Mullane Marianne J, Thomas Hannah M, Carapetis Jonathan R, Lizama Catalina, Billingham Wesley, Cooper Matthew N, Everest Christine, Sampson Claudia R, Newall Nelly, Pearce Sarah, Lannigan Francis, McNulty Eamonn, Cresp Rebecca, Mace Ariel O, Barrow Tina, Bowen Asha C
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia.
Front Pediatr. 2024 Apr 25;12:1367060. doi: 10.3389/fped.2024.1367060. eCollection 2024.
Group A streptococcus (GAS) infections, such as pharyngitis and impetigo, can lead to rheumatic fever and rheumatic heart disease (RHD). Australian Aboriginal and Torres Strait Islander populations experience high rates of RHD and GAS skin infection, yet rates of GAS pharyngitis are unclear. Anecdotally, clinical presentations of pharyngitis, including tonsillar hypertrophy and sore throat, are uncommon. This study aimed to develop a standardised set of tonsil photographs and determine tonsil size distribution from an urban paediatric population.
A prospective cohort of children aged 3-15 years were recruited at the public events "Discover Day" and "Telethon Weekend" (October 2017) in Perth, Western Australia, Australia. Tonsil photographs, symptomatology, and GAS rapid antigen detection tests (RADT) were collected. Tonsil size was graded from the photographs using the Brodsky Grading Scale of tonsillar hypertrophy (Brodsky) by two independent clinicians, and inter-rater reliability calculated. Pharyngitis symptoms and GAS RADT were correlated, and immediate results provided.
Four hundred and twenty-six healthy children participated in the study over three days. The median age was seven years [interquartile range (IQR) 5.9-9.7 years]. Tonsil photographs were collected for 92% of participants, of which 62% were rated as good-quality photographs and 79% were deemed of adequate quality for assessment by both clinicians. When scored by two independent clinicians, 57% received the same grade. Average Brodsky grades (between clinicians) were 11%, 35%, 28%, 22% and 5% of grades 0,1,2,3 and 4, respectively. There was moderate agreement in grading using photographs, and minimal to weak agreement for signs of infection. Of 394 participants, 8% reported a sore throat. Of 334 GAS RADT performed, <1% were positive.
We report the first standardised use of paediatric tonsil photographs to assess tonsil size in urban-living Australian children. This provides a proof of concept from an urban-living cohort that could be compared with children in other settings with high risk of GAS pharyngitis or rheumatic fever such as remote-living Australian Indigenous populations.
A 组链球菌（GAS）感染，如咽炎和脓疱病，可导致风湿热和风湿性心脏病（RHD）。澳大利亚原住民和托雷斯海峡岛民人群中风湿性心脏病和 GAS 皮肤感染的发病率很高，但 GAS 咽炎的发病率尚不清楚。据传闻，咽炎的临床表现，包括扁桃体肥大和喉咙痛并不常见。本研究旨在制定一套标准化的扁桃体照片，并确定城市儿童人群的扁桃体大小分布。
在澳大利亚西澳大利亚州珀斯举行的“发现日”和“慈善马拉松周末”（2017 年 10 月）等公共活动中招募了 3 - 15 岁的前瞻性队列儿童。收集扁桃体照片、症状和 GAS 快速抗原检测试验（RADT）。由两名独立的临床医生根据扁桃体肥大的布罗茨基分级量表（Brodsky）对照片中的扁桃体大小进行分级，并计算评分者间信度。将咽炎症状与 GAS RADT 结果进行关联，并提供即时结果。
在三天内，426 名健康儿童参与了该研究。中位年龄为 7 岁[四分位间距（IQR）5.9 - 9.7 岁]。92%的参与者收集到了扁桃体照片，其中 62%被评为高质量照片，79%被两名临床医生认为质量足以进行评估。由两名独立临床医生评分时，57%的参与者获得相同等级。平均布罗茨基分级（临床医生之间）分别为 0、1、2、3 和 4 级的 11%、35%、28%、22%和 5%。使用照片进行分级时有中度一致性，而对于感染迹象则为最小到弱一致性。在 394 名参与者中，8%报告有喉咙痛。在进行的 334 次 GAS RADT 检测中，阳性率<1%。
我们报告了首次标准化使用儿科扁桃体照片来评估澳大利亚城市儿童的扁桃体大小。这为城市居住队列提供了一个概念验证，可与其他有 GAS 咽炎或风湿热高风险的环境中的儿童进行比较，如澳大利亚偏远地区的原住民人群。
