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At least 217 records · Page 12Linked to original sources
PubMed1997

Surveillance cultures of blood, urine, and throat specimens are not valuable for predicting cytomegalovirus disease in liver transplant recipients. Boston Center for Liver Transplantation Cytomegalovirus Immune Globulin Study Group.

The role of markers of cytomegalovirus (CMV) infection, such as the isolation of CMV, the presence of CMV antigenemia, or detection of viral DNA by polymerase chain reaction (PCR) assay, as predictors of subsequent CMV disease has been examined in recent studies. We studied the value of performing surveillance cultures of blood, urine, and throat specimens in a cohort of 156 liver transplant recipients who had participated in clinical trials and had received ganciclovir only for documented CMV disease. Cultures of urine and throat specimens for detection of CMV were performed every week, and cultures of blood specimens were performed every other week for the first 2 months after transplantation, then monthly for 6 months. Eighty-nine (57%) of 156 patients developed CMV infection, 41 (46%) of whom developed clinical CMV disease (36 had organ involvement and five had CMV syndrome). Fifty (32%) of 156 patients had positive blood cultures, 35 (22%) had positive urine cultures, and 41 (26%) had positive throat cultures. The positive and negative predictive values of surveillance cultures for predicting CMV disease were as follows: blood cultures, 46% and 83%, respectively; urine cultures, 26% and 74%, respectively; and throat cultures, 32% and 76%, respectively. These data indicate that such cultures are not useful in predicting CMV disease in liver transplant recipients. Future studies should examine the value of alternative markers, such as CMV antigenemia or the detection of viral DNA by PCR, for predicting CMV disease in this setting.

Adult↗
PubMed2002

The impact of recurrent throat infection on children and their families.

BACKGROUND: Recurrent throat problems in children are common and have an impact on the family. The appropriateness of surgery will depend on both clinical and social factors. OBJECTIVES: The aim of this study was to assess the impact on the whole family when a child is suffering from recurrent throat problems, and investigate related parental attitudes. METHODS: A total of 1190 parents of children in northern England for whom tonsillectomy or adeno-tonsillectomy was a possible treatment option were sent a questionnaire covering social and clinical issues such as children's symptoms, the impact on family life and parental attitudes. RESULTS: The majority of children had experienced more than four episodes in the previous year, had their sleep affected and time off school. Most parents were worried and reported disruption to the family, including taking time off work and cross-infection. Parental disruption, worry and eagerness for surgery were significantly associated with the duration of episodes of throat problems and the number of episodes in the previous year, but not with duration of tonsillitis. Time off school, or parental time off work was significantly associated with parental worry and disruption, but not with eagerness for surgery. CONCLUSION: This work highlights the impact of recurrent throat problems and related parental attitudes, and will aid in striking a balance between clinical requirements and the needs and wishes of the family.

Adolescent↗
PubMed2004

Patient-clinician agreement on signs and symptoms of 'strep throat': a MetroNet study.

BACKGROUND: Despite substantial use of the telephone in health care, only a few studies have formally evaluated the appropriateness of telephone-based management for acute medical problems. The accuracy of patients' report of signs and symptoms remains unknown. OBJECTIVE: We compared the agreement between patient self-assessment and clinician assessment on the typical signs and symptoms of group A beta-haemolytic Streptococcus (GABHS) to investigate the potential difficulties of using patient self-report to triage sore throat patients. METHODS: In this cross-sectional study, each of 200 adult pharyngitis patients was instructed to examine him/herself and to record the symptoms and physical findings. Two clinicians independently interviewed and examined each patient and recorded their findings. Each patient then had a rapid GABHS antigen test, the results of which were blinded to both clinicians and patients. Each patient self-assessment was compared with the findings of each clinician, and the agreement and disagreement between them computed. RESULTS: We found varying levels of agreement (kappa=-0.05 to 0.71) between patients and clinicians on sore throat history and physical assessments. Importantly, there was fair to substantial agreement (kappa=0.20-0.71) on the key signs and symptoms used in GABHS clinical prediction rules. As expected, history items had the highest agreement (kappa=0.52-0.71). Patients were more likely than clinicians to report rather than deny a specific physical sign. CONCLUSION: Adult sore throat patients may reliably report their symptoms, but may not be able to assess and report accurately on relevant physical signs of pharyngitis. Patients have a tendency to over-report physical signs. This study indicates the potential difficulties associated with telephone triage of sore throat patients, or other illnesses that require assessment of physical signs.

Adolescent↗
PubMed1996

Frequency of throat-skeleton fractures in hanging.

A total of 109 cases of suicidal or accidental hanging were evaluated and the number of hyoid bone or thyroid cartilage fractures or both was investigated in relation to the highest point of the ligature mark. In 73 cases (67%), at least a single fracture of the throat skeleton was detectable, and the youngest individual with positive findings was aged 14 years. In 28 of the 73 positive cases (38%), a single fracture was found, whereas 27 individuals (37%) showed a twofold injury. Three fractures of the throat skeleton were observed in 11 cases (15%), and in seven individuals (10%), all the horns of the hyoid and thyroid cartilage were broken. The youngest individual with four fractures was 28 years old (elastic non-ossified throat skeleton). Even though a higher incidence of positive results and in particular of multiple fractures could be established in cases with a highest point of the ligature mark at or behind the ears, no clear correlation between frequency and number of throat-skeleton fractures was detectable in our series.

Adolescent↗
PubMed2001

Social causes of correlational selection and the resolution of a heritable throat color polymorphism in a lizard.

When selection acts on social or behavioral traits, the fitness of an individual depends on the phenotypes of its competitors. Here, we describe methods and statistical inference for measuring natural selection in small social groups. We measured selection on throat color alleles that arises from microgeographic variation in allele frequency at natal sites of side-blotched lizards (Uta stansburiana). Previous game-theoretic analysis indicates that two color morphs of female side-blotched lizards are engaged in an offspring quantity-quality game that promotes a density- and frequency-dependent cycle. Orange-throated females are r-strategists. They lay large clutches of small progeny, which have poor survival at high density, but good survival at low density. In contrast, yellow-throated females are K-strategists. They lay small clutches of large progeny, which have good survival at high density. We tested three predictions of the female game: (1) orange progeny should have a fitness advantage at low density; (2) correlational selection acts to couple color alleles and progeny size; and (3) this correlational selection arises from frequency-dependent selection in which large hatchling size confers an advantage, but only when yellow alleles are rare. We also confirmed the heritability of color, and therefore its genetic basis, by producing progeny from controlled matings. A parsimonious cause of the high heritability is that three alleles (o, b, y) segregate as one genetic factor. We review the physiology of color formation to explain the possible genetic architecture of the throat color trait. Heritability of color was nearly additive in our breeding study, allowing us to compute a genotypic value for each individual and thus predict the frequency of progeny alleles released on 116 plots. Rather than study the fitness of individual progeny, we studied how the fitness of their color alleles varied with allele frequency on plots. We confirmed prediction 1: When orange alleles are present in female progeny, they have higher fitness at low density when compared to other alleles. Even though the difference in egg size of the female morphs was small (0.02 g), it led to knife-edged survival effects for their progeny depending on local social context. Selection on hatchling survival was not only dependent on color alleles, but on a fitness interaction between color alleles and hatchling size, which confirmed prediction 2. Sire effects, which are not confounded by maternal phenotype, allowed us to resolve the frequency dependence of correlational selection on egg size and color alleles and thereby confirmed prediction 3. Selection favored large size when yellow sire alleles were rare, but small size when they were common. Correlational selection promotes the formation of a self-reinforcing genetic correlation between the morphs and life-history variation, which causes selection in the next density and frequency cycle to be exacerbated. We discuss general conditions for the evolution of self-reinforcing genetic correlations that arise from social selection associated with frequency-dependent sexual and natural selection.

Alleles↗
PubMed1987

Magill versus Mallinckrodt tracheal tubes. A comparative study of postoperative sore throat.

An attempt to assess the relative merits of Magill and Mallinckrodt tracheal tubes is described. One hundred patients scheduled for routine gynaecological operations were randomly allocated to one of two groups of 50; in one, Magill red rubber tubes were used and in the other, Mallinckrodt tubes. The incidence and severity of postoperative sore throat were assessed on the day after operation. Fifty percent of those intubated with Magill tubes suffered sore throats, compared with 28% with Mallinckrodt (p less than 0.05). In both groups, sore throat was more frequent in younger patients undergoing short operations: smokers intubated with Magill tubes had significantly more sore throat than smokers in whom Mallinckrodt tubes were used.

Adolescent↗
PubMed1986

Children's sore throats related to parental smoking.

There has been concern that the smoking of tobacco can adversely affect the health of non-smokers. This is most cogent in children who are subject to smoke at home. The aim of this study is to relate children's sore throats to the smoking habits of their parents. The parents of 154 children were asked about the age, sex, birthweight, method of postnatal feeding and age at starting school or day nursery of the child, the frequency of sore throats, smoking habits and history of tonsillectomy of all members of the household, the size of family, the dwelling size, and the occupation of the father. Analysis by multiple regression showed a significant association between children's sore throats and maternal smoking. Reduction in domestic cigarette smoke exposure should benefit the child by reducing the number of sore throats he or she suffers.

Adolescent↗
PubMed1969

Detection of group A streptococci in throat swabs by direct fluorometry.

A direct fluorometric test for the rapid detection of group A streptococci from throat swabs was compared with the microscopic fluorescent-antibody test. Formalinized throat swab cultures (490) were examined by the two methods, and the results agreed on 84% of the specimens. In another comparison, 15-hr broth cultures of 103 freshly taken throat swabs were tested by both methods. Of the specimens tested, 101 (98%) were either positive or negative by both methods. In all cases, the latter results correlated with the demonstration of presence or absence of group A streptococci in the specimens by cultural isolation and precipitin grouping tests. It may be feasible to use the direct fluorometric test in a diagnostic laboratory as described or possibly to adapt it for automatic processing of throat swab cultures.

Bacteriological Techniques↗
PubMed1977

Bacterial interference. IV. Epidemiological determinants of the antagonistic activity of the normal throat flora against group A streptococci.

A study was performed to identify epidemiological factors such as age, race, sex, and time of culture that might influence the ability of the normal pharyngeal flora to interfere with growth of group A streptococci. From March 1974 through February 1975, throat swabs were obtained from 952 individuals. Cultures were assayed by an agar overlay procedure for the presence of bacteria capable of inhibiting growth of group A streptococci. The observed inhibition was then determined to be bacteriostatic or bactericidal by use of a broth filtrate technique. Regardless of age, race, or sex, subjects were more likely to harbor interfering flora if cultured during the months of March and April, which coincided with the highest prevalence of group A streptococci in the community. Race and sex of subjects appeared not to influence the inhibitory activity of throat flora either quantitatively or qualitatively. However, among individuals with interfering flora, the prevalence of bactericidal organisms increased and bacteriostatic organisms decreased with advancing age. Since the presence of bactericidal, and not bacteriostatic, organisms has been associated with resistance to colonization of the throat by group A streptococci, this higher prevalence of bactericidal organisms in older individuals suggests that bacterial interference may be one of the mechanisms that account for the greater resistance of adults than children to streptococcal throat infection.

Adolescent↗
PubMed1997

Role of putative virulence factors of Streptococcus pyogenes in mouse models of long-term throat colonization and pneumonia.

To investigate the role of putative virulence factors of Streptococcus pyogenes (group A streptococcus; GAS) in causing disease, we introduced specific mutations in GAS strain B514, a natural mouse pathogen, and tested the mutant strains in two models of infection. To study late stages of disease, we used our previously described mouse model (C3HeB/FeJ mice) in which pneumonia and systemic spread of the streptococcus follow intratracheal inoculation. To study the early stages of disease, we report here a model of long-term (at least 21 days) throat colonization following intranasal inoculation of C57BL/10SnJ mice. When the three emm family genes of GAS strain B514-Sm were deleted, the mutant showed no significant difference from the wild type in induction of long-term throat colonization or pneumonia. We inactivated the scpA gene, which encodes a complement C5a peptidase, by insertion of a nonreplicative plasmid and found no significant difference from the wild type in the incidence of throat colonization. However, there was a small but statistically significant decrease in the incidence of pneumonia caused by the scpA mutant. Finally, we demonstrated a very important effect of the hyaluronic acid capsule in both models. Following intranasal inoculation of mice with a mutant in which a nonreplicative plasmid was inserted into the hasA gene, which encodes hyaluronate synthase, we found that all bacteria recovered from the throats of the mice were encapsulated revertants. Following intratracheal inoculation with the hasA mutant, the incidence of pneumonia within 72 h was significantly reduced from that of the control strain (P = 0.006). These results indicate that the hyaluronic acid capsule of S. pyogenes B514 confers an important selective advantage for survival of the bacteria in the upper respiratory tract and is also an important determinant in induction of pneumonia in our model system.

Adhesins, Bacterial↗
PubMed1983

Effect of atmosphere and duration of incubation on primary isolation of group A streptococci from throat cultures.

The optimal incubation conditions for isolation of group A streptococci from throat cultures are controversial. Therefore, we compared the effects of aerobic and anaerobic incubations after 24 and 48 h on the recovery of group A streptococci. Throat swabs submitted to the clinical laboratory were inoculated onto duplicate 5% sheep blood agar plates, incubated aerobically or anaerobically (GasPak jar) at 35 degrees C, and examined semiquantitatively after 24 and 48 h. Group A streptococci were identified by the fluorescent-antibody technique. Of 1,040 specimens, 506 (48.6%) grew beta-hemolytic streptococci, including 200 (19.2%) group A streptococci. Group A streptococci were recovered significantly more often with anaerobic incubation than with aerobic incubation after 24 h (182 versus 138; P less than 0.001) and after 48 h (193 versus 174; P less than 0.05). Non-group A beta-hemolytic streptococci also were recovered significantly more often with anaerobic incubation after 24 and 48 h (P less than 0.001). Colony counts were not affected by the incubation atmosphere. We conclude that incubation of throat cultures in an anaerobic atmosphere is superior to incubation in air for detection of group A streptococci. The greater sensitivity of anaerobic incubation, however, may not justify the extra laboratory effort and cost required to differentiate group A streptococci from the non-group A streptococci detected as a result of anaerobic incubation. Throat cultures should be examined after 24 and 48 h, especially if plates are incubated aerobically.

Adult↗
PubMed1991

Rifampicin prophylaxis for throat carriage of Haemophilus influenzae type b in patients with invasive disease and their contacts.

OBJECTIVE: To determine rates of colonisation with Haemophilus influenzae type b among household contacts of children with invasive H influenzae type b disease; compliance among medical staff with recommendations for use of rifampicin prophylaxis; and effects of rifampicin treatment in H influenzae type b colonisation of patients and contacts. DESIGN: Prospective study of patients and their household contacts. SETTING: Royal Children's Hospital (the major paediatric hospital) in Victoria, Australia, with catchment population of 4.2 million, including 300,000 children aged under 5 years. SUBJECTS: 234 patients (age range 6 weeks to 8 years) with 235 episodes of all types of invasive H influenzae type b disease admitted during 1988-9 and their contacts. MAIN OUTCOME MEASURES: Positive cultures of H influenzae type b from throat swabs taken at admission and six weeks subsequently; recording of rifampicin prophylaxis. RESULTS: The percentage of patients with positive throat cultures fell from 69% (33/48) on day 1 of admission to 9% (4/47) after three days' treatment; at six weeks' follow up 32% (32/99) of patients who had not received rifampicin and 8% (5/61) who had, had positive throat cultures. Among household contacts, 33% (62/190) of children and 7% (25/359) of adults were colonised, and the colonisation rates were similar in contacts of patients with all types of H influenzae type b disease. Rifampicin prophylaxis was indicated in 85 families; in 34% it was not prescribed at all for contacts and in 41% not as recommended. The colonisation rates at follow up were significantly less in siblings given rifampicin (12%, 9/78), particularly in families in which all members were treated (3%), than in those in which they were not (36%) (odds ratio 21.5; 95% confidence interval 3.0 to 103.4). CONCLUSIONS: The rate of throat colonisation with H influenzae type b was similar among siblings of children with all types of invasive H influenzae type b disease. Colonisation in contacts can be reduced by rifampicin prophylaxis, but some contacts remained colonised or were recolonised by the time of follow up. Medical staff complied poorly with current recommendations for rifampicin prophylaxis, which reduces its intrinsically limited value in preventing H influenzae type b disease.

Child↗
PubMed1997

Open randomised trial of prescribing strategies in managing sore throat.

OBJECTIVE: To assess three prescribing strategies for sore throat. DESIGN: Randomised follow up study. SETTING: 11 general practices in the South and West region. SUBJECTS: 716 patients aged 4 years and over with sore throat and an abnormal physical sign in the throat; 84% had tonsillitis or pharyngitis. Patients were randomised to three groups: prescription for antibiotics for 10 days (group 1,246 patients); no prescription (group 2,230 patients); or prescription for antibiotics if symptoms were not starting to settle after three days (group 3; 238 patients). MAIN OUTCOME MEASURES: Duration of symptoms; satisfaction and compliance with and perceived efficacy of antibiotics; time off school or work. Outcomes were documented in 582 subjects (81%). RESULTS: Median duration of antibiotic use differed significantly in the three groups (10 v 0 v 0 days, P < 0.001); 69% of patients in group 3 did not use their prescription. The proportion of patients better by day 3 did not differ significantly (37% v 35% v 30%, P = 0.28), nor did the duration of illness (median 4 v 5 v 5 days, P = 0.39), days off work or school (median 2 v 2 v 1, P = 0.13), or proportion of patients satisfied (96% v 90% v 93%, P = 0.09), although group 1 had fewer days of fever (median 1 v 2 v 2 days, P = 0.04). More patients in group 1 thought the antibiotics were effective (87% v 55% v 60%, P < 0.001) and intended coming to the doctor in future attacks (79% v 54% v 57%, P < 0.001). "Legitimation" of illness-to explain to work or school (60%) or family or friends (37%)-was an important reason for consultation. Patients who were more satisfied got better more quickly, and satisfaction related strongly to how well the doctor dealt with patient's concerns. CONCLUSION: Prescribing antibiotics for sore throat only marginally affects the resolution of symptoms but enhances belief in antibiotics and intention to consult in future when compared with the acceptable strategies of no prescription or delayed prescription. Psychosocial factors are important in the decision to see a general practitioner and in predicting the duration of illness.

Adolescent↗
PubMed2000

Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff--a randomized controlled trial.

Sore throat and hoarseness following tracheal intubation is common. The aetiology may include high tracheal cuff pressures. We performed a double-blind, randomized controlled trial in 126 intubated patients to compare the incidence and severity of sore throat and hoarseness following inflation of the cuff using air or saline. Intra-cuff pressures were compared to assess any change due to inward diffusion of nitrous oxide. The incidence of significant sore throat and/or hoarseness overall was 15.0%. There was no statistically significant difference between the groups (air 15.9%, saline 14.5%). In the air group mean intra-cuff pressure increased significantly (start 14.0 mmHg, end 40.9 mmHg), while in the saline group there was no significant increase (start 12.7 mmHg, end 14.6 mmHg). The substitution of saline reliably results in sustained low intra-cuff pressures but high tracheal cuff pressure is not an important factor in the development of sore throat or hoarseness postoperatively within the pressure range and duration of operation studied.

Double-Blind Method↗
PubMed2005

Sore throat in adults--does the introduction of a clinical scoring system improve the management of these patients in a secondary care setting?

OBJECTIVE: To audit sore throat management in adults, introduce proforma-based guidelines and to re-audit clinical practice. SETTING: Adult emergency department of an inner city teaching hospital. METHODS: A literature search was carried out to identify relevant guidelines. In stage one, patients presenting to the emergency department with sore throat were identified retrospectively from the emergency department attendance register. Proformas were completed retrospectively. In stage two, new guidelines were introduced and staff educated about the guidelines. In stage three, patients presenting with sore throat were identified at triage and proformas were completed at time of consultation. OUTCOME MEASURES: (1) appropriate clinical assessment of the likelihood of bacterial infection using the clinical scoring system, (2) appropriateness of antibiotic prescription, (3) recommendation of supportive treatments to patients. RESULTS: Introduction of a clinical scoring system reduced the inappropriate prescribing of antibiotics from 44 per cent to 11 per cent. Correct antibiotic prescription rose from 60 per cent to 100 per cent. Although the variety of advice given about supportive treatment increased, the actual number of patients receiving documented supportive advice fell from 67.8 per cent in stage one to 58 per cent in stage three. CONCLUSION: The introduction of clinically based guidelines for the diagnosis and management of sore throat in adults can reduce inappropriate antibiotic prescribing.

Adult↗
PubMed1995

Antimicrobial resistance in Haemophilus influenzae isolated from blood, cerebrospinal fluid, middle ear fluid and throat samples of children. A nationwide study in Finland in 1988-1990.

A nation-wide survey of the prevalence of antimicrobial resistance in Haemophilus influenzae was conducted on isolates collected in 1988-90 from middle ear fluid (MEF), blood, or cerebrospinal fluid (CSF) in infected children or throat samples of healthy children. Altogether 885 strains were examined regarding capsular type b, beta-lactamase production and the minimal inhibitory concentration (MIC) of ampicillin, cefaclor, erythromycin, tetracycline, chloramphenicol, trimethoprim and trimethoprim-sulfamethoxazole for these strains was determined by the agar dilution method. 99% (578/585) of MEF isolates, 93% (112/121) of throat isolates, but only 6% (10/179) of blood/CSF isolates were not of type b (Hib). The rate of beta-lactamase production was 11.4% among Hib strains, 8.0% among non-type b MEF isolates, and 4.5% among non-type b throat isolates. No increase in the prevalence of beta-lactamase production in H. influenzae has taken place in Finland since the early 1980s. Resistance to ampicillin among strains that lacked beta-lactamase activity was rare (0.2%). Of the non-type b MEF and throat isolates, 5.9% and 2.7%, respectively, were resistant to trimethoprim and 3.6% and 2.7%, respectively, to trimethoprim-sulfamethoxazole. Resistance to other drugs was rare (< 2%) in all isolate groups.

Ampicillin↗
PubMed1986

Incidence and management of sore throat in general practice.

A total of 1051 patients with sore throat were registered by 358 general practitioners (GPs) each participating for one week some time during a one-year study period. Contacts related to emergency medical service work, and contacts by telephone only were also included. The annual incidence of sore throat was estimated to be 100 per 1 000 person years. A bacterial or presumedly bacterial etiology was clinically diagnosed in 64% of the patients, and a viral or presumedly viral etiology in 30% of cases, while for six per cent of the patients, the GP was in doubt as to the etiology. The strategy of management was as follows: nine per cent had a throat swab taken and antibiotics prescribed; 15% were swabbed, and did not receive an immediate prescription; 54% were prescribed antibiotics without being swabbed; and 23% were neither swabbed nor treated with antibiotics. With increasing age of the doctor, increasing frequencies were found regarding the clinical assumption of a bacterial etiology and prescribing of antibiotics, whereas the frequency of obtaining throat swabs decreased. Similar findings were made when the type of contact was home visit as opposed to contact at the surgery.

Adolescent↗
PubMed1992

An algorithm for a selective use of throat swabs in the diagnosis of group A streptococcal pharyngo-tonsillitis in general practice.

A prospective evaluation was made of an algorithm for a selective use of throat swabs in patients with sore throat in general practice. The algorithm states that a throat swab should be obtained (a) in all children younger than 15 years; (b) in patients aged 15 years or more who have pain on swallowing and at least three of four signs (enlarged or hyperaemic tonsils; exudate; enlarged or tender angular lymph nodes; and a temperature > or = 38 degrees C); and (c) in adults aged 15-44 years with pain on swallowing and one or two of the four signs, but not both cough and coryza. Group A streptococci were found by laboratory culture in 30% of throat swabs from 1783 patients. Using these results as the reference, the algorithm was 95% sensitive and 26% specific, and assigned 80% of the patients to be swabbed. Its positive and negative predictive values in this setting were 36% and 92%, respectively. It is concluded that this algorithm may be useful in general practice.

Acute Disease↗