Clinical Application of a Scoring System in the Diagnosis of Group A Streptococcal Pharyngitis

PURPOSE: A scoring system could be clinically useful in determining cases in which a throat culture may be omitted or in cases whether antibiotics may be initiated or not. We propose to make a clinical guideline of antibiotics administration in patients with pharyngitis. METHODS: From Apr. 1996. to Mar. 1997, throat cultures were taken from 321 cases (72 cases from Kyung-Hee Medical Center, 249 cases from 3 local pediatric clinics). On the first day of visit, 9 clinical items on a score-card were checked and a tentative diagnosis for streptococcal or non-streptococcal infection was made. These clinical scores were compared with the results of the throat swab cultures. RESULTS: Of 321 cases with pharyngitis, 55 cases (17%) proved to have group A streptococci by throat culture. The positive culture rate of group A streptococci was 18.5% from 3 local pediatric clinics, and 12.5% from Kyung-Hee Medical Center. The positive culture rate of group A streptococci were 40% in above 31 points of score, 31.5% in 29 to 30 points, 20.5% in 27 to 28 points. The sensitivity and specificity of the scoring system using a score at least 28 above points were 71% and 67%, respectively. CONCLUSION: The clinical diagnosis of streptococcal pharyngitis indicates that patients age 5 to 10 years, findings of abnormal pharynx, high fever and no past history of antibiotics use. Further modification of the scoring system for diagnosis of streptococcal pharyngitis should be made to prevent antibiotics abuse and correct diagnosis of pharyngitis.

A Case of Takayasu's Arteritis : Managed with Percutaneous Transluminal Angioplasty

Takayasu's arteritis is a chronic vasculitic disease of the aorta, its major branches and the pulmonary arteries, resulting in stenosing, occlusive or aneurysmal lesion. While the precise etiology of Takayasu's disease is unknown, an autoimmune mechanism or active tuberculous inflammation have been suggested. It is more common in young oriental women but has a rare incidence in children. We experienced a case of Takayasu arteritis type IV in an 8years old girl. The diagnosis was made by physial examination and digital substraction aortography(DSA) which showed narrowing of left common carotid artery, right subclavin artery and left renal artery. The perfusion defect at posterior segment of right upper lobe was noted in lung perfusion scan. Medical treatment and percutaneous transluminal angioplasty(PTA) were performed. In addition to case report, a brief review of literature was added.