PDF(Pubmed)
Abstract：
OBJECTIVE: Fusobacterium necrophorum is a common cause of pharyngotonsillitis. However, no guidelines exist on when to diagnose or treat it. We aimed to investigate associations between clinical criteria and F. necrophorum-positivity in pharyngotonsillitis and assess the predictive potential of a simple scoring system.
METHODS: Pharyngotonsillitis patients who were tested for F. necrophorum (PCR) and presented to hospitals in the Skåne Region, Sweden, between 2013-2020 were eligible. Data were retrieved from electronic chart reviews and registries. By logistic regression we investigated associations between F. necrophorum-positivity and pre-specified criteria: age 13-30 years, symptom duration ≤ 3 days, absence of viral symptoms (e.g. cough, coryza), fever, tonsillar swelling/exudate, lymphadenopathy and CRP ≥ 50 mg/L. In secondary analyses, associated variables were weighted by strength of association into a score and its predictive accuracy of F. necrophorum was assessed.
RESULTS: Among 561 cases included, 184 (33%) had F. necrophorum, which was associated with the following criteria: age 13-30, symptom duration ≤ 3 days, absence of viral symptoms, tonsillar swelling/exudate and CRP ≥ 50 mg/L. Age 13-30 had the strongest association (OR5.7 95%CI 3.7-8.8). After weighting, these five variables had a sensitivity and specificity of 68% and 71% respectively to predict F. necrophorum-positivity at the proposed cut-off.
CONCLUSIONS: Our results suggest that F. necrophorum cases presenting to hospitals might be better distinguished from other pharyngotonsillitis cases by a simple scoring system presented, with age 13-30 being the strongest predictor for F. necrophorum. Prospective studies, involving primary care settings, are needed to evaluate generalisability of findings beyond cases presenting to hospitals.
METHODS: Pharyngotonsillitis patients who were tested for F. necrophorum (PCR) and presented to hospitals in the Skåne Region, Sweden, between 2013-2020 were eligible. Data were retrieved from electronic chart reviews and registries. By logistic regression we investigated associations between F. necrophorum-positivity and pre-specified criteria: age 13-30 years, symptom duration ≤ 3 days, absence of viral symptoms (e.g. cough, coryza), fever, tonsillar swelling/exudate, lymphadenopathy and CRP ≥ 50 mg/L. In secondary analyses, associated variables were weighted by strength of association into a score and its predictive accuracy of F. necrophorum was assessed.
RESULTS: Among 561 cases included, 184 (33%) had F. necrophorum, which was associated with the following criteria: age 13-30, symptom duration ≤ 3 days, absence of viral symptoms, tonsillar swelling/exudate and CRP ≥ 50 mg/L. Age 13-30 had the strongest association (OR5.7 95%CI 3.7-8.8). After weighting, these five variables had a sensitivity and specificity of 68% and 71% respectively to predict F. necrophorum-positivity at the proposed cut-off.
CONCLUSIONS: Our results suggest that F. necrophorum cases presenting to hospitals might be better distinguished from other pharyngotonsillitis cases by a simple scoring system presented, with age 13-30 being the strongest predictor for F. necrophorum. Prospective studies, involving primary care settings, are needed to evaluate generalisability of findings beyond cases presenting to hospitals.
摘要：
目的：坏死梭杆菌是咽喉炎的常见原因。然而,没有关于何时诊断或治疗的指南。我们的目的是调查临床标准与咽喉炎坏死F.阳性之间的关联，并评估简单评分系统的预测潜力。
方法：咽喉炎患者接受了尸检F.死角（PCR）检测，并被送到Skóne地区的医院，瑞典,在2013-2020年之间是合格的。数据是从电子图表审查和登记册中检索的。通过逻辑回归，我们调查了坏死F.阳性与预先指定的标准之间的关联：年龄13-30岁，症状持续时间≤3天，没有病毒症状(例如咳嗽，coryza),发烧,扁桃体肿胀/渗出物，淋巴结肿大和CRP≥50mg/L在二级分析中，通过关联强度对相关变量进行加权评分,并评估其对坏死F.的预测准确性.
结果：纳入561例，184例（33%）有尸检F，与以下标准相关：年龄13-30岁，症状持续时间≤3天，没有病毒症状，扁桃体肿胀/渗出物和CRP≥50mg/L年龄13-30有最强的关联（OR5.795CI3.7-8.8）。加权后，这5个变量在预测建议的截止值时的坏死F.阳性的敏感性和特异性分别为68%和71%.
结论：我们的结果表明，通过提供一个简单的评分系统，医院出现的坏死F.年龄在13-30岁之间是尸检F.的最强预测因子。前瞻性研究,涉及初级保健设置，除了提交给医院的病例外，还需要评估调查结果的普遍性。
方法：咽喉炎患者接受了尸检F.死角（PCR）检测，并被送到Skóne地区的医院，瑞典,在2013-2020年之间是合格的。数据是从电子图表审查和登记册中检索的。通过逻辑回归，我们调查了坏死F.阳性与预先指定的标准之间的关联：年龄13-30岁，症状持续时间≤3天，没有病毒症状(例如咳嗽，coryza),发烧,扁桃体肿胀/渗出物，淋巴结肿大和CRP≥50mg/L在二级分析中，通过关联强度对相关变量进行加权评分,并评估其对坏死F.的预测准确性.
结果：纳入561例，184例（33%）有尸检F，与以下标准相关：年龄13-30岁，症状持续时间≤3天，没有病毒症状，扁桃体肿胀/渗出物和CRP≥50mg/L年龄13-30有最强的关联（OR5.795CI3.7-8.8）。加权后，这5个变量在预测建议的截止值时的坏死F.阳性的敏感性和特异性分别为68%和71%.
结论：我们的结果表明，通过提供一个简单的评分系统，医院出现的坏死F.年龄在13-30岁之间是尸检F.的最强预测因子。前瞻性研究,涉及初级保健设置，除了提交给医院的病例外，还需要评估调查结果的普遍性。
