Abstract
Objective: Group A β hemolytic streptococcus (GAS) sore throat primarily occurs among children in 5–15 years age group, and if not treated appropriately causes rheumatic fever/.rheumatic heart disease (RF/RHD). Present study was aimed at validation of a clinical scoring system for diagnosis of GAS.Methods: Five hundred and thirty six children in 5–15 years age group were enrolled by systematic random selection of households from a peri-urban slum of Chandigarh. They were visited fortnightly at their home for one year to record signs and symptoms of cough and cold. Throat swabs were collected in 918 episodes, of which 123 (13.4%) were GAS culture positive.Result : Significant association of GAS was found with pain in the throat, enlarged tonsils, pharyngeal erythema and tender cervical lymphadenopahty. According to the percentage positivity of GAS culture, weighted scores were assigned to age of the child, season of occurrence, fever, size of tonsil, pharyngeal erythema and exudate, lymphadenopathy and pain in throat. Combinations of various symptoms and signs gave sensitivity of 86–89% and specificity of 83–89% whereas clinical score of 15 or more had 91% sensitivity and 98% specificity for diagnosis of GAS pharyngitis.Conclusion: As the level of clinical acumen and prevalence of GAS may differ in different primary care settings of the country, the proposed scoring system should be validated and adapted to suit local conditions before establishing it in the primary prophylaxis strategy to prevention of RF/RHD.
Similar content being viewed by others
References
Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Schwartz RH. Diagnosis and management of group A Streptococcal pharyngitis: A practice guideline.Clin Infect Dis 1997; 25 : 574–583.
Prakash K, Lakshmy A. Streptococcal throat carriage in school children with special reference to seasonal incidence.Southeast Asean J Trop Med Pub Health 1992; 23: 705–710.
Wahi V, Ganguly NK. Recent advance in diagnosis of streptococcal infection in case of pharyngitis and in rheumatic fever rheumatic heart disease.Bulletin of Post-Graduate Institute of Medical Education and Research 1984; 18:151–153.
Padmavati S. Present status of rheumatic fever and rheumatic heart disease in India.Ind Heart J 1995; 47: 395–398.
Kumar R. Controlling rheumatic heart disease in developing countries.World Health Forum 1995; 16: 47–51.
Reed BD, Huck W, French T. Diagnosis of group A β hemolytic streptococcus using clinical scoring criteria, directigen 1-2-3 group A Streptococcal test, and culture.Arch Intern Med 1990; 150:1727–1732.
Mathur NB. Bacteriological examination of pharyngeal secretions.Ind Pediatr 1992; 29:1071–1075.
Breese BB. A simple score card for the tentative diagnosis of streptococcal pharyngitis.Am J Dis Child 1977; 131: 514–517.
Seppala H, Lahtonen R, Ziegler T et al. Clinical scoring system in the evaluation of adult pharyngitis.Arch Otolaryngol Head Neck Surg 1993; 119: 288–291.
Ouchterlony O. Antigen-antibody reaction in gel. IV types of reactions in coordinated systems of system of diffusion.Acta Pathological of Microbiologica Scandinavica 1953; 32: 231–240.
Altman DG.Practical Statistics for Medical Research, London: Chapman & Hall, 1991 p. 409–418.
Dajani A, Taubert K, Ferrieri P et al. Treatment of acute streptococcal pharyngitis and prevention oh rheumatic fever: A statement of health professionals. Special Statement.Pediatrics 1995; 96: 758.
Siegel AC, Johnson EE, Stollerman GH. Controlled studies of streptococcal pharyngitis in a pediatric population.N Eng J Med 1961; 265: 559–566.
Kaplan EL, Top FH, Dudding BA, Wannamaker LW. Diagnosis of streptococcal pharyngitis: differentiation of active infection from the carrier state in the symptomatic child.J Infect Dis 1971; 123: 490–501.
Shulman ST. Streptococcal pharyngitis: Clinical and epidemiological factors.Pediatr Infec Dis J 1989; 8 : 816–819.
Honikman LH, Masseil BF. Guidelines for the selective use of throat cultures in the diagnosis of streptococcal respiratory infection.Pediatrics 1971; 48: 573–582.
Cauwenberg PBV, Mijnsbrugge AMV. Pharyngitis: a survey of the microbiologic etiology.Pediatr Infect Dis J 1991; 10: S39–42.
Bisno AL. Acute pharyngitis: etiology and diagnosis.Pediatr 1996; 97 : S949–954.
Moses AE, Ziv A, Harari M, Rahav G, Shapiro M, Engelhard D. Increased incidence and severity of Streptococcus pyogenes bacteremia in young children.Pediatr Infect Dis J 1995; 14:767–770.
Schugk J, Harjola VP, Sivonen A, Varkila JV, Valtonene MA. clinical study of beta hemolytic group A, B, C and G streptococcal bacteriemia in adults over an 8 years period.Scand J Infect Dis 1997; 29: 233–244.
Wald ER, Green MD, Schwartz B, Barbadora K. A streptococcal score card revisited.Pediatr Enter Care 1998; 14:109.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nandi, S., Kumar, R., Ray, P. et al. Clinical score card for diagnosis of group a streptococcal sore throat. Indian J Pediatr 69, 471–475 (2002). https://doi.org/10.1007/BF02722644
Issue Date:
DOI: https://doi.org/10.1007/BF02722644