2006, Number 6
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ABSTRACTObjective: to evaluate the degree of identification of main signs and symptoms of streptococcal pharyngitis by resident doctors, general practitioners, family physicians and pediatri-cians.
Materials and methods: a prospective, cross-sectional and comparative study was done. A validated questionnaire was applied including the following topics: social demographic, main signs and symptoms, clinical cases; and clinical pictures. We interviewed resident doctors (n = 40), general physicians (n = 21), family physicians (n = 35) and pediatricians (n = 19) from different institutions (SSa, ISSSTE, IMSS) in Guadala-jara, Mexico, from March to August 2005. Scores were interpreted as very good, good, regular and poor, and these scores were related with the specialty and clinical years of experience. Statistical analysis: c2, student t test and linear regression.
Results: this study included 115 physicians between 22 to 60 years old (mean = 39) and with 0 to 31 (mean =10) clinical years of experience. Regarding the conceptual identification of main signs and symptoms, tonsil exudates were recognized by 33 to 61 % of physicians, and a clinical case of streptococcal tonsillitis was recognized by 50 to 70 %. A clinical picture of tonsil caseum was misinterpreted as streptococcal tonsillitis by 13 to 35 % of the physicians. There was no association between years of clinical experience and the scores obtained in clinical cases (r = 0.20) or clinical pictures (r = 0.09).
Conclusions: the clinical identification of streptococcal tonsillitis was regular to poor among all the interviewed physicians, and there had no correlation with the years of clinical experience. The reinforcement in teaching to recognize the key signs and symptoms of streptococcal tonsillitis at medical school would result in better recognition, more rational use of antimicrobials and reduction in health institutions costs.
Stevens DL. Group A Beta-Hemolytic Streptococci: virulence factors, pathogenesis, and spectrum of clinical infections. En: Stevens DL, Kaplan EL, editors. Streptococcal infections: clinical aspects, microbiology, and molecular pathogenesis. First edition. New York, NY: Oxford University Press; 2000. p. 19-36.