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Journal of Tropical Pediatrics Advance Access published online on March 29, 2008
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmm122
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© The Author [2008]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Variation in Clinical Presentation of Childhood Group A Streptococcal Pharyngitis in Four Countries

Anne W. Rimoina, Christa L. Fischer Walkerb, Rohit A. Chitalec, Hala S. Hamzad, A. Vincee, Dace Gardovskaf, Antonio L. da Cunhag, S. Qazih and Mark C. Steinhoffb

aDepartment of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
bDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
cCoordinating Office of Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
dDepartment of Pediatrics, University of Cairo, Egypt
eDepartment of Infectious Disease Hospital, Zagreb, Croatia
fDepartment of Pediatrics, Children University Clinical Hospital, Riga, Latvia
gDepartment of Pediatrics, Federal University of Rio de Janeiro, Brazil
hDepartment of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland

Correspondence: Anne W. Rimoin PhD, MPH, UCLA School of Public Health, Department of Epidemiology, CHS 71-279B, Los Angeles, CA 90095, USA. E-mail < arimoin{at}ucla.edu>.


  Abstract

We conducted a cross-sectional study from September 2001 to August 2003 during which children between 2 and 12 years of age presenting with complaint of sore throat were recruited from urban pediatric clinics in Brazil, Croatia, Egypt and Latvia. The objective of the study was to compare clinical signs and symptoms of children presenting to urban pediatric clinics with sore throat in and between countries and to identify common clinical criteria predicting group A beta hemolytic streptococcal (GAS) pharyngitis. Using a single standard protocol in all four sites, clinical data were recorded and throat swabs obtained for standard GAS culture in 2040 children. Signs and symptoms were tested for statistical association with GAS positive/negative pharyngitis, and were compared using {chi}2 tests, ANOVA and Odds Ratios. Clinical signs of GAS pharyngitis in children presenting to clinics varied significantly between countries, and there were few signs or symptom that could statistically be associated with GAS pharyngitis in all four countries, though several were useful in two or three countries. Our results indicate that the clinical manifestations of pharyngitis in clinics may vary by region. It is therefore critical that clinical decision rules for management of pharyngitis should have local validation.

Key Words: clinical signs • streptococcal pharyngitis • Group A beta hemolytic streptococcal (GAS)


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