TO THE EDITOR: The article (1) forw...

TO THE EDITOR: The article (1) forward pharyngitis by Vincent and colleagues raises several questions about their approach to diagnosis and treatment of assign places to A beta-hemolytic streptococcal pharyngitis.

They report the sensitivity and specificity of throat agriculture as 97 and 99 percent respectively, for diagnosing cluster A beta-hemolytic streptococci, citing McIsaac's article, (2) which have the appearances to be higher than reported in the literature. McIsaac and colleagues (2) compared the sensitivity and specificity of a score-based approach to the diagnosis of sore throat in their population as compared to throat agriculture but did not provide the sensitivity and specificity of throat tillage in their article. Perhaps a more accurate estimate be deriveds from the study by Gerber and colleagues. (3) The sensitivity and specificity of refinement is reported as 78 and 99 percent respectively. Similarly, in an article published in American Family Physician, Hayes and colleagues4 state that subject to ideal conditions, the sensitivity of throat agriculture for group A beta-hemolytic streptococci is single 90 percent; in office settings, the sensitivity ranges from 29 to 90 percent (4) The specificity of throat improvement is 99 percent under ideal conditions and can be anywhere from 76 to 99 percent in office settings. (4)

The authors also praise obtaining cultures if symptoms do not improve, citing the article by way of Attia. (5) Attia and colleagues sought to determine the performance of a predictive pattern for group A beta-hemolytic streptococcal pharyngitis and did not commend follow-up cultures if symptoms do not improve. (5) We fail to understand the reasons for obtaining refinements in these patients as shown in Figure 1 of the article (1) according to Vincent and colleagues because a certain quantity of of these patients have already been treated based forward rapid strep test results. It is unclear whether they intend to identify bacteriologic failures, relapse, or reinfection.

SONAL SINGH, MD

JAMES DOLAN, MD

Department of Internal Medicine

Unity Health System

1555 protracted Pond Rd.

Rochester, NY 14626

REFERENCES

(1) Vincent MT Celestin N Hussain AN. Pharyngitis. Am Fam Physician 2004;69:1465-70

(2) McIsaac WJ Goel V To T gentle DE. The validity of a sore throat score in family practice. CMAJ 2000;163:811-5

(3) Gerber MA, Tanz RR Kabat W Dennis E Bell GL Kaplan EL et al. Optical immunoassay proof for group A beta-hemolytic streptococcal pharyngitis. An office-based, multicenter investigation. JAMA 1997;277:899-903

(4) Hayes C Williamson H Jr Management of cluster A beta-hemolytic streptococcal pharyngitis [published correction appears in Am Fam Physician 2002;65:1282] Am Fam Physician 2001;63:1557-64

(5) Attia MW Zaoutis T Klein JD Meier FA. Performance of a predictive type for streptococcal pharyngitis in children [published correction appears in Arch Pediatr Adolesc M 2001;155:1179] Arch Pediatr Adolesc M 2001;155:687-91

IN REPLY: Dr Singh and Dolan raise the question of the sensitivity of throat cultivation to diagnose streptococcal pharyngitis and reinforce the importance of obtaining the specimen in a less degree than "ideal conditions." In our article, (1) we recognized the significance and described the convenient technique for obtaining a throat agriculture under the subsection "Laboratory Evaluation" and state in Table 1 a sensitivity of "97 percent ends dependent on the technique, medium, and incubation." (2) Several of the regards that support a sensitivity greater than 90 percent of throat civilization for the diagnosis of assign places to A beta-hemolytic streptococcus report a sensitivity of 90 to 97 percent when performed fitly (2-5) A question also is raised about the necessity of obtaining a throat tillage in the subset of patients who do not improve following treatment. Bisno and colleagues (2) state that these patients require reculture to identify treatment failures, reinfection, or relapse.

MIRIAM T VINCENT, M MD PHD

ANEELA N HUSSAIN, MD

State University of recently made known York-Downstate Medical Center

Department of Family Medicine

450 Clarkson Ave., chest 67

Brooklyn, NY 11203-2098

REFERENCES

(1) Vincent MT Celestin N Hussain AN. Pharyngitis. Am Fam Physician 2004;69:1465-70

(2) Bisno AL, Gerber MA, Gwaltney JM Jr Kaplan EL Schwartz RH; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of cluster A streptococcal pharyngitis. Clin Infect Dis 2002;35:113-25

(3) Gerber MA. Diagnosis of assemblage A streptococcal pharyngitis. Pediatr Ann 1998;27:269-73

(4) Bisno AL. Acute pharyngitis. N Engl J M 2001;344: 205-11

(5) Pitetti RD Wald ER Strep throat: considering the diagnostic options. Patient Care 1999;33:119-45

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