Procalcitonin-guided Detection of Streptococcal Acute Tonsillitis

Streptococcal Acute Tonsillitis Clinical Trial

Official title:

Procalcitonin-guided Detection of Streptococcal Acute Tonsillitis

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT01657968
• Other study ID #: 1-10-72-321-12
• Secondary ID: 2007-58-0010
• Status: Recruiting
• Phase: N/A
• First received: July 31, 2012
• Last updated: January 17, 2013
• Start date: August 2012
• Est. completion date: March 2013

Study information

• Verified date: January 2013
• Source: Aarhus University Hospital
• Contact: Ann MG Christensen, medical student
• Phone: +45 28740001
• Email: ann.mgc[@]hotmail.com
• Is FDA regulated: No
• Health authority: Denmark: Ethics CommitteeDenmark: Danish Dataprotection Agency
• Study type: Observational

Clinical Trial Summary

The primary purpose of the present study is to investigate the usefulness of Procalcitonin as a supplement to the Streptococcal antigen test and Centor criteria in the differential diagnose making between Streptococcal and non-Streptococcal acute tonsillitis.

Furthermore, the investigators aim to examine Procalcitonin as a diagnostic marker in acute tonsillitis due to Fusobacterium Necrophorum.

Description:

Acute tonsillitis is based on typical symptoms (sore throat, pain on swallowing, and fever) and clinical findings of tonsillar exudate and hyperemia.

10-20% of patients seen by their family physician, have acute tonsillitis due to streptococci group A. In Denmark, Centors criteria and the Streptococcal antigen test (Strep. A-test) are gold standard in the diagnostic process of streptococcal acute tonsillitis. Although the sensitivity and specificity of the Strep. A-test is biochemically high, its clinical reliability is reduced due to several influential factors. Moreover, studies suggest that 4-10% of patients are tested false-negative based on clinical criteria and the Strep A-test.

Fusobacterium necrophorum are suspected to be the cause of acute tonsillitis in teenagers and young adults (5-15%). However, there is no rapid test available for this bacterium. Since tonsillar surface swab is not included in the diagnostic standard, family physicians get no information about infection due to Fusobacterium necrophorum or other pathogens.

C-reactive protein, leukocyte count and absolute neutrophil count as diagnostic markers are examined with variable results. Procalcitonin is a relatively new marker of bacterial infection, which has the advantage of more rapid and specific induction compared to the other markers.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 200
• Est. completion date: March 2013
• Est. primary completion date: March 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 15 Years to 40 Years

Eligibility

Patients with acute tonsillitis:

Inclusion Criteria:

• Age between 15 and 40 years.

• Subjective and objective signs of Acute Tonsillitis + presents of 2-4 Centor Criteria.

• participation accept after verbal and written information.

Exclusion Criteria:

• Antibiotic treatment within the last month.

• Other infection within the last month.

• Inadequate tonsil swabs due to lack of cooperation.

• Suspicion of peritonsillar abscess

Control patients:

Inclusion criteria:

• Age between 15 and 40 years.

• Participation accept after verbal and written information.

Exclusion Criteria:

• Antibiotic treatment within the last month.

• Infection within the last month.

• Tonsillectomy

• More than 2 cases of acute tonsillitis within the last 12 months.

Study Design

Observational Model: Case Control, Time Perspective: Prospective

Related Conditions & MeSH terms

• Streptococcal Acute Tonsillitis
• Tonsillitis

Locations

Country	Name	City	State
Denmark	Skoedstrup Medical Clinics	Skodstrup

Sponsors (2)

Lead Sponsor	Collaborator
Aarhus University Hospital	Skodstrup Medical Clinic, Denmark

Country where clinical trial is conducted

Denmark, 

References & Publications (22)

Aliyu SH, Marriott RK, Curran MD, Parmar S, Bentley N, Brown NM, Brazier JS, Ludlam H. Real-time PCR investigation into the importance of Fusobacterium necrophorum as a cause of acute pharyngitis in general practice. J Med Microbiol. 2004 Oct;53(Pt 10):10 — View Citation

Begovac J, Bobinac E, Benic B, Desnica B, Maretic T, Basnec A, Kuzmanovic N. Asymptomatic pharyngeal carriage of beta-haemolytic streptococci and streptococcal pharyngitis among patients at an urban hospital in Croatia. Eur J Epidemiol. 1993 Jul;9(4):405- — View Citation

Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239-46. — View Citation

Centor RM. Expand the pharyngitis paradigm for adolescents and young adults. Ann Intern Med. 2009 Dec 1;151(11):812-5. doi: 10.7326/0003-4819-151-11-200912010-00011. — View Citation

Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD000023. Review. Update in: Cochrane Database Syst Rev. 2013;11:CD000023. — View Citation

Diamantis PK, George S, Alexander DK, Georgios MF, Constantinos AB, Sofia M, John AP, George AV. C-Reactive Protein and serum Procalcitonin Levels as Markers of Bacterial Upper Respiratory Tract Infections. American Journal if Infectious Diseases 5(4): 28

Edmonson MB, Farwell KR. Relationship between the clinical likelihood of group a streptococcal pharyngitis and the sensitivity of a rapid antigen-detection test in a pediatric practice. Pediatrics. 2005 Feb;115(2):280-5. — View Citation

Ehlers Klug T, Rusan M, Fuursted K, Ovesen T. Fusobacterium necrophorum: most prevalent pathogen in peritonsillar abscess in Denmark. Clin Infect Dis. 2009 Nov 15;49(10):1467-72. doi: 10.1086/644616. — View Citation

Elsammak M, Hanna H, Ghazal A, Edeen FB, Kandil M. Diagnostic value of serum procalcitonin and C-reactive protein in Egyptian children with streptococcal tonsillopharyngitis. Pediatr Infect Dis J. 2006 Feb;25(2):174-6. — View Citation

Gulich MS, Matschiner A, Glück R, Zeitler HP. Improving diagnostic accuracy of bacterial pharyngitis by near patient measurement of C-reactive protein (CRP). Br J Gen Pract. 1999 Feb;49(439):119-21. — View Citation

Jensen A, Hagelskjaer Kristensen L, Prag J. Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by real-time PCR. Clin Microbiol Infect. 2007 Jul;13(7):695-701. Epub 2007 Apr 2. — View Citation

Kaplan EL, Wannamaker LW. C-reactive protein in streptococcal pharyngitis. Pediatrics. 1977 Jul;60(1):28-32. — View Citation

Komaroff AL, Pass TM, Aronson MD, Ervin CT, Cretin S, Winickoff RN, Branch WT Jr. The prediction of streptococcal pharyngitis in adults. J Gen Intern Med. 1986 Jan-Feb;1(1):1-7. — View Citation

Lindbaek M, Høiby EA, Lermark G, Steinsholt IM, Hjortdahl P. Which is the best method to trace group A streptococci in sore throat patients: culture or GAS antigen test? Scand J Prim Health Care. 2004 Dec;22(4):233-8. — View Citation

McIsaac WJ, Goel V, To T, Low DE. The validity of a sore throat score in family practice. CMAJ. 2000 Oct 3;163(7):811-5. — View Citation

Murray PR, Baron EJ, Jorgensen JH, et al. Manual of clinical microbiology. 9th ed. Washington, DC: ASM Press. 2007.

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 Aug;145(3):204-6. — View Citation

Rimoin AW, Walker CL, Hamza HS, Elminawi N, Ghafar HA, Vince A, da Cunha AL, Qazi S, Gardovska D, Steinhoff MC. The utility of rapid antigen detection testing for the diagnosis of streptococcal pharyngitis in low-resource settings. Int J Infect Dis. 2010 — View Citation

Rusan M, Klug TE, Ovesen T. An overview of the microbiology of acute ear, nose and throat infections requiring hospitalisation. Eur J Clin Microbiol Infect Dis. 2009 Mar;28(3):243-51. doi: 10.1007/s10096-008-0619-y. Epub 2008 Oct 2. — View Citation

Stenfeldt K, Hermansson A. Acute mastoiditis in southern Sweden: a study of occurrence and clinical course of acute mastoiditis before and after introduction of new treatment recommendations for AOM. Eur Arch Otorhinolaryngol. 2010 Dec;267(12):1855-61. do — View Citation

Veasy LG, Tani LY, Hill HR. Persistence of acute rheumatic fever in the intermountain area of the United States. J Pediatr. 1994 Jan;124(1):9-16. — View Citation

Ylikoski J, Karjalainen J. Acute tonsillitis in young men: etiological agents and their differentiation. Scand J Infect Dis. 1989;21(2):169-74. — View Citation

* Note: There are 22 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Cultured bacteria	In both the acute tonsillitis group and the healthy control group.	Tonsillar surface swabs obtained at time of consultation. The consultation takes about 30 minuts and results will be analyzed approx. 1 time per week.	No
Primary	Procalcitonin	Procalcitonin from all 100 participants will be analyzed at once.	The participants will bee examined in family practice in 30 minuts, measurement results will be available after 3-4 month (average)	No
Secondary	Centor score		The participants will bee examined in family practice in 30 minuts, measurement results will be available after the consultation	No