title: Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis.
abstract: Nucleic acid amplification tests (NAATs) have frequently been the standard diagnostic approach when specific infectious agents are sought in a clinic specimen. They can be applied for specific agents such as S. pyogenes, or commercial multiplex NAATs for detection of a variety of pathogens in gastrointestinal, bloodstream, and respiratory infections may be used. NAATs are both rapid and sensitive. For many years, S. pyogenes testing algorithms used a rapid and specific group A streptococcal antigen test to screen throat specimens, followed, in some clinical settings, by a throat culture for S. pyogenes to increase the sensitivity of its detection. Now S. pyogenes NAATs are being used with increasing frequency. Given their accuracy, rapidity, and ease of use, should they replace antigen detection and culture for the detection of bacterial pharyngitis? Bobbi Pritt and Robin Patel of the Mayo Clinic, where S. pyogenes NAATs have been used for well over a decade with great success, will explain the advantages of this approach, while Richard (Tom) Thomson and Tom Kirn of the NorthShore University HealthSystem will discuss their concerns about this approach to diagnosing bacterial pharyngitis.
authors.affiliation: Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bobbi S
authors.initials: BS
authors.lastname: Pritt
authors.affiliation: Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA patel.robin@mayo.edu RThomson@northshore.org.
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
authors.affiliation: Departments of Pathology & Laboratory Medicine and Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kirn
authors.affiliation: Department of Pathology & Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA patel.robin@mayo.edu RThomson@northshore.org.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Thomson
mesh_terms: D000942:Antigens, Bacterial / Q000032:analysis; D001431:Bacteriological Techniques / Q000379:methods; D004269:DNA, Bacterial / Q000032:analysis; D003955:Diagnostic Tests, Routine / Q000379:methods*; D006801:Humans; D007118:Immunoassay / Q000379:methods*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D010612:Pharyngitis / Q000175:diagnosis* / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis*; D013297:Streptococcus pyogenes / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*
chemical_list: D000942:Antigens, Bacterial; D004269:DNA, Bacterial