Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.
Department of Research and Development, Region Kronoberg, Växjö, Sweden.
BMC Infect Dis. 2021 Sep 17;21(1):971. doi: 10.1186/s12879-021-06665-9.
Few studies on pharyngotonsillitis have examined the clinical presentation of different aetiologies where pathogens have been detected using molecular methods. We aimed to assess how well clinical signs and symptoms can predict (1) the presence or absence of a broad range of viruses and bacteria, and (2) reconsultations for a sore throat or a complication.
In this descriptive observational prospective study in primary health care 220 patients aged 15-45 with suspected pharyngotonsillitis were sampled from nose, throat and blood and screened for 20 bacteria and viruses using polymerase chain reaction (PCR), culture and serology. Odds ratios (OR) and predictive values with 95% confidence intervals (CI) were used to show association between microbiological findings and clinical signs and symptoms. Patients were followed up after 3 months by reviewing electronic medical records.
Both cough and coryza were more common in patients with only viruses (67%) than in patients with only bacteria (21%) (p < 0.001), whereas tonsillar coating was more common in patients with only bacteria (53%) than in patients with only viruses (29%) (p = 0.006). Tonsillar coating (adjusted OR 6.0; 95% CI 2.5-14) and a lack of cough (adjusted OR 3.5; 95% CI 1.5-8.0) were significantly associated with Streptococcus pyogenes (group A streptococci; GAS) and with any bacterial finding. A Centor score of 3-4 had a positive predictive value of 49% (95% CI 42-57) for GAS and 66% (95% CI 57-74) for any bacterial findings. The use of rapid antigen detection test for GAS increased the positive predictive value for this group to 93%.
Signs and symptoms, both single and combined, were insufficient to rule in GAS or other pathogens. However, both cough and coryza were useful to rule out GAS. The results support the clinical approach of restricting rapid antigen detection testing to patients with 3-4 Centor criteria. The low carriage rate of bacteria among asymptomatic controls implied that most detections in patients represented a true infection.
使用分子方法检测病原体的研究中，很少有研究关注不同病因的咽扁桃体炎的临床表现。我们旨在评估临床症状和体征在多大程度上可以预测：（1）广泛的病毒和细菌的存在或不存在；（2） 咽痛或并发症的复诊。
本研究为初级保健中描述性观察性前瞻性研究，220 名年龄在 15-45 岁之间、疑似患有咽扁桃体炎的患者，从鼻、咽和血液中取样，使用聚合酶链反应（PCR）、培养和血清学方法筛查 20 种细菌和病毒。比值比（OR）和 95%置信区间（CI）的预测值用于显示微生物学发现与临床症状和体征之间的关联。通过查阅电子病历，在 3 个月后对患者进行随访。
仅有病毒（67%）的患者比仅有细菌（21%）的患者更常出现咳嗽和鼻漏（p<0.001），而扁桃体覆盖在仅有细菌（53%）的患者中比仅有病毒（29%）的患者更常见（p=0.006）。扁桃体覆盖（调整后的 OR 6.0；95%CI 2.5-14）和无咳嗽（调整后的 OR 3.5；95%CI 1.5-8.0）与化脓性链球菌（A 组链球菌；GAS）和任何细菌发现显著相关。Centor 评分为 3-4 时，对 GAS 的阳性预测值为 49%（95%CI 42-57），对任何细菌发现的阳性预测值为 66%（95%CI 57-74）。GAS 的快速抗原检测试验的使用增加了该组的阳性预测值至 93%。
无论是单一症状还是联合症状，都不足以确定 GAS 或其他病原体的存在。然而，咳嗽和鼻漏都有助于排除 GAS。这些结果支持对 Centor 标准为 3-4 的患者限制使用快速抗原检测试验的临床方法。无症状对照组中细菌的携带率较低意味着患者中的大多数检测都代表了真正的感染。
