Cohen R, Estrangin E, Lecompte M D, Bouhanna C A, Wollner A, Koskas M, Martin P, Deforche D, Geslin P
Service de Microbiologie, Centre Hospitalier Intercommunal, Créteil.
Presse Med. 1994 Dec 3;23(38):1753-7.
While viruses are usually the causal agents of common sore throat in children, bacterial infections cannot be distinguished solely on the basis of clinical presentation. Thus most physicians in France prefer to prescribe antibiotics in order to prevent rheumatismal complications of group A streptococcal infections. We updated current epidemiological data on bacterial pharyngitis in paediatric out-patient clinics.
A prospective study was conducted from March 1 to June 1, 1992 by 9 physicians. Throat swabs were obtained from 102 controls and from 307 patients with acute pharyngitis. Samples were transferred to the same bacteriology laboratory for examination.
The mean age of the children was 6.1 years for patients and 7.2 years for controls. Throat swabs were inoculated for culture within a mean delay of 22.6 hours. Cultures were performed on Columbia blood medium with nalidixic acid and colistin then incubated in CO2 enriched atmosphere and on trypticase blood soy medium + 3.5% NaCl. Group A streptococcal strains were identified by search for beta-haemolysis and latex characterisation of group A polyosides. Group A streptococcal strains were found in 8.8% of the controls and 36.8% of the patients. Groups B, C or G streptococci were found in 10.8 et 11.4% of the controls and patients respectively (NS). Arcanobacterium haemolyticum was never isolated. Clinical association of sore throat, erythematous pharyngitis, fever > 38 degrees C and cervical lymph nodes was found in only 33.63% of the sore throat cases with group A streptococcal infection and in 7.73% of those without group A streptococcal infection (p < 0.0001, sensitivity 33%, specificity 92%).
These results emphasize the necessity either to treat all pharyngitis or to do throat swabs or rapid group A streptococcal tests for diagnosis.
虽然病毒通常是儿童常见咽喉痛的病原体，但仅根据临床表现无法区分细菌感染。因此，法国的大多数医生更倾向于开抗生素以预防A组链球菌感染的风湿性并发症。我们更新了儿科门诊细菌性咽炎的当前流行病学数据。
1992年3月1日至6月1日，9名医生进行了一项前瞻性研究。从102名对照者和307名急性咽炎患者中获取咽拭子。样本被送往同一个细菌学实验室进行检查。
患者儿童的平均年龄为6.1岁，对照者为7.2岁。咽拭子接种培养的平均延迟时间为22.6小时。在含萘啶酸和黏菌素的哥伦比亚血培养基上进行培养，然后在富含二氧化碳的环境中孵育，并在胰蛋白酶大豆血培养基+3.5%氯化钠上进行培养。通过寻找β溶血和A组多聚糖的乳胶鉴定来识别A组链球菌菌株。在8.8%的对照者和36.8%的患者中发现了A组链球菌菌株。B、C或G组链球菌分别在10.8%的对照者和11.4%的患者中发现（无显著性差异）。从未分离出溶血隐秘杆菌。在仅33.63%的A组链球菌感染咽喉痛病例和7.73%的非A组链球菌感染咽喉痛病例中发现了咽喉痛、咽红、发热>38℃和颈部淋巴结肿大的临床关联（p<0.0001，敏感性33%，特异性92%）。
这些结果强调了要么治疗所有咽炎，要么进行咽拭子检查或A组链球菌快速检测以进行诊断的必要性。
