Nandi Sobhan, Kumar Rajesh, Ray Pallab, Vohra Harpreet, Ganguly Nirmal K
Department of Experimental Medicine and Biotechnology, PGIMER, Chandigarh, India.
Indian J Pediatr. 2002 Jun;69(6):471-5. doi: 10.1007/BF02722644.
Group A beta 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.
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.
Significant association of GAS was found with pain in the throat, enlarged tonsils, pharyngeal erythema and tender cervical lymphadenopathy. 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.
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.
A组β溶血性链球菌（GAS）性咽痛主要发生在5 - 15岁的儿童中，若未得到恰当治疗可导致风湿热/风湿性心脏病（RF/RHD）。本研究旨在验证一种用于诊断GAS的临床评分系统。
通过系统随机抽取昌迪加尔城郊贫民窟的家庭，招募了536名5 - 15岁的儿童。在一年时间里，每两周对他们进行一次家访，记录咳嗽和感冒的症状和体征。共采集了918份咽拭子，其中123份（13.4%）GAS培养呈阳性。
发现GAS与咽痛、扁桃体肿大、咽部红斑及颈部淋巴结压痛显著相关。根据GAS培养的阳性百分比，对儿童年龄、发病季节、发热、扁桃体大小、咽部红斑及渗出物、淋巴结病和咽痛进行加权评分。各种症状和体征的组合敏感性为86 - 89%，特异性为83 - 89%，而临床评分为15分及以上对诊断GAS性咽炎的敏感性为91%，特异性为98%。
由于该国不同基层医疗环境下的临床敏锐度水平和GAS患病率可能不同，在将拟议的评分系统纳入预防RF/RHD的一级预防策略之前，应先对其进行验证并使其适应当地情况。
