title: Clinical predictors of streptococcal pharyngitis in adults.
abstract: BACKGROUND
  Acute pharyngitis in children is one of the most frequent illnesses for which primary care physicians are consulted. It is caused more frequently by viruses than by bacteria, but it is difficult to differentiate the causative agent by clinical signs alone. Group A Streptococcus accounts for 30% of children with a sore throat, and only in these cases is antibiotic therapy definitely indicated. However, the frequency and symptomatology of streptococcal pharyngitis in adults is not well established.
  
  
  OBJECTIVE
  To examine the clinical features that could distinguish sore throat caused by beta-hemolytic group A Streptococcus in adults.
  
  
  METHODS
  Patients aged over 16 years old (n = 207) who presented with a sore throat to community clinics were examined and throat cultures were taken. The microbiologic confirmation of Group A Streptococcus was correlated with symptoms and clinical signs by univariate analysis.
  
  
  RESULTS
  About 24% of the patients with positive cultures were younger individuals. Chills, absence of cough, pain in swallowing, absence of rhinitis, headache, vomiting, tonsillar exudate, oral malodor, fever > 38 degrees C and sweats had high sensitivity but low specificity for streptococcal pharyngitis. Univariate analysis suggested that chills and pharyngeal exudate had the greatest predictive value for streptococcal pharyngitis (P = 0.044, odds ratio 2.45; P = 0.001, OR 5.49, respectively). When compared with a published scoring method (Centor criteria), large inconsistencies were found.
  
  
  CONCLUSIONS
  Our adult population had a relatively high prevalence of group A Streptococcus, and their presentation differed from that of pediatric patients. In primary care, a throat swab culture is not necessary in adults with a low score (0-1 points).
authors.affiliation: Infectious Diseases Unit, HaEmek Medical Center, Afula, Israel.
authors.forename: Bibiana
authors.initials: B
authors.lastname: Chazan
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shaabi
authors.forename: Elias
authors.initials: E
authors.lastname: Bishara
authors.forename: Raul
authors.initials: R
authors.lastname: Colodner
authors.forename: Raul
authors.initials: R
authors.lastname: Raz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000382:microbiology; D003937:Diagnosis, Differential; D005122:Exudates and Transudates / Q000382:microbiology; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018579:Patient Selection; D010612:Pharyngitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013297:Streptococcus pyogenes