Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study

Little, Paul; Hobbs, FD Richard; Mant, David; McNulty, C.; Mullee, Mark

doi:10.3399/bjgp12x658322

Cited by 29 publications

(34 citation statements)

References 18 publications

(21 reference statements)

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“…Table 2 summarizes the clinical signs and symptoms of patients with pharyngitis associated with Group A streptococcus, Group C streptococcus, and F necrophorum from 3 studies, 1 of which included F necrophorum. 4,5,7 The clinical presentations are very similar for patients with any of the 3 bacteria, again supporting the idea that they may be pathogenic.The argument for detection and treatment is threefold. While Group C streptococcus is not a cause of rheumatic fever, this is an exceedingly rare complication of Group A streptococcus, and treatment solely for that purpose is not cost-effective.…”

supporting

confidence: 55%

“…4,5,10,16,[17][18][19][20][21][22][23][24][25][26] An updated search made just before we wrote the manuscript identified 2 additional studies 7, 27 for a final count of 16 included studies (Figure 1). Table 1 summarizes the study characteristics: 6 reported the prevalence of Group C streptococcus, 4,5,[17][18][19][20] 3 the prevalence of F necrophorum, 16,21,22 and 7 the prevalence of both pathogens. 7,10,[23][24][25][26][27] Data collection ranged from 2000 to 2014 and took place in 9 countries.…”

Section: Resultsmentioning

confidence: 99%

“…3,4 For example, in a study of 606 adults in primary care who had sore throat, those with Group C or G streptococcal infection resembled those with Group A streptococcus in rapidity of onset, likelihood of adenopathy, intensity of pharyngeal inflammation, and likelihood of purulence. 5 In addition, Group C streptococcus appears to share some of the virulence factors found in Group A. 6 While it is not known to cause rheumatic fever, identification and treatment may reduce the duration of symptoms and the period of communicability of the infection.…”

mentioning

confidence: 99%

“…Seven stud- ies did not mention including or excluding patients with prior antibiotic use. 5,10,16,20,22,24,26 Of these 7, 5 were laboratory-based. It was because the laboratory-based studies did not indicate why swabs were submitted or provide details regarding previous antibiotics that we stratified our analysis by setting.…”

mentioning

confidence: 99%

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Prevalence of Group C Streptococcus and Fusobacterium Necrophorum in Patients With Sore Throat: A Meta-Analysis

Marchello¹,

Ebell²

2016

The Annals of Family Medicine

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PURPOSEThe prevalence of Group C beta-hemolytic streptococcus and Fusobacterium necrophorum among patients with sore throat in the outpatient setting has not been previously summarized. We set out to derive prevalence information from the existing literature. METHODSWe performed a systematic review of MEDLINE for studies reporting the prevalence of F necrophorum or Group C streptococcus or both in prospective, consecutive series of outpatients with sore throat, as well as laboratory-based studies of throat cultures submitted from primary care. We limited searches to studies where the majority of data was collected after January 1, 2000, to reflect contemporary microbiological methods and prevalences. Each author independently reviewed the articles for inclusion and abstraction of data; we resolved discrepancies by consensus discussion. We then performed a meta-analysis to calculate the pooled prevalence estimates using a random effects model of raw proportions. RESULTSA total of 16 studies met our inclusion criteria. The overall prevalences of Group C streptococcus and F necrophorum were 6.1% (95% CI, 3.2%-9.0%) and 18.9% (95% CI, 10.5%-27.2%), respectively. When stratified by study type, the prevalences of Group C streptococcus and F necrophorum in laboratory-based studies were 6.6% (95% CI, -1.0% to 14.2%) and 18.8% (95% CI, 6.5%-31.1%), respectively. In primary care patients with sore throat, Group C streptococcus had a prevalence of 6.1% (95% CI, 3.1%-9.2%), while F necrophorum had a prevalence of 19.4% (95% CI, 14.7%-24.1%).CONCLUSIONS Group C streptococcus and Fusobacterium necrophorum are commonly detected in patients with acute pharyngitis. Research is needed, however, to determine whether these bacteria are truly pathogenic in patients with pharyngitis and whether antibiotics reduce the duration of symptoms or the likelihood of complications. Ann Fam Med 2016;14:567-574. doi: 10.1370/afm.2005. INTRODUCTION Pharyngitis is an important cause of morbidity, and was responsible for 1.4% of all visits 1 to ambulatory care physicians in 2012, making it the 10th most common reason for such visits. While most cases of pharyngitis are viral, Group A beta-hemolytic streptococci are responsible for approximately 10% of episodes in adults and up to 30% in children. Recently, it has been suggested that 2 other bacteria may be important causes of pharyngitis, but their prevalence has not been well described.The first, Group C beta-hemolytic streptococcus, is often found in patients with acute pharyngitis. While it is traditionally not thought to be a pathogen, recent studies have found that it appears to cause symptoms similar to those caused by Group A streptococcus. 3,4 For example, in a study of 606 adults in primary care who had sore throat, those with Group C or G streptococcal infection resembled those with Group A streptococcus in rapidity of onset, likelihood of adenopathy, intensity of pharyngeal inflammation, and likelihood of purulence. 5 In addition, Group C streptococcus appears to share some of ...

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supporting

confidence: 55%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Prevalence of Group C Streptococcus and Fusobacterium Necrophorum in Patients With Sore Throat: A Meta-Analysis

Marchello¹,

Ebell²

2016

The Annals of Family Medicine

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“…Streptococcus groups C and G will not be detected although they are likely to be associated with a similar clinical illness. 12,13 It is not clear currently to what extent incorporating scores and/or tests into clinical practice will influence prescribing and outcomes. In lower respiratory tract infection the C-reactive protein (CRP) is a potential candidate for near-patient testing and has been shown to add discriminatory ability for a detailed clinical assessment alone to detect pneumonia.…”

Section: Consultation Interventionmentioning

confidence: 99%