Materiały źródłowe

• #1 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.4F (38C), tonsillar exudates, and cervical adenopathy. Available diagnostic tests include throat culture and rapid antigen detection testing. Throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly. The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy. […] Pharyngitis is diagnosed in 11 million patients in U.S. emergency departments and ambulatory settings annually. Most episodes are viral. Group A beta-hemolytic streptococcus (GABHS), the most common bacterial etiology, accounts for 15 to 30 percent of cases of acute pharyngitis in children and 5 to 20 percent in adults.

• #2 Rapid Tests for the Diagnosis of Group A Streptococcal Infection: A Review of Diagnostic Test Accuracy, Clinical Utility, Safety, and Cost-Effectiveness – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532707/

  Group A Streptococcus (GA Strep) also referred to as Group A beta-hemolytic Streptococcus, or Streptococcus pyogenes is a gram positive bacteria which causes a variety of disease conditions and complications. These include conditions such as pharyngitis (throat infection) and skin infections, and more serious conditions such as glomerulonephritis, sepsis, rheumatic heart disease, toxic shock syndrome and necrotizing fasciitis. Pharyngitis is one of the common conditions that present at the primary health care facilities or emergency departments. Pharyngitis arises commonly from viral infection and less commonly from bacterial infection. It is estimated that GA Strep accounts for 20% to 40% of cases of pharyngitis in children and 5% to 15% in adults. It is associated with considerable cost to society; in the US the estimated annual cost incurred from GA Strep pharyngitis in children is between $224 and $539 million. […]

• #3 Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011–2015 | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3835-4

  Clinical guidelines for the diagnosis of group A streptococcal (GAS) pharyngitis recommend the use of a rapid antigen detection test (RADT) and/or bacterial culture. […] Current guidelines for diagnosis of GAS pharyngitis in the United States recommend the use of a rapid antigen detection test (RADT) and/or bacterial culture of a throat swab. […] RADT assays have the benefits of ease of use, rapid turnaround time ( 10min), and high specificity (95%) but have relatively low sensitivity (70-90%). […] As such, negative RADT results require a confirmatory bacterial culture in pediatric patients, patients at high risk of complications from GAS pharyngitis, and any setting in which clinicians wish to maximize diagnostic sensitivity. […] A number of nucleic acid amplification testing (NAAT) assays for GAS pharyngitis diagnosis have received US Food and Drug Administration (FDA) clearance over the last 3 years.

• #4 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  Because the signs and symptoms of GABHS pharyngitis overlap extensively with other infectious causes, making a diagnosis based solely on clinical findings is difficult. In patients with acute febrile respiratory illness, physicians accurately differentiate bacterial from viral infections using only the history and physical findings about one half of the time. No single element of the patients history or physical examination reliably confirms or excludes GABHS pharyngitis. Sore throat, fever with sudden onset (temperature greater than 100.4 F [38 C]), and exposure to Streptococcus within the preceding two weeks suggest GABHS infection. […] The original Centor 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 and validated in 600 adults and children. The cumulative score determines the likelihood of streptococcal pharyngitis and the need for antibiotics.

• #5 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  Because the signs and symptoms of GABHS pharyngitis overlap extensively with other infectious causes, making a diagnosis based solely on clinical findings is difficult. In patients with acute febrile respiratory illness, physicians accurately differentiate bacterial from viral infections using only the history and physical findings about one half of the time. No single element of the patients history or physical examination reliably confirms or excludes GABHS pharyngitis. Sore throat, fever with sudden onset (temperature greater than 100.4 F [38 C]), and exposure to Streptococcus within the preceding two weeks suggest GABHS infection. […] The original Centor 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 and validated in 600 adults and children. The cumulative score determines the likelihood of streptococcal pharyngitis and the need for antibiotics.

• #6 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Patients with clear viral symptoms don’t need testing for group A streptococcal bacteria. […] Confirm a negative rapid antigen detection test with a throat culture for symptomatic children aged 3 years or older. […] To confirm group A strep pharyngitis, healthcare providers need to use either a rapid antigen detection test (RADT) or throat culture. […] RADTs have high specificity for group A strep bacteria but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic test. […] Healthcare providers can use a positive RADT or throat culture as confirmation of group A strep pharyngitis. […] Healthcare providers should follow up a negative RADT with a throat culture. […] Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing acute rheumatic fever. […] Healthcare providers cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms.

• #7 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  Because the signs and symptoms of GABHS pharyngitis overlap extensively with other infectious causes, making a diagnosis based solely on clinical findings is difficult. In patients with acute febrile respiratory illness, physicians accurately differentiate bacterial from viral infections using only the history and physical findings about one half of the time. No single element of the patients history or physical examination reliably confirms or excludes GABHS pharyngitis. Sore throat, fever with sudden onset (temperature greater than 100.4 F [38 C]), and exposure to Streptococcus within the preceding two weeks suggest GABHS infection. […] The original Centor 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 and validated in 600 adults and children. The cumulative score determines the likelihood of streptococcal pharyngitis and the need for antibiotics.

• #8 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  Because the signs and symptoms of GABHS pharyngitis overlap extensively with other infectious causes, making a diagnosis based solely on clinical findings is difficult. In patients with acute febrile respiratory illness, physicians accurately differentiate bacterial from viral infections using only the history and physical findings about one half of the time. No single element of the patients history or physical examination reliably confirms or excludes GABHS pharyngitis. Sore throat, fever with sudden onset (temperature greater than 100.4 F [38 C]), and exposure to Streptococcus within the preceding two weeks suggest GABHS infection. […] The original Centor 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 and validated in 600 adults and children. The cumulative score determines the likelihood of streptococcal pharyngitis and the need for antibiotics.

• #9 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Patients with clear viral symptoms don’t need testing for group A streptococcal bacteria. […] Confirm a negative rapid antigen detection test with a throat culture for symptomatic children aged 3 years or older. […] To confirm group A strep pharyngitis, healthcare providers need to use either a rapid antigen detection test (RADT) or throat culture. […] RADTs have high specificity for group A strep bacteria but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic test. […] Healthcare providers can use a positive RADT or throat culture as confirmation of group A strep pharyngitis. […] Healthcare providers should follow up a negative RADT with a throat culture. […] Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing acute rheumatic fever. […] Healthcare providers cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms.

• #10 Laboratory Diagnosis of Streptococcus pyogenes (group A streptococci) – Streptococcus pyogenes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK343617/

  Laboratory diagnosis of group A streptococcal infections still largely relies on culturing bacteria from clinical specimens. […] To detect streptococci in clinical samples (and especially S. pyogenes), the material is most often cultured on blood agar plates, which facilitates an easy preliminary screen for -hemolytic colonies. […] Subsequent confirmation of suspicious colonies as S. pyogenes can be achieved by several easy, rapidly performed laboratory tests that are still widely applied in clinical microbiology, despite the increasing use of automated identification systems. […] Special procedures have been developed to optimize the identification of S. pyogenes in throat cultures. […] When properly performed and interpreted, culturing throat swabs on a 5% sheep blood agar with trypticase soy base incubated in air remains the gold standard and reference method for the diagnosis of S. pyogenes acute pharyngitis.

• #11 Laboratory Diagnosis of Streptococcus pyogenes (group A streptococci) – Streptococcus pyogenes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK343617/

  These conditions represent reliable and well-accepted methods with a sensitivity of 90% or higher, as shown with studies using duplicate throat cultures. […] A definitive diagnosis should include a positive Lancefield group A antigen test. […] The bacitracin test, along with the Lancefield antigen A test, is used for greater specificity in the identification of S. pyogenes, since other -hemolytic strains of streptococci that may contain the group A antigen are resistant to bacitracin. […] The GASDirect test identifies specific rRNA sequences of S. pyogenes in pharyngeal specimens by a single-stranded chemiluminescent nucleic acid probe. […] The test has performed well in comparison to standard streptococcal culture methods and has received FDA clearance. […] The diagnosis of poststreptococcal diseases, such as rheumatic fever or glomerulonephritis, can be aided by the detection of certain streptococcal antibodies. […] A fourfold rise in antibody titers is regarded as a definitive proof of antecedent streptococcal infection. […] The most widely used antibodies for the diagnosis of poststreptococcal diseases are anti-streptolysin O and anti-DNase B.

• #12 Strep throat – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/strep-throat/diagnosis-treatment/drc-20350344

  Your doctor will conduct a physical exam, look for signs and symptoms of strep throat, and probably order one or more of the following tests: […] Rapid antigen test. Your doctor may perform a rapid antigen test on a swab sample from your throat. This test can detect strep bacteria in minutes by looking for substances (antigens) in the throat. If the test is negative but your doctor still suspects strep, he or she might do a throat culture. […] Molecular (polymerase chain reaction, or PCR) test. This test is also done using a swab sample from your throat. […] Throat culture. A sterile swab is rubbed over the back of the throat and tonsils to get a sample of the secretions. It’s not painful, but it may cause gagging. The sample is then cultured in a laboratory for the presence of bacteria, but results can take as long as two days.

• #13 Rapid Tests for the Diagnosis of Group A Streptococcal Infection: A Review of Diagnostic Test Accuracy, Clinical Utility, Safety, and Cost-Effectiveness – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532707/

  Accurate and rapid diagnosis of GA Strep is important as there is a possibility that throat and skin infections could lead to severe life-threatening invasive conditions as well as post infection immune mediated complications if left untreated. Diagnosis of GA strep is challenging which makes it difficult to decide on the appropriate care pathway. It is difficult to distinguish between GA strep infection and viral infection. Antibiotics are useful to treat pharyngitis from bacterial infection but not viral infection. Considering the issue of antimicrobial resistance which is on the rise, unnecessary use of antibiotics could be detrimental, hence accurate diagnosis is important. […] […] Diagnostic tests based on throat culture are generally considered as the gold standard for diagnosing GA Strep. However, these culture based tests are associated with a time lag between sample collection and obtaining test results, and may take up to 48 hours. It may not always be feasible for the patient to return to the clinic and get appropriate treatment based on test results or while waiting for test results there is a possibility that the patients symptoms may worsen. Several non-culture-based, rapid tests for diagnosing GA Strep have been developed. These rapid tests are based on immunoassays and more recently on molecular assays. There are several types of immunoassays such as latex agglutination, enzyme immunoassay, immunochromatographic assays and optical immunoassays. Molecular assays are based on methods such as DNA probes, polymerase chain reaction (PCR) and fluorescence in situ hybridization. There is a perception that use of these rapid tests may enable faster diagnosis and hence prevent inappropriate use of antibiotics and use of more effective treatment strategies. […]

• #14 Laboratory Diagnosis of Streptococcus pyogenes (group A streptococci) – Streptococcus pyogenes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK343617/

  Laboratory diagnosis of group A streptococcal infections still largely relies on culturing bacteria from clinical specimens. […] To detect streptococci in clinical samples (and especially S. pyogenes), the material is most often cultured on blood agar plates, which facilitates an easy preliminary screen for -hemolytic colonies. […] Subsequent confirmation of suspicious colonies as S. pyogenes can be achieved by several easy, rapidly performed laboratory tests that are still widely applied in clinical microbiology, despite the increasing use of automated identification systems. […] Special procedures have been developed to optimize the identification of S. pyogenes in throat cultures. […] When properly performed and interpreted, culturing throat swabs on a 5% sheep blood agar with trypticase soy base incubated in air remains the gold standard and reference method for the diagnosis of S. pyogenes acute pharyngitis.

• #15 Laboratory Diagnosis of Streptococcus pyogenes (group A streptococci) – Streptococcus pyogenes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK343617/

  Laboratory diagnosis of group A streptococcal infections still largely relies on culturing bacteria from clinical specimens. […] To detect streptococci in clinical samples (and especially S. pyogenes), the material is most often cultured on blood agar plates, which facilitates an easy preliminary screen for -hemolytic colonies. […] Subsequent confirmation of suspicious colonies as S. pyogenes can be achieved by several easy, rapidly performed laboratory tests that are still widely applied in clinical microbiology, despite the increasing use of automated identification systems. […] Special procedures have been developed to optimize the identification of S. pyogenes in throat cultures. […] When properly performed and interpreted, culturing throat swabs on a 5% sheep blood agar with trypticase soy base incubated in air remains the gold standard and reference method for the diagnosis of S. pyogenes acute pharyngitis.

• #16 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  With correct sampling and plating techniques, a single-swab throat culture is 90 to 95 percent sensitive. RADT allows for earlier treatment, symptom improvement, and reduced disease spread. RADT specificity ranges from 90 to 99 percent. […] Whether negative RADT results in children and adolescents require confirmatory throat culture is controversial. The American Academy of Pediatrics (AAP) recommends that negative RADT results in children be confirmed using throat culture unless physicians can guarantee that RADT sensitivity is similar to that of throat culture in their practice. […] Streptococcal antibody titers are not useful for diagnosing streptococcal pharyngitis and are not routinely recommended. They may be indicated to confirm previous infection in persons with suspected acute poststreptococcal glomerulonephritis or rheumatic fever.

• #17 What is the performance of rapid tests for the diagnosis of strep throat in children? | Cochrane

  https://www.cochrane.org/CD010502/ARI_what-performance-rapid-tests-diagnosis-strep-throat-children

  In a population of 1000 children with a GAS prevalence of 30%, 43 patients with GAS will be missed. […] Whether or not RADT can be used as a stand-alone test to rule out GAS will depend mainly on the epidemiological context. […] The sensitivity of EIA and OIA tests seems comparable. […] RADT specificity is sufficiently high to ensure against unnecessary use of antibiotics. […] Compared with throat culture, rapid antigen detection tests (RADTs) offer diagnosis at the point of care (within five to 10 minutes). […] To determine the diagnostic accuracy of RADTs for diagnosing GAS in children with pharyngitis. […] We included studies that compared RADT for GAS pharyngitis with throat culture on a blood agar plate in a microbiology laboratory in children seen in ambulatory care. […] In studies in which all participants underwent both RADT and throat culture (105 test evaluations; 58,244 participants; median prevalence of participants with GAS was 29.5%), RADT had a summary sensitivity of 85.6%; 95% confidence interval (CI) 83.3 to 87.6 and a summary specificity of 95.4%; 95% CI 94.5 to 96.2. […] The sensitivity of EIA and OIA tests was comparable (summary sensitivity 85.4% versus 86.2%).

• #18 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  With correct sampling and plating techniques, a single-swab throat culture is 90 to 95 percent sensitive. RADT allows for earlier treatment, symptom improvement, and reduced disease spread. RADT specificity ranges from 90 to 99 percent. […] Whether negative RADT results in children and adolescents require confirmatory throat culture is controversial. The American Academy of Pediatrics (AAP) recommends that negative RADT results in children be confirmed using throat culture unless physicians can guarantee that RADT sensitivity is similar to that of throat culture in their practice. […] Streptococcal antibody titers are not useful for diagnosing streptococcal pharyngitis and are not routinely recommended. They may be indicated to confirm previous infection in persons with suspected acute poststreptococcal glomerulonephritis or rheumatic fever.

• #19 Rapid Tests for the Diagnosis of Group A Streptococcal Infection: A Review of Diagnostic Test Accuracy, Clinical Utility, Safety, and Cost-Effectiveness – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532707/

  Accurate and rapid diagnosis of GA Strep is important as there is a possibility that throat and skin infections could lead to severe life-threatening invasive conditions as well as post infection immune mediated complications if left untreated. Diagnosis of GA strep is challenging which makes it difficult to decide on the appropriate care pathway. It is difficult to distinguish between GA strep infection and viral infection. Antibiotics are useful to treat pharyngitis from bacterial infection but not viral infection. Considering the issue of antimicrobial resistance which is on the rise, unnecessary use of antibiotics could be detrimental, hence accurate diagnosis is important. […] […] Diagnostic tests based on throat culture are generally considered as the gold standard for diagnosing GA Strep. However, these culture based tests are associated with a time lag between sample collection and obtaining test results, and may take up to 48 hours. It may not always be feasible for the patient to return to the clinic and get appropriate treatment based on test results or while waiting for test results there is a possibility that the patients symptoms may worsen. Several non-culture-based, rapid tests for diagnosing GA Strep have been developed. These rapid tests are based on immunoassays and more recently on molecular assays. There are several types of immunoassays such as latex agglutination, enzyme immunoassay, immunochromatographic assays and optical immunoassays. Molecular assays are based on methods such as DNA probes, polymerase chain reaction (PCR) and fluorescence in situ hybridization. There is a perception that use of these rapid tests may enable faster diagnosis and hence prevent inappropriate use of antibiotics and use of more effective treatment strategies. […]

• #20 What is the performance of rapid tests for the diagnosis of strep throat in children? | Cochrane

  https://www.cochrane.org/CD010502/ARI_what-performance-rapid-tests-diagnosis-strep-throat-children

  What is the performance of rapid tests for the diagnosis of strep throat in children? […] Simple, rapid tests for the diagnosis of strep throat have been available since the 1980s. […] We reviewed the evidence about the performance of rapid tests for correctly detecting strep throat in children seen in Outpatient departments with a main complaint of sore throat. […] On average, rapid tests for strep throat had a sensitivity (ability to correctly detect people with the disease) of 86% and a specificity (ability to correctly identify people who do not have the disease) of 95%. […] The two types of rapid tests under evaluation seemed to have comparable sensitivity (85.4% versus 86.2% for enzyme immunoassays and optical immunoassays, respectively). […] Based on these results, we would expect that amongst 100 children with strep throat, 86 would be correctly detected with the rapid test while 14 would be missed and not receive antibiotic treatment.

• #21 Testing for Strep Throat or Scarlet Fever | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/testing/index.html

  Healthcare providers can do a quick test to see if someone has strep throat or scarlet fever. […] Testing for group A strep bacteria helps healthcare providers diagnose and treat the illness. […] They may need to test for strep throat or scarlet fever. There are two types of tests: a rapid strep test and throat culture. […] If healthcare providers suspect strep throat or scarlet fever, they will test for group A strep. Generally, healthcare providers will do a rapid strep test first, then decide if a throat culture is needed. […] A rapid strep test involves swabbing the throat and running a test on the swab. The test quickly shows if group A strep bacteria are likely causing the illness. […] A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses.

• #22 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Patients with clear viral symptoms don’t need testing for group A streptococcal bacteria. […] Confirm a negative rapid antigen detection test with a throat culture for symptomatic children aged 3 years or older. […] To confirm group A strep pharyngitis, healthcare providers need to use either a rapid antigen detection test (RADT) or throat culture. […] RADTs have high specificity for group A strep bacteria but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic test. […] Healthcare providers can use a positive RADT or throat culture as confirmation of group A strep pharyngitis. […] Healthcare providers should follow up a negative RADT with a throat culture. […] Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing acute rheumatic fever. […] Healthcare providers cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms.

• #23 Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011–2015 | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3835-4

  Clinical guidelines for the diagnosis of group A streptococcal (GAS) pharyngitis recommend the use of a rapid antigen detection test (RADT) and/or bacterial culture. […] Current guidelines for diagnosis of GAS pharyngitis in the United States recommend the use of a rapid antigen detection test (RADT) and/or bacterial culture of a throat swab. […] RADT assays have the benefits of ease of use, rapid turnaround time ( 10min), and high specificity (95%) but have relatively low sensitivity (70-90%). […] As such, negative RADT results require a confirmatory bacterial culture in pediatric patients, patients at high risk of complications from GAS pharyngitis, and any setting in which clinicians wish to maximize diagnostic sensitivity. […] A number of nucleic acid amplification testing (NAAT) assays for GAS pharyngitis diagnosis have received US Food and Drug Administration (FDA) clearance over the last 3 years.

• #24 Rapid Tests for the Diagnosis of Group A Streptococcal Infection: A Review of Diagnostic Test Accuracy, Clinical Utility, Safety, and Cost-Effectiveness – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532707/

  Accurate and rapid diagnosis of GA Strep is important as there is a possibility that throat and skin infections could lead to severe life-threatening invasive conditions as well as post infection immune mediated complications if left untreated. Diagnosis of GA strep is challenging which makes it difficult to decide on the appropriate care pathway. It is difficult to distinguish between GA strep infection and viral infection. Antibiotics are useful to treat pharyngitis from bacterial infection but not viral infection. Considering the issue of antimicrobial resistance which is on the rise, unnecessary use of antibiotics could be detrimental, hence accurate diagnosis is important. […] […] Diagnostic tests based on throat culture are generally considered as the gold standard for diagnosing GA Strep. However, these culture based tests are associated with a time lag between sample collection and obtaining test results, and may take up to 48 hours. It may not always be feasible for the patient to return to the clinic and get appropriate treatment based on test results or while waiting for test results there is a possibility that the patients symptoms may worsen. Several non-culture-based, rapid tests for diagnosing GA Strep have been developed. These rapid tests are based on immunoassays and more recently on molecular assays. There are several types of immunoassays such as latex agglutination, enzyme immunoassay, immunochromatographic assays and optical immunoassays. Molecular assays are based on methods such as DNA probes, polymerase chain reaction (PCR) and fluorescence in situ hybridization. There is a perception that use of these rapid tests may enable faster diagnosis and hence prevent inappropriate use of antibiotics and use of more effective treatment strategies. […]

• #25 Rapid Tests for the Diagnosis of Group A Streptococcal Infection: A Review of Diagnostic Test Accuracy, Clinical Utility, Safety, and Cost-Effectiveness – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532707/

  The purpose of this review is to evaluate the diagnostic accuracy of non-culture based tests to diagnose GA Strep infection; their clinical utility; their associated adverse effects, if any; and their cost-effectiveness. […] […] From systematic reviews and observational studies the sensitivity values ranged between 82% and 100% for molecular assays and between 55% and 94% for immunoassays. Specificities for the two test types were 91% to 99% for molecular assays and 81% to 100% for immunoassays. […] […] One pragmatic adaptive RCT showed no clear advantage of rapid antigen test over clinical score for management of group a streptococcus infection. Evidence regarding change in treatment strategy with respect to use of antibiotics resulting from use of rapid antigen detection tests for diagnosis is conflicting. […]

• #26 Group A Streptococcal Pharyngitis Diagnosis | MDedge

  https://medauth2.mdedge.com/content/group-streptococcal-pharyngitis-diagnosis

  RADT solves the time-delay issues and has near 100% specificity but sensitivity used to be as low as 65%, hence the 2012 Infectious Diseases Society of America guideline recommendation for backup throat culture for negative tests. […] However, current RADT have sensitivities in the 85%-90% range. […] So a positive RADT reliably and quickly indicates GAS antigens are present. […] NAAT have the highest combined sensitivity and specificity, near 100% for each, and a positive reliably indicates GAS nucleic acids are present. […] Pretest patient screening therefore is critical to increase the positive predictive value of positive GAS testing results. […] The history and physical can be helpful. […] In the simplest form of pretest screening, eliminate those younger than 3 years old or those with viral type sign/symptoms, eg conjunctivitis, cough, coryza.

• #27 Laboratory Diagnosis of Streptococcus pyogenes (group A streptococci) – Streptococcus pyogenes – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK343617/

  These conditions represent reliable and well-accepted methods with a sensitivity of 90% or higher, as shown with studies using duplicate throat cultures. […] A definitive diagnosis should include a positive Lancefield group A antigen test. […] The bacitracin test, along with the Lancefield antigen A test, is used for greater specificity in the identification of S. pyogenes, since other -hemolytic strains of streptococci that may contain the group A antigen are resistant to bacitracin. […] The GASDirect test identifies specific rRNA sequences of S. pyogenes in pharyngeal specimens by a single-stranded chemiluminescent nucleic acid probe. […] The test has performed well in comparison to standard streptococcal culture methods and has received FDA clearance. […] The diagnosis of poststreptococcal diseases, such as rheumatic fever or glomerulonephritis, can be aided by the detection of certain streptococcal antibodies. […] A fourfold rise in antibody titers is regarded as a definitive proof of antecedent streptococcal infection. […] The most widely used antibodies for the diagnosis of poststreptococcal diseases are anti-streptolysin O and anti-DNase B.

• #28 The Evolution of Group A Streptococcus Pharyngitis Testing | myadlm.org

  https://myadlm.org/cln/articles/2018/september/the-evolution-of-group-a-streptococcus-pharyngitis-testing

  GAS Direct has performed well in comparison with standard streptococcal culture methods, exhibiting a sensitivity and specificity of 94.8% and 100%, respectively (6). […] Another commercial isothermal DNA amplification assay, the Illumigene assay from Meridian Bio-science, has demonstrated excellent sensitivity (93.1%) and specificity (91.4%) for the direct detection of S. pyogenes and has emerged as an appropriate alternative to culture (7). […] The first POC test for GAS detection on the market was the Alere i Strep A from Abbott, followed by Cobas Strep A Assay from Roche, the Xpert Xpress Strep A from Cepheid, and more recently, the modified version of Abbotts Alere i Strep A 2 assay (1112). […] With continued research, manufacturers are designing more accurate and sensitive molecular as-says that could eliminate the need for confirmatory culture to detect GAS.

• #29 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  The AAFP, the American College of Physicians (ACP), and the Centers for Disease Control and Prevention recommend using a clinical prediction model to manage suspected GABHS pharyngitis. Guidelines from the IDSA, conversely, state that clinical diagnosis of GABHS pharyngitis cannot be made with certainty, even by experienced physicians, and that diagnostic testing is required.

• #30 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  The AAFP, the American College of Physicians (ACP), and the Centers for Disease Control and Prevention recommend using a clinical prediction model to manage suspected GABHS pharyngitis. Guidelines from the IDSA, conversely, state that clinical diagnosis of GABHS pharyngitis cannot be made with certainty, even by experienced physicians, and that diagnostic testing is required.

• #31 Diagnosis and Management of Group A Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0215/p880.html

  The Infectious Diseases Society of America (IDSA) recently updated a 1997 guideline for the diagnosis and management of group A streptococcal pharyngitis. […] The IDSA defined group A streptococcal pharyngitis as an acute infection of the oropharynx or nasopharynx that is caused by Streptococcus pyogenes. Accurate diagnosis and optimal treatment of this infection are important to: […] The IDSA recommends that, if acute group A streptococcal pharyngitis is suspected, laboratory testing should be performed to support the diagnosis. Throat culture or a rapid antigen detection test (RADT) may be used. […] Culture of a throat swab specimen remains the standard for identifying group A beta-hemolytic streptococci (sensitivity: 90 to 95 percent) and confirming the clinical diagnosis. […] The IDSA notes that a positive result on a throat culture or RADT adequately confirms the diagnosis. […] In adults, RADTs are an acceptable alternative to throat culture for the diagnosis of group A streptococcal pharyngitis. […] The IDSA recommends cultures for asymptomatic family contacts, with treatment given to those who have positive results.

• #32 Diagnosis and Management of Group A Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0215/p880.html

  The Infectious Diseases Society of America (IDSA) recently updated a 1997 guideline for the diagnosis and management of group A streptococcal pharyngitis. […] The IDSA defined group A streptococcal pharyngitis as an acute infection of the oropharynx or nasopharynx that is caused by Streptococcus pyogenes. Accurate diagnosis and optimal treatment of this infection are important to: […] The IDSA recommends that, if acute group A streptococcal pharyngitis is suspected, laboratory testing should be performed to support the diagnosis. Throat culture or a rapid antigen detection test (RADT) may be used. […] Culture of a throat swab specimen remains the standard for identifying group A beta-hemolytic streptococci (sensitivity: 90 to 95 percent) and confirming the clinical diagnosis. […] The IDSA notes that a positive result on a throat culture or RADT adequately confirms the diagnosis. […] In adults, RADTs are an acceptable alternative to throat culture for the diagnosis of group A streptococcal pharyngitis. […] The IDSA recommends cultures for asymptomatic family contacts, with treatment given to those who have positive results.

• #33 Group A Streptococcal Pharyngitis Diagnosis | MDedge

  https://medauth2.mdedge.com/content/group-streptococcal-pharyngitis-diagnosis

  During peak group A streptococcal pharyngitis (GAS) season, are we using the best tools in the best way? […] Its wintertime, peak season for GAS pharyngitis, and youd think that this far into the 21st century we would have a foolproof process for diagnosing which among the many patients with pharyngitis have true GAS pharyngitis. […] Several good reviews are excellent resources for those wishing a refresher on GAS diagnosis/management issues. […] A quality throat specimen involves swabbing both tonsillar pillars plus posterior pharynx without touching tongue or inner cheeks. […] Culture is considered a gold standard for detecting clinically relevant GAS by CDC. […] Culture has good sensitivity (estimated 80%-90% varying among studies and by quality of specimens) and 99% specificity but requires 16-24 hours for results.

• #34 Group A Streptococcal (GAS) Infections Workup: Approach Considerations, Pharyngitis, Acute Rheumatic Fever

  https://emedicine.medscape.com/article/228936-workup

  Throat culture remains the criterion standard diagnostic test for streptococcal pharyngitis. […] If performed correctly, culture of a single throat swab on a blood agar plate yields a sensitivity of 90-95% for the detection of group A streptococci (GAS) in the pharynx. […] Although some throat culture results are false-positive (eg, they do not reflect acute infection but, rather, symptomatic carriage), all patients with positive culture results are treated with antibiotics. […] When the diagnosis of streptococcal pharyngitis seems particularly likely based on examination findings or when social factors necessitate an immediate decision about antibiotic therapy, the use of rapid antigen detection tests capable within minutes of identifying GAS directly from the throat swab is a reasonable option in most practice settings.

• #35 Group A Streptococcal (GAS) Infections Workup: Approach Considerations, Pharyngitis, Acute Rheumatic Fever

  https://emedicine.medscape.com/article/228936-workup

  Throat culture remains the criterion standard diagnostic test for streptococcal pharyngitis. […] If performed correctly, culture of a single throat swab on a blood agar plate yields a sensitivity of 90-95% for the detection of group A streptococci (GAS) in the pharynx. […] Although some throat culture results are false-positive (eg, they do not reflect acute infection but, rather, symptomatic carriage), all patients with positive culture results are treated with antibiotics. […] When the diagnosis of streptococcal pharyngitis seems particularly likely based on examination findings or when social factors necessitate an immediate decision about antibiotic therapy, the use of rapid antigen detection tests capable within minutes of identifying GAS directly from the throat swab is a reasonable option in most practice settings.

• #36 Group A Streptococcal (GAS) Infections Workup: Approach Considerations, Pharyngitis, Acute Rheumatic Fever

  https://emedicine.medscape.com/article/228936-workup

  Throat culture remains the criterion standard diagnostic test for streptococcal pharyngitis. […] If performed correctly, culture of a single throat swab on a blood agar plate yields a sensitivity of 90-95% for the detection of group A streptococci (GAS) in the pharynx. […] Although some throat culture results are false-positive (eg, they do not reflect acute infection but, rather, symptomatic carriage), all patients with positive culture results are treated with antibiotics. […] When the diagnosis of streptococcal pharyngitis seems particularly likely based on examination findings or when social factors necessitate an immediate decision about antibiotic therapy, the use of rapid antigen detection tests capable within minutes of identifying GAS directly from the throat swab is a reasonable option in most practice settings.

• #37 Strep Antigen Test, Group A Strep Test | Meridian Bioscience

  https://www.meridianbioscience.com/diagnostics/disease-areas/respiratory/group-a-streptococcus/

  The signs and symptoms of GAS pharyngitis overlap extensively with other infectious causes, making it difficult to diagnose based solely on clinical findings. Accurate diagnosis of Group A Strep is important as it can help prevent unnecessary antibiotic treatment, which can lead to the development of antimicrobial resistance, especially in young children. […] Early Group A Streptococcus (GAS) is critical for ensuring timely treatment and preventing the spread of infection, particularly in healthcare and community settings. […] Strepococcus pyogenese, also known as Group A Strep is the primary cause of acute pharyngitis (Strep Throat) in children and adults. […] Infections with Group A Strep can lead to complications like acute rheumatic fever or glomerulonephritis. It can also lead to invasive infections that can have a mortality rate of 25%-30%. […] Studies show that of the 70% of the patients that receive antibiotics only 20%-30% actually need it. Over prescription of antibiotic is of concern especially in young children, since over use of antibiotics can increase the potential for resistance.

• #38 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Patients with clear viral symptoms don’t need testing for group A streptococcal bacteria. […] Confirm a negative rapid antigen detection test with a throat culture for symptomatic children aged 3 years or older. […] To confirm group A strep pharyngitis, healthcare providers need to use either a rapid antigen detection test (RADT) or throat culture. […] RADTs have high specificity for group A strep bacteria but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic test. […] Healthcare providers can use a positive RADT or throat culture as confirmation of group A strep pharyngitis. […] Healthcare providers should follow up a negative RADT with a throat culture. […] Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing acute rheumatic fever. […] Healthcare providers cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms.

• #39 Streptococcal infection – group A | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/streptococcal-infection-group-a

  GAS infection is diagnosed by a doctor through clinical examination and laboratory testing to detect the bacteria. […] The sample used for laboratory testing depends on the type of infection. Samples may include a throat swab, skin swab, blood, cerebrospinal fluid or other bodily fluid or tissues. […] Treatment is mainly through antibiotic medication. […] It is important to complete the course of antibiotic treatment as prescribed by your doctor. Untreated infection can lead to serious illness and complications and can spread infection to others.

• #40 Strep throat – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338

  Strep throat can lead to serious complications. Antibiotic treatment reduces the risk. […] Strep infection may lead to inflammatory illnesses, including: Rheumatic fever, a serious inflammatory condition that can affect the heart, joints, nervous system and skin. […] A possible relationship has been suggested between strep infection and a rare condition called pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS).

• #41 Strep Antigen Test, Group A Strep Test | Meridian Bioscience

  https://www.meridianbioscience.com/diagnostics/disease-areas/respiratory/group-a-streptococcus/

  The signs and symptoms of GAS pharyngitis overlap extensively with other infectious causes, making it difficult to diagnose based solely on clinical findings. Accurate diagnosis of Group A Strep is important as it can help prevent unnecessary antibiotic treatment, which can lead to the development of antimicrobial resistance, especially in young children. […] Early Group A Streptococcus (GAS) is critical for ensuring timely treatment and preventing the spread of infection, particularly in healthcare and community settings. […] Strepococcus pyogenese, also known as Group A Strep is the primary cause of acute pharyngitis (Strep Throat) in children and adults. […] Infections with Group A Strep can lead to complications like acute rheumatic fever or glomerulonephritis. It can also lead to invasive infections that can have a mortality rate of 25%-30%. […] Studies show that of the 70% of the patients that receive antibiotics only 20%-30% actually need it. Over prescription of antibiotic is of concern especially in young children, since over use of antibiotics can increase the potential for resistance.

• #42 Strep Antigen Test, Group A Strep Test | Meridian Bioscience

  https://www.meridianbioscience.com/diagnostics/disease-areas/respiratory/group-a-streptococcus/

  The signs and symptoms of GAS pharyngitis overlap extensively with other infectious causes, making it difficult to diagnose based solely on clinical findings. Accurate diagnosis of Group A Strep is important as it can help prevent unnecessary antibiotic treatment, which can lead to the development of antimicrobial resistance, especially in young children. […] Early Group A Streptococcus (GAS) is critical for ensuring timely treatment and preventing the spread of infection, particularly in healthcare and community settings. […] Strepococcus pyogenese, also known as Group A Strep is the primary cause of acute pharyngitis (Strep Throat) in children and adults. […] Infections with Group A Strep can lead to complications like acute rheumatic fever or glomerulonephritis. It can also lead to invasive infections that can have a mortality rate of 25%-30%. […] Studies show that of the 70% of the patients that receive antibiotics only 20%-30% actually need it. Over prescription of antibiotic is of concern especially in young children, since over use of antibiotics can increase the potential for resistance.

• #43 Strep Throat Rapid Tests, Symptoms & Treatment | Abbott Point of Care

  https://www.globalpointofcare.abbott/us/en/knowledge-insights/consumer-education/strep-throat.html

  A rapid molecular strep test will give you answers in minutes without the need for a follow-up throat culture, helping your clinician determine whether you need antibiotics so you can begin treatment sooner. […] It is important for clinicians to have a clear and accurate strep throat diagnosis before prescribing antibiotics. This can help reduce overuse of antibiotics. […] Strep throat cannot be diagnosed just by examining you. With a traditional rapid strep throat test, a follow-up test in a lab may be required to confirm results, which can take at least 24-48 hours for your clinician to get results back. […] Rapid molecular tests for strep throat can return accurate answers in as little as two minutes, without the need for a follow-up throat culture lab test. Your clinician can diagnose strep and confidently prescribe treatment in the same office visit.

• #44 Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011–2015 | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3835-4

  Of interest, while the overall use of NAAT alone was infrequent, the proportion of events diagnosed using NAAT vs. other test types increased 3.5-fold over the study period and roughly doubled in 2014 and again in 2015, coinciding with the approval of GAS pharyngitis NAAT assays. […] Given that the literature indicates a 5-30% prevalence of GAS for pharyngitis, this confirms high rates of unnecessary antibiotic use. […] In contrast, NAAT alone had roughly equivalent rates of antibiotic prescription to those with the current gold standard of RADT plus culture. […] These results suggest that optimal testing practices that maximize diagnostic sensitivity may lead to more judicious antibiotic prescribing. […] Diagnostic systems utilizing NAAT technology have demonstrated sensitivity and specificity in clinical trials, but it is important to note that each diagnostic system is unique.

• #45 Strep Throat Rapid Tests, Symptoms & Treatment | Abbott Point of Care

  https://www.globalpointofcare.abbott/us/en/knowledge-insights/consumer-education/strep-throat.html

  The earlier you get diagnosed with strep throat, the better. Not only will you feel better sooner, you can reduce the spread of the infection, and prevent serious complications. Antibiotics are the best treatment for strep throat, and starting them early can help you feel better sooner, prevent complications, and reduce the spread of the infection. […] Rapid molecular testing for strep throat can aid in getting diagnosed faster and starting treatment immediately, avoid complications, and get back to school or work sooner.

• #46 Strep Throat Rapid Tests, Symptoms & Treatment | Abbott Point of Care

  https://www.globalpointofcare.abbott/us/en/knowledge-insights/consumer-education/strep-throat.html

  The earlier you get diagnosed with strep throat, the better. Not only will you feel better sooner, you can reduce the spread of the infection, and prevent serious complications. Antibiotics are the best treatment for strep throat, and starting them early can help you feel better sooner, prevent complications, and reduce the spread of the infection. […] Rapid molecular testing for strep throat can aid in getting diagnosed faster and starting treatment immediately, avoid complications, and get back to school or work sooner.

• #47 Strep Throat Rapid Tests, Symptoms & Treatment | Abbott Point of Care

  https://www.globalpointofcare.abbott/us/en/knowledge-insights/consumer-education/strep-throat.html

  The earlier you get diagnosed with strep throat, the better. Not only will you feel better sooner, you can reduce the spread of the infection, and prevent serious complications. Antibiotics are the best treatment for strep throat, and starting them early can help you feel better sooner, prevent complications, and reduce the spread of the infection. […] Rapid molecular testing for strep throat can aid in getting diagnosed faster and starting treatment immediately, avoid complications, and get back to school or work sooner.

• #48 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Patients with clear viral symptoms don’t need testing for group A streptococcal bacteria. […] Confirm a negative rapid antigen detection test with a throat culture for symptomatic children aged 3 years or older. […] To confirm group A strep pharyngitis, healthcare providers need to use either a rapid antigen detection test (RADT) or throat culture. […] RADTs have high specificity for group A strep bacteria but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic test. […] Healthcare providers can use a positive RADT or throat culture as confirmation of group A strep pharyngitis. […] Healthcare providers should follow up a negative RADT with a throat culture. […] Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing acute rheumatic fever. […] Healthcare providers cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms.

• #49 Diagnosis and Treatment of Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0301/p383.html

  With correct sampling and plating techniques, a single-swab throat culture is 90 to 95 percent sensitive. RADT allows for earlier treatment, symptom improvement, and reduced disease spread. RADT specificity ranges from 90 to 99 percent. […] Whether negative RADT results in children and adolescents require confirmatory throat culture is controversial. The American Academy of Pediatrics (AAP) recommends that negative RADT results in children be confirmed using throat culture unless physicians can guarantee that RADT sensitivity is similar to that of throat culture in their practice. […] Streptococcal antibody titers are not useful for diagnosing streptococcal pharyngitis and are not routinely recommended. They may be indicated to confirm previous infection in persons with suspected acute poststreptococcal glomerulonephritis or rheumatic fever.

• #50 Group A streptococcal (GAS) pharyngitis: A practical guide to diagnosis and treatment | Canadian Paediatric Society

  https://cps.ca/documents/position/group-a-streptococcal

  Testing for GAS pharyngitis is recommended for children presenting with moderate to severe sore throat, fever, absence of cough and rhinorrhea, and purulent and/or inflamed tonsils. […] Microbiological confirmation of GAS pharyngitis using RADT and/or culture is recommended before initiating antimicrobial therapy in low-risk populations. Treatment of first choice for GAS pharyngitis is 10 days of amoxicillin or penicillin. […] In communities at high risk for ARF (and specifically in northern or Indigenous communities), testing should be considered in any child 3 years of age presenting with sore throat.

• #51 Group A streptococcal (GAS) pharyngitis: A practical guide to diagnosis and treatment | Canadian Paediatric Society

  https://cps.ca/documents/position/group-a-streptococcal

  Testing for GAS pharyngitis is recommended for children presenting with moderate to severe sore throat, fever, absence of cough and rhinorrhea, and purulent and/or inflamed tonsils. […] Microbiological confirmation of GAS pharyngitis using RADT and/or culture is recommended before initiating antimicrobial therapy in low-risk populations. Treatment of first choice for GAS pharyngitis is 10 days of amoxicillin or penicillin. […] In communities at high risk for ARF (and specifically in northern or Indigenous communities), testing should be considered in any child 3 years of age presenting with sore throat.

• #52 Diagnosis and Management of Group A Streptococcal Pharyngitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0215/p880.html

  The Infectious Diseases Society of America (IDSA) recently updated a 1997 guideline for the diagnosis and management of group A streptococcal pharyngitis. […] The IDSA defined group A streptococcal pharyngitis as an acute infection of the oropharynx or nasopharynx that is caused by Streptococcus pyogenes. Accurate diagnosis and optimal treatment of this infection are important to: […] The IDSA recommends that, if acute group A streptococcal pharyngitis is suspected, laboratory testing should be performed to support the diagnosis. Throat culture or a rapid antigen detection test (RADT) may be used. […] Culture of a throat swab specimen remains the standard for identifying group A beta-hemolytic streptococci (sensitivity: 90 to 95 percent) and confirming the clinical diagnosis. […] The IDSA notes that a positive result on a throat culture or RADT adequately confirms the diagnosis. […] In adults, RADTs are an acceptable alternative to throat culture for the diagnosis of group A streptococcal pharyngitis. […] The IDSA recommends cultures for asymptomatic family contacts, with treatment given to those who have positive results.

• #53 Diagnosis and Management of Group A Streptococcal Pharyngitis – PcMED Project

  https://pcmedproject.com/id/diagnosis-and-management-of-group-a-streptococcal-pharyngitis/

  If RADT is positive further testing is unnecessary given RADT’s high specificity. […] Positive RADT does not distinguish between carriage and acute infection. […] Throat culture or RADT should be used to confirm the diagnosis of GAS pharyngitis. […] Antibiotics are recommended for the treatment of Group A Streptococcal pharyngitis to reduce the duration and severity of symptoms, prevent complications, and reduce the risk of transmission to others. […] Penicillin is the first-line agent for most patients with Group A Streptococcal pharyngitis.

• #54 Strep Throat Symptoms and Diagnosis

  https://www.everydayhealth.com/strep-throat/symptoms-strep-throat-how-its-diagnosed/

  Strep throat is an infection caused by bacteria known as Group A streptococcus. […] Its important to get tested for, and diagnosed with, strep throat before starting any treatment for your infection. […] Once you receive a diagnosis of strep throat, its important to begin treatment with antibiotics promptly to prevent any complications. […] To diagnose or rule out strep throat, your doctor will first ask about your history of symptoms and perform a physical examination. […] If your doctor suspects strep throat based on this examination, a throat swab will be tested for the presence of strep bacteria. […] Typically, doctors will recommend a test for most children but only test adults if they meet two or more strep criteria, such as having white patches on the tonsils (tonsillar exudates), swollen and tender lymph nodes, fever, or an absence of cough.

• #55 Strep A

  https://www.nhs.uk/conditions/strep-a/

  Most strep A infections are not serious and can be treated with antibiotics. […] Serious strep A infections (invasive group A strep, iGAS) need to be treated in hospital with antibiotics. […] Most strep A infections can be easily treated with antibiotics.

• #56 Strep throat – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/strep-throat/diagnosis-treatment/drc-20350344

  If your doctor diagnoses you or your child with strep throat, your doctor will likely prescribe an oral antibiotic. If taken within 48 hours of the onset of the illness, antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to others. […] For strep throat, some basic questions to ask your doctor include: What tests are needed? […] If you think you or your child might have a strep infection, take steps to relieve symptoms and avoid spreading infection: […] Gargle with 1/4 teaspoon (1.5 grams) of table salt in 8 ounces (237 milliliters) of warm water.

• #57 Strep throat – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/strep-throat/diagnosis-treatment/drc-20350344

  If your doctor diagnoses you or your child with strep throat, your doctor will likely prescribe an oral antibiotic. If taken within 48 hours of the onset of the illness, antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to others. […] For strep throat, some basic questions to ask your doctor include: What tests are needed? […] If you think you or your child might have a strep infection, take steps to relieve symptoms and avoid spreading infection: […] Gargle with 1/4 teaspoon (1.5 grams) of table salt in 8 ounces (237 milliliters) of warm water.

• #58 Clinical Practice Guidelines for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by IDSA

  https://www.idsociety.org/practice-guideline/streptococcal-pharyngitis/

  The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. […] The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. […] Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.

• #59 Group A Streptococcus Treatment and Management

  https://www.uspharmacist.com/article/group-a-streptococcus-treatment-and-management

  Those with GAS pharyngitis should be treated with either penicillin or amoxicillin, given their relatively low cost and low adverse effects. […] If either of these therapies is chosen, a total of 10 days of treatment should be completed. […] After the antibiotic treatment, patients may see the disappearance of symptoms within 1 to 3 days and may return to work or school after 24 hours of treatment.

• #60 Group A Streptococcus Treatment and Management

  https://www.uspharmacist.com/article/group-a-streptococcus-treatment-and-management

  Those with GAS pharyngitis should be treated with either penicillin or amoxicillin, given their relatively low cost and low adverse effects. […] If either of these therapies is chosen, a total of 10 days of treatment should be completed. […] After the antibiotic treatment, patients may see the disappearance of symptoms within 1 to 3 days and may return to work or school after 24 hours of treatment.

• #61 Strep A Test: MedlinePlus Medical TestLock

  https://medlineplus.gov/lab-tests/strep-a-test/

  If the throat culture is positive, it means you or your child has strep throat or other strep infection. […] If the throat culture is negative, it means your symptoms are not being caused by strep A bacteria. Your provider will probably order more tests to help make a diagnosis. […] If you or your child is diagnosed with strep throat, you will need to take antibiotics. Most often you will need to take them for 10 days. […] It’s important to take the antibiotics as prescribed and to finish the medicine even if you start feeling better. […] Strep A can cause other infections besides strep throat. These infections are less common than strep throat but are often more serious.

• #62 Diagnosis and Management of Group A Strep Pharyngitis – PCI-Lab

  https://familymedicine.uw.edu/pci-lab/projects/archive,testing/diagnosis-management-strep/

  A new wave of polymerase chain reaction (PCR) tests are now receiving FDA clearance, which have sufficiently high sensitivity and specificity to use as standalone tests to identify the underlying cause of acute pharyngitis. […] Currently practice involves using a rapid point of care test to detect the group A streptococcal bacteria that causes many of these infections. […] New point of care tests that use PCR technology have the potential to provide diagnostic tools that primary care clinicians need to identify (or rule out) bacterial and viral pathogens. […] The high sensitivity and specificity of these molecular tests could lead to more efficient health care, and in the case of infections, more targeted use (or avoidance) of antibiotics and antivirals.

• #63 Diagnosis and Management of Group A Strep Pharyngitis – PCI-Lab

  https://familymedicine.uw.edu/pci-lab/projects/archive,testing/diagnosis-management-strep/

  A new wave of polymerase chain reaction (PCR) tests are now receiving FDA clearance, which have sufficiently high sensitivity and specificity to use as standalone tests to identify the underlying cause of acute pharyngitis. […] Currently practice involves using a rapid point of care test to detect the group A streptococcal bacteria that causes many of these infections. […] New point of care tests that use PCR technology have the potential to provide diagnostic tools that primary care clinicians need to identify (or rule out) bacterial and viral pathogens. […] The high sensitivity and specificity of these molecular tests could lead to more efficient health care, and in the case of infections, more targeted use (or avoidance) of antibiotics and antivirals.

• #64 Diagnosis and Management of Group A Strep Pharyngitis – PCI-Lab

  https://familymedicine.uw.edu/pci-lab/projects/archive,testing/diagnosis-management-strep/

  A new wave of polymerase chain reaction (PCR) tests are now receiving FDA clearance, which have sufficiently high sensitivity and specificity to use as standalone tests to identify the underlying cause of acute pharyngitis. […] Currently practice involves using a rapid point of care test to detect the group A streptococcal bacteria that causes many of these infections. […] New point of care tests that use PCR technology have the potential to provide diagnostic tools that primary care clinicians need to identify (or rule out) bacterial and viral pathogens. […] The high sensitivity and specificity of these molecular tests could lead to more efficient health care, and in the case of infections, more targeted use (or avoidance) of antibiotics and antivirals.

• #65 Strep A Test | Fast and Accurate Diagnosis | GetTested

  https://gettested.io/product/strep-a-test?srsltid=AfmBOopdraCcVOqvj7HqZ0zDeUCwh1TDFArlmEilkODcQ4PWsenI0eAh

  With the Strep A Rapid Test, you can conveniently assess your Strep A status in the privacy of your home. […] Our Strep A test is a home test kit with instant results. After ordering, we will send you a kit with everything you need to perform the test yourself. Results are obtained within 10 minutes. […] It will give you a positive or negative result. Positive means that the test has detected the presence of Streptococcus A specific antigens in the sample. […] Yes, but it is not suitable for use on children under the age of 2 years.

• #66 Strep A Test | Fast and Accurate Diagnosis | GetTested

  https://gettested.io/product/strep-a-test?srsltid=AfmBOopdraCcVOqvj7HqZ0zDeUCwh1TDFArlmEilkODcQ4PWsenI0eAh

  With the Strep A Rapid Test, you can conveniently assess your Strep A status in the privacy of your home. […] Our Strep A test is a home test kit with instant results. After ordering, we will send you a kit with everything you need to perform the test yourself. Results are obtained within 10 minutes. […] It will give you a positive or negative result. Positive means that the test has detected the presence of Streptococcus A specific antigens in the sample. […] Yes, but it is not suitable for use on children under the age of 2 years.

• #67 Strep A Test | Fast and Accurate Diagnosis | GetTested

  https://gettested.io/product/strep-a-test?srsltid=AfmBOopdraCcVOqvj7HqZ0zDeUCwh1TDFArlmEilkODcQ4PWsenI0eAh

  With the Strep A Rapid Test, you can conveniently assess your Strep A status in the privacy of your home. […] Our Strep A test is a home test kit with instant results. After ordering, we will send you a kit with everything you need to perform the test yourself. Results are obtained within 10 minutes. […] It will give you a positive or negative result. Positive means that the test has detected the presence of Streptococcus A specific antigens in the sample. […] Yes, but it is not suitable for use on children under the age of 2 years.

• #68 Streptococcus A (Strep A) | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/streptococcus-a-strep-a/

  Strep A tests are not available through the NHS in Scotland for self-testing at home. Should you or your child need to be tested for Strep A, your GP or other healthcare professional will advise you. […] Your healthcare professional will consider antibiotics if they think: you or your child need medication to get better or to ease symptoms; you or your child are at risk of serious complications from a GAS infection; you or your child has scarlet fever.

• #69 The Evolution of Group A Streptococcus Pharyngitis Testing | myadlm.org

  https://myadlm.org/cln/articles/2018/september/the-evolution-of-group-a-streptococcus-pharyngitis-testing

  GAS Direct has performed well in comparison with standard streptococcal culture methods, exhibiting a sensitivity and specificity of 94.8% and 100%, respectively (6). […] Another commercial isothermal DNA amplification assay, the Illumigene assay from Meridian Bio-science, has demonstrated excellent sensitivity (93.1%) and specificity (91.4%) for the direct detection of S. pyogenes and has emerged as an appropriate alternative to culture (7). […] The first POC test for GAS detection on the market was the Alere i Strep A from Abbott, followed by Cobas Strep A Assay from Roche, the Xpert Xpress Strep A from Cepheid, and more recently, the modified version of Abbotts Alere i Strep A 2 assay (1112). […] With continued research, manufacturers are designing more accurate and sensitive molecular as-says that could eliminate the need for confirmatory culture to detect GAS.

• #70 Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011–2015 | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3835-4

  These real-world data suggest that clinical guidelines should consider the role of newer diagnostic methods such as NAAT to improve the accuracy of GAS pharyngitis diagnosis as well as stress the overall value of diagnostic use along with clinical symptoms to confirm bacterial infections that require antibiotic treatment.

• #71 Rapid Tests for the Diagnosis of Group A Streptococcal Infection: A Review of Diagnostic Test Accuracy, Clinical Utility, Safety, and Cost-Effectiveness – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532707/

  The purpose of this review is to evaluate the diagnostic accuracy of non-culture based tests to diagnose GA Strep infection; their clinical utility; their associated adverse effects, if any; and their cost-effectiveness. […] […] From systematic reviews and observational studies the sensitivity values ranged between 82% and 100% for molecular assays and between 55% and 94% for immunoassays. Specificities for the two test types were 91% to 99% for molecular assays and 81% to 100% for immunoassays. […] […] One pragmatic adaptive RCT showed no clear advantage of rapid antigen test over clinical score for management of group a streptococcus infection. Evidence regarding change in treatment strategy with respect to use of antibiotics resulting from use of rapid antigen detection tests for diagnosis is conflicting. […]

• #72 Group A Streptococcal Pharyngitis Diagnosis | MDedge

  https://medauth2.mdedge.com/content/group-streptococcal-pharyngitis-diagnosis

  RADT solves the time-delay issues and has near 100% specificity but sensitivity used to be as low as 65%, hence the 2012 Infectious Diseases Society of America guideline recommendation for backup throat culture for negative tests. […] However, current RADT have sensitivities in the 85%-90% range. […] So a positive RADT reliably and quickly indicates GAS antigens are present. […] NAAT have the highest combined sensitivity and specificity, near 100% for each, and a positive reliably indicates GAS nucleic acids are present. […] Pretest patient screening therefore is critical to increase the positive predictive value of positive GAS testing results. […] The history and physical can be helpful. […] In the simplest form of pretest screening, eliminate those younger than 3 years old or those with viral type sign/symptoms, eg conjunctivitis, cough, coryza.

• #73 The Evolution of Group A Streptococcus Pharyngitis Testing | myadlm.org

  https://myadlm.org/cln/articles/2018/september/the-evolution-of-group-a-streptococcus-pharyngitis-testing

  GAS Direct has performed well in comparison with standard streptococcal culture methods, exhibiting a sensitivity and specificity of 94.8% and 100%, respectively (6). […] Another commercial isothermal DNA amplification assay, the Illumigene assay from Meridian Bio-science, has demonstrated excellent sensitivity (93.1%) and specificity (91.4%) for the direct detection of S. pyogenes and has emerged as an appropriate alternative to culture (7). […] The first POC test for GAS detection on the market was the Alere i Strep A from Abbott, followed by Cobas Strep A Assay from Roche, the Xpert Xpress Strep A from Cepheid, and more recently, the modified version of Abbotts Alere i Strep A 2 assay (1112). […] With continued research, manufacturers are designing more accurate and sensitive molecular as-says that could eliminate the need for confirmatory culture to detect GAS.

• #74 Early Strep A diagnosis can ensure prompt treatment | Aidian

  https://www.aidian.nl/nieuws/early-strep-a-diagnosis-can-ensure-prompt-treatment-and-minimal-spread-of-the-infection

  Early Strep A diagnosis can ensure prompt treatment and minimal spread of the infection. […] Testing of Strep A is important as GAS pharyngitis should be treated with antibiotics. […] Early verification or exclusion of Strep A infection: Enables prompt antibiotic treatment, and minimal spread of the infection. […] GAS pharyngitis is diagnosed by rapid antigen detection test or bacterial culture, and is treated with antibiotics. […] Fast and accurate QuikRead go Strep A test aids in early GAS detection and drives evidence-based treatment in point-of-care environment.

• #75 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Patients with clear viral symptoms don’t need testing for group A streptococcal bacteria. […] Confirm a negative rapid antigen detection test with a throat culture for symptomatic children aged 3 years or older. […] To confirm group A strep pharyngitis, healthcare providers need to use either a rapid antigen detection test (RADT) or throat culture. […] RADTs have high specificity for group A strep bacteria but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic test. […] Healthcare providers can use a positive RADT or throat culture as confirmation of group A strep pharyngitis. […] Healthcare providers should follow up a negative RADT with a throat culture. […] Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing acute rheumatic fever. […] Healthcare providers cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms.

• #76 Clinical Guidance for Group A Streptococcal Pharyngitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html

  Patients with clear viral symptoms don’t need testing for group A streptococcal bacteria. […] Confirm a negative rapid antigen detection test with a throat culture for symptomatic children aged 3 years or older. […] To confirm group A strep pharyngitis, healthcare providers need to use either a rapid antigen detection test (RADT) or throat culture. […] RADTs have high specificity for group A strep bacteria but varying sensitivities when compared to throat culture. Throat culture is the gold standard diagnostic test. […] Healthcare providers can use a positive RADT or throat culture as confirmation of group A strep pharyngitis. […] Healthcare providers should follow up a negative RADT with a throat culture. […] Giving antibiotics to children with confirmed group A strep pharyngitis can reduce their risk of developing acute rheumatic fever. […] Healthcare providers cannot use clinical examination to differentiate viral and group A strep pharyngitis in the absence of viral symptoms.

• #77 Diagnosis and Management of Group A Streptococcal Pharyngitis – PcMED Project

  https://pcmedproject.com/id/diagnosis-and-management-of-group-a-streptococcal-pharyngitis/

  If RADT is positive further testing is unnecessary given RADT’s high specificity. […] Positive RADT does not distinguish between carriage and acute infection. […] Throat culture or RADT should be used to confirm the diagnosis of GAS pharyngitis. […] Antibiotics are recommended for the treatment of Group A Streptococcal pharyngitis to reduce the duration and severity of symptoms, prevent complications, and reduce the risk of transmission to others. […] Penicillin is the first-line agent for most patients with Group A Streptococcal pharyngitis.

• #78 Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011–2015 | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3835-4

  Of interest, while the overall use of NAAT alone was infrequent, the proportion of events diagnosed using NAAT vs. other test types increased 3.5-fold over the study period and roughly doubled in 2014 and again in 2015, coinciding with the approval of GAS pharyngitis NAAT assays. […] Given that the literature indicates a 5-30% prevalence of GAS for pharyngitis, this confirms high rates of unnecessary antibiotic use. […] In contrast, NAAT alone had roughly equivalent rates of antibiotic prescription to those with the current gold standard of RADT plus culture. […] These results suggest that optimal testing practices that maximize diagnostic sensitivity may lead to more judicious antibiotic prescribing. […] Diagnostic systems utilizing NAAT technology have demonstrated sensitivity and specificity in clinical trials, but it is important to note that each diagnostic system is unique.

• #79 Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011–2015 | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3835-4

  These real-world data suggest that clinical guidelines should consider the role of newer diagnostic methods such as NAAT to improve the accuracy of GAS pharyngitis diagnosis as well as stress the overall value of diagnostic use along with clinical symptoms to confirm bacterial infections that require antibiotic treatment.

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