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Streptococcal Pharyngitis: Diagnosis by Gram Stain

GEORGE CRAWFORD, M.D.; FRANK BRANCATO, Ph.D.; and KING K. HOLMES, M.D.
[+] Article and Author Information

Grant support: National Institutes of Health Program Project AI 12192-02 and a U.S. Air Force Institute of Technology postdoctoral training fellowship (GC).

▸Requests for reprints should be addressed to George Crawford, M.D.; WHMC/SGHMI; Lackland Air Force Base, TX 78236.


Seattle, Washington


© 1979 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1979;90(3):293-297. doi:10.7326/0003-4819-90-3-293
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Group A beta-hemolytic streptococci were isolated from 49 (10.4%) of 472 patients with pharyngitis. Throat culture results, interpreted by five observers of varying experience, showed the mean sensitivity, specificity, and predictive value of a positive Gram-stained smear of pharyngeal secretions as 73%, 96%, and 71%. Assignment to a high-risk group by clinical algorithm gave sensitivity, specificity, and predictive value of only 45%, 83%, and 23%. The Gram-stained smear is the most accurate method of early diagnosis of streptococcal pharyngitis.

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