Chazan Bibiana, Shaabi Mohamed, Bishara Elias, Colodner Raul, Raz Raul
Infectious Diseases Unit, HaEmek Medical Center, Afula, Israel.
Isr Med Assoc J. 2003 Jun;5(6):413-5.
Acute pharyngitis in children is one of the most frequent illnesses for which primary care physicians are consulted. It is caused more frequently by viruses than by bacteria, but it is difficult to differentiate the causative agent by clinical signs alone. Group A Streptococcus accounts for 30% of children with a sore throat, and only in these cases is antibiotic therapy definitely indicated. However, the frequency and symptomatology of streptococcal pharyngitis in adults is not well established.
To examine the clinical features that could distinguish sore throat caused by beta-hemolytic group A Streptococcus in adults.
Patients aged over 16 years old (n = 207) who presented with a sore throat to community clinics were examined and throat cultures were taken. The microbiologic confirmation of Group A Streptococcus was correlated with symptoms and clinical signs by univariate analysis.
About 24% of the patients with positive cultures were younger individuals. Chills, absence of cough, pain in swallowing, absence of rhinitis, headache, vomiting, tonsillar exudate, oral malodor, fever > 38 degrees C and sweats had high sensitivity but low specificity for streptococcal pharyngitis. Univariate analysis suggested that chills and pharyngeal exudate had the greatest predictive value for streptococcal pharyngitis (P = 0.044, odds ratio 2.45; P = 0.001, OR 5.49, respectively). When compared with a published scoring method (Centor criteria), large inconsistencies were found.
Our adult population had a relatively high prevalence of group A Streptococcus, and their presentation differed from that of pediatric patients. In primary care, a throat swab culture is not necessary in adults with a low score (0-1 points).
儿童急性咽炎是基层医疗医生会诊最多的疾病之一。其病因多为病毒而非细菌，但仅通过临床症状很难区分病原体。A组链球菌导致30%的儿童喉咙痛，只有在这些病例中才明确需要使用抗生素治疗。然而，成人链球菌性咽炎的发病率和症状学尚未明确。
研究可区分成人A组β溶血性链球菌引起的喉咙痛的临床特征。
对在社区诊所就诊的16岁以上患者（n = 207）进行检查并采集咽喉培养样本。通过单因素分析将A组链球菌的微生物学确诊结果与症状和临床体征相关联。
培养结果呈阳性的患者中约24%为年轻人。寒战、无咳嗽、吞咽疼痛、无鼻炎、头痛、呕吐、扁桃体渗出物、口臭、体温>38摄氏度和出汗对链球菌性咽炎具有高敏感性但低特异性。单因素分析表明，寒战和咽部渗出物对链球菌性咽炎具有最大的预测价值（P = 0.044，比值比2.45；P = 0.001，OR分别为5.49）。与已发表的评分方法（森托标准）相比，发现存在较大差异。
我们研究中的成年人群A组链球菌患病率相对较高，其表现与儿科患者不同。在基层医疗中，评分较低（0 - 1分）的成人患者无需进行咽喉拭子培养。
