Aetiology of acute pharyngitis: the role of atypical bacteria

Abstract

In order to establish the role of atypical bacteria and compare characteristics of different infectious agents in acute pharyngitis, 127 patients with acute pharyngitis (66 males; median age, 5 . 33 years; range, 6 months to 14 years) and 130 healthy subjects of similar sex and age were studied. Serology with paired samples and PCR on nasopharyngeal aspirates and throat cultures were used to identify bacteria and viruses. Viruses were identified in 43 patients (33 . 8 %) and five controls (3 . 8 %; P , 0 . 0001), potential bacterial pathogens in 34 patients (26 . 8 %) and 26 controls (20 %; P ¼ 0 . 256) and mixed viral/bacterial pathogens in 26 patients (20 . 5 %) and none of the controls (P , 0 . 0001). The main aetiological agents were adenovirus, respiratory syncytial virus (RSV), Mycoplasma pneumoniae, Streptococcus pyogenes and Chlamydia pneumoniae. M. pneumoniae was the agent found most frequently as a single pathogen. A history of recurrent pharyngitis, having older siblings and a negative outcome were significantly more common among patients with acute M. pneumoniae infection than among those with infections due to other pathogens or healthy controls. This study demonstrates that: (i) adenovirus and RSV have a prominent role in acute pharyngitis; (ii) S. pyogenes is found frequently, but it is not possible to distinguish simple carriers from patients with a true infection; (iii) M. pneumoniae appears to be able to cause acute pharyngitis per se; and (iv) C. pneumoniae seems to be mainly a co-pathogen. To avoid the risk of an incorrect therapeutic approach, simple laboratory investigations that allow rapid identification of M. pneumoniae infections are urgently needed. INTRODUCTIONAcute pharyngitis is one of the most common childhood illnesses to be diagnosed in an outpatient setting (Bisno et al., 1997(Bisno et al., , 2002Bisno, 2001). Viruses and Streptococcus pyogenes are considered to be the most frequent causes of this disease, but particular attention is usually given only to streptococcal cases, as they may be followed by severe early and late complications and are the only ones for which antibiotic treatment is definitely indicated (Bisno et al., 1997(Bisno et al., , 2002Bisno, 2001).It has recently been demonstrated that a significant part of non-streptococcal acute pharyngitis may be associated with Mycoplasma pneumoniae and/or Chlamydia pneumoniae infection, but it has not been established whether these atypical bacteria act simply as co-pathogens or as primary aetiological agents, nor is it known what the outcome of such infections is when they are not treated with antibiotics Esposito et al., 2002b). Definition of the real role of M. pneumoniae and C. pneumoniae in causing acute pharyngitis would be useful for deciding the best diagnostic and therapeutic approach. If these bacteria are primary causes of pharyngitis, and if the disease is likely to have a more complicated course unless treated with adequate antimicrobial agents, some cases that are not usually treated (as they are considered t...

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