Sains Malaysiana 50(11)(2021): 3345-3354

http://doi.org/10.17576/jsm-2021-5011-18

Evaluation of Rapid Antigen Detection Test for Group A Streptococci Pharyngitis among Children in an Out-Patient Clinic in Malaysia

(Penilaian Ujian Antigen Pantas untuk Pengesanan Keradangan Farinks oleh Streptokokus Kumpulan A dalam Kalangan Kanak-Kanak di Klinik Pesakit Luar di Malaysia)

ZAILI ZAKI¹, ASRUL ABDUL WAHAB²*, RAMLIZA RAMLI², AFAAF ESA³ & EZURA MADIANA MD. MONOTO³

¹Department of Pathology, Queen Elizabeth Hospital, Karung Berkunci 2029, 88586 Kota Kinabalu, Sabah, Malaysia

²Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

³Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

Diserahkan: 22 Mei 2020/Diterima: 7 Mac 2021

ABSTRACT

One of the most common conditions encountered in the out-patient setting is acute pharyngitis. Group A Streptococcus (GAS) accounts for 15%-30% of cases of sore throat particularly in children under 15 years old. Rapid antigen testing (RADT) is an alternative diagnostic method to detect GAS pharyngitis. This study was done to evaluate the agreement between RADT whereby BIONEXIA® Strep A Plus (BioMérieux, France) kit was used and throat culture in the diagnosis of GAS pharyngitis in children presented with a sore throat. One hundred and ten children from a primary health care clinic with sore throat were included in this study. All children were evaluated based on McIsaac scoring and throat swab samples were taken for both throat culture and RADT testing. The prevalence of GAS pharyngitis by RADT in this study was 7.3% over one year. A higher incidence of GAS pharyngitis was noted in the school-aged children than the preschool-age children. There was no correlation between cough, lymph node enlargement, and tonsillar enlargement in predicting GAS pharyngitis. The sensitivity and specificity of RADT were 100% and 98%, respectively, when taking throat culture as a gold standard. A good agreement between RADT and throat culture was achieved (k=0.848). McIsaac scoring was noted to have good predictability for GAS pharyngitis with AUC=0.82. In conclusion, the rapid streptococcal antigen detection test showed excellent sensitivity and specificity and detecting GAS from the throat swab samples. Thus, it can be used to aid in the diagnosis of group A Streptococcal pharyngitis and could reduce the overuse of antibiotics. McIsaac score has also proven to be useful as a screening tool for bacterial pharyngitis.

Keywords: Group A Streptococcal pharyngitis; McIsaac score; rapid antigen detection test

ABSTRAK

Keradangan farinks akut adalah salah satu keadaan yang biasa dijumpai di klinik pesakit luar. Antara 15 hingga 30 peratus daripada kesakitan tekak terutamanya dalam kalangan kanak-kanak di bawah umur 15 tahun ini adalah disebabkan oleh jangkitan Streptokokus Kumpulan A. Ujian antigen pantas adalah ujian alternatif yang boleh dilakukan bagi mengesan jangkitan Streptokokus Kumpulan A ini. Kajian ini dijalankan dengan objektif untuk menilai persamaan antara ujian antigen pantas (BIONEXIA^® Strep A Plus kit) dan kultur bakteria dalam pengenalpastian radang farinks yang disebabkan oleh Streptokokus kumpulan A ini. Seramai 110 pesakit kanak-kanak yang mengalami sakit tekak telah dilibatkan dalam kajian ini. Sistem Pemarkahan McIsaac dan sapuan tekak telah dilakukan ke atas semua kanak-kanak tersebut. Ujian antigen pantas dan kultur bakteria dibuat untuk semua sampel sapuan tekak tersebut. Berdasarkan kepada keputusan ujian tersebut, didapati prevalens Streptokokus kumpulan A melalui ujian antigen pantas sebagai penyebab radang farinks adalah pada kadar 7.3 peratus. Didapati juga, prevalens ini lebih tinggi dalam kalangan kanak-kanak yang bersekolah berbanding dengan mereka di bawah umur persekolahan. Kajian ini tidak menunjukkan sebarang hubung kait antara batuk, bengkak kelenjar dan bengkak tonsil sebagai simptom penentu untuk radang farinks Streptokokus kumpulan A. Kesensitifan dan kekhususan ujian antigen pantas ini pula didapati pada kadar 100 peratus dan 98 peratus. Kepatuhan antara ujian antigen pantas dan kultur bakteria juga didapati pada kadar yang sangat baik (k=0.848). Sistem Pemarkahan McIsaac pula menunjukkan prestasi yang baik untuk digunakan sebagai penentu kepada radang farinks Streptokokus kumpulan A ini dengan AUC=0.82. Kesimpulannya, ujian antigen pantas ini telah menunjukkan ujian ini mempunyai kesensitifan dan kekhususan yang sangat baik apabila kaedah kultur bakteria dijadikan sebagai ujian piawai. Oleh tu, kaedah ujian ini boleh digunakan untuk membantu mengesan penyakit ini dan dapat mengurangkan salah guna antibiotik dalam perawatan pesakit. Selain itu, Sistem Pemarkahan McIsaac juga telah didapati sangat berguna untuk diguna pakai sebagai alat saringan untuk radang farinks yang disebabkan oleh bakteria.

Kata kunci: Sistem pemarkahan McIsaac; Streptokokus kumpulan A radang farinks; ujian antigen pantas

RUJUKAN

Alcaide, M.L. & Bisno, A.L. 2007. Pharyngitis and epiglotititis. Infectious Disease Clinics of North America 21: 449-469.

Altun, H.U., Meral, T. & Aribas, E.T. 2015. The specificity and sensitivity results of the rapid antigen test used in the diagnosis of Group A beta haemolytic streptococcal tonsillopharyngitis. Acta Medica Mediterranea 31: 287-290.

Bisno, A.L., Peter, G.S. & Kaplan, E.L. 2002. Diagnosis of strep throat in adults: Are clinical criteria really good enough? Clinical Infectious Diseases 35: 126-129. 

Carapetis, J.R., Steer, A.C., Mulholland, E.K. & Weber, M. 2005. The global burden of group A streptococcal diseases. The Lancet Infectious Diseases 5: 685-694.

Clinical and Laboratory standard institute (CLSI). 2019. Performance standards for antimicrobial susceptibility testing. 29^th CLSI supplement M100: 88-91.

Cohen, J.F., Chalumeau, M., Levy, C., Bidet, P., Thollot, F., Wollner, A., Bingen, E. & Cohen, R. 2012. Spectrum and inoculum size effect of a rapid antigen detection test for Group A streptococcus in children with pharyngitis. PLoS ONE 7: e39085. doi:10.1371/journal.pone.0039085.

Cooper, R.J., Hoffman, J.R., Bartlett, J.G., Besser, R.E., Gonzales, R., Hickner, J.M. & Sande, M.A. 2001. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Annals of Internal Medicine 134: 509-517.

DeMuri, G.P., Sterkel, A.K., Kubica, P.A., Duster, M.N., Reed, K.D. & Wald, E.R. 2017. Macrolide and clindamycin resistance in Group A Streptococci isolated from children with pharyngitis. The Pediatric Infectious Disease Journal 36: 342-344.

Farmand, S., Henneke, P., Hufnagel, M. & Berner, R. 2012. Significant decline in the erythromycin resistance of group A streptococcus isolates at a German paediatric tertiary care centre. European Journal of Clinical Microbiology & Infectious Diseases 31: 707-710.

Fine, A.M., Nizet, V. & Mandl, K.D. 2012. Large-scale validation of the Centor and McIsaac scores to predict Group A streptococcal pharyngitis. The Archives of Internal Medicine 172: 847-852.

Hildreth, A.F., Takhar, S., Clark, M.A. & Hatten, B. 2015. Evidence-based evaluation and management of patients with pharyngitis in the Emergency Department. Emergency Medicine Practice 17: 1-16.

Kish, L. 1965. Survey Sampling. New York: John Wiley and Sons, Inc.

Kose, E., Kose, S.S., Akca, D., Yildiz, K., Elmas, C., Baris, M. & Anil, M. 2016. The effect of rapid antigen detection test on antibiotic prescription decision of clinicians and reducing antibiotic costs in children with acute pharyngitis. Journal of Tropical Pediatrics 62: 308-315.

Lean, W.L., Arnup, S., Danchin, M. & Steer, A.C. 2014. Rapid diagnostic tests for group A streptococcal pharyngitis: A meta-analysis. Pediatrics 134: 771-781.

Llor, C., Henández, S., Sierra, N., Moragas, A., Hernández, M. & Bayona, C. 2010. Association between use of rapid antigen detection tests and adherence to antibiotics in suspected streptococcal pharyngitis. Scandinavian Journal of Primary Health Care 28: 12-17.

McIsaac, W.J., Kellner, J.D., Aufricht, P., Vanjaka, A. & Low, D.E. 2004. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 291: 1587-1595.

Oliver, J., Malliya Wadu, E., Pierse, N., Moreland, N.J., Williamson, D.A. & Baker, M.G. 2018. Group A streptococcus pharyngitis and pharyngeal carriage: A meta-analysis. PLOS Neglected Tropical Diseases 12: e0006335. https://doi.org/10.1371/journal.pntd.0006335.

Orda, U., Mitra, B., Orda, S., Fitzgerald, M., Gunnarsson, R., Rofe, G. & Dargan, A. 2016.  Point of care testing group A streptococci in patients presenting with pharyngitis will improve appropriate antibiotic prescription. Emergency Medicine Australasia 28: 199-204. 

Plainvert, C., Duquesne, I., Touak, G., Dmytruk, N. & Poyart, C. 2015. In vitro evaluation and comparison of 5 rapid antigen detection tests for the diagnosis of beta-haemolytic group A streptococcal pharyngitis. Diagnostic Microbiology and Infectious Disease 83: 105-111.

Rimoin, A.W., Walker, C.L.F., Hamza, H.S., Elminawi, N., Ghafar, H.A., Vince, A., da Cunha, A.L.A., Qazi, S., Gardovska, D. & Steinhoff, M.C. 2010. The utility of rapid antigen detection testing for the diagnosis of streptococcal pharyngitis in low-resource settings. International Journal of Infectious Diseases 14: 1048-1053.

Stewart, E.H., Davis, B., Clemans-Taylor, B.L., Littenberg, B., Estrada, C.A. & Centor, R.M. 2014. Rapid antigen Group A streptococcus test to diagnose pharyngitis: A systematic review and meta-analysis. PLoS ONE 9: e111727. doi:10.1371/journal.pone.0111727.

Tiemstra, J. & Miranda, R.L.F. 2009. Role of non-group A streptococci in acute pharyngitis. Journal of the American Board of Family Medicine 22: 663-669.

Wang, J., Zhou, N., Xu, B., Hao, H., Kang, L., Zheng, Y., Jiang, Y. & Jiang, H. 2012. Identification and cluster analysis of Streptococcus pyogenes by MALDI-TOF mass spectrometry. PLoS ONE 7: e47152. doi:10.1371/journal.pone.0047152.

Wessels, M.R. 2011. Clinical practice. Streptococcal pharyngitis. New England Journal of Medicine 364: 648-655.

*Pengarang untuk surat-menyurat; email: saw@ppukm.ukm.edu.my