title: Identification of Streptococcus pyogenes - Phenotypic Tests vs Molecular Assay (spy1258PCR): A Comparative Study.
abstract: BACKGROUND
  Traditionally Group A Streptococcus pyogenes (GAS) is differentiated from other beta haemolytic streptococci (BHS) by certain presumptive tests such as bacitracin sensitivity and production of Pyrollidonyl Aryl Sulfatase (PYR). The phenotypic and genotypic confirmatory tests are Lancefield grouping for cell wall carbohydrate antigen and PCR for spy1258 gene respectively. Reliance on presumptive tests alone may lead to misidentification of isolates.
  
  
  OBJECTIVE
  To compare the predictive values of routine phenotypic tests with spy1258 PCR for the identification of Streptococcus pyogenes.
  
  
  METHODS
  This comparative analytical study was carried out in the Department of Microbiology, JIPMER, Puducherry, over a period of 18 months (1(st) November 2013 to 30(th) April 2015). Two hundred and six consecutive BHS isolates from various clinical samples were subjected to phenotypic tests such as bacitracin sensitivity, PYR test and Lancefield grouping. The results were compared with spy1258 PCR which was considered 95 the confirmatory test for identification.
  
  
  RESULTS
  The sensitivity and specificity of phenotypic tests were as follows; Susceptibility to bacitracin - 95.42%, 70.96%, PYR test - 95.42%, 77.41%, Lancefield grouping- 97.71%, 80.64%.
  
  
  CONCLUSIONS
  Clinical laboratories should not depend on bacitracin sensitivity as a single presumptive test for the routine identification of GAS but should use supplemental tests such as PYR test or latex agglutination test and for best results use spy1258 PCR.
authors.affiliation: PhD Scholar, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: Tintu
authors.initials: T
authors.lastname: Abraham
authors.affiliation: Professor, Department of Microbiology, JIPMER , Puducherry, India .
authors.forename: Sujatha
authors.initials: S
authors.lastname: Sistla
keywords: Bacitracin sensitivity; Lancefield grouping; PYR test