A Comparison of Clinical Characteristics between Adenoviral and Group A Streptococcal Pharyngitis in Children

So Hyong Kim; Hye Ryeong Jeong; In Uk Kim; Mu Yeol Yang; Sung Min Cho; Eun Kyeong Kang

doi:10.14776/kjpid.2014.21.2.121

Journal List > Korean J Pediatr Infect Dis > v.21(2) > 1096422

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Jeong, Kim, Yang, Cho, and Kang: A Comparison of Clinical Characteristics between Adenoviral and Group A Streptococcal Pharyngitis in Children

Original Article

Korean J Pediatr Infect Dis 2014;21(2):121-128.

Published online: 20 January 2014

DOI: https://doi.org/10.14776/kjpid.2014.21.2.121

A Comparison of Clinical Characteristics between Adenoviral and Group A Streptococcal Pharyngitis in Children

So Hyong Kim, M.D., Hye Ryeong Jeong, M.D., In Uk Kim, M.D., Mu Yeol Yang, M.D., Sung Min Cho, M.D., Eun Kyeong Kang, M.D.

Department of Pediatrics, Dongguk University Ilsan Hospital, Koyang, Korea

Revised 20 February 2014 Revised 28 April 2014 Accepted NaN May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the clinical characteristics and laboratory finding between adenoviral and group A streptococcal (GAS) pharyngitis. Methods: A retrospective review of medical records was performed in the patients with adenovirus infection among those who were admitted for febrile respiratory disease from January 2011 to July 2013 and GAS pharyngitis among those who visited for symptoms of scarlet fever from August 2006 to July 2013. Results: 179 patients (AV1 group) were diagnosed with adenoviral pharyngitis and 37 (AV2 group) of these patients had adenovirus single infection. 26 patients (GAS group) were diagnosed with scarlet fever. Adenoviral infection (AV2 group) developed in younger patients compared to GAS group (2.8±2.1 years vs. 5.4±1.8 years, P=0.000). Total durations of fever and admission were longer in AV2 (6.3±2.6 days vs. 3.3±1.9 days, P=0.000; 4.1±1.2 days vs. 1.9±1.8 days, P=0.000, respectively). WBC counts were higher in AV2 (11,449±5,680 cells/mm² vs. 6,722±6,941 cells/mm², P=0.000). CRP was not significantly different between AV2 and GAS group (3.8±3.2 mg/dL vs. 5.2±5.1 mg/dL, P=0.368). No difference was found between two groups in the percentage of antibiotics use (91.9% vs. 100%, P=0.261). Conclusion: Clinical characteristics and measures of inflammation in the laboratory findings were similar between adenoviral and GAS pharyngitis group. It is necessary to conduct the test for respiratory virus and bacteria in early stage to differentiate in the pharyngitis patients with leukocytosis and elevation of CRP level.

Keywords: Adenovirus, Pharyngitis, Group A streptococcus, WBC, CRP

References

1. Kwon HJ, Rhie YJ, Seo WH, Jang GY, Choi BM, Lee JH, et al. Clinical manifestations of respiratory adenoviral infection among hospitalized children in Korea. Pediatrics International. 2013; 55:450–4.

2. Kawasaki Y, Hosoya M, Katayose M, Suzuki H. Correlation between serum interleukin 6 and C-reactive protein concentrations in patients with adenoviral respiratory infection. Pediatr Infect Dis J. 2002; 21:370–4.

3. Chen HL, Chiou SS, Hsiao HP, Ke GM, Lin YC, Lin KH, et al. Respiratory adenoviral infections in children: a study of hospitalized cases in southern Taiwan in 2001–2002, J Trop Pediatr. 2004; 50:279–84.

4. Cherry JD. Adenoviruses. Feigin RD, Cherry JD, editors. editors.Textbook of Pediatric Infectious Disease. 2nd ed.Philadelphia: WB Saunders Co;2006. p. 1666–84.

5. Ruuskanen O, Meurman O, Sarkkinen H. Adenoviral diseases in children: a study of 105 cases. Pediatrics. 1985; 76:79–83.

6. Putto A, Meurman O, Ruuskanen O. C-reactive protein in the differentiation of adenoviral, Epstein-Barr viral and streptococcal tonsillitis in children. Eur J Pediatr. 1986; 145:204–6.

7. Mistchenko AS, Diez RA, Mariani AL, Robaldo J, Maffey AF, Bay-ley-Bustamante G, et al. Cytokines in adenoviral disease in children: association of interleukin-6, inter-leukin-8, and tumor necrosis factor alpha levels with clinical outcome. J Pediatr. 1994; 124:714–20.

8. Peltola V, Mertsola J, Ruuskanen O. Comparison of total white blood cell count and serum c-reactive protein levels in confirmed bacterial and viral infections. J Pediatr. 2006; 149:721–4.

9. American College of Emergency Physicians Clinical Policies Committee; Subcommittee on Pediatric Fever. Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med. 2003; 42:530–45.

10. Toikka P, Irjala K, Juvé n T, Virkki R, Mertsola J, Leinonen M, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J. 2000; 19:598–602.

11. Jartti T, Lehtinen P, Vuorinen T, Ö sterback R, van den Hoogen B, Osterhaus AD, et al. Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children. Emerg Infect Dis. 2004; 10:1095–101.

12. Ruuskanen O, Sarkkinen H, Meurman O, Hurme P, Rossi T, Halonen P, et al. Rapid diagnosis of adenoviral tonsillitis: a prospective clinical study. J Pediatr. 1984; 104:725–8.

13. Dominguez O, Rojo P, de Las Heras S, Folgueira D, Contreras JR. Clinical presentation and characteristics of pharyngeal adenovirus infections. Pediatr Infect Dis J. 2005; 24:733–4.

14. Peled N, Nakar C, Huberman H, Scherf E, Samra Z, Finkelstein Y, et al. Adenovirus infection in hospitalized immunocompetent children. Clin Pediatr (Phila). 2004; 43:223–9.

15. Ruuskanen O, Putto A, Sarkkinen H, Meurman O, Irjala K. C-reactive protein in respiratory virus infections. J Pediatr. 1985; 107:97–100.

16. Appenzeller C, Ammann RA, Duppenthaler A, Gorgiev-ski-Hrisoho M, Aebi C. Serum C-reactive protein in children with adenovirus infection. Swiss Med Wkly. 2002; 132:345–50.

17. Hsieh TH, Chen PY, Huang FL, Wang JD, Wang LC, Lin HK, et al. Are empiric antibiotics for acute exudative tonsillitis needed in children? J Microbiol Immunol Infect. 2011; 44:328–32.

18. Chi H, Chiu NC, Li WC, Huang FY. Etiology of acute pharyngitis in children: is antibiotic therapy needed? J Microbiol Immunol Infect. 2003; 36:26–30.

19. Sun J, Wu KG, Hwang B. Evaluation of the etiologic agents for acute suppurative tonsillitis in children. Zhonghua Yi Xue Za Zhi (Taipei). 2002; 65:212–7.

20. Douglas RM, Miles H, Hansman D, Fadejevs A, Moore B, Bollen MD. Acute tonsillitis in children: microbial pathogens in relation to age. Pathology. 1984; 16:79–82.

21. Putto A. Febrile exudative tonsillitis: viral or streptococcal? Pediatrics. 1987; 80:6–12.

22. Pulliam PN, Attia MW, Cronan KM. C-reactive protein in febrile children 1 to 36 months of age with clinically undetectable serious bacterial infection. Pediatrics. 2001; 108:1275–9.

23. Peltola H, Jaakkola M. C-reactive protein in early detection of bacteremic versus viral infections in immunocompetent and compromised children. J Pediatr. 1988; 113:641–6.

24. Barone SR, Pontrelli LR, Krilov LR. The differentiation of classic Kawasaki disease, atypical Kawasaki disease, and acute adenoviral infection: use of clinical features and a rapid direct fluorescent antigen test. Arch Pediatr Adolesc Med. 2000; 154:453–6.

25. Bierbaum S, Forster J, Berner R, Rü cker G, Rohde G, Neumann-Haefelin D, et al. Detection of respiratory viruses using a multiplex real-time PCR assay in Germany, 2009/10. Arch Virol. 2013; 15:[Epub ahead of print].

26. Dowell SF, Schwartz B. Resistant pneumococci: protecting patients through judicious use of antibiotics. Am Fam Physician. 1997; 55:1647–54.

Fig. 1.

(A)Age distribution and (B)monthly distribution of adenoviral and group A strepto-coccal pharyngitis.

Table 1.

Clinical Manifestations of Adenoviral and Group A Streptococcal Pharyngitis

	No. of case (%)			P^∗	P^†
	AV1	AV2	GAS	P^∗	P^†
Median age (years)	2.4±1.6	2.8±2.1	5.4±1.8	0.000	0.000
Total duration of fever (days)	6.0±2.9	6.3±2.6	3.3±1.9	0.000	0.000
Fever peak (℃)	39.3±0.8	39.4±0.7	38.9±0.8	0.031	0.039
Duration of admission (days)	4.3±1.5	4.1±1.2	1.9±1.8	0.000	0.000
Symptom
Cough	133 (74.3)	26 (70.3)	1 (3.8)	0.000	0.000
Rhinorrhea	123 (68.7)	23 (62.2)	6 (23.1)	0.000	0.004
Nasal stuffiness	32 (17.9)	11 (29.7)	0 (0.0)	0.017	0.002
Sore throat	27 (15.1)	6 (16.2)	10 (38.5)	0.011	0.076
Vomiting	21 (11.7)	5 (13.5)	4 (15.4)	0.532	1.000
Diarrhea	25 (14.0)	6 (16.2)	0 (0.0)	0.050	0.038
Poor oral intake	81 (45.3)	17 (45.9)	5 (19.2)	0.018	0.035
Physical examination
Pharyngeal injection	152 (84.9)	33 (89.2)	14 (53.8)	0.001	0.003
Exudates on tonsils	30 (16.8)	8 (21.6)	2 (7.7)	0.384	0.175
Post nasal drip	13 (7.3)	3 (8.1)	0 (0.0)	0.380	0.261
TM injection	23 (12.8)	7 (18.9)	0 (0.0)	0.050	0.035
Cervical L/N	12 (6.7)^‡	3 (8.1)^‡	6 (23.1)	0.015	0.144
Conjunctival injection	37 (20.7)^‡	15 (40.5)^‡	1 (3.8)	0.055	0.001
Skin rash	0 (0.0)	0 (0.0)	26 (100.0)	0.000	0.000
Strawberry tongue	3 (1.7)	1 (2.7)	3 (11.5)	0.028	0.297

NOTE; Data are no.(%) of patients, unless otherwise indicated. Abbreviations; TM, tympanic membrane; L/N, lymph node; AV1, adenoviurs group 1; AV2, adenoviurs group 2; GAS, group A streptococcus.

P∗: the P value of comparison of AV1 and GAS. P

^† : the P value of comparison of AV2 and GAS.

^‡ : Numbers of patients diagnosed with pharyngoconjunctival fever.

Table 2.

Laboratory Findings of Adenoviral and Group A Streptococcal Pharyngitis

	AV1	AV2	GAS	P^∗	P^†
WBC (/mm³)	12,483±5,158	11,449±5,680	6,722±6,941	0.000	0.000
Neu (%)	52.6±18.7	52.5±17.1	69.1±14.8	0.000	0.000
Lym (%)	35.8±17.4	35.8±16.7	19.7±12.5	0.000	0.000
AST (IU/L)	43.6±60.0	46.0±77.9	25.8±6.9	0.000	0.008
ALT (IU/L)	34.3±83.0	30.8±88.4	14.1±4.2	0.170	0.413
LDH (IU/L)	310±151	319±117	341±130	0.261	0.675
CRP (mg/dL)	3.2±3.5	3.8±3.2	5.2±5.1	0.039	0.368

P∗: the P value of comparison of AV1 and GAS. P

^† : the P value of comparison of AV2 and GAS. Abbreviations: WBC, white blood cell; Neu, neutrophil; Lym, lymphocyte; AST, aspartate ransaminase; ALT, alanine transa-minase; LDH, lactate dehydrogenase; AV1, adenoviurs group 1; AV2, adenoviurs group 2; GAS, group A streptococcus.

TOOLS

Similar articles