Strep throat laboratory tests: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Strep throat}} | {{Strep throat}} | ||
{{CMG}}{{AE}}{{AA}} | {{CMG}}; {{AE}} {{AA}} | ||
==Overview== | ==Overview== | ||
History and clinical examination can be used to diagnosis viral pharyngitis when clear viral symptoms (e.g., cough, rhinorrhea, hoarseness, oral ulcers, conjunctivitis) are present; these patients do not need testing for group A strep. However, clinical examination cannot be used to differentiate viral and group A strep pharyngitis in the absence of viral symptoms, even for experienced clinicians. Group A streptococcal pharyngitis may be diagnosed with the help of rapid antigen detection test (RADT) and throat culture.<ref name=cdcp>http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref> | History and clinical examination can be used to diagnosis viral pharyngitis when clear viral symptoms (e.g., [[cough]], [[rhinorrhea]], hoarseness, [[oral ulcers]], [[conjunctivitis]]) are present; these patients do not need testing for group A strep. However, clinical examination cannot be used to differentiate viral and group A strep [[pharyngitis]] in the absence of viral symptoms, even for experienced clinicians. Group A streptococcal pharyngitis may be diagnosed with the help of [[rapid antigen detection test]] (RADT) and [[throat culture]].<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref> | ||
==Laboratory tests== | ==Laboratory tests== | ||
History and clinical examination can be used to diagnosis viral pharyngitis when clear viral symptoms (e.g., cough, rhinorrhea, hoarseness, oral ulcers, conjunctivitis) are present; these patients do not need testing for group A strep. However, clinical examination cannot be used to differentiate viral and group A strep pharyngitis in the absence of viral symptoms, even for experienced clinicians. | History and clinical examination can be used to diagnosis viral pharyngitis when clear viral symptoms (e.g., [[cough]], [[rhinorrhea]], [[hoarseness]], [[oral ulcers]], [[conjunctivitis]]) are present; these patients do not need testing for group A strep. However, clinical examination cannot be used to differentiate viral and group A strep [[pharyngitis]] in the absence of viral symptoms, even for experienced clinicians. | ||
Group A streptococcal pharyngitis may be diagnosed with the help of following | Group A streptococcal [[pharyngitis]] may be diagnosed with the help of following laboratory tests:<ref name="cdcp">http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016</ref> | ||
===Rapid antigen detection test (RADT)=== | ===[[Rapid antigen detection test]] (RADT)=== | ||
RADTs have higher specificity for group A streptococcal throat but lower | RADTs have higher specificity for group A streptococcal throat but lower [[Sensitivity (tests)|sensitivity]] than [[throat culture]].<ref name="pmid17009909">{{cite journal| author=Leung AK, Newman R, Kumar A, Davies HD| title=Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis. | journal=Expert Rev Mol Diagn | year= 2006 | volume= 6 | issue= 5 | pages= 761-6 | pmid=17009909 | doi=10.1586/14737159.6.5.761 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17009909 }} </ref><ref name="pmid20397147">{{cite journal| author=Sarikaya S, Aktaş C, Ay D, Cetin A, Celikmen F| title=Sensitivity and specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department. | journal=Ear Nose Throat J | year= 2010 | volume= 89 | issue= 4 | pages= 180-2 | pmid=20397147 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20397147 }} </ref><ref name="pmid19171607">{{cite journal| author=Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST| title=Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. | journal=Pediatrics | year= 2009 | volume= 123 | issue= 2 | pages= 437-44 | pmid=19171607 | doi=10.1542/peds.2008-0488 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19171607 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19949185 Review in: Evid Based Med. 2009 Dec;14(6):183] </ref><ref name="pmid25369170">{{cite journal| author=Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada CA, Centor RM| title=Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis. | journal=PLoS One | year= 2014 | volume= 9 | issue= 11 | pages= e111727 | pmid=25369170 | doi=10.1371/journal.pone.0111727 | pmc=4219770 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25369170 }} </ref><ref name="pmid7618495">{{cite journal| author=Joslyn SA, Hoekstra GL, Sutherland JE| title=Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis. | journal=J Am Board Fam Pract | year= 1995 | volume= 8 | issue= 3 | pages= 177-82 | pmid=7618495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7618495 }} </ref> | ||
===Throat culture=== | ===Throat culture=== | ||
Throat culture is the gold standard diagnostic test for group A streptococcal pharyngitis. Individuals with negative rapid antigen detection test and high clinical suspicion of strep throat must be confirmed with throat culture.<ref name="pmid20397147">{{cite journal| author=Sarikaya S, Aktaş C, Ay D, Cetin A, Celikmen F| title=Sensitivity and specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department. | journal=Ear Nose Throat J | year= 2010 | volume= 89 | issue= 4 | pages= 180-2 | pmid=20397147 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20397147 }} </ref><ref name="pmid19171607">{{cite journal| author=Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST| title=Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. | journal=Pediatrics | year= 2009 | volume= 123 | issue= 2 | pages= 437-44 | pmid=19171607 | doi=10.1542/peds.2008-0488 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19171607 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19949185 Review in: Evid Based Med. 2009 Dec;14(6):183] </ref><ref name="pmid25369170">{{cite journal| author=Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada CA, Centor RM| title=Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis. | journal=PLoS One | year= 2014 | volume= 9 | issue= 11 | pages= e111727 | pmid=25369170 | doi=10.1371/journal.pone.0111727 | pmc=4219770 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25369170 }} </ref><ref name="pmid7618495">{{cite journal| author=Joslyn SA, Hoekstra GL, Sutherland JE| title=Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis. | journal=J Am Board Fam Pract | year= 1995 | volume= 8 | issue= 3 | pages= 177-82 | pmid=7618495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7618495 }} </ref><ref name="pmid9745311">{{cite journal| author=Pichichero ME| title=Group A beta-hemolytic streptococcal infections. | journal=Pediatr Rev | year= 1998 | volume= 19 | issue= 9 | pages= 291-302 | pmid=9745311 | doi=10.1542/pir.19-9-291 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745311 }} </ref> | Throat culture is the gold standard diagnostic test for group A streptococcal pharyngitis. Individuals with negative rapid antigen detection test and high clinical suspicion of strep throat must be confirmed with [[throat culture]].<ref name="pmid20397147">{{cite journal| author=Sarikaya S, Aktaş C, Ay D, Cetin A, Celikmen F| title=Sensitivity and specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department. | journal=Ear Nose Throat J | year= 2010 | volume= 89 | issue= 4 | pages= 180-2 | pmid=20397147 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20397147 }} </ref><ref name="pmid19171607">{{cite journal| author=Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST| title=Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. | journal=Pediatrics | year= 2009 | volume= 123 | issue= 2 | pages= 437-44 | pmid=19171607 | doi=10.1542/peds.2008-0488 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19171607 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19949185 Review in: Evid Based Med. 2009 Dec;14(6):183] </ref><ref name="pmid25369170">{{cite journal| author=Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada CA, Centor RM| title=Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis. | journal=PLoS One | year= 2014 | volume= 9 | issue= 11 | pages= e111727 | pmid=25369170 | doi=10.1371/journal.pone.0111727 | pmc=4219770 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25369170 }} </ref><ref name="pmid7618495">{{cite journal| author=Joslyn SA, Hoekstra GL, Sutherland JE| title=Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis. | journal=J Am Board Fam Pract | year= 1995 | volume= 8 | issue= 3 | pages= 177-82 | pmid=7618495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7618495 }} </ref><ref name="pmid9745311">{{cite journal| author=Pichichero ME| title=Group A beta-hemolytic streptococcal infections. | journal=Pediatr Rev | year= 1998 | volume= 19 | issue= 9 | pages= 291-302 | pmid=9745311 | doi=10.1542/pir.19-9-291 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745311 }} </ref> | ||
===GAS serology=== | ===GAS serology=== | ||
There is no role of group A streptococcal serology in the diagnosis of strep throat. | There is no role of group A streptococcal [[serology]] in the diagnosis of strep throat. | ||
===Molecular assays=== | ===Molecular assays=== | ||
Molecular assays such as nucleic acid amplification tests [NAAT] | Molecular assays such as [[NAAT|nucleic acid amplification tests]] ([[NAAT]]) and [[polymerase chain reaction]] assays ([[PCR]]) are not routinely used for the detection of strep throat. | ||
==References== | ==References== | ||
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{{WS}} | {{WS}} | ||
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[[Category:Pediatrics]] | |||
[[Category:Otolaryngology]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
History and clinical examination can be used to diagnosis viral pharyngitis when clear viral symptoms (e.g., cough, rhinorrhea, hoarseness, oral ulcers, conjunctivitis) are present; these patients do not need testing for group A strep. However, clinical examination cannot be used to differentiate viral and group A strep pharyngitis in the absence of viral symptoms, even for experienced clinicians. Group A streptococcal pharyngitis may be diagnosed with the help of rapid antigen detection test (RADT) and throat culture.[1]
Laboratory tests
History and clinical examination can be used to diagnosis viral pharyngitis when clear viral symptoms (e.g., cough, rhinorrhea, hoarseness, oral ulcers, conjunctivitis) are present; these patients do not need testing for group A strep. However, clinical examination cannot be used to differentiate viral and group A strep pharyngitis in the absence of viral symptoms, even for experienced clinicians. Group A streptococcal pharyngitis may be diagnosed with the help of following laboratory tests:[1]
Rapid antigen detection test (RADT)
RADTs have higher specificity for group A streptococcal throat but lower sensitivity than throat culture.[2][3][4][5][6]
Throat culture
Throat culture is the gold standard diagnostic test for group A streptococcal pharyngitis. Individuals with negative rapid antigen detection test and high clinical suspicion of strep throat must be confirmed with throat culture.[3][4][5][6][7]
GAS serology
There is no role of group A streptococcal serology in the diagnosis of strep throat.
Molecular assays
Molecular assays such as nucleic acid amplification tests (NAAT) and polymerase chain reaction assays (PCR) are not routinely used for the detection of strep throat.
References
- ↑ 1.0 1.1 http://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html Accessed on October 18, 2016
- ↑ Leung AK, Newman R, Kumar A, Davies HD (2006). "Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis". Expert Rev Mol Diagn. 6 (5): 761–6. doi:10.1586/14737159.6.5.761. PMID 17009909.
- ↑ 3.0 3.1 Sarikaya S, Aktaş C, Ay D, Cetin A, Celikmen F (2010). "Sensitivity and specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department". Ear Nose Throat J. 89 (4): 180–2. PMID 20397147.
- ↑ 4.0 4.1 Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST (2009). "Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis". Pediatrics. 123 (2): 437–44. doi:10.1542/peds.2008-0488. PMID 19171607. Review in: Evid Based Med. 2009 Dec;14(6):183
- ↑ 5.0 5.1 Stewart EH, Davis B, Clemans-Taylor BL, Littenberg B, Estrada CA, Centor RM (2014). "Rapid antigen group A streptococcus test to diagnose pharyngitis: a systematic review and meta-analysis". PLoS One. 9 (11): e111727. doi:10.1371/journal.pone.0111727. PMC 4219770. PMID 25369170.
- ↑ 6.0 6.1 Joslyn SA, Hoekstra GL, Sutherland JE (1995). "Rapid antigen detection testing in diagnosing group A beta-hemolytic streptococcal pharyngitis". J Am Board Fam Pract. 8 (3): 177–82. PMID 7618495.
- ↑ Pichichero ME (1998). "Group A beta-hemolytic streptococcal infections". Pediatr Rev. 19 (9): 291–302. doi:10.1542/pir.19-9-291. PMID 9745311.