Pharyngitis in Adults: The Presence and Coexistence of Viruses and Bacterial Organisms

Huovinen, Pentti; Lahtonen, Riitta; Ziegler, Thedi; Meurman, Olli; Hakkarainen, Kati; Miettinen, A; Arstila, Pertti; Eskola, J.; Saikku, Pekka

doi:10.7326/0003-4819-110-8-612

Cited by 123 publications

(62 citation statements)

References 22 publications

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“…These limitations are compounded by the relatively low prevalence of GABHSP relative to pharyngitis of viral and bacterial etiologies other than Streptococcus pyogenes. 22,25 The positive predictive value of the clinical findings relied upon to form an impression, tonsillar exudate, tender adenopathy, enlarged tonsils, and pharyngeal erythema, was 46%; more than one of two patients appearing to have GABHSP will be misdiagnosed. Given the tendency of clinicians in this study to base their impressions on the most reliable signs and symptoms, the clear implication is that the history and physical have somewhat limited value in the diagnosis of GABHSP.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, in ANCOVA analysis, where clinical impression was used as a continuous outcome, each 1% increase in tonsillar exudate elevated the strength of clinical impression by 0.44%. Tonsillar exudate is known to occur in viral as well as bacterial pharyngitis, 21,22 although the frequency is greater in GABHSP. 23 The results of regression analysis in this study are comparable to those of Attia et al 24 The signs and symptoms used by clinicians in this study functioned with a sensitivity and specificity of 71% and 77%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Concordance of Clinical Findings and Clinical Judgment in the Diagnosis of Streptococcal Pharyngitis

Nawaz

Smith

Mazhari

et al. 2000

Academic Emergency Medicine

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Abstract. Objective: It is uncertain how reliably clinicians apply clinical predictors of group A beta hemolytic streptococcal pharyngitis (GABHSP) to form a clinical impression, and how reliably this impression predicts culture results. The objective was to study clinician accuracy in diagnosing GABHSP. Methods: This was a prospective cohort study, conducted at an urgent care center of a major university. A convenience sample of 218 patients, aged 9-83 years, presenting with sore throat, was enrolled. Symptoms and signs of pharyngitis were documented on a standardized form; the likelihood of GABHSP was plotted on a visual analog scale; and throat culture was obtained. A comparison was then made between the clinical impression on presentation and the throat culture result. Results: Throat cultures were positive for GABHSP in 41 patients (19%). The probability of GABHSP was related to node size and tenderness, tonsillar exudate and hypertrophy, and pharyngeal erythema (p < 0.05); but not throat soreness, degree of fever, or cough. A strong clinical impression of GABHSP (>50% on the visual analog scale) was associated with tonsillar exudate and hypertrophy, tender nodes, and pharyngeal erythema. Together, these four predictors had a sensitivity of 71%, a specificity of 77%, and a positive predictive value of 46%. Conclusions: Clinicians in this study based their impression of GABHSP on the most reliable symptoms and signs. While a strong clinical suspicion of GABHSP predicted a greater probability of positive culture, the clinicians consistently overestimated the probability of GABHSP. Symptoms and signs predict GABHSP unreliably when used alone; they are helpful in modifying estimates of disease probability to facilitate optimal use of laboratory tests and antibiotics. Key words: streptococcal infections, diagnosis; pharyngitis, microbiology; reagent kits; diagnostic, standards. ACADEMIC EMERGENCY MEDICINE 2000; 7:1104-1109 S ORE throat is the sixth leading cause of visits to physicians in the ambulatory care setting, resulting in nearly 21 million visits each year. 1 Group A beta hemolytic streptococcal pharyngitis (GABHSP) accounts for only 10-20% of sore throats, 2-4 most cases being of viral etiology. Treatment of GABHSP with antibiotics is indicated to prevent post-streptococcal rheumatic fever in susceptible patients. 5,6 Clinicians are known to overestimate the probability of GABHSP based on clinical findings alone, 7 and consequently antibiotics are prescribed for up to 75% of patients. [8][9][10][11][12][13][14][15] Inappropriate use of antibiotics contributes to microbial resistance, and is considered an important public health threat in the United States. Clinical impression of GABHSP has been reported to have a sensitivity of 0.39, a specificity of 0.55, and an accuracy of 0.51. 17 Certain clinical signs and symptoms are associated with a higher likelihood of GABHSP. These include tonsillar enlargement and exudate, tender and enlarged cervical nodes, and fever. [18][19][20] Whether clinicians base the...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Concordance of Clinical Findings and Clinical Judgment in the Diagnosis of Streptococcal Pharyngitis

Nawaz

Smith

Mazhari

et al. 2000

Academic Emergency Medicine

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“…1,2 Although this condition shows a viral etiological origin, approximately 5% to 17% of the cases are bacteriological which is mostly Group A β-hemolytic streptococci.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Serum Vitamin D Levels and Childhood Recurrent Tonsillitis

Elbistanlı¹,

Güneş²,

Yeğin³

et al. 2017

Otolaryngol Open J

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“…У взрослых примерно 5-10% случаев фарингита вызваны бета-гемо-литическим стрептококком группы А [2]. Реже в этиологии бактериальных фарингитов отмечается роль бета-гемо-литических стрептококков группы С, Corynebacterium diphtheriae, Neisseria gonorrhoeae, Arcanobacterium haemolyticum, Chla mydia pneumoniae, Mycoplasma pneumoniae [3]. Наиболее распространенными возбудителями бактери-альной суперинфекции при острых вирусных синуситах остаются Streptococcus pneumoniae, Haemophilus influenzae и Mora xella catarrhalis [4].…”

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Antibacterial Therapy for Acute and Chronic Diseases of the Upper Respiratory Tract in Adults

Дербенева¹

2017

Medicinskij sovet

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В статье представлены наиболее часто встречающиеся заболевания верхних дыхательных путей у взрослых, дифферен-циально-диагностические критерии острой респираторной вирусной инфекции, острого тонзиллофарингита, острого и хронического риносинусита. Обсуждаются необходимость, сроки назначения антибактериальной терапии, а также группы антибиотиков и их дозировки при этих заболеваниях.

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Pharyngitis in Adults: The Presence and Coexistence of Viruses and Bacterial Organisms

Cited by 123 publications

References 22 publications

Concordance of Clinical Findings and Clinical Judgment in the Diagnosis of Streptococcal Pharyngitis

Concordance of Clinical Findings and Clinical Judgment in the Diagnosis of Streptococcal Pharyngitis

Relationship Between Serum Vitamin D Levels and Childhood Recurrent Tonsillitis

Antibacterial Therapy for Acute and Chronic Diseases of the Upper Respiratory Tract in Adults

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