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May 16, 1986, Vol 255, No. 19 >
ARTICLE | May 16, 1986

Detection of Group A Streptococci in the Laboratory or Physician's Office: Title and subTitle BreakCulture vs Antibody Methods FREE

James A. Kellogg, PhD; John P. Manzella, MD
[+] Author Affiliations

Reprint requests to Clinical Microbiology Laboratory, York Hospital, 1001 S George St, York, PA 17405 (Dr Kellogg).


JAMA. 1986;255(19):2638-2642. doi:10.1001/jama.1986.03370190122037
Text Size: A A A
Published online
Article
References

Much controversy has existed concerning the clinical significance of small numbers of group A streptococci (eg, one to ten or even 50 colonies) recovered in culture. The relative quantity of streptococci recovered is, in part, technique dependent. This review documents the need for sensitive throat culture technology, addresses technical problems associated with the culture procedure, and, in light of these problems, explores the need for very carefully performed studies on streptococcal antigen detection kits before their implementation as a routine test either in physicians' offices or in microbiology laboratories.

(JAMA 1986;255:2638-2642)

REFERENCES

1 +
Breese BB:  Culturing β-hemolytic streptococci in pediatric practice: Observation after 20 years . J Pediatr 1969;;75:164-166.
2 +
Shulman ST, Amren DP, Bisno AL, et al:  Prevention of rheumatic fever: A statement for health professionals by the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Disease in the Young . Circulation 1984;;70:1118A-1122A.
3 +
Breese BB, Disney FA, Talpey WB, et al:  β-Hemolytic streptococcal infection: The clinical and epidemiologic importance of the number of organisms found in culture . AJDC 1970;;119:18-26.
4 +
Packer H, Arnoult MB, Sprunt DH:  A study of hemolytic streptococcal infections in relation to antistreptolysin O titer changes in orphanage children . J Pediatr 1956;;48:545-562.
5 +
Kaplan EL, Top Jr FH, Dudding BA, et al:  Diagnosis of streptococcal pharyngitis: Differentiation of active infection from the carrier state in the symptomatic child . J Infect Dis 1971;; 123:490-501.
6 +
Moffet HL: Pediatric Infectious Diseases: A Problem-Oriented Approach . New York, JB Lippincott, 1975;, pp 15-49.
7 +
Kurzynski TA, Meise CK:  Evaluation of sulfamethoxazole-trimethoprim blood agar plates for recovery of group A streptococci from throat cultures . J Clin Microbiol 1979;;9:189-193.
8 +
Randolph MF, Redys JJ, Cope JB:  Evaluation of aerobic and anaerobic methods for recovery of streptococci from throat cultures . J Pediatr 1984;;104:897-899.
9 +
Gunn BA, Ohashi DK, Gaydos CA, et al:  Selective and enhanced recovery of group A and B streptococci from throat cultures with sheep blood agar containing sulfamethoxazole and trimethoprim . J Clin Microbiol 1977;;5:650-655.
10 +
Kurzynski TA, Van Holten CM:  Evaluation of techniques for isolation of group A streptococci from throat cultures . J Clin Microbiol 1981;;13:891-894.
11 +
Beerman CA, Goldblatt SA:  Screening for group A streptococcus by means of anaerobic primary plate technique . J Pediatr 1982;;101:70-72.
12 +
Lauer BA, Reller LB, Mirrett S:  Effect of atmosphere and duration of incubation on primary isolation of group A streptococci from throat cultures . J Clin Microbiol 1983;;17:338-340.
13 +
Kaplan EL, Crouser R, Huwe BB, et al:  Significance of quantitative salivary cultures for group A and non-group A β-hemolytic streptococci in patients with pharyngitis and in their family contacts . Pediatrics 1979;;64:904-912.
14 +
Bisno AL:  Therapeutic strategies for the prevention of rheumatic fever . Ann Intern Med 1977;;86:494-496.
15 +
Cornfeld D, Hubbard JP:  A four-year study of the occurrence of β-hemolytic streptococci in 64 school children . N Engl J Med 1961;;264:211-215.
16 +
Wannamaker LW:  Changes and changing concepts in the biology of group A streptococci and in the epidemiology of streptococcal infections . Rev Infect Dis 1979;;1:967-973.
17 +
Breese BB, Denny FW, Dillon HC, et al:  Consensus: Difficult management problems in children with streptococcal pharyngitis . Pediatr Infect Dis 1985;;4:10-13.
18 +
Radetsky M, Wheeler RC, Roe MH, et al:  Comparative evaluation of kits for rapid diagnosis of group A streptococcal disease . Pediatr Infect Dis 1985;;4:274-281.
19 +
Ross PW:  Throat swabs and swabbing technique . Practitioner 1971;;207:791-796.
20 +
Saslaw MS, Jenks SA, Saul M:  Frequency of recovery of β-hemolytic streptococci as related to number of throat swabs . J Lab Clin Med 1959;;54:151-154.
21 +
Brien JH, Bass JW:  Streptococcal pharyngitis: Optimal site for throat culture . J Pediatr 1985;;106:781-783.
22 +
Todd JK:  Throat cultures in the office laboratory . Pediatr Infect Dis 1982;;1:265-270.
23 +
Breese BB, Disney FA:  The accuracy of diagnosis of β-streptococcal infections on clinical grounds . J Pediatr 1954;;44:670-673.
24 +
Saslaw MS, Streitfeld MM:  Group A β-hemolytic streptococci and rheumatic fever in Miami, Florida: I. Bacteriologic observations from October 1954 through May 1955 . Dis Chest 1959;;35:175-193.
25 +
Marenstein JH, Rogers KD:  Streptococcal pharyngitis: Early treatment and management by nurse practitioners . JAMA 1974;;227:1278-1282.
26 +
Collee JG, Watt B, Brown R, et al:  The recovery of anaerobic bacteria from swabs . J Hyg 1974;;72:339-347.
27 +
Chamovitz R, Catanzaro FJ, Stetson CA, et al:  Prevention of rheumatic fever by treatment of previous streptococcal infections: I. Evaluation of benzathine penicillin G . N Engl J Med 1954;;251:466-471.
28 +
Siegel AC, Johnson EE, Stollerman GH:  Controlled studies of streptococcal pharyngitis in a pediatric population: I. Factors related to the attack rate of rheumatic fever . N Engl J Med 1961;;265:559-566.
29 +
Wannamaker LW:  A method for culturing β-hemolytic streptococci from the throat . Circulation 1965;;32:1054-1058.
30 +
Edmond EW, Cramblett HG, Siewers CMF, et al:  Comparison of efficacy of phenoxymethyl penicillin and buffered penicillin G in treatment of streptococcal pharyngitis . J Pediatr 1966;;68:442-447.
31 +
Krober MS, Bass JW, Michels GN:  Streptococcal pharyngitis: Placebo-controlled double blind evaluation of clinical response to penicillin therapy . JAMA 1985;;253:1271-1274.
32 +
Miceika BG, Vitous AS, Thompson KD:  Detection of group A streptococcal antigen directly from throat swabs with a ten-minute latex agglutination test . J Clin Microbiol 1985;; 21:467-469.
33 +
Kaplan EL;  The throat culture: Its technique, pitfalls, limitations and meaning . Conn Med 1973;;37:45-48.
34 +
Petran EI:  Comparison of the fluorescent antibody and the bacitracin disk methods for the identification of group A streptococci . Am J Clin Pathol 1964;;41:224-226.
35 +
Schaub IG, Mazeika I, Lee R, et al:  Ecologic studies of rheumatic fever and rheumatic heart disease: I. Procedure for isolating β-hemolytic streptococci . Am J Hyg 1957;;67:46-56.
36 +
Breese BB:  β-Hemolytic streptococcus: Its bacteriologic culture and character . AJDC 1978;; 132:502-508.
37 +
Randolph MF, Redys JJ, Cope J, et al:  Streptococcal pharyngitis: Evaluation of a new diagnostic kit for clinic and office use . AJDC 1976;;130:171-172.
38 +
Schwartz RH, Quinnell RK:  Throat cultures in the office . Am Fam Physician 1980;; 21:72-78.
39 +
Sprunt K, Vail D, Asnes RS:  Identification of Streptococcus pyogenes in a pediatric outpatient department: A practical system designed for rapid results and resident training . Pediatrics 1974;;54:718-723.
40 +
Larsson P, Lind L:  The need for control of throat streptococcal cultures in general practice . Scand J Infect Dis 1983;;39( (suppl) ):79-82.
41 +
Tucker JB, Barasz D, Greenfield S, et al:  Throat culturing techniques in the family practice model unit . J Fam Pract 1981;;12:925-931.
42 +
Dykstra MA, McLaughlin JC, Bartlett RC:  Comparison of media and techniques for detection of group A streptococci in throat swab specimens . J Clin Microbiol 1979;;9:236-238.
43 +
Murray PR, Wold AD, Schreck CA, et al:  Effects of selective media and atmosphere of incubation on the isolation of group A streptococci . J Clin Microbiol 1976;;4:54-56.
44 +
Libertin CR, Wold AD, Washington JA II:  Effects of trimethoprim-sulfamethoxazole and incubation atmosphere on isolation of group A streptococci . J Clin Microbiol 1983;;18:680-682.
45 +
Hayden GF, Dudley S, Hendley JO:  Use of an anaerobic jar in processing pediatric throat cultures . Clin Pediatr 1984;;23:224-227.
46 +
Belli DC, Auckenthaler R, Paunier L, et al:  Throat cultures for group A β-hemolytic streptococcus . AJDC 1984;;138:274-276.
47 +
Marraro RV:  Reduced oxygen tension for recovery of (group A) streptococci in throat cultures . Am J Med Tech 1974;;40:41-44.
48 +
Smith RE, Pease NMF, Reiquam CW, et al:  A comparison of multiple technics in the recovery of group A streptococci from throat cultures of children . Am J Clin Pathol 1965;;44:689-694.
49 +
Pien FD, Ow CL, Isaacson NS, et al:  Evaluation of anaerobic incubation for recovery of group A streptococci from throat cultures . J Clin Microbiol 1979;;10:392-393.
50 +
Kellogg JA, Bankert DA, Levisky JS:  Suitability of a throat culture method for evaluation of group A streptococcal antigen detection kits . Am J Clin Pathol , in press.
51 +
Carlson JR, Merz WG, Hansen BE, et al:  Improved recovery of group A β-hemolytic streptococci with a new selective medium . J Clin Microbiol 1985;;21:307-309.
52 +
Radetsky M, Todd JK:  Criteria for the evaluation of new diagnostic tests . Pediatr Infect Dis 1984;;3:461-466.
53 +
Campos JM, Charilaou CC:  Evaluation of Detect-A-Strep and the Culturette Ten-Minute Strep ID kits for detection of group A streptococcal antigen in oropharyngeal swabs from children . J Clin Microbiol 1985;;22:145-148.
54 +
Slifkin M. Gil GM:  Evaluation of the Culturette brand Ten-Minute Group A Strep ID technique . J Clin Microbiol 1984;;20:12-14.
55 +
Matteson ML, Anhalt JP:  Effect of delay in processing on the performance of Directigen for the detection of group A streptococci in throat swabs . J Clin Microbiol 1985;;21:993-994.
56 +
Miller JM, Phillips HL, Graves RK, et al:  Evaluation of the Directigen Group A Strep Test Kit . J Clin Microbiol 1984;;20:846-848.
57 +
Berkowitz CD, Anthony BF, Kaplan EL, et al:  Cooperative study of latex agglutination to identify group A streptococcal antigen on throat swabs in patients with acute pharyngitis . J Pediatr 1985;;107:89-92.
58 +
Chang MJ, Mohla C:  Ten-minute detection of group A streptococci in pediatric throat swabs . J Clin Microbiol 1985;;21:258-259.
59 +
McCusker JJ, McCoy EL, Young CL, et al:  Comparison of Directigen Group A Strep Test with a traditional culture technique for detection of group A β-hemolytic streptococci . J Clin Microbiol 1984;;20:824-825.
60 +
Gerber MA, Spadaccini LJ, Wright LL, et al:  Latex agglutination tests for rapid identification of group A streptococci directly from throat swabs . J Pediatr 1984;;105:702-705.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Breese BB:  Culturing β-hemolytic streptococci in pediatric practice: Observation after 20 years . J Pediatr 1969;;75:164-166.
2 +
Shulman ST, Amren DP, Bisno AL, et al:  Prevention of rheumatic fever: A statement for health professionals by the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Disease in the Young . Circulation 1984;;70:1118A-1122A.
3 +
Breese BB, Disney FA, Talpey WB, et al:  β-Hemolytic streptococcal infection: The clinical and epidemiologic importance of the number of organisms found in culture . AJDC 1970;;119:18-26.
4 +
Packer H, Arnoult MB, Sprunt DH:  A study of hemolytic streptococcal infections in relation to antistreptolysin O titer changes in orphanage children . J Pediatr 1956;;48:545-562.
5 +
Kaplan EL, Top Jr FH, Dudding BA, et al:  Diagnosis of streptococcal pharyngitis: Differentiation of active infection from the carrier state in the symptomatic child . J Infect Dis 1971;; 123:490-501.
6 +
Moffet HL: Pediatric Infectious Diseases: A Problem-Oriented Approach . New York, JB Lippincott, 1975;, pp 15-49.
7 +
Kurzynski TA, Meise CK:  Evaluation of sulfamethoxazole-trimethoprim blood agar plates for recovery of group A streptococci from throat cultures . J Clin Microbiol 1979;;9:189-193.
8 +
Randolph MF, Redys JJ, Cope JB:  Evaluation of aerobic and anaerobic methods for recovery of streptococci from throat cultures . J Pediatr 1984;;104:897-899.
9 +
Gunn BA, Ohashi DK, Gaydos CA, et al:  Selective and enhanced recovery of group A and B streptococci from throat cultures with sheep blood agar containing sulfamethoxazole and trimethoprim . J Clin Microbiol 1977;;5:650-655.
10 +
Kurzynski TA, Van Holten CM:  Evaluation of techniques for isolation of group A streptococci from throat cultures . J Clin Microbiol 1981;;13:891-894.
11 +
Beerman CA, Goldblatt SA:  Screening for group A streptococcus by means of anaerobic primary plate technique . J Pediatr 1982;;101:70-72.
12 +
Lauer BA, Reller LB, Mirrett S:  Effect of atmosphere and duration of incubation on primary isolation of group A streptococci from throat cultures . J Clin Microbiol 1983;;17:338-340.
13 +
Kaplan EL, Crouser R, Huwe BB, et al:  Significance of quantitative salivary cultures for group A and non-group A β-hemolytic streptococci in patients with pharyngitis and in their family contacts . Pediatrics 1979;;64:904-912.
14 +
Bisno AL:  Therapeutic strategies for the prevention of rheumatic fever . Ann Intern Med 1977;;86:494-496.
15 +
Cornfeld D, Hubbard JP:  A four-year study of the occurrence of β-hemolytic streptococci in 64 school children . N Engl J Med 1961;;264:211-215.
16 +
Wannamaker LW:  Changes and changing concepts in the biology of group A streptococci and in the epidemiology of streptococcal infections . Rev Infect Dis 1979;;1:967-973.
17 +
Breese BB, Denny FW, Dillon HC, et al:  Consensus: Difficult management problems in children with streptococcal pharyngitis . Pediatr Infect Dis 1985;;4:10-13.
18 +
Radetsky M, Wheeler RC, Roe MH, et al:  Comparative evaluation of kits for rapid diagnosis of group A streptococcal disease . Pediatr Infect Dis 1985;;4:274-281.
19 +
Ross PW:  Throat swabs and swabbing technique . Practitioner 1971;;207:791-796.
20 +
Saslaw MS, Jenks SA, Saul M:  Frequency of recovery of β-hemolytic streptococci as related to number of throat swabs . J Lab Clin Med 1959;;54:151-154.
21 +
Brien JH, Bass JW:  Streptococcal pharyngitis: Optimal site for throat culture . J Pediatr 1985;;106:781-783.
22 +
Todd JK:  Throat cultures in the office laboratory . Pediatr Infect Dis 1982;;1:265-270.
23 +
Breese BB, Disney FA:  The accuracy of diagnosis of β-streptococcal infections on clinical grounds . J Pediatr 1954;;44:670-673.
24 +
Saslaw MS, Streitfeld MM:  Group A β-hemolytic streptococci and rheumatic fever in Miami, Florida: I. Bacteriologic observations from October 1954 through May 1955 . Dis Chest 1959;;35:175-193.
25 +
Marenstein JH, Rogers KD:  Streptococcal pharyngitis: Early treatment and management by nurse practitioners . JAMA 1974;;227:1278-1282.
26 +
Collee JG, Watt B, Brown R, et al:  The recovery of anaerobic bacteria from swabs . J Hyg 1974;;72:339-347.
27 +
Chamovitz R, Catanzaro FJ, Stetson CA, et al:  Prevention of rheumatic fever by treatment of previous streptococcal infections: I. Evaluation of benzathine penicillin G . N Engl J Med 1954;;251:466-471.
28 +
Siegel AC, Johnson EE, Stollerman GH:  Controlled studies of streptococcal pharyngitis in a pediatric population: I. Factors related to the attack rate of rheumatic fever . N Engl J Med 1961;;265:559-566.
29 +
Wannamaker LW:  A method for culturing β-hemolytic streptococci from the throat . Circulation 1965;;32:1054-1058.
30 +
Edmond EW, Cramblett HG, Siewers CMF, et al:  Comparison of efficacy of phenoxymethyl penicillin and buffered penicillin G in treatment of streptococcal pharyngitis . J Pediatr 1966;;68:442-447.
31 +
Krober MS, Bass JW, Michels GN:  Streptococcal pharyngitis: Placebo-controlled double blind evaluation of clinical response to penicillin therapy . JAMA 1985;;253:1271-1274.
32 +
Miceika BG, Vitous AS, Thompson KD:  Detection of group A streptococcal antigen directly from throat swabs with a ten-minute latex agglutination test . J Clin Microbiol 1985;; 21:467-469.
33 +
Kaplan EL;  The throat culture: Its technique, pitfalls, limitations and meaning . Conn Med 1973;;37:45-48.
34 +
Petran EI:  Comparison of the fluorescent antibody and the bacitracin disk methods for the identification of group A streptococci . Am J Clin Pathol 1964;;41:224-226.
35 +
Schaub IG, Mazeika I, Lee R, et al:  Ecologic studies of rheumatic fever and rheumatic heart disease: I. Procedure for isolating β-hemolytic streptococci . Am J Hyg 1957;;67:46-56.
36 +
Breese BB:  β-Hemolytic streptococcus: Its bacteriologic culture and character . AJDC 1978;; 132:502-508.
37 +
Randolph MF, Redys JJ, Cope J, et al:  Streptococcal pharyngitis: Evaluation of a new diagnostic kit for clinic and office use . AJDC 1976;;130:171-172.
38 +
Schwartz RH, Quinnell RK:  Throat cultures in the office . Am Fam Physician 1980;; 21:72-78.
39 +
Sprunt K, Vail D, Asnes RS:  Identification of Streptococcus pyogenes in a pediatric outpatient department: A practical system designed for rapid results and resident training . Pediatrics 1974;;54:718-723.
40 +
Larsson P, Lind L:  The need for control of throat streptococcal cultures in general practice . Scand J Infect Dis 1983;;39( (suppl) ):79-82.
41 +
Tucker JB, Barasz D, Greenfield S, et al:  Throat culturing techniques in the family practice model unit . J Fam Pract 1981;;12:925-931.
42 +
Dykstra MA, McLaughlin JC, Bartlett RC:  Comparison of media and techniques for detection of group A streptococci in throat swab specimens . J Clin Microbiol 1979;;9:236-238.
43 +
Murray PR, Wold AD, Schreck CA, et al:  Effects of selective media and atmosphere of incubation on the isolation of group A streptococci . J Clin Microbiol 1976;;4:54-56.
44 +
Libertin CR, Wold AD, Washington JA II:  Effects of trimethoprim-sulfamethoxazole and incubation atmosphere on isolation of group A streptococci . J Clin Microbiol 1983;;18:680-682.
45 +
Hayden GF, Dudley S, Hendley JO:  Use of an anaerobic jar in processing pediatric throat cultures . Clin Pediatr 1984;;23:224-227.
46 +
Belli DC, Auckenthaler R, Paunier L, et al:  Throat cultures for group A β-hemolytic streptococcus . AJDC 1984;;138:274-276.
47 +
Marraro RV:  Reduced oxygen tension for recovery of (group A) streptococci in throat cultures . Am J Med Tech 1974;;40:41-44.
48 +
Smith RE, Pease NMF, Reiquam CW, et al:  A comparison of multiple technics in the recovery of group A streptococci from throat cultures of children . Am J Clin Pathol 1965;;44:689-694.
49 +
Pien FD, Ow CL, Isaacson NS, et al:  Evaluation of anaerobic incubation for recovery of group A streptococci from throat cultures . J Clin Microbiol 1979;;10:392-393.
50 +
Kellogg JA, Bankert DA, Levisky JS:  Suitability of a throat culture method for evaluation of group A streptococcal antigen detection kits . Am J Clin Pathol , in press.
51 +
Carlson JR, Merz WG, Hansen BE, et al:  Improved recovery of group A β-hemolytic streptococci with a new selective medium . J Clin Microbiol 1985;;21:307-309.
52 +
Radetsky M, Todd JK:  Criteria for the evaluation of new diagnostic tests . Pediatr Infect Dis 1984;;3:461-466.
53 +
Campos JM, Charilaou CC:  Evaluation of Detect-A-Strep and the Culturette Ten-Minute Strep ID kits for detection of group A streptococcal antigen in oropharyngeal swabs from children . J Clin Microbiol 1985;;22:145-148.
54 +
Slifkin M. Gil GM:  Evaluation of the Culturette brand Ten-Minute Group A Strep ID technique . J Clin Microbiol 1984;;20:12-14.
55 +
Matteson ML, Anhalt JP:  Effect of delay in processing on the performance of Directigen for the detection of group A streptococci in throat swabs . J Clin Microbiol 1985;;21:993-994.
56 +
Miller JM, Phillips HL, Graves RK, et al:  Evaluation of the Directigen Group A Strep Test Kit . J Clin Microbiol 1984;;20:846-848.
57 +
Berkowitz CD, Anthony BF, Kaplan EL, et al:  Cooperative study of latex agglutination to identify group A streptococcal antigen on throat swabs in patients with acute pharyngitis . J Pediatr 1985;;107:89-92.
58 +
Chang MJ, Mohla C:  Ten-minute detection of group A streptococci in pediatric throat swabs . J Clin Microbiol 1985;;21:258-259.
59 +
McCusker JJ, McCoy EL, Young CL, et al:  Comparison of Directigen Group A Strep Test with a traditional culture technique for detection of group A β-hemolytic streptococci . J Clin Microbiol 1984;;20:824-825.
60 +
Gerber MA, Spadaccini LJ, Wright LL, et al:  Latex agglutination tests for rapid identification of group A streptococci directly from throat swabs . J Pediatr 1984;;105:702-705.

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