Joan Neuner, MD; Mark D. Aronson, MD
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Neuner J., Aronson M.; Diagnosis and Management of Adults with Pharyngitis. Ann Intern Med. 2004;140:763. doi: 10.7326/0003-4819-140-9-200405040-00023
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Published: Ann Intern Med. 2004;140(9):763.
Dr. Corwin is concerned about the possible poor sensitivity of pharyngeal culture compared with the ASLO titre. The test characteristics of pharyngeal culture when compared with a variety of other tests have varied in the literature, as we reviewed in our article and its appendix. Probably because ASLO assessment takes at least a week and thus cannot be used for treatment decisions in the clinical setting, there is unfortunately little information regarding ASLO titers in a group of patients “suspicious” for streptococcal pharyngitis or in patients receiving rapid immunoassay testing. This lack of data made it difficult for us to use ASLO as our gold standard. Furthermore, some of the issues regarding sensitivity may be reduced with careful attention to culture technique (1), and recent studies using polymerase chain reaction to assess both immunoassays and pharyngeal culture suggest that test performance of culture is much better than the 70% sensitivity cited by Dr. Corwin (2). For these reasons, although we agree that it is less than ideal, we and authors of similar studies have chosen to use pharyngeal culture as a gold standard.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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