Strep throat epidemiology and demographics: Difference between revisions

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==Sensitivity & Specificity==
==Overview==
A study of 729 patients with pharyngitis in which 17% had a positive throat culture for group A streptococcus, identified the following four best predictors of streptococcus<ref name="pmid3534175">Centor RM, Dalton HP, Campbell MS, Lynch MR, Watlington AT, Garner BK. Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients. J Gen Intern Med. 1986 Jul-Aug;1(4):248-51. PMID 3534175</ref>:
GAS [[pharyngitis]] is the most common bacterial cause of [[pharyngitis]].<ref name="pmid17806050">{{cite journal| author=Cohen-Poradosu R, Kasper DL| title=Group A streptococcus epidemiology and vaccine implications. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 7 | pages= 863-5 | pmid=17806050 | doi=10.1086/521263 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17806050  }} </ref> Worldwide, the incidence of group A stretococcal pharyngitis (GAS) is estimated to be above 616 million cases annually.<ref name="pmid16253886">{{cite journal| author=Carapetis JR, Steer AC, Mulholland EK, Weber M| title=The global burden of group A streptococcal diseases. | journal=Lancet Infect Dis | year= 2005 | volume= 5 | issue= 11 | pages= 685-94 | pmid=16253886 | doi=10.1016/S1473-3099(05)70267-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16253886  }} </ref> It commonly affects children aged 5-15 years and is rare in children age less than 3 years.<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref> GAS pharyngitis is common in winter and early spring season.<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>


1. Lack of cough     
==Epidemiology==
* [[sensitivity (tests)|Sensitivity]] = 56%
*GAS pharyngitis is the most common bacterial cause of [[pharyngitis]].<ref name="pmid17806050">{{cite journal| author=Cohen-Poradosu R, Kasper DL| title=Group A streptococcus epidemiology and vaccine implications. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 7 | pages= 863-5 | pmid=17806050 | doi=10.1086/521263 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17806050  }} </ref>
* [[specificity (tests)|Specificity]] = 74%
**Worldwide, the [[incidence]] of group A stretococcal pharyngitis (GAS) is estimated to be above 616 million cases annually.<ref name="pmid16253886">{{cite journal| author=Carapetis JR, Steer AC, Mulholland EK, Weber M| title=The global burden of group A streptococcal diseases. | journal=Lancet Infect Dis | year= 2005 | volume= 5 | issue= 11 | pages= 685-94 | pmid=16253886 | doi=10.1016/S1473-3099(05)70267-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16253886  }} </ref><ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>
2. Swollen tender anterior cervical nodes
**It accounts for 20-30% cases of acute [[bacterial pharyngitis]] in children and 5-15% in adults.<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref><ref name="pmid17806050">{{cite journal| author=Cohen-Poradosu R, Kasper DL| title=Group A streptococcus epidemiology and vaccine implications. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 7 | pages= 863-5 | pmid=17806050 | doi=10.1086/521263 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17806050  }} </ref>
3. (Marked) tonsillar exudates. Although the original study did not specify the degree of exudate, 'marked exudate' may be more accurate. A subsequent study of 693 patients with 9.7% having positive cultures found that 'marked exudates' had a sensitivity and specificity of 21% and 70% while 'pinpoint exudates' were nonspecific with sensitivity and specificity of 22% and 45%<ref name="pmid3534166">Komaroff AL, Pass TM, Aronson MD, Ervin CT, Cretin S, Winickoff RN, Branch WT Jr. The prediction of streptococcal pharyngitis in adults. J Gen Intern Med. 1986 Jan-Feb;1(1):1-7. PMID 3534166</ref>.
**The [[CDC]] does not track the incidence of GAS [[pharyngitis]].<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>
* [[sensitivity (tests)|Sensitivity]] = 65%
* [[specificity (tests)|Specificity]] = 69%
4. History of fever
* [[sensitivity (tests)|Sensitivity]] = 78%
* [[specificity (tests)|Specificity]] = 45%
5.hurts when swallowing.


When these findings are counted in a patient, the probabilities of positive cultures in the original study (prevalence=17%) are<ref name="pmid3534175">.</ref>:
==Demographics==
* 4 findings -> 55.7%
The following demographic factors may affect the incidence and prevalence of GAS [[pharyngitis]].<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>
* 3 findings -> 30.1 – 34.1%
===Age===
* 2 findings -> 14.1 – 16.6%
Group A streptococcal pharyngitis commonly affects children aged 5-15 years and is rare in children aged less than 3 years.<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>
* 1 findings -> 6.0 - 6.9%
* 0 findings -> 2.5%


The probabilities can also be computed with the following equation:
===Sex===
X = −2.69 +  1.04 (exudtons) + 1 (swolacn) - 0.95 (cough) + 0.89  (fevhist)
Men and women are affected equally by Group A streptococcal pharyngitis.<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>
 
===Race===
There is no racial predilection to Group A streptococcal pharyngitis.<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>
 
===Environmental factors===
GAS pharyngitis is common in winter and early spring.<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

GAS pharyngitis is the most common bacterial cause of pharyngitis.[1] Worldwide, the incidence of group A stretococcal pharyngitis (GAS) is estimated to be above 616 million cases annually.[2] It commonly affects children aged 5-15 years and is rare in children age less than 3 years.[3] GAS pharyngitis is common in winter and early spring season.[3]

Epidemiology

Demographics

The following demographic factors may affect the incidence and prevalence of GAS pharyngitis.[3]

Age

Group A streptococcal pharyngitis commonly affects children aged 5-15 years and is rare in children aged less than 3 years.[3]

Sex

Men and women are affected equally by Group A streptococcal pharyngitis.[3]

Race

There is no racial predilection to Group A streptococcal pharyngitis.[3]

Environmental factors

GAS pharyngitis is common in winter and early spring.[3]

References

  1. ↑ 1.0 1.1 1.2 Cohen-Poradosu R, Kasper DL (2007). "Group A streptococcus epidemiology and vaccine implications". Clin Infect Dis. 45 (7): 863–5. doi:10.1086/521263. PMID 17806050.
  2. ↑ 2.0 2.1 Carapetis JR, Steer AC, Mulholland EK, Weber M (2005). "The global burden of group A streptococcal diseases". Lancet Infect Dis. 5 (11): 685–94. doi:10.1016/S1473-3099(05)70267-X. PMID 16253886.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016

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