Group C beta hemolytic <i>Streptococci</i> as a potential pathogen in patients presenting with an uncomplicated acute sore throat – a systematic literature review and meta-analysis

Gunnarsson, Ronny; Manchal, Naveen

doi:10.1080/02813432.2020.1753374

Cited by 11 publications

(12 citation statements)

References 70 publications

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“…However, compared with the results for GAS, the association between FN and the uncomplicated acute sore throat appears to be considerably weaker and only marginally higher than the P-EPV of 53% (95% CI 36% to 67%) previously found for adults harbouring Group C streptococci (GCS). 15 Furthermore, the narrow CIs for GAS P-EPV are in contrast with the wide CIs associated with the P-EPV for FN.…”

Section: Discussionmentioning

confidence: 96%

“…Using a random effects meta-analysis would have provided ORs for harbouring FN among cases compared with controls. The statistical technique we used for meta-analysis, P-EPV, has been used previously 15 and provides a probability for a true connection between FN and the symptom of a sore throat in the studied group. This outcome is a plain percent between 0% and 100%.…”

Section: Methodsmentioning

confidence: 99%

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Acute sore throat and Fusobacterium necrophorum in primary healthcare: a systematic review and meta-analysis

et al. 2021

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PurposeThe main objective of this review was to describe and quantify the association between Fusobacterium necrophorum (FN) and acute sore throat in primary healthcare (PHC).MethodsIn this systematic review and meta-analysis, we searched Scopus and PubMed for case–control studies reporting the prevalence of FN in patients attending primary care for an uncomplicated acute sore throat as well as in healthy controls. Only studies published in English were considered. Publications were not included if they were case studies, or if they included patients prescribed antibiotics before the throat swab, patients with a concurrent malignant disease, on immunosuppression, having an HIV infection, or patients having another acute infection in addition to a sore throat. Inclusion criteria and methods were specified in advance and published in PROSPERO. The primary outcome was positive etiologic predictive value (P-EPV), quantifying the probability for an association between acute sore throat and findings of FN in the pharynx. For comparison, our secondary outcome was the corresponding P-EPV for group A Streptococcus (GAS).ResultsPubMed and Scopus yielded 258 and 232 studies, respectively. Removing duplicates and screening the abstracts resulted in 53 studies subsequently read in full text. For the four studies of medium to high quality included in the meta-analysis, the cumulative P-EPV regarding FN was 64% (95% CI 33% to 83%). GAS, based on data from the same publications and patients, yielded a positive EPV of 93% (95% CI 83% to 99%).ConclusionsThe results indicate that FN may play a role in PHC patients with an acute sore throat, but the association is much weaker compared with GAS.

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Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

Acute sore throat and Fusobacterium necrophorum in primary healthcare: a systematic review and meta-analysis

et al. 2021

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“…However, systematic reviews focusing on case-control studies have not established that SDSE is linked to the uncomplicated acute sore throat to the extent that it should be considered in the management of these patients. [11][12][13][14]…”

Section: Aetiology Of the Sore Throatmentioning

confidence: 99%

Improving antibiotics targeting using PCR point-of-care testing for group A streptococci in patients with uncomplicated acute sore throat

Gunnarsson¹,

Orda²,

Elliott³

et al. 2021

Aust J Gen Pract

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The software G*Power version 3.1.9.2 was used assuming logistic regression with antibiotic prescribing as the dependent variable. 37,38 The researchers aimed to collect data from 300 patients. Role of the funding sourceThis study was funded by James Cook University and Bond University, both in Australia. Some of the authors are employed by these universities. The PCR devices and test kits were purchased from Abbott. Hence, Abbott was not a funder and had no influence on study design, analysis of data or writing of the manuscript.

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Section: Introductionmentioning

confidence: 99%

“…In addition to GAS, Streptococcus dysgalactiae subspecies equisimilis (SDSE), formerly described as large colony group C or G streptococci in the Lancefield classification system [ 7 ], has been detected in 9 to 15% of young adults with pharyngotonsillitis [ 8 – 10 ], and the anaerobe Fusobacterium necrophorum has been detected in 18–19% of patients with pharyngotonsillitis in primary healthcare (PHC) [ 11 , 12 ]. Both bacteria, however, are also recovered from healthy controls, and their roles as pathogens in pharyngotonsillitis are still disputed [ 10 – 14 ]. F. necrophorum , the main pathogen causing the severe but unusual Lemierre’s syndrome [ 15 ], has been associated with peritonsillar abscesses [ 16 ] and several case reports have described complications following pharyngotonsillitis associated with group C and group G streptococci [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Association between bacterial finding, antibiotic treatment and clinical course in patients with pharyngotonsillitis: a registry-based study in primary healthcare in Sweden

et al. 2021

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Background The role of non-group A streptococci and Fusobacterium necrophorum in pharyngotonsillitis has been disputed and few prospective studies have evaluated the effect of antibiotic treatment. This study uses registry data to investigate the relation between antibiotic prescription for pharyngotonsillitis in primary healthcare and return visits for pharyngotonsillitis, complications, and tonsillectomy. Methods Retrospective data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for all patients diagnosed with pharyngotonsillitis between 2012 and 2016. From these data, two cohorts were formed: one based on rapid antigen detection tests (RADT) for group A streptococci (GAS) and one based on routine throat cultures for β-haemolytic streptococci and F. necrophorum. The 90 days following the inclusion visit were assessed for new visits for pharyngotonsillitis, complications, and tonsillectomy, and related to bacterial aetiology and antibiotic prescriptions given at inclusion. Results In the RADT cohort (n = 13,781), antibiotic prescription for patients with a positive RADT for GAS was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (8.7% vs. 12%; p = 0.02), but not with the complication rate within 30 days (1.5% vs. 1.8%; p = 0.7) or with the tonsillectomy rate within 90 days (0.27% vs. 0.26%; p = 1). In contrast, antibiotic prescription for patients with a negative RADT was associated with more return visits for pharyngotonsillitis within 30 days (9.7% vs. 7.0%; p = 0.01). In the culture cohort (n = 1 370), antibiotic prescription for patients with Streptococcus dysgalactiae ssp. equisimilis was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (15% vs. 29%; p = 0.03). Conclusions Antibiotic prescription was associated with fewer return visits for pharyngotonsillitis in patients with a positive RADT for GAS but with more return visits in patients with a negative RADT for GAS. There were no differences in purulent complications related to antibiotic prescription.

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Group C beta hemolytic Streptococci as a potential pathogen in patients presenting with an uncomplicated acute sore throat – a systematic literature review and meta-analysis

Abstract: Manchal (2020) Group C beta hemolytic Streptococci as a potential pathogen in patients presenting with an uncomplicated acute sore throat -a systematic literature review and meta-analysis,

Cited by 11 publications

References 70 publications

Acute sore throat and Fusobacterium necrophorum in primary healthcare: a systematic review and meta-analysis

Acute sore throat and Fusobacterium necrophorum in primary healthcare: a systematic review and meta-analysis

Improving antibiotics targeting using PCR point-of-care testing for group A streptococci in patients with uncomplicated acute sore throat

Association between bacterial finding, antibiotic treatment and clinical course in patients with pharyngotonsillitis: a registry-based study in primary healthcare in Sweden

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