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Br J Gen Pract. 2012 Nov;62(604):e787-94. doi: 10.3399/bjgp12X658322.

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

Author information

1
Primary Care and Population Science, Faculty of Medicine University of Southampton, UK. p.little@soton.ac.uk

Abstract

BACKGROUND:

Management of pharyngitis is commonly based on features which are thought to be associated with Lancefield group A beta-haemolytic streptococci (GABHS) but it is debatable which features best predict GABHS. Non-group A strains share major virulence factors with group A, but it is unclear how commonly they present and whether their presentation differs.

AIM:

To assess the incidence and clinical variables associated with streptococcal infections.

DESIGN AND SETTING:

Prospective diagnostic cohort study in UK primary care.

METHOD:

The presence of pathogenic streptococci from throat swabs was assessed among patients aged ≥5 years presenting with acute sore throat.

RESULTS:

Pathogenic streptococci were found in 204/597 patients (34%, 95% CI = 31 to 38%): 33% (68/204) were non-group A streptococci, mostly C (n = 29), G (n = 18) and B (n = 17); rarely D (n = 3) and Streptococcus pneumoniae (n = 1). Patients presented with similar features whether the streptococci were group A or non-group A. The features best predicting A, C or G beta-haemolytic streptococci were patient's assessment of severity (odds ratio [OR] for a bad sore throat 3.31, 95% CI = 1.24 to 8.83); doctors' assessment of severity (severely inflamed tonsils OR 2.28, 95% CI = 1.39 to 3.74); absence of a bad cough (OR 2.73, 95% CI = 1.56 to 4.76), absence of a coryza (OR 1.54, 95% CI = 0.99 to 2.41); and moderately bad or worse muscle aches (OR 2.20, 95% CI = 1.41 to 3.42).

CONCLUSION:

Non-group A strains commonly cause streptococcal sore throats, and present with similar symptomatic clinical features to group A streptococci. The best features to predict streptococcal sore throat presenting in primary care deserve revisiting.

PMID:
23211183
PMCID:
PMC3481520
DOI:
10.3399/bjgp12X658322
[Indexed for MEDLINE]
Free PMC Article

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