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Pagels J, Torisson G, Wasserstrom L, Hedin K, Holm K, Nygren D. Symptoms predictive of Fusobacterium necrophorum pharyngotonsillitis - an observational study of cases presenting to hospitals in Southern Sweden. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04827-6. [PMID: 38609699 DOI: 10.1007/s10096-024-04827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Fusobacterium necrophorum is a common cause of pharyngotonsillitis. However, no guidelines exist on when to diagnose or treat it. We aimed to investigate associations between clinical criteria and F. necrophorum-positivity in pharyngotonsillitis and assess the predictive potential of a simple scoring system. METHODS Pharyngotonsillitis patients who were tested for F. necrophorum (PCR) and presented to hospitals in the Skåne Region, Sweden, between 2013-2020 were eligible. Data were retrieved from electronic chart reviews and registries. By logistic regression we investigated associations between F. necrophorum-positivity and pre-specified criteria: age 13-30 years, symptom duration ≤ 3 days, absence of viral symptoms (e.g. cough, coryza), fever, tonsillar swelling/exudate, lymphadenopathy and CRP ≥ 50 mg/L. In secondary analyses, associated variables were weighted by strength of association into a score and its predictive accuracy of F. necrophorum was assessed. RESULTS Among 561 cases included, 184 (33%) had F. necrophorum, which was associated with the following criteria: age 13-30, symptom duration ≤ 3 days, absence of viral symptoms, tonsillar swelling/exudate and CRP ≥ 50 mg/L. Age 13-30 had the strongest association (OR5.7 95%CI 3.7-8.8). After weighting, these five variables had a sensitivity and specificity of 68% and 71% respectively to predict F. necrophorum-positivity at the proposed cut-off. CONCLUSION Our results suggest that F. necrophorum cases presenting to hospitals might be better distinguished from other pharyngotonsillitis cases by a simple scoring system presented, with age 13-30 being the strongest predictor for F. necrophorum. Prospective studies, involving primary care settings, are needed to evaluate generalisability of findings beyond cases presenting to hospitals.
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Affiliation(s)
- Josefina Pagels
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden.
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lisa Wasserstrom
- Department of Clinical Microbiology, Infection Control and Prevention, Skåne University Hospital, Lund, Sweden
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Katarina Hedin
- Futurum, Jönköping, Region Jönköping County, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
| | - David Nygren
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund/Malmö, Sweden
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Proulx C, Autmizgine J, Drouin O, Panetta L, Delisle GA, Luu TM, Quach C, Kakkar F. Isolated rhinorrhea in the presentation of SARS-CoV-2 infection among preschool- versus school-aged children. Paediatr Child Health 2022; 27:S22-S26. [PMID: 35620556 PMCID: PMC9126269 DOI: 10.1093/pch/pxab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives Rapid identification and isolation of SARS-CoV-2 cases are priorities in school and child care settings to prevent further outbreaks. The objective of this study was to compare the clinical presentation of SARS-CoV-2 infections among preschool (<5 years) versus school-aged (≥5 years) children diagnosed with SARS-CoV-2 infection, and, specifically, the probability of presenting with an isolated symptom, such rhinorrhea or sore throat. Methods Retrospective study of children (≤18 years of age) diagnosed with SARS-CoV-2 in the outpatient COVID-19 clinic or the Emergency Department at the Centre Hospitalier Universitaire Sainte-Justine (Montreal, Quebec, Canada) February through May 2020. Results Of 3,789 children tested, 105 (3%) were positive for SARS-CoV-2, and 104 included in the analysis (n=49 age <5 years and n=55 age ≥5 years). While fever was the most common presenting symptom across both age groups, in the absence of fever, the presence of a combination of two or more symptoms identified the majority (92%) of cases. Isolated single symptom presentations were uncommon (<5% of cases). Most importantly, not a single child in either age group presented with isolated rhinorrhea or sore throat. Conclusions While there are differences in the clinical manifestations of COVID-19 in preschool- versus school-aged children, in both age groups, isolated rhinorrhea was not a manifestation of SARS-CoV-2 infection. These results could help further guide testing criteria and exclusion criteria in child care and school settings.
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Affiliation(s)
- Catherine Proulx
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Julie Autmizgine
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada.,Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Luc Panetta
- Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Gaelle A Delisle
- Infection Prevention and Control Unit, Department of Pediatric Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Division of General Pediatrics, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Caroline Quach
- Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Infection Prevention and Control Unit, Department of Pediatric Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Department of Microbiology, Infectious Disease and Immunology, Université de Montréal, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Research Center, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada.,Division of Infectious Diseases, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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Nilsson MP, Winter C, Kristoffersson U, Rehn M, Larsson C, Saal LH, Loman N. Efficacy versus effectiveness of clinical genetic testing criteria for BRCA1 and BRCA2 hereditary mutations in incident breast cancer. Fam Cancer 2017; 16:187-193. [PMID: 28120249 PMCID: PMC5357494 DOI: 10.1007/s10689-016-9953-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increasing evidence supports the benefit of identifying BRCA1 and BRCA2 germline mutations in early breast cancer. Selection of patients for genetic testing is based on defined criteria taking individual and family history related factors into account. It is important to make a distinction between efficacy and effectiveness of BRCA testing criteria. Efficacy can be defined as the performance under ideal circumstances, whereas effectiveness refers to its real life performance. To allow for an unbiased and detailed evaluation of efficacy and effectiveness of the Swedish BRCA testing criteria, we retrospectively analyzed a prospectively collected cohort of 273 breast cancer patients from the well-characterized, population-based, single-site All Breast Cancer in Malmö (ABiM) study. The patients were diagnosed with breast cancer during the years 2007 through 2009. Out of 20 mutation carriers identified, 13 fulfilled Swedish criteria at time of diagnosis. Thus, the efficacy of these criteria was 65%. Excluding three patients in whom a mutation was already known at time of diagnosis, only 3/17 had been identified in the clinical routine, corresponding to an effectiveness of 18%. Here we detail the reasons why mutation carriers in our cohort were not detected though routine health care. In conclusion, effectiveness of BRCA testing criteria was much lower than efficacy. Our results indicate that current testing criteria and procedures associated with BRCA1 and BRCA2 testing are insufficient. There is room for improvement of their efficacy, but even more so regarding effectiveness. Clinical BRCA testing routines need to be critically revised.
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Affiliation(s)
- Martin P Nilsson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Christof Winter
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulf Kristoffersson
- Department of Clinical Genetics, Laboratory Medicine Region Skåne, Lund, Sweden.,Department of Clinical Genetics, Lund University, Lund, Sweden
| | - Martin Rehn
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Christer Larsson
- Department of Translational Cancer Research, Lund University, Lund, Sweden
| | - Lao H Saal
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden.,CREATE Health Strategic Centre for Translational Cancer Research, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden. .,Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.
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