of childhood pharyngitis. The Centor/McIsaac score is an important scoring method used in the early diagnosis of patients presenting with symptoms of Group A beta hemolytic streptococcus (GABHS) pharyngitis. In this study, we aimed to determine the relationship between Centor/McIsaac score and patients’ symptoms, and to investigate any conformity between Rapid Antigen Test positivity and high Centor/McIsaac score.
Materials and methods: Data were obtained retrospectively by scanning the files of patients (age 2 to 18 years) diagnosed with GABHS who were hospitalized between May and December 2017. Inclusion criteria were, being between the ages of 2 and 18 years and to be diagnosed with group A beta hemolytic streptococcal pharyngitis. Receiving antibiotic treatment within the last 14 days, being under 2 years of age and over 18 years of age are exclusion criteria. Daily clinical findings and test results (complete blood count, neutrophil and lymphocyte percentages, rapid antigen test, throat culture) were collected from medical records. The Centor/McIsaac scores calculated according to symptoms and rapid antigen test results used for GABHS antigen detection from throat swab samples, used for the initiation of effective treatment and to shorten hospitalization, were recorded from patient files. Student's t test was used to analyze the data that showed normal distribution among independent groups. The chi-square test was used for the analysis of categorical variables. P<0.05 was considered statistically significant.
Results: A total of 236 patients were included in the study. The average age of the patients was 7 years. The frequency of pharyngitis symptoms was similar in patients younger and older than 7 years of age. There was no statistically significant difference between those younger and older than 7 years of age in terms of throat culture positivity (p=0.059). There was no statistically significant difference between Centor/McIsaac scores of the two age groups (p=0.063). The Centor/McIsaac score (3.62±1.01) of those with positive rapid antigen test was significantly higher than that of those with negative rapid antigen test (2.78±1.28) (p=0.001). Centor/McIsaac scores of those with and without fever, those with and without tonsillar hypertrophy, those with and without cough were also compared. Centor/McIsaac scores of those with fever (3.53±1.02) were higher compared to those without (1.63±0.89) (p=0.001), scores were higher in those with tonsillar hypertrophy (3.68±1.01) compared to those without (2.10±0.97) (p=0.001), and scores were again higher in those without cough (3.67±1.07) compared to those with cough (2.22±0.99) (p<0.001).
Conclusion: The intensity of symptoms seen in GABHS infection leads to higher Centor/McIsaac scores. The correlation between rapid antigen test results and Centor/McIsaac score shows the increasing importance of Centor/McIsaac score in early diagnosis of GABHS pharyngitis.

Keywords

• Tonsillopharyngitis
• Centor/McIsaac score
• rapid antigen test

Tonsillofarenjit tanısında Centor/Mclsaac skoru arasındaki korelasyon

Öz

Amaç: A grubu beta hemolitik streptokok (GABHS) çocukluk çağı farenjit vakalarının %20-40’ında tanımlanır. Centor/McIsaac skoru A grubu beta hemolitik streptokok farenjiti semptomları ile başvuran hastaların erken tanısında kullanılan önemli bir skorlama yöntemidir. Bu çalışmada Centor/McIsaac skor ile hastaların semptomları arasındaki ilişkiyi saptamayı ve Hızlı Antijen Test pozitifliği ile yüksek Centor/McIsaac skoru arasındaki herhangi bir uygunluğu incelemeyi amaçladık.
Gereç ve yöntem: : Mayıs ile Aralık 2017 arasında hastanede yatmış olan GABHS tanısı alan hastaların (2 ila 18 yaş) dosyaları taranarak retrospektif olarak veriler elde edildi.  Dahil edilme kriterleri 2 ve 18 yaş arasında olmak, A grubu beta hemolitik streptokok farenjit tanısı almasıdır. Son 14 gün içinde antibiyotik tedavisi almak, 2 yaş altında ve 18 yaş üstünde olmak  dışlanma kriterleridir. Günlük klinik bulguları ve test sonuçları (tam kan sayımı, nötrofil ve lenfosit yüzdeleri, Hızlı antijen test, boğaz kültür) tıbbi kayıtlardan toplandı. Boğaz sürüntü örneklerinden GABHS antijeninin saptanması, etkin tedavi başlanması ve hastanede kalış süresinin kısaltılması için kullanılan; semptomlar ve hızlı antijen test sonuçlarına göre hesaplanan Centor/McIsaac skorları hasta dosyalarından kaydedildi. Bağımsız gruplar arasında normal dağılım gösteren verilerin analizinde Student t test kullanıldı. Kategorik değişkenlerin analizi için kikare testi kullanıldı. P<0,05 istatiksel olarak anlamlı kabul edildi.
Bulgular: Çalışmaya toplam 236 hasta dahil edildi. Hastaların ortalama yaşı 7 yaştı. 7 yaş altında ve 7 yaş üstünde farenjit semptomlarının sıklığı benzerdi. 7 yaş altındakiler ve üstündekiler arasında boğaz kültürü pozitifliği açısından istatiksel olarak anlamlı fark yoktu (p=0,059). İki yaş grubunun Centor/McIsaac skorları arasında istatiksel olarak anlamlı bir fark yoktu (p=0,063). Hızlı antijen testi pozitif olanların Centor/McIsaac skoru (3,62±1,01), hızlı antijen test negatif olanlarınkinden (2,78±1,28) anlamlı düzeyde yüksekti (p=0,001). Ateşi olanlar ve ateşi olmayanların, tonsiller hipertrofi olanların ve olmayanların, öksürük olmayanlar ve öksürük olanlar Centor/McScorları da karşılaştırılmıştır. Ateşi olanların (3,53±1,02) ateş olmayanlara göre (1,63±0,89) (p=0,001), tonsiller hipertrofi olanların (3,68±1,01) tonsiller hipertrofi olmayanlara göre (2,10±0,97) (p=0,001) Centor/McIsaac skorları daha yüksekti ve  yine öksürük olmayanların (3,67±1,07) öksürük olanlara (2,22±0,99) (p<0,001) göre skorları daha yüksekti.
Sonuç: GABHS infeksiyonunda görülen semptomların yoğunluğu, daha yüksek Centor/McIsaac skorlarına neden olmaktadır. Hızlı antijen test sonuçları ile Centor/McIsaac skorun arasındaki korelasyon, GABS farenjitinin erken tanısında Centor/McIsaac skorun öneminin arttığını göstermektedir.

Anahtar Kelimeler

• tonsillofarenjit
• Centor/McIsaac skor
• hızlı antijen test

References

1. Referans 1. Küçük Ö, Biçer S, Giray T et al. Validity of rapid antigen detection testing in Group A Beta-Hemolytic Streptococcal tonsillopharyngitis. Indian J Pediatr 2014;81:138-142. https://doi.org/10.1007/s12098-013-1067-y
2. Referans 2. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics 2010;126:557-564. https://doi.org/10.1542/peds.2009-2648
3. Referans 3. Borchardt RA. Diagnosis and management of group A beta hemolytic streptococcal pharyngitis. JAAPA 2013;26:53-54. https://doi.org/10.1097/01.jaa.0000433876.39648.52
4. Referans 4. Shulman ST, Bisno AL, Clegg HW et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012;55:86-102. https://doi.org/10.1093/cid/cis629
5. Referans 5. Lindbaek M, Hoiby EA, Lermark G, Steinsholt MI, Hjortdahl P. Which is the best method to trace group A streptococci in sore throat patients: culture or GAS antigen test? Scand J Prim Health Care 2004;22:233-238. https://doi.org/10.1080/02813430410006675
6. Referans 6. Fontes MJ, Bottrel FB, Fonseca MT, Lasmar LB, Diamante R, Camargos PA. Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test. J Pediatr (Rio J) 2007;83:465-470. https://doi.org/10.2223/JPED.1695
7. Referans 7. Hryniewicz W, Albrecht P, Radzikowski A. Guidelines for the management of community acquired-respiratory tract infection. Recommendations of approach in respiratory tract infections. In National Program of Antibiotics Protection. National Medicines Institute 2016. Available at: https://www.antybiotyki.edu.pl/Rekomendacje2016.pdf. Accessed on 9 May 2019
8. Referans 8. 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;1:239-246. https://doi.org/10.1177/0272989X8100100304

9. Referans 9. McIsaac WJ, Goel V, To T, Low DE. The validity of a sore throat score in family practice. CMAJ 2000;163:811-815. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80502/ Accessed on 3 October 2000
10. Referans 10. Wessels MR. Clinical practice streptecoccal pharyngitis. N Engl J Med 2011;364:648-655. https://doi.org/10.1056/NEJMcp1009126
11. Referans 11. Stefaniuk E, Bosacka K, WankeRytt M, Hryniewicz W. The use of rapid test QuikRead go Strep A in bacterial pharyngotonsillitis diagnosing and therapeutic decisions. Eur J Clin Microbiol Infect Dis 2017;36:1733-1738. https://doi.org/10.1007/s10096-017-2986-8
12. Referans 12. Bisno AL, Garnet SP, Kaplan EL. Diagnosis of strep throat in adults: are clinical criteria really good enough? Clin Infect Dis 2002;35:126-129. https://doi.org/10.1086/342056
13. Referans 13. ElGhany SMA, Abdelmaksoud AA, Saber SM, Abd El Hamid DH. Group A beta-hemolytic streptococcal pharyngitis and carriage rate among Egyptian children: a case-control study. Ann Saudi Med 2015;35:377-382. https://doi.org/10.5144/0256-4947.2015.37
14. Referans 14. Telmesani AM, Ghazi HO. A study of group A streptococcal bacteria isolation from less than 12 years with acute tonsillitis, pharyngitis and healthy primary school chidren. J Family Community Med 2002;9:23-26.
15. Referans 15. BaSaddik IA, Munibari AA, Alhilali AM, et al. Prevalance of Group A beta hemolytic Streptococcus isolated from children with acute pharyngotonsillitis in Aden, Yemen. Trop Med Int Health 2014;19:431-439. https://doi.org/10.1111/tmi.12264
16. Referans 16. Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group a streptococcal pharyngitis. Arch Intern Med 2012;172:847-852. https://doi.org/10.1001/archinternmed.2012.950
17. Referans 17. Felsenstein S, Faddoul D, Sposto R, Battoon K, Polanco CM, Dien Bard J. Molecular and clinical diagnosis of group a streptococcal pharyngitis in children. J Clin Microbiol 2014;52:3884-3889. https://doi.org/10.1128/JCM.01489-14
18. Referans 18. Roggen I, Van Berlaer G, Gordts F, Pierard D, Hubloue I. Centor criteria in children in a paediatric emergency department:for what is worth. BMJ Open 2013;3:e002712. https://doi.org/10.1136/bmjopen-2013-002712
19. Referans 19. Shaikh N, Swaminathan N, Hooper EG. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. J Pediatr 2012;160:487-493. https://doi.org/10.1016/j.jpeds.2011.09.011
20. Referans 20. Cohen JF, Chalumeau M, Levy C et al. Spectrum and inoculum size effect of rapid antigen detection test for group A streptococcus in children with pharyngitis. PLoS One 2012;7:e39085. https://doi.org/10.1371/journal.pone.0039085
21. Referans 21. 21. Azrad M, Danilov E, Goshen S, Nitzan O, Peretz A. Detection of group a streptococcus in pharyngitis by two rapid tests: comparison of the BD veritor and quikRead go strep A. Eur J Clin Microbiol Infect Dis 2019;38:1179-1185. https://doi.org/10.1007/s10096-019-03527-w
22. Referans 22. McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998;158:75-83.
23. Referans 23. Çamurdan AD, Çamurdan OM, Ok I, Sahin F, Ilhan MN, Beyazova U. Diagnostic value of rapid antigen detection test for streptococcal pharyngitis in a pediatric population. Int J Pediatr Otorhinolaryngol 2008,72:1203-1206. https://doi.org/10.1016/j.ijporl.2008.04.008