title: Comparison of illumigene Group A Streptococcus Assay with Culture of Throat Swabs from Children with Sore Throats in the New Zealand School-Based Rheumatic Fever Prevention Program.
abstract: Group A streptococcal (GAS) pharyngitis is a particularly important condition in areas of New Zealand where the incidence of acute rheumatic fever remains unacceptably high. Prompt diagnosis and treatment of GAS pharyngitis are cornerstones of the Rheumatic Fever Prevention Programme, but these are hindered by the turnaround time of culture. Tests with excellent performance and rapid turnaround times are needed. For this study, throat swabs (Copan ESwabs) were collected from schoolchildren self-identifying with a sore throat. Samples were tested by routine culture and the illumigene GAS assay using loop-mediated isothermal amplification. Discrepant results were resolved by retesting of the same specimen by an alternative molecular assay. Seven hundred fifty-seven throat swab specimens were tested by both methods. The performance characteristics of the illumigene assay using culture on blood agar as the "gold standard" and following discrepancy analysis were as follows: sensitivity, 82% and 87%, respectively; specificity, 93% and 98%, respectively; positive predictive value, 61% and 88%, respectively; and negative predictive value, 97% and 97%, respectively. In our unique setting of a school-based throat swabbing program, the illumigene assay did not perform quite as well as described in previous reports. Despite this, its improved sensitivity and rapid turnaround time compared with those of culture are appealing.
authors.affiliation: Labtests, Auckland, New Zealand arlo.upton@labtests.co.nz.
authors.forename: Arlo
authors.initials: A
authors.lastname: Upton
authors.affiliation: Labtests, Auckland, New Zealand.
authors.forename: Liselle
authors.initials: L
authors.lastname: Bissessor
authors.affiliation: Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Farrell
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Stanford T
authors.initials: ST
authors.lastname: Shulman
authors.affiliation: Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Xiaotian
authors.initials: X
authors.lastname: Zheng
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Diana
authors.initials: D
authors.lastname: Lennon
mesh_terms: D001431:Bacteriological Techniques / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D009520:New Zealand; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D010612:Pharyngitis / Q000175:diagnosis* / Q000382:microbiology; D011237:Predictive Value of Tests; D012213:Rheumatic Fever / Q000517:prevention & control; D012574:Schools; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*