The aetiology of pharyngotonsillitis in adolescents and adults – Fusobacterium necrophorum is commonly found

Abstract

Sore throat is common in primary healthcare. Aetiological studies have focused on the presence of a limited number of pathogens. The aim of the present study was to investigate the presence of a wide range of bacteria and viruses, including Fusobacterium necrophorum, in patients with pharyngotonsillitis and in asymptomatic controls. A prospective case control study was performed in primary healthcare in Kronoberg County, Sweden. Patients (n=220) aged 15 to 45 years with a suspected acute pharyngotonsillitis, and controls (n=128), were included. Nasopharyngeal and throat swabs were analysed for β-hemolytic streptococci, F. necrophorum, Mycoplasma pneumoniae, and Chlamydophila pneumoniae, and 13 respiratory viruses. Serum samples were analysed for antibodies to Epstein-Barr virus. The patient history and symptoms, including Centor score, were analysed in relation to pathogens. In 155/220 (70.5%) of the patients, as compared to 26/128 (20.3%) of the controls (p <0.001), at least one microorganism was found. Group A streptococci, F. necrophorum, and influenza B virus were the three most common findings, and all significantly more common in patients than in controls (p <0.001, p 0.001, and p 0.002, respectively). Patients with F. necrophorum only (n=14) displayed a lower Centor score than patients with Group A streptococcus only (n=46), but a higher score than patients with influenza B, other viruses, or no potential pathogen (Kruskal-Wallis p <0.001). A pathogen was detected in 70% of the patients, displaying a wide range of pathogens contributing to the aetiology of pharyngotonsillitis. This study supports F. necrophorum as one of the pathogens to be considered in the aetiology of pharyngotonsillitis.

Peritonsillar Abscess

“…9,47,48 Recent studies point to a major role of F necrophorum in PTA, 4,9,10 and this anaerobe may also play a pathogenic role in acute tonsillitis. [49][50][51][52] This concordance of 2 significant pathogens between PTA and acute tonsillitis lends further support to the acute tonsillitis hypothesis. However, it can be argued that bacteria can exert their pathogenic potential at different anatomic sites without causal relationship.…”

Fusobacterium necrophorum findings in Denmark from 2010 to 2014 using data from the Danish microbiology database

“…3 Most of the throat swabs were from Viborg Hospital (Middle part of Central Jutland). 4 Most of the peritonsillar abscess were from Skejby Hospital (Eastern part of Central Jutland).…”

“…Accumulating evidence suggests that Fusobacterium necrophorum can cause acute and recurrent tonsillitis (1)(2)(3)(4)(5)(6). F. necrophorum tonsillitis can progress to peritonsillar abscess (PTA) and, although rarely, to Lemierre's syndrome, a life-threatening metastatic septicaemia in youngsters (7)(8)(9)(10).…”

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

“…They found higher percentages of patients with Group C streptococcus (3.6% vs 0.8%, P = .16) and F necrophorum (15.0% vs 3.1%, P = .001) in the symptomatic patients, ratios similar to those for Group A streptococcus (30% vs 2.3%, P <.001) and rhinovirus (6.4% vs 2.3%, P = .09). 27 Another found F necrophorum in 14 of 85 university students with sore throat (16.5%), compared with 29 of 326 who were asymptomatic (8.9%). 21 Most recently, Centor and colleagues found higher rates of both F necrophorum (20.5% vs 9.4%) and Group C streptococcus (9.0% vs 3.9%) in university students with sore throat than in asymptomatic controls.…”

“…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.The prevalence of Group C streptococcus is summarized in the forest plot in Figure 2. The overall prevalence of Group C streptococcus was 6.1% (95% CI, 3.2%-9.0%) with a range from 0.5% 14 to 24.8%.…”