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Correspondence

Indian Pediatr 2019;56: 508

Is Modified Centor Score Sensitive for Diagnosis of Streptococcal Pharyngitis in Indian Children?

 

Prawin Kumar* and Jagdish P Goyal

Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Email: [email protected]

 


We read with great interest the recent article by Vasudevan, et al. [1] published in Indian Pediatrics. Some of the aspects of this study require attention as streptococcal pharyngitis is a common condition in routine clinical practice.

The modified Centor score is a validated score for streptococcal pharyngitis from 3 to 76 years of age; children below 3 years of age were neither included in original Centor nor in McIsaac modified Centor score. However, in this study authors had also included children below 3 years of age. Furthermore, in McIsaac modified Centor scoring, the score range from 0 to 3 in ³45 years, 0 to 4 in age 15-44 years and 0 to 5 in children 3-14 years of age [2]. The maximum score one can get is 5; however, in this study, eight children (5 in culture positive and 3 in culture negative group) had score above 5, which need clarification.

The symptom of ‘cough’ had the highest sensitivity for streptococcal pharyngitis in this study; however, absence of cough is more valid clinical indicator for the diagnosis of streptococcal pharyngitis in children, and even in modified Centor score one point is being attributed to absence of cough [3,4].

Rhinorrhea is an important symptom for viral upper respiratory tract also infection and authors had also mentioned in methodology that children with such symptoms were excluded from the study. However, fifty children (16 in culture positive and 34 in culture negative group) had rhinorrhea as one of the symptom in this study. A child with current viral infection may have false positive throat culture due to chronic streptococcal colonization [4]. These factors might have been responsible for low positive predictive value for modified Centor score for the diagnosis of streptococcal pharyngitis in this study. It would have been interesting if author could have also investigated for viral etiology in this study.

The authors presented antibiotic sensitive pattern to different antimicrobial agents used in streptococcal pharyngitis, which is very helpful information for clinical practice. However, as Penicillin or first generation cephalosporin is the antimicrobial therapy of choice in streptococcal pharyngitis, it would be informative for general practitioner if author had also provided information about resistance to these antibiotics.

References

1. Vasudevan J, Mannu A, Ganvi G. McIsaac modification of centor score in diagnosis of streptococcal pharyngitis and antibiotic sensitivity pattern of beta-hemolytic strepto-cocci in Chennai, India. Indian Pediatr. 2019;56;49-52.

2. McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004;291:1587-95.

3. Lindgren C, Neuman MI, Monuteaux MC, Mandl KD, Fine AM. Patient and parent-reported signs and symptoms for group A streptococcal pharyngitis. Pediatrics. 2016; 138:e20160317.

4. Tanz RR. Acute Pharyngitis. In: Kliegman RM, Stanton BF, St Jeme JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 1st South Asia ed. New Delhi: Elsevier;2016. p. 2017-21.

 

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