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Performance of Clinical Features, Acute Phase Reactants and Group A Streptococcus Rapid Test in Evaluation of the Etiologic Agents for Tonsillopharyngitis in Children by Bahri Elmas, Mehmet Köroğlu, Hüseyin A. Terzi, Ferhat G. Aslan, Engin Menekşe, Mustafa Kösecik, Mustafa Altindiş

Background: It is important to determine the causative agent of tonsillopharyngitis in children, whether group A beta-hemolytic streptococcus (GABHS) or another agent. In this study, we investigated epidemiological data and clinical symptoms and also evaluated the performance of group A streptococcus rapid test (GASRT) and acute- phase reactant tests in distinguishing viral and bacterial agents by performing assays for GABHS and for Epstein- Barr virus (EBV), herpes simplex virus type 1 (HSV-1), adenovirus, and enterovirus, from samples obtained from children with tonsillopharyngitis.
Methods: One hundred fifty pediatric patients were evaluated for complaints of body fever, sore throat, headache, cough, and abdominal pain. Identification of GAS isolates was performed using culture, a rapid test for GAS de- tection, and a L-pyrrolidonyl arylamidase (PYR) test, as well as a latex agglutination test and the Vitek 2 automat- ed system when needed. The complete blood count (CBC), neutrophil/lymphocyte ratio (NLR), anti-streptolysin O (ASO), sedimentation, and high-sensitivity C-reactive protein (hs-CRP) were quantified. Molecular analyses were performed for EBV, adenovirus, enterovirus, and HSV-1 detection using the Anatolia Montania 4896 RT PCR platform.
Results: Throat cultures were positive for GABHS in 11 (7.3%) children. The absence of coughing and the pres- ence of painful cervical LAP were significantly higher in the GABHS-positive group. GASRT was positive in 14 (9.2%) children; 10 (90%) of the 11 GABHS culture-positive cases were also positive for GASRT. In the GABHS- positive group, there was no difference in sedimentation or ASO values compared with GABHS-negative group. When the viral agent-positive group was compared with the group where no agent was found, WBC, NLR, and CRP were significantly higher, and PLT was significantly lower.
Conclusions: Causative agent of acute tonsillopharyngytis in children is usually a virus. EBV was the most com- mon viral agent in tonsillopharyngitis. The absence of coughing and the presence of painful cervical lymphade- nopathy can be important indicators in the diagnosis of GABHS positivity. GASRT is a highly reliable assay. WBC, NLR, and CRP are higher in GABHS-positive patients.

DOI: 10.7754/Clin.Lab.2017.170124