Ehrlich T P, Schwartz R H, Wientzen R, Thorne M M
Department of Family Practice, Medical College of Virginia, Fairfax Family Practice Center Inc.
Arch Fam Med. 1993 Aug;2(8):866-9. doi: 10.1001/archfami.2.8.866.
To compare the sensitivity and specificity of Concise Strep A (Hybritech, San Diego, Calif), an immunochromatographic group A streptococcal rapid antigen detection system, with a two-plate culture method for the diagnosis of streptococcal pharyngitis, and to evaluate the need for routine back-up culture when this rapid test is used.
Throat cultures were obtained from 351 children with acute pharyngitis by duplicate rayon-tipped swabs held in parallel and vigorously rubbed against both tonsils and the posterior pharyngeal wall. One swab was tested for group A streptococcal antigen by a registered licensed laboratory technologist in the pediatrician's office. The other swab was streaked over each of two sheep blood agar plates, one of which was enhanced with trimethoprim in combination with sulfamethoxazole. The plain sheep blood agar plate was then incubated in a candle-extinguish jar. The enhanced agar plate was placed in a gas-pack anaerobic jar. Both plates were incubated for up to 48 hours at 35 degrees C.
A six-person group pediatric practice.
Three hundred fifty-one children.
The Concise Strep A antigen detection test produced 129 positive results. Only six of the 129 were not confirmed by culture method. There were four false-negative rapid streptococcal antigen detection test results, all of which were found after a single overnight incubation. The sensitivity for the Concise Strep A test was 96.9% and the specificity was 97.4%. The plain 5% sheep blood agar plate (without trimethoprim and sulfamethoxazole), which was incubated in a candle-extinguish jar, identified 123 (97%) of the 127 positive throat cultures. The second 24-hour incubation and use of trimethoprim and sulfamethoxazole agar were not rewarding for this study.
Concise Strep A, a polyclonal antibody test, in conjunction with a color immunochromatographic assay for soluble streptococcal carbohydrate antigen A appears to be accurate, sensitive, and specific when throat swabs are carefully obtained and when qualified, licensed laboratory technologists perform the procedure. Further studies should be done to confirm our findings, especially when nurses or office staff perform the rapid test procedure in the office setting. If our findings are confirmed, the use of back-up cultures for negative rapid test results obtained using Concise Strep A would be unnecessary.
比较免疫层析法A群链球菌快速抗原检测系统（简明A群链球菌检测试剂，Hybritech公司，加利福尼亚州圣地亚哥）与双平板培养法诊断链球菌性咽炎的敏感性和特异性，并评估使用该快速检测方法时进行常规备份培养的必要性。
通过用两根平行的人造纤维头拭子同时用力擦拭双侧扁桃体和咽后壁，从351名患有急性咽炎的儿童中获取咽拭子标本。一名注册的执业实验室技术人员在儿科医生办公室对其中一根拭子进行A群链球菌抗原检测。另一根拭子分别接种在两个羊血琼脂平板上，其中一个平板添加甲氧苄啶和磺胺甲恶唑进行强化。普通羊血琼脂平板随后置于烛缸中培养。强化琼脂平板置于气袋式厌氧罐中。两个平板均在35℃下培养长达48小时。
一个由六人组成的儿科诊所。
351名儿童。
简明A群链球菌抗原检测试验产生了129个阳性结果。129个结果中只有6个未被培养法证实。有4例假阴性快速链球菌抗原检测试验结果，均在单次过夜培养后发现。简明A群链球菌检测试验的敏感性为96.9%，特异性为97.4%。置于烛缸中培养的普通5%羊血琼脂平板（不含甲氧苄啶和磺胺甲恶唑），在127份阳性咽拭子培养物中鉴定出123份（97%）。第二次24小时培养以及使用甲氧苄啶和磺胺甲恶唑琼脂对本研究并无帮助。
简明A群链球菌检测试剂是一种多克隆抗体检测方法，结合可溶性A群链球菌碳水化合物抗原的彩色免疫层析测定法，在仔细采集咽拭子标本且由合格的执业实验室技术人员操作时，似乎准确、敏感且特异。应进行进一步研究以证实我们的发现，尤其是当护士或办公室工作人员在办公室环境中进行快速检测程序时。如果我们的发现得到证实，对于使用简明A群链球菌检测试剂获得的快速检测阴性结果，无需进行备份培养。
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