McIsaac Modification of Centor Score in Diagnosis of Streptococcal Pharyngitis and Antibiotic Sensitivity Pattern of Beta-hemolytic Streptococci in Chennai, India

Background and Aims:Antibiotics are frequently prescribed for sore throat in developing countries, that in turn leads to huge healthcare expenditure and their irrational use may lead to antimicrobial resistance in the community. The aim of this study is to investigate the effect of environmental factors on the frequency of occurrence of group A beta hemolytic streptococcus (GABHS) sore throat and to work out enhancing effect on the sensitivity and specificity and positive predictive value of the signs and symptoms of GABHS sore throat for facilitation of rational antibiotic use.Settings and Design:This was a prospective, cross sectional study conducted over period of one year in Pediatric Outpatient Department (OPD) of a Tertiary care teaching hospital.Methods:All the children between the age of 5 years and 15 years of age presenting in OPD with the signs and symptoms of sore throat were included in the study.Statistical Analysis Used:Statistical analysis was carried out by using Statistical Package for Social Sciences software and statistical tests of Pearson's Coefficient, Chi-square Test, Fischer's Test, Likelihood Ratio, Odds Ratio, and ROC Curve were applied.Results:Out of 225 children of the study group, 153 (68%) of the children were in the 5-10 years’ age group. Positive throat swab culture was found to be positively associated with high grade fever, pain in throat while swallowing, severely enlarged tonsils, tender lymphadenopathy, poor housing condition, fuel used for cooking, and presence of smoker in house.Conclusions:The study stresses on the need of carefully evaluating children presenting with the symptoms of sore throat as majority of the cases may be viral and thus, self-limiting. Poor housing conditions and indoor pollution contribute to the increased prevalence of sore throat.

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“…[67] However, group A streptococcus is the most common bacterial as well as treatable cause of bacterial pharyngitis. [589]…”

Section: Introductionmentioning

confidence: 99%

Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice

Bhalla

Bhardwaj

Gupta

et al. 2019

J Family Med Prim Care

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“…and Asia, i.e. China 38,39 (with Hong Kong 8 ), India, 40 Japan, 41 Malaysia 42 and Thailand 43 . Regarding the Middle East, the principal recommendations were found from Iran, 44,45 Israel, 46 Saudi Arabia 47 and Turkey 48 .…”

Section: Resultsmentioning

confidence: 99%

Worldwide comparison of treatment guidelines for sore throat

Coutinho

Duerden

Sessa³

et al. 2021

Int. J. Clin. Pract.

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Introduction Sore throat (acute pharyngitis) is globally one of the most frequent reasons for seeking healthcare. Its etiology is mostly viral. In 15%‐30% of cases, group A streptococci (GAS) are detected, which may cause acute rheumatic fever. We have done a worldwide systematic review to compare diagnostic and therapeutic guidelines across countries and regions. Previous reviews of sore throat guidelines were limited to specific regions and/or language; this is the first global review. Materials and Methods Searches were performed in MEDLINE, EMBASE and COCHRANE (key words: sore throat, pharyngitis, tonsillitis or pharyngotonsillitis, and management, guidance, guideline or recommendation) and on the web sites of major health authorities and associated institutions from Africa, Asia, Europe, Middle East, North America, Oceania and South America. Results Thirty‐six guidelines were identified from 26 countries. Most common are recommendations relying on the symptom‐ and age‐based Centor or McIsaac scores. However, antibiotic treatment may be based on other symptomatic criteria; in the most extreme approach just sore throat in children. The recommendation of GAS‐specific diagnostic tests is mainly limited to countries where such tests are readily available, although some countries choose not to use them. Penicillins are consistently recommended as first‐line antibiotics. By contrast, guidance for symptomatic treatment is variable and mostly sparse or missing. African countries without sore throat guidelines and Asian countries bypassing them are afflicted by rising antibiotic resistance. Conclusion The availability of sore throat guidelines varies considerably by region and country. Moreover, important divergence is found among the guidelines regarding diagnostic and treatment criteria. This may be explained by the historical background or adoption of external guidelines, rather than local incidences of GAS infections or acute rheumatic fever. Absence of recommendations on symptomatic treatment in many guidelines is concerning, and raises issues about antimicrobial stewardship, as this should be the mainstay of sore throat management, rather than antibiotics.

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“…Previous research indicates the prevalence rate of S. pyogenes-caused pharyngitis to be approximately 14% using antigen testing in children and 19% using PCR in children and adults. 16,22 The PCR results of another study indicated that 10.3% of symptomatic patients and 1.1% of asymptomatic medical students were positive for S. pyogenes. 17 Although it is unlikely that the antigen test was more sensitive than the PCR assay for detecting S. pyogenes in the present study, it is possible that the collection method of the nasopharyngeal samples might have resulted in a lower bacterial yield than the traditional throat swabs used in the other studies.…”

Section: Discussionmentioning

confidence: 98%

“…These findings confirm observations from previous reports and suggests that the specificity and sensitivity of this cut-off score for S. pyogenes pharyngitis may be much lower in other populations. 16 , 24 , 25 Moreover, this measure may give false-positive results with pathogens other than S. pyogenes . Therefore, the authors propose that the Centor cut-off score should not be relied upon to initiate penicillin therapy in the Emirati population, although further studies are necessary to confirm these findings.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, a clinical examination was conducted for those who reported symptoms of pharyngitis to determine the presence of any fever (a temperature of ≥38°C), tonsillar enlargement with exudates, tenderness of the anterior cervical lymph nodes and the absence of a cough, in accordance with the revised Centor criteria. 9 , 16 For the purposes of the study, a Centor score of one point assigned to each of the aforementioned criteria. All of the participants were instructed to report to the research nurse if they developed symptoms of pharyngitis before beginning antibiotic treatment.…”

Section: Methodsmentioning

confidence: 99%

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Nasopharyngeal Isolates from a Cohort of Medical Students with or without Pharyngitis

Narchi

George

Al-Hamad

et al. 2020

Sultan Qaboos Univ Med J

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Objectives: Few studies have investigated pharyngeal colonisation in the United Arab Emirates (UAE). This study aims to identify the pharyngeal organisms present in a cohort of medical students with and without symptomatic pharyngitis. Methods: This study was conducted between September 2016 and June 2018 at the College of Medicine and Health Sciences, UAE University, Al-Ain. Nasopharyngeal swabs were collected from preclinical and clinical medical students attending the college during the study period. The specimens were tested for 16 viral and nine bacterial pathogens using a real-time polymerase chain reaction assay. Results: A total of 352 nasopharyngeal swabs were collected from 287 students; of these, 22 (7.7%) had pharyngitis symptoms. Overall, the most common isolates were human rhinovirus, Streptococcus pneumoniae and Haemophilus influenzae, with no significant differences in terms of gender, year of study or stage of study. The prevalence of S. pyogenes in asymptomatic and symptomatic students was 1.1% and 0%, respectively. A Centor score of ≥2 was not associated with S. pyogenes-positive samples. Six pathogens were isolated from symptomatic students including H. influenzae. Fusobacterium necrophorum was not detected in any of the samples. Conclusion: The diagnosis and management of pharyngitis should be tailored to common pathogens in the region. This study found that S. pyogenes and F. necrophorum were not detected among students with symptoms of pharyngitis; moreover, Centor scores of ≥2 were not associated with the presence of S. pyogenes. This cut-off score therefore should not be employed as an empirical measure to initiate penicillin therapy in this population.Keywords: Pharyngitis; Pharynx; Asymptomatic Infections; Carrier State; Fusobacterium necrophorum; Streptococcus pyogenes; Penicillins; United Arab Emirates.

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McIsaac Modification of Centor Score in Diagnosis of Streptococcal Pharyngitis and Antibiotic Sensitivity Pattern of Beta-hemolytic Streptococci in Chennai, India

Cited by 8 publications

References 9 publications

Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice

Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice

Worldwide comparison of treatment guidelines for sore throat

Nasopharyngeal Isolates from a Cohort of Medical Students with or without Pharyngitis

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