Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0242429 (sore throat)
 2,760 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Wright-stained throat smears from 174 outpatients with a chief complaint of sore throat were examined. In the presence of tonsillar and/or pharyngeal exudate, cervical lymphadenitis, temperature greater than or equal to 24 less than or equal to 72h, examination of the throat smears would have doubled the accuracy of differentiating streptococcal pharyngitis (SP) from nonstreptococcal pharyngitis (NSP). In the presence of one, two, three, or all four of the preceding presenting characteristics, examination of throat smears would have increased the diagnostic accuracy by 46, 50, 13, and 14 per cent, respectively. Examination of a Wright-stained throat smear may help distinguish SP from NSP among patients in an outpatient setting where follow-up and, therefore, treatment based on culture results may not be optimal.
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PMID:Examination of pharyngeal secretions to determine the etiology of pharyngitis. 78 18

In order to devise a strategy for the management of acute pharyngitis, the clinical features of 418 adults with sore throat were noted and throat cultures were obtained. Patients with cultures positive for group A beta-hemolytic streptococci had a significantly higher (P less than or equal to .01) frequency of recent exposure to streptococcal infection, pharyngeal exudate, enlarged or tender cervical nodes, and high fever (greater than or equal to 38.3 C [101 F]. Patients with negative cultures complained more frequently of cough. On the basis of these symptoms and signs, a clinical algorithm was developed and discriminant function scores were computed that identify patient populations with different probabilities of having streptococcal pharyngitis. The patients with moderate and high probabilities included 91% of patients with positive cultures but only 67% of the total patient population. These methods could be the basis for more efficient evaluation of adults with sore throat.
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PMID:Recognition of streptococcal pharyngitis in adults. 110 66

The aim of the study was to explore whether penicillin was superior to placebo in altering the clinical course of proven streptococcal pharyngitis. A randomised, parallel, double blind placebo controlled trial of 10 days duration was undertaken in 42 general practices in the Gent region (Flemish part of Belgium). Phenoxymethylpenicillin (adults 250 mg t.i.d. and children 125 mg t.i.d.) or placebo were administrated to 173 patients, aged 5 to 50 y, with acute sore throat and a positive culture for Group A beta-haemolytic streptococci. Penicillin and placebo tablets were identical. Patient compliance was monitored by assay of penicillin in urine (Sarcina lutea method). The primary outcome variable was sore throat as recorded by the physician on Day 3. The experiences of the patients themselves over the 10 day period were also assessed. Secondary outcome variables were other local and general symptoms and signs of streptococcal throat infection. In the penicillin group on Day 3, 23.2% of the patients still complained of sore throat versus 65.9% in the placebo group: difference 42.7% (C.I. 29.4%, 56.1%). This finding was confirmed by survival analysis of the symptom 'sore throat', as recorded by the patients. The physicians recorded on Day 3 a significant positive effect on another symptom (malaise: P < 0.04) and certain clinical signs (abnormal throat: P < 0.07; and redness of throat: P < 0.003). Penicillin had more adverse effects than placebo (P < 0.007). It also inhibited the rise in ASLO (P < 0.001). In this study in general practice, penicillin had a slight but definitive positive effect on the clinical evolution of streptococcal pharyngitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of penicillin on the clinical course of streptococcal pharyngitis in general practice. 149 37

We report on 4 patients with rheumatic fever hospitalized and investigated in our clinics within a 12 month period between 1990 and 1991. In each case a clinically non-severe sore throat preceded the outbreak of rheumatic fever. In three cases diagnosis was according to the revised Jones criteria. Polyarthritis was the only major symptom in these cases. One patient suffered from monarthritis. Minor symptoms were fever, arthralgia, elevated blood sedimentation rates and elevated values for CRP and for antistreptolysin O. The joint symptoms were treated with nonsteroidal drugs and subsided. One of the patients had a recurrence 9 months after the first attack even though correct secondary prophylaxis with a 4-weekly intramuscular regimen of 1.2 million units of benzathine penicillin was carried out. We discuss some epidemiological aspects and diagnostic difficulties resulting from a changing clinical pattern of the disease, and emphasize the need for streptococcal sore throat treatment and continuous secondary prophylaxis to prevent recurrences.
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PMID:[Rheumatic fever. Its current status based on 4 cases]. 156 18

The impact of a rapid streptococcal screening test (RSS) on clinical decision making in the management of patients with acute pharyngitis was evaluated. Physicians managing 95 ambulatory patients with the complaint of sore throat were asked to estimate the probability of group A beta-hemolytic streptococcal pharyngitis (GRABS) in each patient and whether they intended to treat with antibiotics both before and after the results of the RSS were known. Simultaneous throat cultures were obtained for 80 patients at the discretion of the treating physicians. Regression analysis revealed that the RSS result was an important independent predictor for the posttest decision to treat with antibiotics and for the estimated probability of disease. The mean absolute log-likelihood ratio was used to quantify the effect of the RSS on diagnostic certainty; a greater contribution to diagnostic certainty occurred when the RSS was positive. Physicians would have prescribed an antibiotic 49 times without the benefit of the RSS and prescribed an antibiotic 48 times given the RSS result. Without the RSS, the treatment decision contradicted the throat culture result in 25 cases. With the RSS, this occurred in 26 cases. The RSS, while influencing decision making, especially when positive, did not decrease the use of antibiotics.
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PMID:The impact of a rapid screen for streptococcal pharyngitis on clinical decision making in the emergency department. 186 80

Several studies have implicated Mycoplasma pneumoniae as an important cause of nonstreptococcal pharyngitis in certain clinical settings. This study was performed to determine the prevalence of M. pneumoniae infection in family practice patients with sore throats and to identify patient characteristics predictive of this infection. M. pneumoniae throat cultures were obtained from 419 patients aged five years or older who were seen in one of four family practice offices with a complaint of sore throat. The overall prevalence of M. pneumoniae infection was 13%. It was characterized by more frequent hoarseness and less frequent complaint of postnasal drip when compared with other nonstreptococcal infections. Compared to patients with streptococcal pharyngitis, M. pneumoniae patients revealed a strikingly dissimilar clinical presentation. In particular, while pharyngitis is predictive of streptococcal infections, its presence did not predict M. pneumoniae infection. Recently developed rapid office-based tests for M. pneumoniae may allow timely diagnosis of this common and formerly elusive pathogen. Further study is required to validate the utility of such methods and to evaluate the efficacy of treatment.
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PMID:The prevalence of Mycoplasma pneumoniae in ambulatory patients with nonstreptococcal sore throat. 190 44

Sore throats are most commonly due to infections, many of which are viral and do not require specific treatment. Symptoms and signs of the common cold, influenza or croup, the occurrence of conjunctivitis in some adenoviral infections, generalised lymphadenopathy and splenomegaly in glandular fever or the presence of vesicles characteristic of herpangina (Coxsackie A virus) or of herpes simplex infection, occasionally enable a clinical diagnosis and avoid the need for antibiotic therapy. In the case of treatable conditions a typical membrane may suggest diphtheria, a scarlatiniform rash infection due to Streptococcus pyogenes or to Corynebacterium haemolyticum, and a cherry-red epiglottis Haemophilus influenzae type b. Associated atypical pneumonia suggests infection with Mycoplasma pneumoniae or Chlamydia pneumoniae. Pharyngitis due to Neisseria gonorrhoeae may be accompanied by infection at other sites or by other sexually transmitted diseases. Candidal infection, in the appropriate clinical circumstance, should suggest HIV infection. Surgical drainage is required in the case of peritonsillar or retropharyngeal abscess. Noninfectious cases of sore throat, e.g. thyroiditis, are relatively uncommon considerations in the differential diagnosis of acute febrile pharyngitis. The most common problem is to recognise streptococcal pharyngitis, which requires antibiotic treatment for 10 days to avoid the risk of rheumatic fever.
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PMID:The sore throat. When to investigate and when to prescribe. 207

Cultures for group A beta-hemolytic Streptococcus were performed on 806 patients presenting with a sore throat to five urgent care centers. The accuracies of a clinical scoring system and of a liposomal in-office direct test for Streptococcus were compared with culture results. The Directigen 1-2-3 group A streptococcal test had a sensitivity of 67%, a specificity of 85%, a positive predictive value of 61%, and a negative predictive value of 89% compared with culture. The scoring system had a sensitivity of 26%, a specificity of 94%, a positive predictive value of 58%, and a negative predictive value of 79%. Using a combination of the direct test results and the clinical score did not improve the accuracy significantly over the use of either alone. The rates of delayed treatment, unnecessary treatment, and increased costs were compared using different combinations of the clinical scoring system, the in-office streptococcal test, and culture. Neither the Directigen 1-2-3 group A streptococcal test nor the clinical score can replace culture in the diagnosis of group A beta-hemolytic streptococcal pharyngitis.
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PMID:Diagnosis of group A beta-hemolytic Streptococcus using clinical scoring criteria, Directigen 1-2-3 group A streptococcal test, and culture. 220 Mar 83

Antibodies to group A streptococcal polysaccharide were estimated in the following groups of patients: (I) Patients with uncomplicated streptococcal pharyngitis: 10 patients, followed up for 3 months. (II) Patients with acute rheumatic fever: 8 patients with first attack followed up for one year. (III) Patients with reactivated rheumatic heart disease: 10 patients, followed up for one year. (IV) Patients with chronic rheumatic heart disease: followed up for one year. (V) normal controls without any history of sore throat/fever/vaccination/rheumatic disease: 10 patients followed up for one year. Group (I) patients did not show any significant elevation in anticarbohydrate antibodies by both ELISA and RIA. In the case of (III) and (IV), antibody levels were significantly higher as compared to group (V) and remained so till one year of follow up. In group (II) patients there was no significant rise in antibody levels. There was a good correlation between the ELISA and RIA used to detect the antibody levels. These findings suggest that the use of ELISA to detect anticarbohydrate antibody can be of help in diagnosing cases of rheumatic heart disease (both acute and chronic RHD).
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PMID:Enzyme immunoassay (ELISA) for the detection of anticarbohydrate antibodies in rheumatic fever and rheumatic heart disease. 268 29

Some physicians test for group A streptococcal pharyngitis in all patients who have a sore throat, while others use a variety of clinical strategies to select patients to be tested. Using published data on the accuracy of a clinical decision rule, this benefit-cost analysis compares the calculated outcomes of 21 different management strategies applied to 1,000 hypothetical adults with pharyngitis. Strategies that best accomplish one physician's treatment goals may perform poorly when evaluated in a different practice setting or using different goals. The best strategies are identified for different treatment objectives and for different assumptions about the benefits of treatment so each physician can choose a strategy consistent with his or her preferences.
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PMID:Selective testing for streptococcal pharyngitis in adults. 311 51


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