Evaluation of two ELISA tests for the rapid detection of group A streptococci.

We examined 579 oropharyngeal swab specimens from children presenting with pharyngitis in order to compare two rapid diagnostic ELISA tests for group A streptococcal antigen: the TestPack Strep A (TPSA), and the Direct Strep A EIA (DSAE), with an anaerobically incubated sheep blood agar culture. The sensitivities of the methods were respectively 60.8% (TPSA) and 64.4% (DSAE), the specificities 98.3% (TPSA) and 93.2% (DSAE), the positive predictive values 88.6% (TPSA) and 70.3% (DSAE) and the negative predictive values 92.0% (TPSA) and 91.2% (DSAE). We conclude that the TPSA is easy to interpret and is sufficiently specific to initiate treatment in patients with a positive test. It is not sufficiently sensitive to ensure negative or intermediate results. The performance of the DSAE test is similar but the specificity is slightly lower and more false positive results occur.