Clinical Manifestations and Susceptibility Pattern of Group A Streptococcal Pharyngitis in Children Presented with Acute Fever and Sore Throat in a Tertiary Hospital
Clinical Manifestations and Susceptibility Pattern of Group A Streptococcus
Keywords:
Group A streptococcus, pharyngitis, throat cultureAbstract
Acute sore throat in children is usually caused by viruses. Group A Streptococcus is the most common bacteria that triggers this infection. This prospective study was intended to evaluate the clinical manifestations of group A streptococcal pharyngitis and its susceptibility to antibiotics in children. Throat swabs were acquired from 134 children aged 1-15 years who presented with acute fever and sore throat at the Pediatric Outpatient Department of Naresuan University Hospital between May 1, 2016 and April 30, 2017. Cultures were positive for group A streptococcus in 10 patients (7.5%) and negative group A streptococcus result in 124 patients (92.5%). Acute pharyngitis was diagnosed in 42.6% of the patients. During physical examination, most patients had tonsillar exudate, palatal petechiae and scarlatiniform rash. The carlatiniform rash contributed significantly to the diagnosis of group A streptococcal infection [30% vs 4.8%; p = 0.002, OR 8.43 (95%CI 1.73-40.99)] as compared to the culture negative group. Group A streptococcus isolates were completely sensitive to penicillin and resistant to macrolides (10%). Thus, a child with fever, sore throat which lasts for seven days and with accompanying scarlatiniform rash due to streptococcus group A infection can be given penicillin treatment
References
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29. Tack KJ, Hedrick JA, Rothstein E, Nemeth MA, Keyserling C, Pichichero ME. A study of 5-day cefdinir treatment for streptococcal pharyngitis in children. Arch Pediatr Adolesc Med 1997;151(1):45-9.
2. Lindbaek M, Hoiby EA, Lermark G, Steinsholt IM, Hjortdahl 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(517):615-9.
3. American Academy of Pediatrics. Group A streptococcal infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, editors. Red Book 2018-2021: Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village: American Academy of
Pediatrics; 2018. p.748-62.
4. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005;5(11):685-94.
5. Wessels MR. Streptococcal pharyngitis. N Engl J Med 2011;364(7):648-55.
6. Greer R, Althaus T, Ling C, Intralawan D, Nedsuwan S, Thaipadungpanit J, et al. Prevalence of group A streptococcus in primary care patients and the utility of C-reactive protein and clinical scores for its identification in Thailand. Am J Trop Med Hyg 2020;102(2):377-83.
7. Aalbers J, O'Brien KK, Chan WS, Falk GA, Teljeur C, Dimitrov BD, et al. Predicting streptococcal pharyngitis in adults in primary care: A systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med 2011;9(67):1-11.
8. Hersh AL, Jackson MA, Hicks LA; American Academy of Pediatrics Committee on Infectious Diseases. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013;132(6):1146-54.
9. 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 (11):847-52.
10. McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998;158(1):75-83.
11. The Thai Society of Pediatric Respiratory and Critical Care Medicine, The Royal Collage Pediatricians of Thailand. Guidelines for the treatment of acute respiratory tract infections in children 2019. Bangkok: Beyond Enterprise Co., Ltd; 2019. p.19-26.
12. Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician 2009;79(5):383-90.
13. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev 2004;7(3):571-80.
14. Bourgeois FT, Mandl KD, Valim C, Shannon MW. Pediatric adverse drug events in the outpatient setting: An 11-year national analysis. Pediatrics 2009;124(4):e744-50.
15. Cohen AL, Budnitz DS, Weidenbach KN, Jernigan DB, Schroeder TJ, Shehab N, et al. National surveillance of emergency department visits for outpatient adverse drug events in children and adolescents. J Pediatr 2008;152(3):416-21.
16. Gagliotti C, Nobilio L, Milandri M, Moro ML, Romagna E. Antibiotic Resistance Study Group, macrolide prescriptions and erythromycin resistance of Streptococcus pyogenes. Clin Infect Dis 2006;42(8):1153-56.
17. Treebupachatsakul P, Tiengrim S, Thamlikitkul V. Upper respiratory tract infection in Thai adults: Prevalence and prediction of bacterial causes, and effectiveness of using clinical practice guidelines. J Med Assoc Thai 2006:89(8);1178-86.
18. Boonyasiri A, Thamlikitkul V. Effectiveness of multifaceted interventions on rational use of antibiotics for patients with upper respiratory tract infections and acute diarrhea. J Med Assoc Thai 2014;97 (Suppl 3):S13-9.
19. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal disease. Lancet Infect Dis 2005;5(11):685-94.
20. Cohen JF, Cohen R, Bidet P, Elbez A, Levy C, Bossuyt PM, et al. Efficiency of a clinical prediction model for selective rapid testing in children with pharyngitis: A prospective, multicenter study. PLoS One 2017;12(2):e0172871.
21. Limbergen JV, Kalima P, Taheri S, Beattie TF. Streptococcus A in paediatric accident and emergency: Are rapid streptococcal tests and clinical examination of any help?. Emerg Med J 2006;23(1):32-4.
22. Nishiyama M, Morioka I, Taniguchi-Ikeda M, Mori T, Tomioka K, Nakanishi K, et al. Clinical features predicting group A streptococcal pharyngitis in a Japanese paediatric primary emergency medical centre. J Int Med Res 2018;46(5):1791-800.
23. Lin MH, Chang PF, Fong WK, Yen CW, Hung KL, Lin SJ. Epidemiological and clinical features of group A streptococcus pharyngitis in children. Acta Paediatr Taiwan 2003;44(5):274-8.
24. 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(4):e002712.
25. Little P. Penicillin for acute sore throat in children: Randomised, double blind trial. Commentary: More valid criteria may be needed. BMJ 2003;327(7427):1327-8.
26. Tanz RR, Shulman ST, Shortridge VD, Kabat W, Kabat K, Cederlund E, et al. Community- based surveillance in the United States of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis 2004;39(12):1794-801.
27. Bingen E, Bidet P, Mihaila-Amrouche L, Doit C, Forcet S, Brahimi N, et al. Emergence of macrolide-resistant Streptococcus pyogenes strains in French children. Antimicrob Agents Chemother 2004;48(9):3559-62.
28. Gherardi G, Petrelli D, Di Luca MC, Pimentel de Araujo F, Bernaschi P, Repetto A, et al. Decline in macrolide resistance rates among Streptococcus pyogenes causing pharyngitis in children isolated in Italy. Eur J Clin Microbiol Infect Dis 2015;34(9):1797-802.
29. Tack KJ, Hedrick JA, Rothstein E, Nemeth MA, Keyserling C, Pichichero ME. A study of 5-day cefdinir treatment for streptococcal pharyngitis in children. Arch Pediatr Adolesc Med 1997;151(1):45-9.
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2020-10-13
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