检测确诊病毒性咽炎儿童中的 A 组链球菌和抗病毒宿主反应。
Detection of group A streptococcus in children with confirmed viral pharyngitis and antiviral host response.
机构信息
Departments of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
Emergency Services, Turku University Hospital and University of Turku, Turku, Finland.
出版信息
Eur J Pediatr. 2022 Dec;181(12):4059-4065. doi: 10.1007/s00431-022-04633-2. Epub 2022 Sep 27.
UNLABELLED
Our aim was to study the detection of group A streptococcus (GAS) with different diagnostic methods in paediatric pharyngitis patients with and without a confirmed viral infection. In this prospective observational study, throat swabs and blood samples were collected from children (age 1-16 years) presenting to the emergency department with febrile pharyngitis. A confirmed viral infection was defined as a positive virus diagnostic test (nucleic acid amplification test [NAAT] and/or serology) together with an antiviral immune response of the host demonstrated by elevated (≥ 175 µg/L) myxovirus resistance protein A (MxA) blood concentration. Testing for GAS was performed by a throat culture, by 2 rapid antigen detection tests (StrepTop and mariPOC) and by 2 NAATs (Simplexa and Illumigene). Altogether, 83 children were recruited of whom 48 had samples available for GAS testing. Confirmed viral infection was diagnosed in 30/48 (63%) children with febrile pharyngitis. Enteroviruses 11/30 (37%), adenoviruses 9/30 (30%) and rhinoviruses 9/30 (30%) were the most common viruses detected. GAS was detected by throat culture in 5/30 (17%) with and in 6/18 (33%) patients without a confirmed viral infection. Respectively, GAS was detected in 4/30 (13%) and 6/18 (33%) by StrepTop, 13/30 (43%) and 10/18 (56%) by mariPOC, 6/30 (20%) and 9/18 (50%) by Simplexa, and 5/30 (17%) and 6/18 (30%) patients by Illumigene.
CONCLUSION
GAS was frequently detected also in paediatric pharyngitis patients with a confirmed viral infection. The presence of antiviral host response and increased GAS detection by sensitive methods suggest incidental throat carriage of GAS in viral pharyngitis.
WHAT IS KNOWN
•The frequency and significance of GAS-virus co-detection are poorly characterised in children with pharyngitis. •Detection of a virus and the antiviral host response likely indicates symptomatic infection.
WHAT IS NEW
•Group A streptococcus (GAS) was detected in 17-43% of the children with confirmed viral pharyngitis depending on the GAS diagnostic method. •Our results emphasize the risk of detecting and treating incidental pharyngeal carriage of GAS in children with viral pharyngitis.
目的
研究不同诊断方法在伴有和不伴有病毒感染的儿科咽炎患者中对 A 组链球菌（GAS）的检测效果。
方法
前瞻性观察性研究中，收集因发热性咽炎就诊于急诊的 1-16 岁儿童的咽拭子和血样。病毒感染的确诊标准为病毒诊断检测（核酸扩增试验[NAAT]和/或血清学）阳性且宿主的抗病毒免疫反应升高（≥175μg/L 血浓度），即存在抗 黏液病毒蛋白 A（MxA）抗体。GAS 检测采用咽拭培养、2 种快速抗原检测（StrepTop 和 mariPOC）和 2 种 NAAT（Simplexa 和 Illumigene）。共招募 83 名儿童，其中 48 名有 GAS 检测样本。30/48（63%）例发热性咽炎患儿确诊病毒感染。30 例患儿中检出肠道病毒 11 例（37%）、腺病毒 9 例（30%）和鼻病毒 9 例（30%）。GAS 培养法在 30 例伴病毒感染的患儿中检出 5 例（17%），在 18 例无病毒感染的患儿中检出 6 例（33%）。StrepTop 法分别在 30 例患儿中检出 4 例（13%），在 18 例患儿中检出 6 例（33%），mariPOC 法分别在 30 例患儿中检出 13 例（43%），在 18 例患儿中检出 10 例（56%），Simplexa 法分别在 30 例患儿中检出 6 例（20%），在 18 例患儿中检出 9 例（50%），Illumigene 法分别在 30 例患儿中检出 5 例（17%），在 18 例患儿中检出 6 例（30%）。
结论
在伴有病毒感染的儿科咽炎患儿中，GAS 也较常被检出。宿主抗病毒反应的存在以及敏感方法检测到的 GAS 增加提示病毒性咽炎患者存在 GAS 咽峡部偶然携带。
已知内容
GAS 与病毒的共同检出率在咽峡炎患儿中特征描述较差。
病毒的检测和宿主的抗病毒反应可能表明是有症状的感染。
新内容
根据 GAS 检测方法的不同，在伴有病毒感染的儿童中，GAS 的检出率为 17%-43%。
我们的研究结果强调了在病毒性咽炎患儿中检测和治疗偶然发生的 GAS 咽峡部携带的风险。
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