title: [Diagnosis of streptococcal pharyngotonsillitis in children and adolescents: clinical picture limitations].
abstract: OBJECTIVE
  To assess the utility of clinical features for diagnosis of streptococcal pharyngotonsillitis in pediatrics.
  
  
  METHODS
  A total of 335 children aged 1-18 years old and presenting clinical manifestations of acute pharyngotonsillitis (APT) were subjected to clinical interviews, physical examinations, and throat swab specimen collection to perform cultures and latex particle agglutination tests (LPATs) for group A streptococcus (GAS) detection. Signs and symptoms of patients were compared to their throat cultures and LPATs results. A clinical score was designed based on the multivariate logistic regression analysis and also was compared to throat cultures and LPATs results. Positive throat cultures and/ or LPATs results were used as a reference standard to establish definitive streptococcal APT diagnosis.
  
  
  RESULTS
  78 children (23.4%) showed positivity for GAS in at least one of the two diagnostic tests. Coryza absence (odds ratio [OR]=1.80; p=0.040), conjunctivitis absence (OR=2.47; p=0.029), pharyngeal erythema (OR=3.99; p=0.006), pharyngeal exudate (OR=2.02; p=0.011), and tonsillar swelling (OR=2.60; p=0.007) were significantly associated with streptococcal pharyngotonsilitis. The highest clinical score, characterized by coryza absense, pharyngeal exudate, and pharyngeal erythema had a 45.6% sensitivity, a 74.5% especificity, and a likelihood ratio of 1.79 for streptococcal pharyngotonsilitis.
  
  
  CONCLUSIONS
  Clinical presentation should not be used to confirm streptococcal pharyngotonsilitis, because its performance as a diagnostic test is low. Thus, it is necessary to enhance laboratory test availability, especially of LPATs that allow an acurate and fast diagnosis of streptococcal pharyngotonsilitis.
authors.affiliation: Universidade Federal de São João del-Rei (UFSJ), Divinópolis, MG, Brasil.
authors.forename: Aurelino Rocha
authors.initials: AR
authors.lastname: Barbosa Júnior
authors.affiliation: Universidade Federal de São João del-Rei (UFSJ), Divinópolis, MG, Brasil.
authors.forename: Cláudia Di Lorenzo
authors.initials: CD
authors.lastname: Oliveira
authors.affiliation: Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil.
authors.forename: Maria Jussara Fernandes
authors.initials: MJ
authors.lastname: Fontes
authors.affiliation: Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil.
authors.forename: Laura Maria de Lima Bezário Facury
authors.initials: LM
authors.lastname: Lasmar
authors.affiliation: Universidade Federal de São João del-Rei (UFSJ), Divinópolis, MG, Brasil. Electronic address: paulo.camargos@pq.cnpq.br.
authors.forename: Paulo Augusto Moreira
authors.initials: PA
authors.lastname: Camargos
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D007223:Infant; D010612:Pharyngitis / Q000175:diagnosis* / Q000382:microbiology*; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes; D063189:Symptom Assessment; D014069:Tonsillitis / Q000175:diagnosis / Q000382:microbiology
keywords: Adolescent; Adolescente; Children; Criança; Diagnosis; Diagnóstico; Faringite; Pharyngitis; Streptococcus