TY - JOUR
T1 - Streptococcal group A, C and G pharyngitis in school children
T2 - A prospective cohort study in Southern India
AU - John Melbin Jose, J.
AU - Brahmadathan, Kootallur N.
AU - Abraham, Vinod J.
AU - Huang, Chiung Yu
AU - Morens, David
AU - Hoe, Nancy P.
AU - Follmann, Dean A.
AU - Krause, Richard M.
N1 - Publisher Copyright:
© 2018 Cambridge University Press.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Diagnosing streptococcal pharyngitis in children on the basis of clinical appearance and throat culture is complicated by high colonisation rates and by the ability of other pathogens to cause clinically similar disease. To characterise the epidemiology of Lancefield Group A, C and G β-haemolytic streptococcus (GAS, GCS and GGS, respectively) in children, we conducted a 2-year prospective study of 307 school children between 7 and 11 years old. GGS and GAS were commonly identified organisms both for silent streptococcal colonisation and symptomatic sore throat, while GCS was uncommonly found. Streptococcal culture positivity at the time of clinical pharyngitis was estimated to reflect true streptococcal pharyngitis in only 26% of instances, with the frequency varying from 54% for children rarely colonised to 1% for children frequently colonised. Numerous GAS emm types were identified, including several types previously associated with severe pharyngitis (e.g. emm types 1, 3 and 28). No severe complications were seen in any child. These data suggest that the clinical diagnosis of streptococcal pharyngitis is likely to remain difficult and that treatment decisions will remain clouded by uncertainty. There remains a need for organism-specific rapid point-of-care streptococcal diagnostic tests and tests that can distinguish between streptococcal colonisation and disease.
AB - Diagnosing streptococcal pharyngitis in children on the basis of clinical appearance and throat culture is complicated by high colonisation rates and by the ability of other pathogens to cause clinically similar disease. To characterise the epidemiology of Lancefield Group A, C and G β-haemolytic streptococcus (GAS, GCS and GGS, respectively) in children, we conducted a 2-year prospective study of 307 school children between 7 and 11 years old. GGS and GAS were commonly identified organisms both for silent streptococcal colonisation and symptomatic sore throat, while GCS was uncommonly found. Streptococcal culture positivity at the time of clinical pharyngitis was estimated to reflect true streptococcal pharyngitis in only 26% of instances, with the frequency varying from 54% for children rarely colonised to 1% for children frequently colonised. Numerous GAS emm types were identified, including several types previously associated with severe pharyngitis (e.g. emm types 1, 3 and 28). No severe complications were seen in any child. These data suggest that the clinical diagnosis of streptococcal pharyngitis is likely to remain difficult and that treatment decisions will remain clouded by uncertainty. There remains a need for organism-specific rapid point-of-care streptococcal diagnostic tests and tests that can distinguish between streptococcal colonisation and disease.
KW - Epidemiology
KW - streptococcal infections
KW - surveillance
UR - http://www.scopus.com/inward/record.url?scp=85044946895&partnerID=8YFLogxK
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U2 - 10.1017/S095026881800064X
DO - 10.1017/S095026881800064X
M3 - Article
C2 - 29616606
AN - SCOPUS:85044946895
SN - 0950-2688
VL - 146
SP - 848
EP - 853
JO - Epidemiology and infection
JF - Epidemiology and infection
IS - 7
ER -