PMID- 29135828
DCOM- 20190110
LR  - 20190110
IS  - 1532-0987 (Electronic)
IS  - 0891-3668 (Linking)
VI  - 37
IP  - 3
DP  - 2018 Mar
TI  - Improved Diagnostic Performance of an Immunofluorescence-based Rapid Antigen
      Detection Test for Group A Streptococci in Children With Pharyngitis.
PG  - 206-211
LID - 10.1097/INF.0000000000001825 [doi]
AB  - 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.
FAU - Lacroix, Laurence
AU  - Lacroix L
FAU - Cherkaoui, Abdessalam
AU  - Cherkaoui A
FAU - Schaller, Diane
AU  - Schaller D
FAU - Manzano, Sergio
AU  - Manzano S
FAU - Galetto-Lacour, Annick
AU  - Galetto-Lacour A
FAU - Pfeifer, Ulrich
AU  - Pfeifer U
FAU - Tabin, Rene
AU  - Tabin R
FAU - Gervaix, Alain
AU  - Gervaix A
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Pediatr Infect Dis J
JT  - The Pediatric infectious disease journal
JID - 8701858
RN  - 0 (Antigens, Bacterial)
SB  - IM
MH  - Adolescent
MH  - *Antigens, Bacterial
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - *Fluorescent Antibody Technique/methods
MH  - Humans
MH  - Male
MH  - Pharyngitis/*diagnosis/immunology/*microbiology
MH  - Prevalence
MH  - Prospective Studies
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Streptococcal Infections/*diagnosis/epidemiology/immunology/*microbiology
MH  - *Streptococcus pyogenes/immunology
EDAT- 2017/11/15 06:00
MHDA- 2019/01/11 06:00
CRDT- 2017/11/15 06:00
PHST- 2017/11/15 06:00 [pubmed]
PHST- 2019/01/11 06:00 [medline]
PHST- 2017/11/15 06:00 [entrez]
AID - 10.1097/INF.0000000000001825 [doi]
PST - ppublish
SO  - Pediatr Infect Dis J. 2018 Mar;37(3):206-211. doi: 10.1097/INF.0000000000001825.