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The prediction of streptococcal pharyngitis in adults

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Abstract

The usefulness of clinical and laboratory findings for prediction of the presence of Group A streptococci on throat culture and of an increase in antistreptococcal antibodies was investigated in 693 adult patients. Several findings were shown to increase the likelihood of streptococcal isolation, alone and in combination: tonsillar exudate, tonsillar enlargement, tender anterior cervical adenopathy, myalgias, and a positive throat culture in the preceding year. Compared with a frequency of 9.7% in all patients, the probabilities of a positive culture were quite different (ranging from 2 to 53%) in subgroups of patients with different combinations of these clinical findings. The results of a leukocyte count and measurement of C-reactive protein added little additional predictive information. While clinical findings can never predict perfectly the results of a throat culture, they nevertheless can provide useful information — particularly in tending to “rule out” streptococcal infection — in adult patients with pharyngitis.

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Received from the Divisions of General Medicine and Primary Care, Joint Department of Medicine, Brigham and Women’s Hospital and Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts: the Charles A. Dana Research Center and the Harvard-Thorndike Laboratory: the Institute for Health Research, Harvard School of Public Health: the Harvard Community Health Plan (Kenmore Branch), Boston, Massachusetts; and the Rhode Island Group Health Association, Providence, Rhode Island.

Supported by grants from the National Center for Health Services Research (HS 02063 and HS 04066) and grants from the Commonwealth Fund, and the Robert Wood Johnson Foundation.

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Komaroff, A.L., Pass, T.M., Aronson, M.D. et al. The prediction of streptococcal pharyngitis in adults. J Gen Intern Med 1, 1–7 (1986). https://doi.org/10.1007/BF02596317

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