A군 연쇄구균 인두염의 임상양상과 두 가지 신속항원검사의 유용성 비교
Clinical Manifestations of Group A Streptococcal Pharyngitis and Comparison of Usefulness of Two Rapid Streptococcal Antigen Tests
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배경: A군 연쇄구균에 의한 인두염을 진단하는 가장 좋은 방법은 인두배양검사이나 많은 시간이 소요되어, 경험적으로 항생제를 투여하는 경우가 상당수이다. 신속항원검사법은 총 15분만에 세균 감염 여부를 확인할 수 있어 불필요한 항생제 사용을 줄이는 데 도움이 된다. 방법: 2011년 8월부터 2012년 7월까지 급성 인두염이 의심되는 3세 이상, 17세 이하의 환자 중 108명에서 두 가지 신속항원검사로 SD Bioline Strep A (SD, Korea), BinaxNOW Strep A (Binax, Inc., USA)와 인두배양검사를 시행하여 그 결과를 비교하였고, A군 연쇄구균 인두염의 임상양상에 대해 평가하였다. 결과: 108명의 환자 중 15명에서 인두배양검사 상 A군 연쇄구균 양성으로 확인되었다. SD Bioline Strep A 검사는 민감도 93.3%, 특이도 97.8%를 보였으며 양성 예측도와 음성 예측도는 87.5%와 98.9%였다. BinaxNOW Strep A 검사는 민감도 86.7%, 특이도 100%를 보였으며 양성 예측도와 음성 예측도는 100%와 97.9%였다. 일치도를 보는 Kappa값은 SD Bioline Strep A와 BinaxNOW Strep A 검사에서 각각 0.887과 0.918으로 높았다(P=0.00). A군 연쇄구균 인두염의 임상양상 평가에서는 성홍열양 피부발진과 딸기모양의 혀만 유의하였다(P<0.05). 결론: A군 연쇄구균 인두염의 진단에서 임상양상만으로는 한계가 있으며, 두 신속항원검사법 모두 인두배양검사를 대체할 수 있는 유용한 검사로 적극적인 활용이 권장된다.
Abstract
Background: Throat culture is the golden standard for diagnosis of group A streptococcal (GAS) pharyngitis. However, because it is a time-consuming procedure, antibiotics are often empirically administrated. Rapid antigen tests (RATs) can detect bacterial infections within 15 minutes, thus helping to reduce unnecessary administration of antibiotics. Methods: In total, 108 patients, between 3 and 17 yr of age, who visited our hospital from August 2011 to July 2012, were tested for suspected acute pharyngitis with two RATs––SD Bioline Strep A (SD, Korea) and BinaxNOW Strep A (Binax, Inc., USA)––as well as throat culture. We compared the sensitivity, specificity, and consistency of the two RATs and assessed the clinical manifestations of GAS pharyngitis. Results: Of the 108 patients, 15 were confirmed to have GAS pharyngitis by throat culture. The SD test showed a sensitivity of 93.3% and a specificity of 97.8%; the positive and negative predictive values were 87.5% and 98.9%, respectively. The Binax test showed a sensitivity of 86.7% and a specificity of 100%; the positive and negative predictive values were 100% and 97.9%, respectively. The Kappa values for conformity degree were high, 0.887 and 0.918 in the SD and the Binax tests, respectively (P=0.00). Clinical manifestation assessment of GAS pharyngitis indicated that scarlatiniform rash and strawberry tongue were significantly associated signs (P<0.05). Conclusions: GAS pharyngitis diagnosis based on clinical manifestations alone has practical limitations. The two RATs are useful as substitutes for throat culture and their frequent use in clinical settings is advisable.
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