Re: Role of Non-Group A Streptococci in Acute Pharyngitis

The Journal of the American Board of Family Medicine

Robert M. Centor¹ 

[1] University of Alabama Huntsville Regional Medical Campus, Huntsville, AL

关键词: Fever;    Arthritis;    Sore Throat;    Pharyngitis;    Adult-Onset Still Disease;    Case Report;   

DOI  :  10.3122/jabfm.2010.03.090267

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

To the Editor: Jeffrey Tiemstra and Rosita L. F. Miranda¹ have added important data concerning the diagnosis and management of acute pharyngitis. Like previous investigators, they found that a significant percentage of adolescents and young adults presenting with acute pharyngitis grow streptococci from a group other than group A strep, which is the classic concern.

Most other articles on this subject have focused on group C and group G streptococci. I doubt that clinical presentation of group B resembles the clinical presentation of group C. In unpublished data, we did not find group B patients having such a presentation. Zwart also found that only A, C, and G caused pharyngitis.² Therefore, I would suggest that the authors look carefully at the distribution of clinical indicators in group B compared with group A and group C.

The Tiemstra article also shows that in practice (rather than in prospective studies) the sensitivity of the group A strep rapid test was only 75%. One can postulate several reasons for a difference in rapid test sensitivity from prospective studies. Just to suggest 2 possibilities: (1) sampling errors might occur more often in practice or (2) there may be publication bias for higher sensitivity studies.³

Like Zwart's classic 2000 BMJ study on treatment, the authors find a high probability of either group A or non-group A strep in patients having high pharyngitis scores.³ That article supports a clinical improvement from antibiotics for group C strep pharyngitis. In that article adults (ages 15–60) experienced a 2-day symptom improvement if they had group A pharyngitis and a 1-day symptom improvement if they had group C pharyngitis.

The addition of headache to the pharyngitis scores, although understandable, makes comparison of this study to previous studies more difficult.

A note of caution: these findings probably apply to the adolescent/young adult age group and not pre-adolescents. Previous studies have shown that non-group A infections occur commonly in college health populations but not pre-adolescents.

Congratulations for continuing the documentation that adolescent and adult pharyngitis is more complex than deciding whether the patient has group A strep.

【 授权许可】

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