Faringitis grup A beta hemolitik streptokokus pada anak-anak klinis dan kultur usap tenggorok

JURIANTI, Adhani, dr. Roni Naning, M.Kes, Sp.A(K)

2008 | Tesis | S2 Ilmu Kesehatan anak

Latar Belakang: Nyeri telan adalah gejala umum pada faringitis (sering terjadi pada umur 10-15 tahun) dapat disebabkan oleh virus atau bakteri, yang secara klinis sulit dibedakan. Insidensi faringitis karena bakteri (GABHS) sekitar 10 – 20% dan diagnosis pasti dengan kultur tenggorokan. Tujuan: Untuk mengetahui nilai diagnosis gejala klinis faringitis GABHS. Metode: Sebuah penelitian observasional, prospektif, uji diagnosis. Subyek penelitian 3 – 14 tahun di Poliklinik RS Dr. Sardjito dan puskesmas di Yogyakarta pada Januari 2005 – Desember 2007 dengan keluhan nyeri telan. Jumlah sampel 88 anak dengan gejala klinis demam, pembesaran tonsil, pembesaran limfonodi, tidak ada batuk. Anak yang mendapat antibiotik 5 hari sebelum penelitian dikeluarkan dalam penelitian. Gejala klinis dilakukan validasi dengan MC Issaac Score dan dilakukan kultur tenggorokan. Hasil: Terdapat 9 (10,2%) dari 88 anak dengan kultur GABHS positip. Mc Issaac Score 1 memiliki sensitivitas 22%, spesifisitas 65%, nilai duga positip 7%, nilai duga negatip 88%, Mc Issaac Score 2 memiliki sensitifitas 11%, spesifisitas 63%, nilai duga positip 3%, nilai duga negatip 86%, Mc Issaac Score 3 memiliki sensitifitas 11%, spesifisitas 85%, nilai duga positip 8%, nilai duga negatip 89%, Mc Issaac Score 4 memiliki sensitifitas 56%, spesifisitas 87%, nilai duga positip 33%, nilai duga negatip 95%. Kesimpulan: Diagnosis faringitis GABHS dengan Mc Issaac Score 4 memiliki sensitifitas 56%, spesifisitas 87%, nilai duga positip 33%, nilai duga negatip 95%.

Background: Sore throat is common sign of respiratory system infection, such as pharyngitis that caused by virus or Group A ß Hemolytic Streptococcus (GABHS). Although GABHS infection is treated a indication for antibiotic therapy, it is important to prevent non supurative sequele. It was found that only 10 to 20% patients have a positive culture. The highest GABHS incidence 30% is found among children of age 10 – 15. Objective: To evaluate the accuracy of sensitivity, specificity GABHS pharyngitis. Methods: An observational, cross sectional study was conducted in Dr. Sardjito Hospital from Januari 2005 until December 2007. Children aged 3 to 14 years who had received a clinical diagnosis exsudat tonsil, anterior cervical lymph inflammation, body temperature higher than 38’C and no cough appears were enrolled. Clinical finding was recorded and classification of pharyngitis according to Mc Issaac Score. Throat culture swab is a gold standard for streptococcal pharyngitis indications. Children who had received any antibiotic therapy within previous 5 days of presentation, presented signs of viral respiratory infection were excluded. Result: The culture was positive GABHS in 9 (10,2%) of the 88 children evaluated. Mc Issaac Score 4 had sensitivity 56%, specificity 87%, positive predictive value 33%, negative predictive value 95%. Conclusions: Mc Issaac Score 4 had sensitivity 56%, specificity 87%, positive predictive value 33%, negative predictive value 95% may be helpful to estimate of probability of infection with GABHS.

Kata Kunci : Faringitis,Grup A beta,hemolitikus streptokokkus (GABHS),skor mclsaac,Kultur usap tenggorok,Group A ß Hemolytic Streptococcus (GABHS),pharyngitis,Mc Issaac Score,throat culture