Microbiological Etiology of Acute Tonsillitis and Clinical Validation of the Centor Score for Group A Streptococcus Detection in Primary Care
DOI:
https://doi.org/10.15407/Keywords:
tonsillitis, bacteria, Centor scale, bacteriological examination, Group A beta-hemolytic streptococcusAbstract
Acute tonsillitis is one of the most common reasons why adults visit a primary care physician. Distinguishing between viral and bacterial causes remains a clinical challenge, resulting in the overprescription of antibiotics for viral infections or the delayed treatment of streptococcal tonsillitis. Using a combination of clinical scales (such as the Centor score) and microbiological methods can improve diagnostic accuracy in adults. The study aimed to characterize the microbial etiology of acute tonsillitis through standardized bacteriological analysis while clinically validating the Centor score for Group A Streptococcus detection in primary health care. Methods. A prospective cohort study was conducted involving 77 patients aged 18 – 45 years who had been clinically diagnosed with acute tonsillitis. Tonsillar samples were analysed using bacteriological culturing on selective media (blood agar and mannitol salt agar), phenotypic identifi cation (Gram staining, the catalase test, and the hemolysis assay) and a quantitative assessment of microbiom (using dominance and frequency indices). Clinical assessment was performed using the Centor scale, followed by ROC analysis of its diagnostic accuracy. Results. Group A beta-haemolytic streptococcus represented 11.62 % of the total isolated strains (95 % confi dence interval: 7.67 – 16.68), which is consistent with global data. Staphylococcus aureus was identified in 7.91 % of samples. The Centor score demonstrated moderate accuracy (AUC = 0.69), with an optimal threshold of ≥4 points (sensitivity: 71.4%; specifi city: 60.0%). The detection rate of Group A beta-haemolytic streptococcus was 12.8% in patients with 2—3 Centor points and 9.67% in patients with 4 or more points. Conclusions. Combining the Centor score with microbiological confirmation for patients with a score of 3 – 4 can reduce the overprescription of antibiotics. To increase diagnostic accuracy, it is recommended to use rapid tests for Group A β-hemolytic streptococcus antigens.
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