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Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: feasibility study

Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: feasibility study
Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: feasibility study
Introduction: sore throat is a common reason for overuse of antibiotics. The value of inflammatory or biomarkers in throat swab or saliva samples in predicting benefit from antibiotics is unknown.

Methods: we used the ‘person-based approach’ to develop an online tool to support self-swabbing and recruited adults and children with sore throats through participating general practices and social media. Participants took bacterial and viral swabs and a saliva sponge swab and passive drool sample. Bacterial swabs were cultured for streptococcus (Group A, B, C, F and G). The viral swab and saliva samples were tested using a routine respiratory panel PCR and Covid-19 PCR testing. We used remaining viral swab and saliva sample volume for biomarker analysis using a panel of 13 biomarkers.

Results: we recruited 11 asymptomatic participants and 45 symptomatic participants. From 45 symptomatic participants, bacterial throat swab, viral throat swab, saliva sponge and saliva drool samples were returned by 41/45 (91.1%), 43/45 (95.6%), 43/45 (95.6%) and 43/45 (95.6%) participants respectively. Three saliva sponge and 6 saliva drool samples were of insufficient quantity. Two adult participants had positive bacterial swabs. Six participants had a virus detected from at least one sample (swab or saliva). All of the biomarkers assessed were detectable from all samples where there was sufficient volume for testing. For most biomarkers we found higher concentrations in the saliva samples. Due to low numbers, we were not able to compare biomarker concentrations in those who did and did not have a bacterial pathogen detected. We found no evidence of a difference between biomarker concentrations between the symptomatic and asymptomatic participants but the distributions were wide.

Conclusions: we have demonstrated that it is feasible for patients with sore throat to self-swab and provide saliva samples for pathogen and biomarker analysis. Typical bacterial and viral pathogens were detected but at low prevalence rates. Further work is needed to determine if measuring biomarkers using oropharyngeal samples can help to differentiate between viral and bacterial pathogens in patients classified as medium or high risk using clinical scores, in order to better guide antibiotic prescribing and reduce inappropriate prescriptions.
infection, inflammatory markers, saliva, sore throat diagnosis, swabs
1664-3224
Lown, Mark
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Miles, Elizabeth A.
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Fisk, Helena L.
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Smith, Kirsten A.
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Muller, Ingrid
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Maund, Emma
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Rogers, Kirsty
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Becque, Taeko
ecd1b4d5-4db8-4442-81c2-04aa291cf2fd
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
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Stuart, Beth
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Thompson, Natalie
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Francis, Nick
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et al.
Lown, Mark
4742d5f8-bcf3-4e0b-811c-920e7d010c9b
Miles, Elizabeth A.
20332899-ecdb-4214-95bc-922dde36d416
Fisk, Helena L.
2483d346-75dd-41b3-a481-10f8bb39cd9f
Smith, Kirsten A.
9da65772-0efa-4267-87ff-563f9757b34e
Muller, Ingrid
2569bf42-51bd-40da-bbfd-dd4dbbd62cad
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Rogers, Kirsty
2aee433b-d8cb-4326-8d2b-870a4108218c
Becque, Taeko
ecd1b4d5-4db8-4442-81c2-04aa291cf2fd
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Thompson, Natalie
f2803da0-85a3-456a-98d0-3b09b3adf9ef
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e

Lown, Mark, Miles, Elizabeth A. and Fisk, Helena L. , et al. (2022) Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: feasibility study. Frontiers in Immunology, 13, [1016181]. (doi:10.3389/fimmu.2022.1016181).

Record type: Article

Abstract

Introduction: sore throat is a common reason for overuse of antibiotics. The value of inflammatory or biomarkers in throat swab or saliva samples in predicting benefit from antibiotics is unknown.

Methods: we used the ‘person-based approach’ to develop an online tool to support self-swabbing and recruited adults and children with sore throats through participating general practices and social media. Participants took bacterial and viral swabs and a saliva sponge swab and passive drool sample. Bacterial swabs were cultured for streptococcus (Group A, B, C, F and G). The viral swab and saliva samples were tested using a routine respiratory panel PCR and Covid-19 PCR testing. We used remaining viral swab and saliva sample volume for biomarker analysis using a panel of 13 biomarkers.

Results: we recruited 11 asymptomatic participants and 45 symptomatic participants. From 45 symptomatic participants, bacterial throat swab, viral throat swab, saliva sponge and saliva drool samples were returned by 41/45 (91.1%), 43/45 (95.6%), 43/45 (95.6%) and 43/45 (95.6%) participants respectively. Three saliva sponge and 6 saliva drool samples were of insufficient quantity. Two adult participants had positive bacterial swabs. Six participants had a virus detected from at least one sample (swab or saliva). All of the biomarkers assessed were detectable from all samples where there was sufficient volume for testing. For most biomarkers we found higher concentrations in the saliva samples. Due to low numbers, we were not able to compare biomarker concentrations in those who did and did not have a bacterial pathogen detected. We found no evidence of a difference between biomarker concentrations between the symptomatic and asymptomatic participants but the distributions were wide.

Conclusions: we have demonstrated that it is feasible for patients with sore throat to self-swab and provide saliva samples for pathogen and biomarker analysis. Typical bacterial and viral pathogens were detected but at low prevalence rates. Further work is needed to determine if measuring biomarkers using oropharyngeal samples can help to differentiate between viral and bacterial pathogens in patients classified as medium or high risk using clinical scores, in order to better guide antibiotic prescribing and reduce inappropriate prescriptions.

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Accepted/In Press date: 22 September 2022
Published date: 6 October 2022
Additional Information: Funding Information: this study/project is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 463). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Keywords: infection, inflammatory markers, saliva, sore throat diagnosis, swabs

Identifiers

Local EPrints ID: 471377
URI: http://eprints.soton.ac.uk/id/eprint/471377
ISSN: 1664-3224
PURE UUID: 040f6e75-ee98-44c4-8e93-451f2e350bad
ORCID for Mark Lown: ORCID iD orcid.org/0000-0001-8309-568X
ORCID for Elizabeth A. Miles: ORCID iD orcid.org/0000-0002-8643-0655
ORCID for Helena L. Fisk: ORCID iD orcid.org/0000-0002-9534-3246
ORCID for Ingrid Muller: ORCID iD orcid.org/0000-0001-9341-6133
ORCID for Emma Maund: ORCID iD orcid.org/0000-0002-3998-6669
ORCID for Kirsty Rogers: ORCID iD orcid.org/0000-0001-5394-4003
ORCID for Taeko Becque: ORCID iD orcid.org/0000-0002-0362-3794
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 04 Nov 2022 17:35
Last modified: 17 Mar 2024 03:58

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Contributors

Author: Mark Lown ORCID iD
Author: Helena L. Fisk ORCID iD
Author: Ingrid Muller ORCID iD
Author: Emma Maund ORCID iD
Author: Kirsty Rogers ORCID iD
Author: Taeko Becque ORCID iD
Author: Michael Moore ORCID iD
Author: Paul Little
Author: Beth Stuart ORCID iD
Author: Natalie Thompson
Author: Nick Francis ORCID iD
Corporate Author: et al.

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