Improved Diagnostic Performance of an Immunofluorescence-based Rapid Antigen Detection Test for Group A Streptococci in Children With Pharyngitis

Autor: Abdessalam Cherkaoui, Alain Gervaix, Laurence Elisabeth Lacroix, René Tabin, Ulrich Pfeifer, Diane Schaller, Annick Galetto-Lacour, Sergio Manzano
Rok vydání: 2017
Předmět:
0301 basic medicine
Male
Rapid antigen detection test
Fluorescent Antibody Technique/methods
Fluorescent Antibody Technique
Group A
0302 clinical medicine
Positive predicative value
Prevalence
Medicine
Prospective Studies
Child
Children
ddc:616
ddc:618
medicine.diagnostic_test
Incidence (epidemiology)
Bacterial
Streptococcus pyogenes/immunology
Pharyngitis
Infectious Diseases
medicine.anatomical_structure
Group A streptococci
Child
Preschool
Female
medicine.symptom
Microbiology (medical)
medicine.medical_specialty
Adolescent
Streptococcus pyogenes
030106 microbiology
Sensitivity and Specificity
Throat culture
03 medical and health sciences
Antigen
Streptococcal
030225 pediatrics
Throat
Internal medicine
Streptococcal Infections
Humans
Antigens
Preschool
Antigens
Bacterial
business.industry
Pharyngitis/diagnosis/immunology/microbiology
Reproducibility of Results
Immunoassay
Pediatrics
Perinatology and Child Health
Streptococcal Infections/diagnosis/epidemiology/immunology/microbiology
business
Zdroj: Pediatric Infectious Disease Journal, Vol. 37, No 3 (2018) pp. 206-211
ISSN: 1532-0987
0891-3668
Popis: BACKGROUND Accurate diagnosis and appropriate treatment of group A streptococcal (GAS) pharyngitis are important to prevent complications. Most available rapid antigen detection tests (RADTs) have shown excellent specificity but often lack sensitivity. Our objective was to compare the diagnostic performances of a new fluorescence-based immunoassay and a classic immunochromatographic RADT using standard throat culture or polymerase chain reaction as references. METHODS Prospective observational study in 2 pediatric emergency departments in children 3-15 years of age presenting with pharyngitis and a McIsaac score ≥2. Three throat swabs were obtained simultaneously: one for culture and one for each of both RADTs. Polymerase chain reaction assay of the DNaseB sequence was performed in case of discordant results (culture negative and either RADTs positive). RESULTS A total of 1002 patients were analyzed, with an overall 37.1% prevalence of GAS pharyngitis. Sensitivity, specificity, positive and negative predictive values were, respectively, 84.9%*, 96.8%, 94.0% and 91.6% for the new fluorescence-based immunoassay, and 75.3%*, 98.1%, 95.9% and 87.0% for the immunochromatographic test (*P < 0.05). CONCLUSIONS The immunofluorescence-based assay demonstrated improved diagnostic performances over the standard immunochromatographic RADT. Similarly specific for GAS detection, it demonstrates significantly higher sensitivity in children with McIsaac scores 2 or more. A negative result rules out a risk of GAS pharyngitis in 91.6% of children, making it an appropriate tool in pediatric emergency settings. Combined to the low incidence of rheumatic strains, critical appraisal of current practice to routinely perform a backup throat culture from children with pharyngitis and with negative GAS RADT could be reconsidered.
Databáze: OpenAIRE
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