Akut Tonsillofarenjitli Çocuklarda Grup A Beta Hemolitik Streptokok Enfeksiyonu Sıklığı

Yıl 2009, Cilt: 7 Sayı: 2, 13 - 17, 01.09.2009

Nevin Cambaz Emin Özkaya , Betül Sezgin Özgül Yiğit Elif Ünver Yeşim Coşkun Nedim Samancı

Öz

Amaç: Bu çalışmada, akut tonsillofarenjitli çocukların boğaz kültürlerinde Grup Abeta hemolitik streptokok GABHS sıklığının belirlenmesi ve hastaların başvuruşikayetleri ile klinik bulgularının irdelenmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada akut tonsillofarenjitle başvuran 420 hasta semptom, klinik bulgu ve boğaz kültürü açısından incelendi. Boğaz kültüründe GABHSüreyen ve üremeyen vakalar başvuru sırasındaki klinik bulgular açısından karşılaştırıldı. Çalışmada ateş koltuk altı 37,50C ve üstü , kusma, burun akıntısı, boğazağrısı, baş ağrısı, öksürük, karın ağrısı, iştahsızlık, servikal lenf bezi hassasiyetisemptom ve bulguları kaydedildi.Bulgular: Yaşları 1-14 yıl arasında değişen ortalama 6,5±3,4 yaş 420 hastanın95’inde %22,62 boğaz kültüründe GABHS üremesi tespit edildi. A grubu beta hemolitik streptokok üreyen vakalarda ateş, boğaz ağrısı, öksürük, karın ağrısı, servikal lenf bezi hassasiyeti bulguları, üreme olmayanlara oranla anlamlı derecedeyüksek bulundu.Sonuç: Çalışmamızda yaşları 1-14 yaş arası olan çocukların boğaz kültüründeGABHS üreme oranı %22,62 olarak bulundu. Boğaz ağrısı, ateş, öksürük, karın ağrısı ve servikal lenf bezleri hassasiyeti olan tonsillofarenjit tanısı almış hastalardaGABHS enfeksiyonu öncelikle düşünülmelidir

Anahtar Kelimeler

Grup A beta hemolitik streptokok, tonsillofarenjit, boğaz kültürü, çocukluk çağı

Frequency of the Group A Beta Hemolytic Streptococcus Infection in Children Presenting with Acute Tonsillopharyngitis

Öz

Aim: The aim of this study was to evaluate the frequency of group A beta hemolytic streptococcus GABHS in children with tonsillopharyngitis and to assess their complaints and clinical findings.Materials and Method: A total of 420 children who presented to our outpatientdepartment with acute tonsillopharyngitis were enrolled to the study. The clinical features of patients with positive throat cultures for GABHS were compared to those with negative culture results. Presence of fever ≥37.50C, axilary , vomiting, coryza, sore throat, cough, abdominal pain, tenderness of cervical lymph nodes, and tonsillopharyngitis were recorded. Results: The mean age of the patients was 6.5±3.4 years range, 1 to 14 years .The positive throat culture rate for GABHS was 22.62% 95 of 420 patients . It wasfound that fever, sore throat, cough, abdominal pain and tender cervical lymph nodes were significantly more frequent in patients with positive throat culture for GABHS than those with negative result for GABHS.Conclusion: GABHS should be firstly considered in patients presenting withsymptoms of fever, sore throat, cough, abdominal pain and tenderness of cervical lymph nodes

Anahtar Kelimeler

Group A beta hemolytic streptococcus, tonsillopharyngitis, throatculture, childhood

Kaynakça

• Gregory F, Hayden, Ronald B. Turner. Acute pharyngitis. İn: Kleigman R.Jenson H, Behrman R, Stanton B, (eds). Nelson Texbook of Pediatrics Philadelphia, Saunders 2007; p:1752-4.
• Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Scwartz RH. Infectious Diseasee Society of America. Practice guidelines for the diagnosis and management of Group A streptoccal pharyngitis. Clin Infec Dis 2002;35:113-25.
• Peter G. Streptococcal pharyngitis. Current therapy and cri- teria for evaluation for evaluation of new agents. Clin Infect Dis 1992;14:218-23.
• Tanz RR, Shulman ST. Pharyngitis. In: Long SS, Pickering LK, Prober CG, (eds). Principles and Practice of Pediatric Infec- tious Diseases. 1st ed. New York, NY: Churchill Livingstone; 1997:200-7.
• Hayse CS, Wiiliams HJK. Management of group A Beta He- molytic Streptoccal pharyngitis Am Fam Physician 2001:15;63:1557-64.
• Perkins A. An approach to diagnosing the acute sore throat. Am Fam Physician 1997;55:131-8, 141-2.
• Topkaya E, Yıldırım T, Arsan S. Isolation ratio and T-serotyping group A streptococi from pediatric upper respiratory tract in- fections in Turkey. Anadolu Kardiyol Derg 2005,5:302-4.
• Martin JM, Green M, Bardabora MT, Wald ER. Group A Streptococci Among School Aged Children: Clinical Charac- teristics and Carrier State; Pediatrics 2004;114:1212-9.
• Hall MC, Kieke B, Gonzales R, Belogia EA. Spectrum bias of a rapid antigen detection test for group A beta-hemolytic streptococcal pharyngitis in a pediatric population Pediat- rics 2004;114:182-6.
• Brook I, Gober AE. Increased recovery of Moraxella catarr- halis and Haemophilus influenzae in association with group A (beta)-haemolytic streptococci in healthy children and tho- se with pharyngo-tonsillitis J Med Microbiol 2006;55: 989-92.
• Stingu CS, Turku T, Dimitriu S, Dimitriu D. The impact of a so- re throat score on clinical management of streptococcal an- gina. Rev Med Chir Soc Med 2005;109:136-9.
• Bassili A, Barakat S, Sawaf GE, Zaher S, Zaki A, Din Saleh EE. Identification of clinical criteria for group A-beta hemolytic streptococcal pharyngitis in children living in a rheumatic fe- ver endemic area. J Trop Pediatr 2002;48:285-93.
• Tanz RR, Shulman ST. Chronic pharyngeal carriege of A streptococci. Pediatr Infect Dis J 2007;26:175-6.
• Ünüvar E, Yıldız İ, Kılıç A, Aslan SS, Çakal B, Toprak S et al. Viral etiology and symptoms of acute upper respiratory tract infections in children. Turk J Med Sci 2009;39:29-35.
• Solak S, Ergönül O. Short communication: clinical predictors of group A beta hemolytic streptocci isolation in upper res- piratory tract infections. Mikrobiyol Bul 2005;39:333-7.
• Nandi S, Kumar R, Ray P, Vohra H, Ganguly NK. Clinical sco- re card for diagnosis of group A streptococcal sore throat. Indian J Pediatr 2002;69:471-5.
• Lindbaek M, Hoiby EA, Lernmark G, Steinsholt IM, Hjordahl P. Clinical symptoms and signs in sore throat patients with large colony variant beta haemolytic streptococci groups C or G versus group A. Br J Gen Pract 2005;55:615-9.
• Sundaresh HP, Kumar A, Hokanson JT, Novack AH, Etiology of cervical lymphadenitis in children. Am Fam Physician 1981;24:147-51.
• Wong MC, Chung CH. Group A streptococcal infection in pa- tients presenting with a sore throat at an accident and emer- gency department: prospective observational study. Hong Kong Med J 2002;8:92-8.
• Lin MH, Fong WK, Chang PF et al. Predictive value of clinical differentiating group A beta hemolytic streptococcal phary- ngitis in children. J Microbiol Immunol Infect 2003;36:21-5.
• Kreher NE, Hicker JM, Barry HC, Messimer SR. Do gastroin- testinal symptoms accompanying sore throat predict strep- tococcal pharyngitis? J Fam Pract 1998;46:154-9.