The bacterial growth in patients presenting with a sore throat was assayed and four clinical features were tested in order to reliably differentiate between beta-haemolytic streptococci group A (GABHS) and other micro-organisms. For 2 years, 53 general practitioners (GPs) in The Netherlands took throat swabs from all patients, aged 4-60, presenting with a sore throat lasting 14 days or less. Four clinical features: fever (history), (tonsillary) exudate, anterior cervical lymphadenopathy and absence of cough were registered. In 70% of the 598 patients one or more micro-organisms were cultured from throat specimens. In 48% of the patients beta-haemolytic streptococci were found (32% group A, 7% group C, 4% group G, 5% others). Enterobacteriaceae were cultured in 5%, Candida albicans in 5%, Staphylococcus aureus in 4%, various others in 8% of the patients. In 30% of the patients cultures remained negative. Of the 270 patients with three or four clinical features, 46% (95% Cl, 40-52%) harboured GABHS in their throats, while in 328 patients with less than three features 21% (95% Cl, 16-25%) were GABHS positive. However, this relationship between presence or absence of clinical features and culture result was not found in the youngest age category (4-14 years old). Culture results were not related to sex, smoking habits or the insurance mode of the patient. The clinical relevance of several micro-organisms, other than beta-haemolytic streptococci, remains to be determined. The four mentioned signs and symptoms were helpful in predicting the probability of GABHS in patients aged 15 years and older.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute respiratory disease is one of the most common reasons to consult a general practitioner. A substantial part of these diseases cannot be explained by an infection with a virus or a common pathogenic bacterium. To study this diagnostic deficit, the prevalence of Chlamydia pneumoniae and Mycoplasma pneumoniae infections was determined in two groups of patients consulting a general practitioner. DNA of C. pneumoniae and M. pneumoniae was detected by a polymerase chain reaction (PCR) in nose/throat swabs from six (1.1%), and from seven (1.3%) patients, respectively, of 557 patients consulting a general practitioner for complaints suggestive for a virus infection during the 1994/1995 respiratory infections season. Two patients remained C. pneumoniae PCR-positive for at least 4 weeks. All others were negative within 3 weeks. Double infections of C. pneumoniae and influenza virus (3/6), and of M. pneumoniae and respiratory syncytial virus (1/7) or rhinovirus (1/7) were diagnosed. During the 1992/1993 season, attempts to isolate C. pneumoniae in cell culture or to detect C. pneumoniae DNA by PCR using throat swabs were all negative for 80 patients with a sore throat, although serological data suggested a C. pneumoniae infection in 13 (16%) patients. A specimen from another patient of this group was M. pneumoniae PCR-positive and the corresponding serum specimens showed a persistent high antibody titre. In summary, the prevalence of acute C. pneumoniae and M. pneumoniae infections was less than 2% in patients consulting a general practitioner.
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Keelpijn Sjoerd Zwart Carien DagnelieSamenvatting Ongeveer 10% van de mensen met keelpijn raadpleegt een arts. Acute keelpijn die langer dan 14 dagen duurt, wordt meestal veroorzaakt door een virus. Een keelontsteking door een virus gaat veelal gepaard met neusverkoudheid en hoesten. Als een bacterie de oorzaak is, betreft het meestal een be`tahemolytische streptokok.Zowel bacterie¨le als virale keelontstekingen hebben meestal een mild natuurlijk beloop en duren niet langer dan een week. Uiteindelijk bepaalt de ernst van het klinisch beeld, zoals toenemende slikpijn, trismus, unilaterale peritonsillaire zwelling en/of ernstige beperking van dagelijkse activiteiten, of de patie¨nt in aanmerking komt voor behandeling met penicilline.Bij risicopatie¨nten of bij een langer durend beloop kan nadere diagnostiek zinvol zijn. Bloedonderzoek is slechts geı¨ndiceerd indien aan een ernstige aandoening (maligniteit) of aan een mononucleosisinfectie wordt gedacht. Keelpijn die langer dan 14 dagen bestaat, heeft vaak een niet-infectieuze oorzaak, zoals inademing van droge lucht of rook, door angst verhoogde spierspanning, verkeerd stemgebruik of keelschrapen of, zelden, een maligniteit. Van klacht naar probleemKeelpijn is een veel voorkomende klacht in de algemene populatie. In een drie maanden durende dagboekregistratie gaf 5% van de mensen aan e´e´n of meer keer keelpijn te hebben gehad.
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