Original Articles Prediction of bacterial pharyngitis in children using clinical features

Ethar M. Malik, Sulafa KM Ali

Abstract


Background: Bacterial pharyngitis (BPh) is a common paediatric problem that can lead to serious long term
cardiovascular complications: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) constitute
significant public health problems in Sudan. Primary prevention of ARF requires prompt diagnosis and
antibiotic treatment of group A streptococcal (GAS) pharyngitis, the commonest pathogen causing BPh.
Materials and Methods: The study is a prospective descriptive cross sectional hospital based study
describing the clinical features of GAS pharyngitis and comparing them with throat culture results. The
study was conducted in the period December 2011 to July 2012 in the Children’s Hospital outpatient clinics.
Children between 5 and 15 years of age who had sore throat and pharyngeal erythema without cough or
runny nose were enrolled in the study. Clinical and demographic information was recorded and throat
culture was done. Sensitivity and specificity were estimated for each clinical feature.
Results: Out of 220 children with pharyngitis, 81 (36.8%) had positive throat culture, 28.2% were due
to GAS. Headache was the only symptom that correlated with culture positive GAS pharyngitis with a
(p-value = 0.001) and the significant sign is the absence of chest findings (p-value=0.005). Fever and
enlarged cervical nodes were 91%, and 88% sensitive, for positive GAS culture, respectively. None of the
clinical features had both high sensitivity and specificity.
Conclusion: Fever, absence of chest findings, headache and enlarged cervical nodes can be used in 5-15
years old children with sore throat as clinical indicators of GAS pharyngitis. However, we need to have a
low threshold to give antibiotics to patients with sore throat living in areas endemic for RHD.

Keywords


Original Articles ;Prediction of ;bacterial ;pharyngitis in; children using ;clinical; features

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References


Rheumatic fever and Rheumatic Heart disease,

Report of a WHO Expert Consultation, Geneva,

World Health Organization (Technical Report

Series, No.923) 2001.

Ibrahim-Khalil S, Elhag M, Ali E, et.al, An

epidemiological survey of rheumatic fever

and rheumatic heart disease in Sahafa Town,

Sudan. Epidemiology and Community Health,

;46:477- 41.

Sulafa KM Ali, Inaam N Eldaim, Samia

H Osman, Sahar M Bakhite. Clinical and

echocardiographic features of children with

rheumatic heart disease and their serum

cytokine profile. Pan Afr Med J. 2012;13:36.

Ethar M Malik, Sulafa KM Ali

Robertson KA, Volmink JA, Mayosi BM.

Antibiotics for the primary prevention of

acute rheumatic fever: a meta-analysis. BMC

Cardiovasc Disord.2005; 5:11.

Soudarssanane MB, Karthigeyan M,

Mahalakshmy T, et.al. Rheumatic fever and

rheumatic heart disease: primary prevention

is the cost effective option. Indian J Pediatr.

;74:567-70.

Karthikeyan G, Mayosi BM. Is primary

prevention of rheumatic fever the missing link

in the control of rheumatic heart disease in

Africa? Circulation 2009;120:709–13.

Irlam J, Mayosi BM, Engel M, Gaziano TA.

Primary prevention of acute rheumatic fever

and rheumatic heart disease with penicillin in

South African children with pharyngitis: a costeffectiveness

analysis. Circ Cardiovasc Qual

Outcomes 2013;6:343–51.

Colquhoun SM, Carapetis JR, Kado JH et.al.

Rheumatic heart disease and its control in

the Pacific. Expert Rev Cardiovasc Ther.

;7:1517-24.

Omer EF, Hadi AE, Sakhi ES.Bacteriology of

sore throats in a Sudanese population. J Trop

Med Hyg. 1985;88:337-41.

Michael R. Wessels. Streptococcal Pharyngitis.

N Engl J Med 2011;364:648-55.

Irlam J, Mayosi BM, Engel M, Gaziano

TAPrimary prevention of acute rheumatic fever

and rheumatic heart disease with penicillin in

South African children with pharyngitis: a costeffectiveness

analysis. Circ Cardiovasc Qual

Outcomes. 2013;6:343-51.

Guidelines of Rheumatic Heart Disease Control

in New Zealand (Internet).

Mark C Steinhoff, Mohamed Khalil Abd El

Khalek, Nagwa Khallaf, Effectiveness of clinical

guidelines for the presumptive treatment of

streptococcal pharyngitis in Egyptian children.

Lancet 1997; 350: 918–21.

Fischer Walker CL, Rimoin AW, Hamza HS,

Steinhoff MC. Comparison of clinical prediction

rules for management of pharyngitis in settings

with limited resources. J Pediatr. 2006;149:64-

Bongani M Mayosi, Habib Gamra, Jean-Marie

Dangou,Joseph Kasonde, for the 2nd All-Africa

Workshop on Rheumatic Fever and Rheumatic

Heart Disease participants Rheumatic heart

disease in Africa: the Mosi-o-Tunya call to

action. The Lancet 2014;2: 438-9.


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