Pharyngitis diagnostic study of choice: Difference between revisions

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{{Pharyngitis}}
{{CMG}}; {{AE}}{{DYM}}
==Overview==
==Overview==
Diagnostic tests provided include throat culture and checking for rapid antigen detection.  Although the sensitivity and specificity of rapid antigen detection testing have improved dramatically, a throat culture is considered the diagnostic standard. It is possible to use the adjusted Centor score to help doctors determine which patients do not need testing, throat culture, rapid antigen detection testing, or empirical antibiotic therapy.
Diagnostic tests provided include [[throat culture]] and checking for rapid antigen detection([[RADT]]).  Although the [[sensitivity]] and [[specificity]] of rapid antigen detection testing have improved dramatically, a throat culture is considered the diagnostic standard. It is possible to use the adjusted [[Centor score]] to help doctors determine which patients do not need testing, [[throat culture]], rapid antigen detection testing, or empirical antibiotic therapy.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
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=== Study of choice ===
=== Study of choice ===


The diagnostic study of choice for bacterial pharyngitis is the throat culture. A single-swab throat culture is 90 to 95 percent sensitive with proper sampling and plating techniques.<ref name="pmid32273409">{{cite journal |vauthors=Sykes EA, Wu V, Beyea MM, Simpson MTW, Beyea JA |title=Pharyngitis: Approach to diagnosis and treatment |journal=Can Fam Physician |volume=66 |issue=4 |pages=251–257 |date=April 2020 |pmid=32273409 |pmc=7145142 |doi= |url=}}</ref> <ref name="pmid29185672">{{cite journal |vauthors=Vazquez MN, Sanders JE |title=Diagnosis and management of group A streptococcal pharyngitis and associated complications |journal=Pediatr Emerg Med Pract |volume=14 |issue=12 |pages=1–20 |date=December 2017 |pmid=29185672 |doi= |url=}}</ref>
The diagnostic study of choice for [[bacterial pharyngitis]] is the throat culture. A single-swab [[throat culture]] is 90 to 95 percent sensitive with proper sampling and plating techniques.<ref name="pmid32273409">{{cite journal |vauthors=Sykes EA, Wu V, Beyea MM, Simpson MTW, Beyea JA |title=Pharyngitis: Approach to diagnosis and treatment |journal=Can Fam Physician |volume=66 |issue=4 |pages=251–257 |date=April 2020 |doi= |url=}}</ref><ref name="pmid29185672">{{cite journal |vauthors=Vazquez MN, Sanders JE |title=Diagnosis and management of group A streptococcal pharyngitis and associated complications |journal=Pediatr Emerg Med Pract |volume=14 |issue=12 |pages=1–20 |date=December 2017 |pmid=29185672 |doi= |url=}}</ref>




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Even though the results of RADT are immediate, the sensitivity and specificity of the results vary widely. each kit is pathogen-specific and unable to distinguish  widely  
Even though the results of RADT are immediate, the sensitivity and specificity of the results vary widely. each kit is pathogen-specific and unable to distinguish  widely  
Between Bacterial and Viral Pharyngitis. Thus, negative results cannot rule out non-GAS bacterial pharyngitis
Between Bacterial and Viral Pharyngitis. Thus, negative results cannot rule out non-GAS bacterial pharyngitis
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====




The original Center score uses four signs and symptoms to estimate the probability of acute [[streptococcal]] [[pharyngitis]] in adults with a [[sore throat]] The score was later modified by adding age. It is important to evaluate for a definitive diagnosis to exclude [[Group A streptococcal infection|GAS]] and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither [[microbiologic]] tests nor [[antimicrobial]] therapy is necessary. The Center score to use for children and adults with a [[sore throat]] to estimate the probability of [[Streptococcus]] pyogenes infection. The various investigations must be performed in the following order:
The original Center score uses four signs and symptoms to estimate the [[probability]] of acute [[streptococcal]] [[pharyngitis]] in adults with a [[sore throat]] The score was later modified by adding age. It is important to evaluate for a definitive diagnosis to exclude [[Group A streptococcal infection|GAS]] and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither [[microbiologic]] tests nor [[antimicrobial]] therapy is necessary. The Center score to use for children and adults with a [[sore throat]] to estimate the probability of [[Streptococcus]] pyogenes infection.<ref name="pmid29185672">{{cite journal |vauthors=Vazquez MN, Sanders JE |title=Diagnosis and management of group A streptococcal pharyngitis and associated complications |journal=Pediatr Emerg Med Pract |volume=14 |issue=12 |pages=1–20 |date=December 2017 |pmid=29185672 |doi= |url=}}</ref> The various investigations must be performed in the following order:


'''Centor criteria'''<br>The original Center score uses four signs and symptoms to estimate the probability of acute [[streptococcal]] [[pharyngitis]] in adults with a [[sore throat]] The score was later modified by adding age. It is important to evaluate for a definitive diagnosis to exclude [[Group A streptococcal infection|GAS]] and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither [[microbiologic]] tests nor [[antimicrobial]] therapy is necessary. The Center score to use for children and adults with a [[sore throat]] to estimate the probability of [[Streptococcus]] pyogenes infection.
=== Name of Diagnostic Criteria ===
'''Centor criteria'''<br>
{| border="5"
{| border="5"
| colspan="2" align="center" |'''Modified Centor criteria'''
| colspan="2" align="center" |'''Modified Centor criteria'''
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|-
|-
|}
|}
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
'''IF there are no established diagnostic criteria'''
There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 09:28, 2 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Delband Yekta Moazami, M.D.[2]

Overview

Diagnostic tests provided include throat culture and checking for rapid antigen detection(RADT). Although the sensitivity and specificity of rapid antigen detection testing have improved dramatically, a throat culture is considered the diagnostic standard. It is possible to use the adjusted Centor score to help doctors determine which patients do not need testing, throat culture, rapid antigen detection testing, or empirical antibiotic therapy.

Diagnostic Study of Choice

Study of choice

The diagnostic study of choice for bacterial pharyngitis is the throat culture. A single-swab throat culture is 90 to 95 percent sensitive with proper sampling and plating techniques.[1][2]


The comparison of various diagnostic studies for bacterial pharyngitis

Test Sensitivity Specificity
Throat culture 90% to 95% 97% to 100%
RADT 38% to 100% 54% to 100%

Even though the results of RADT are immediate, the sensitivity and specificity of the results vary widely. each kit is pathogen-specific and unable to distinguish widely Between Bacterial and Viral Pharyngitis. Thus, negative results cannot rule out non-GAS bacterial pharyngitis

Sequence of Diagnostic Studies

The original Center score uses four signs and symptoms to estimate the probability of acute streptococcal pharyngitis in adults with a sore throat The score was later modified by adding age. It is important to evaluate for a definitive diagnosis to exclude GAS and to avoid unnecessary lab tests and antibiotic use. Centor criteria are a widely used and accepted clinical decision tool in identifying patients for whom neither microbiologic tests nor antimicrobial therapy is necessary. The Center score to use for children and adults with a sore throat to estimate the probability of Streptococcus pyogenes infection.[2] The various investigations must be performed in the following order:

Name of Diagnostic Criteria

Centor criteria

Modified Centor criteria Appropriate management according to the total score
Criteria Points Total score Chance of streptococcal infection in community

with usual levels of infection, %

Suggested management
Fever (temperature > 38°C) +1 0 2-3% No culture or antibiotic is required
Absence of cough +1 1 4-6%
Swollen and tender anterior cervical nodes +1 2 10-12% RADT or Culture and treat only if culture result is positive
Tonsillar swelling or exudates +1 3 27-28%
Age 3–14 yr +1 4 38–63% Culture all and treat emperically with penicillin on clinical grounds
Age 15–44 yr 0
Age ≥ 45 yr -1

References

  1. Sykes EA, Wu V, Beyea MM, Simpson M, Beyea JA (April 2020). "Pharyngitis: Approach to diagnosis and treatment". Can Fam Physician. 66 (4): 251–257. Vancouver style error: initials (help)
  2. 2.0 2.1 Vazquez MN, Sanders JE (December 2017). "Diagnosis and management of group A streptococcal pharyngitis and associated complications". Pediatr Emerg Med Pract. 14 (12): 1–20. PMID 29185672.

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