Dijagnostičke karakteristike McIsaac skora za streptokokni faringitis grupe A kod dece mlađe od tri godine
Scindeks Asistent Scindeks Asistent
PDF (engleski)

Kako citirati

1.
Pavlović M, Berenji K, Rokvić Željko, Ilić T. Dijagnostičke karakteristike McIsaac skora za streptokokni faringitis grupe A kod dece mlađe od tri godine. Vojnosanit Pregl [Internet]. 26. Maj 2026. [citirano 26. Juli 2026.];83(05). Dostupno na: https://test.aseestant.ceon.rs/index.php/vsp/article/view/64905

Sažetak

Uvod/Cilj. Faringitis izazvan β-hemolitičkim streptokokom grupe A (group A β-hemolytic streptococcus – GAS) najčešće pogađa decu školskog uzrasta. Cilj rada bio je da se procene efikasnost i klinička primenljivost McIsaac skora u dijagnostikovanju faringitisa izazvanog GAS-om kod dece mlađe od 3 godine. Metode. Retrospektivnom studijom obuhvaćeno je 282 dece mlađe od 3 godine, kojima je postavljena dijagnoza akutni faringitis u pedijatrijskoj ambulanti u Subotici, Srbija, u periodu od septembra 2023. do avgusta 2024. godine. Prikupljeni su podaci o demografskim i kliničkim karakteristikama, uključujući vrednosti McIsaac skora. Dobijeni rezultati analizirani su u odnosu na nalaze brzog antigenskog testa (rapid antigen detection test – RADT), koji je urađen svakom detetu. Rezultati. Od ukupno 282 dece, 143 (50,7%) bilo je RADT pozitivno. McIsaac skor pokazao je ograničenu dijagnostičku tačnost, sa vrednostima  osetljivosti i specifičnosti za rezultate 0–2 od 69,9% i 38,1%, redom, i za rezultate 3–4 od 30,7% i 61,9%, redom. Analizom receiver operating characteristic (ROC) krive dobijena je vrednost površine ispod krive (area under the curve – AUC) od 0,561. Odsustvo kašlja bio je jedini pojedinačni kriterijum McIsaac skora značajno povezan sa pozitivnim nalazom RADT-a. Zaključak. McIsaac skor, sam po sebi, ima ograničenu efikasnost u prepoznavanju GAS izazvanog faringitisa kod dece mlađe od 3 godine. S obzirom na značajno preklapanje simptoma bakterijskih i virusnih infekcija u ovoj uzrasnoj grupi, neophodne su dodatne dijagnostičke metode radi unapređenja tačnosti dijagnoze.

Ključne reči

deca, predškolska;
dijagnoza;
odojče;
faringitis;
dijagnostički testovi, brzi;
streptococcus pyogenes.
DOI: 10.2298/VSP260212026P

Reference

Sauve L, Forrester AM, Top KA. Group A streptococcal phar-yngitis: A practical guide to diagnosis and treatment. Paediatr Child Health 2021; 26(5): 319–20. DOI: 10.1093/pch/pxab025.

Oliver J, Malliya Wadu E, Pierse N, Moreland NJ, Williamson DA, Baker MG. Group A Streptococcus pharyngitis and phar-yngeal carriage: A meta-analysis. PLoS Negl Trop Dis 2018; 12(3): e0006335. DOI: 10.1371/journal.pntd.0006335.

Van Howe RS, Kusnier LP. Diagnosis and management of phar-yngitis in a pediatric population based on cost-effectiveness and projected health outcomes. Pediatrics 2006; 117(3): 609–19. DOI: 10.1542/peds.2005-0879.

Di Pietro GM, Marchisio P, Bosi P, Castellazzi ML, Lemieux P. Group A Streptococcal Infections in Pediatric Age: Updates about a Re-Emerging Pathogen. Pathogens 2024; 13(5): 350. DOI: 10.3390/pathogens13050350.

Hall MC, Kieke B, Gonzales R, Belongia EA. Spectrum bias of a rapid antigen detection test for group A beta-hemolytic strep-tococcal pharyngitis in a pediatric population. Pediatrics 2004; 114(1): 182–6. DOI: 10.1542/peds.114.1.182.

Cohen JF, Tanz RR, Shulman ST. Group A Streptococcus phar-yngitis in Children: New Perspectives on Rapid Diagnostic Testing and Antimicrobial Stewardship. J Pediatric Infect Dis Soc 2024; 13(4): 250–6. DOI: 10.1093/jpids/piae022.

Taylor A, Webb R. Fifteen-minute consultation: Group A streptococcal pharyngitis, diagnosis and treatment in children. Arch Dis Child Educ Pract Ed 2024; 109(5): 210–21. DOI: 10.1136/archdischild-2023-325755.

Maness DL, Martin M, Mitchell G. Poststreptococcal illness: Recognition and management. Am Fam Physician 2018; 97(8): 517–22.

Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981; 1(3): 239–46. DOI: 10.1177/0272989X8100100304.

McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998; 158(1): 75–83.

Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Group A β-hemolytic Streptococcal Pharyngitis: An Updated Review. Curr Pediatr Rev 2024; 21(1): 2–17. DOI: 10.2174/1573396320666230726145436.

Langlois DM, Andreae M. Group A streptococcal infections. Pediatr Rev 2011; 32(10): 423–9. DOI: 10.1542/pir.32-10-423.

Grüber C, Keil T, Kulig M, Roll S, Wahn U, Wahn V; MAS-90 Study Group. History of respiratory infections in the first 12 years among children from a birth cohort. Pediatr Allergy Im-munol 2008; 19(6): 505–12. DOI: 10.1111/j.1399-3038.2007. 00688.x.

Von Linstow ML, Holst KK, Larsen K, Koch A, Andersen PK, Høgh B. Acute respiratory symptoms and general illness during the first year of life: A population-based birth cohort study. Pediatr Pulmonol 2008; 43(6): 584–93. DOI: 10.1002/ppul.20828.

Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and man-agement of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55(10): 1279–82. DOI: 10.1093/cid/cis847. Erratum in: Clin Infect Dis 2014; 58(10): 1496.

Ruffle A, Beattie G, Prasai A, Jeanes A, Paddock M. Fifteen-minute consultation: A structured approach to the child with palpable cervical lymph nodes. Arch Dis Child Educ Pract Ed 2023; 108(5): 326–9. DOI: 10.1136/archdischild-2020-321378.

Mathews L. Pain in children: neglected, unaddressed and mis-managed. Indian J Palliat Care 2011; 17(Suppl): S70–3. DOI: 10.4103/0973-1075.76247.

Colvin JM, Muenzer JT, Jaffe DM, Smason A, Deych E, Shannon WD, et al. Detection of viruses in young children with fever without an apparent source. Pediatrics 2012; 130(6): e1455–62. DOI: 10.1542/peds.2012-1391.

Trautner BW, Caviness AC, Gerlacher GR, Demmler G, Macias CG. Prospective evaluation of the risk of serious bacterial in-fection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher). Pediatrics 2006; 118(1): 34–40. DOI: 10.1542/peds.2005-2823.

Coutinho G, Duerden M, Sessa A, Caretta-Barradas S, Altiner A. Worldwide comparison of treatment guidelines for sore throat. Int J Clin Pract 2021; 75(5): e13879. DOI: 10.1111/ijcp.13879.

Le Marechal F, Martinot A, Duhamel A, Pruvost I, Dubos F. Streptococcal pharyngitis in children: A meta-analysis of clini-cal decision rules and their clinical variables. BMJ Open 2013; 3(1): e001482. DOI: 10.1136/bmjopen-2012-001482.

Kanagasabai A, Evans C, Jones HE, Hay AD, Dawson S, Savović J, et al. Systematic review and meta-analysis of the accuracy of McIsaac and Centor score in patients presenting to secondary care with pharyngitis. Clin Microbiol Infect 2024; 30(4): 445–52. DOI: 10.1016/j.cmi.2023.12.025.

Nussinovitch M, Finkelstein Y, Amir J, Varsano I. Group A beta-hemolytic streptococcal pharyngitis in preschool children aged 3 months to 5 years. Clin Pediatr (Phila) 1999; 38(6): 357–60. DOI: 10.1177/000992289903800606.

Amir J, Shechter Y, Eilam N, Varsano I. Group A beta-hemolytic streptococcal pharyngitis in children younger than 5 years. Isr J Med Sci 1994; 30(8): 619–22.

Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: A meta-analysis. Pediatrics 2010; 126(3): e557–64. DOI: 10.1542/peds.2009-2648.

Mendes N, Miguéis C, Lindo J, Gonçalves T, Miguéis A. Retro-spective study of group A Streptococcus oropharyngeal infec-tion diagnosis using a rapid antigenic detection test in a paedi-atric population from the central region of Portugal. Eur J Clin Microbiol Infect Dis 2021; 40(6): 1235–43. DOI: 10.1007/s10096-021-04157-x.

Stefaniuk E, Bosacka K, Wanke-Rytt M, Hryniewicz W. The use of rapid test QuikRead go® Strep A in bacterial pharyngotonsil-litis diagnosing and therapeutic decisions. Eur J Clin Microbiol Infect Dis 2017; 36(10): 1733–8. DOI: 10.1007/s10096-017-2986-8.

Azrad M, Danilov E, Goshen S, Nitzan O, Peretz A. Detection of group A Streptococcus in pharyngitis by two rapid tests: Comparison of the BD Veritor™ and the QuikRead go® Strep A. Eur J Clin Microbiol Infect Dis 2019; 38(6): 1179–85. DOI: 10.1007/s10096-019-03527-w.

Ranin L, Opavski N, Djukic S, Mijac V. Epidemiology of dis-eases caused by Streptococcus pyogenes in Serbia during a nine-year period (1991–1999). Indian J Med Res 2004; 119(Suppl): 155–9.

Rick AM, Zaheer HA, Martin JM. Clinical features of group A Streptococcus in children with pharyngitis: Carriers versus acute infection. Pediatr Infect Dis J 2020; 39(6): 483–8. DOI: 10.1097/INF.0000000000002602.