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PubMed1990

Throat culture or rapid strep test?

Clearly, rapid tests for streptococci identification are here to stay, and development of the technology is likely to continue. The most rational use of these tests is to identify streptococcal pharyngitis when patients have severe symptoms or when special situations warrant early detection. Throat culture alone is sufficient for most other patients, and all negative rapid tests should be confirmed by throat culture. Specific antistreptococcal therapy should be initiated if either the rapid test or culture is positive. If the physician decides on the basis of clinical criteria to treat pharyngitis with an antibiotic that covers group A beta-hemolytic streptococci, a rapid test is not necessary. If confirmation of the infection is warranted in these cases, throat culture alone should suffice. No rapid strep test kit clearly outperforms others. With any test, good results depend on the quality of the specimen.

Bacteriological Techniques↗
PubMed2006

A food-borne streptococcal sore throat outbreak in a small community.

Beta-haemolytic group A streptococci (GAS) is a common cause of sore throat, usually spread person-to-person. Outbreaks related to infected food have more seldom been reported. The bacteria may originate from the throat or from wounds on the hands of persons handling the food. An outbreak in Sätila, Sweden, in April/May 2003 involving 153 individuals who fell ill after eating contaminated 'sandwich-layer cakes' was investigated in a descriptive, retrospective cohort study. Questionnaires were distributed, one immediately after the outbreak and one 3 months later. The average attack rate was 72%. 143 individuals sought medical care and 137 were treated with antibiotics. 76 individuals were ill for more than 4 days. GAS isolates of identical T-type were obtained from the throats of the patients, wounds on the caterer's fingers and also from the cakes. PFGE banding patterns of 14 representative isolates were identical, as well as the emm-sequence type, emm 89, of 3 chosen isolates. The study shows that GAS from a small wound on a finger can cause illness in a large number of individuals. To prevent further outbreaks, it is important to increase public awareness of this type of transmission.

Cohort Studies↗
PubMed2000

Group A streptococcal throat colonization is a dynamic phenomenon.

In order to gain knowledge about the nature of group A streptococcal throat colonization of asymptomatic children, we studied a cohort of healthy children selected at random. Those with throat cultures positive for group A Streptococci (GAS) were followed for 5 weeks. Repeat throat swabs were obtained at weekly intervals for antigen detection and culture. GAS obtained were serotyped for T antigen. Twenty-two children were identified as having GAS and 50% had a positive antigen test and culture at least five times in 6 weeks. There was no consistent pattern in the typeable organisms. Most individuals had more than one T-type alternating with non-T-typeable organisms. We conclude that colonization may be a dynamic process involving numerous organism serotypes, which wax and wane.

Antigens, Bacterial↗
PubMed2004

The effects of open throat technique on long term average spectra (LTAS) of female classical voices.

In the third of a series of studies on open throat technique, we compared long term average spectra (LTAS) of six advanced singing students under three conditions: 'optimal' (O), representing maximal open throat, 'sub-optimal' (SO), using reduced open throat, and loud sub-optimal (LSO) to control for the effect of loudness. Using a series of univariate repeated measures ANOVAs with planned orthogonal contrasts, we tested the hypotheses that sound pressure level (SPL) and the ratio of spectral energy in peaks and areas between 0-2 kHz and 2-4 kHz would be reduced in SO and LSO compared to O. There were significant differences between SO and LSO but hypotheses were not confirmed for O. These findings do not accord with differences in vibrato extent and onset between O and SO/LSO (Mitchell and Kenny, in press). These results suggest that while LTAS provides information on energy distribution, measuring spectral energy areas appears to be the most sensitive measure of energy distribution between conditions. Plotting the differences between O and SO/LSO pairs of LTAS clearly indicates the areas of spectral change. The findings from this study also indicate that LTAS are not sufficiently sensitive to measure vocal timbre as they were not consistent with perceptual or other acoustic studies of the same samples.

Acoustics↗
PubMed2000

Contrasting molecular epidemiology of group A streptococci causing tropical and nontropical infections of the skin and throat.

Disease caused by group A streptococci (GAS) in tropical regions often takes the form of impetigo, whereas pharyngitis tends to predominate in temperate zones. GAS derived from asymptomatic throat infections and pyoderma lesions of rural Aboriginal Australians were evaluated for phylogenetic distant emm genes, which represent ecological markers for tissue site preference. On the basis of the percentage of total isolates from a given tissue, emm pattern A-C organisms exhibited a stronger predilection for the throat, whereas pattern D organisms preferred the skin. Only 16% of isolates collected by active surveillance displayed pattern A-C, which reflects the low incidence of oropharyngeal infection. Importantly, most (70%) pattern A-C organisms were isolated from skin sores, despite their innate tendency to infect the throat. Combined with findings from nontropical populations, analysis of the data supports the hypothesis that GAS tissue preferences are genetically predetermined and that host risk factors for infection strongly influence the differential reproduction of individual clones.

Adult↗
PubMed1994

Postoperative throat complaints after tracheal intubation.

We have investigated the incidence of throat complaints 6-24 h after tracheal intubation in 1325 patients. Variables such as anaesthetic drug, intubation time, number of intubation attempts, gastric tube, sex and age were recorded. The incidence of sore throat was considerably lower (14.4%) compared with other reports in the literature and was significantly greater in females (17.0% vs 9.0%) and after thyroid surgery. The incidence of sore throat was not increased after multiple intubation attempts or after administration of suxamethonium or a non-depolarizing neuromuscular blocker.

Adolescent↗
PubMed1997

Sore throat management practices of Canadian family physicians.

OBJECTIVES AND METHODS: A survey was conducted of Canadian family physicians about their usual sore throat management practices. Physician knowledge, attitudes, beliefs and the effect of selected patient factors on variation in practices was assessed. RESULTS: The majority of physicians did not follow North American expert recommendations to usually take a throat culture and wait for culture results before prescribing an antibiotic. Similarly to the practices of family physicians in many countries, they favoured a clinical policy of selective use of throat cultures and decisions about the need for antibiotics based on clinical judgement. CONCLUSIONS: Physician practice site, demographics, knowledge, attitudes, beliefs and patient factors did not explain differences in approach. The implications for antibiotic utilization in the management of upper respiratory tract infections are discussed.

Adult↗
PubMed2002

Clinical findings in patients presenting with sore throat. A study on inter-observer reliability.

BACKGROUND: Several clinical prediction scores have been developed to help practitioners assess the probability of streptococcal throat infection. Prior to this study, it was not known how reliably doctors assess the signs that contribute to these decision aids. OBJECTIVE: The aim of this study was to measure the inter-observer reliability of clinical findings related to sore throat. METHODS: Consecutive patients presenting with sore throat in five primary care practices in Germany took part (n = 126). Each patient was assessed independently by two doctors with regard to lymph nodes, pharynx, soft palate and tonsils. RESULTS: Agreement among practitioners was not satisfactory. CONCLUSIONS: Results suggest that the performance of clinical scoring systems can be improved by training on how to elicit relevant clinical signs. Our findings cast some doubt on the effectiveness of under- and post-graduate training in this area.

Child, Preschool↗
PubMed1975

Direct visualization of enveloped Epstein-Barr Herpesvirus in throat washing with leukocyte-transforming activity.

Mature enveloped virions belonging to the herpes class were found in a concentrated, partially purified specimen of throat washings from a patient undergoing immunosuppressive therapy for prevention of renal homograft rejection. This throat washing contained a high titer of biologically active Epstein-Barr virus and no other human herpesviruses. Epstein-Barr virions were not detected in throat washings from patients with mononucleosis that had only low titers of transforming activity.

Adolescent↗
PubMed1987

DNA-DNA dot hybridization to detect Epstein-Barr virus in throat washings.

To compare the abilities of the nucleic acid dot hybridization assay and the cord blood lymphocyte transformation assay to detect Epstein-Barr virus (EBV), we examined throat washings from healthy control subjects (nine EBV-seronegative and 51 EBV-seropositive), patients with acute infectious mononucleosis, and renal transplant recipients. The dot hybridization assay detected EBV excretion in four (8%) of the EBV-seropositive controls; three of these four were also positive by the lymphocyte transformation assay. Throat washings from seven (87.5%) of eight patients with acute infectious mononucleosis were positive by both assays. EBV was present in throat washings from 13 (50%) of 26 renal transplant recipients. For specimens stored at -70 C for less than four months, the dot hybridization assay had a sensitivity of 90% and a specificity of 98% when compared with the lymphocyte transformation assay. The dot hybridization assay is a rapid, sensitive, and specific test that can be performed on readily available clinical specimens.

Antibodies, Viral↗
PubMed2026

Incidence of invasive group A streptococcal infections and comparison of emm types from invasive infections, pharyngitis, and throat carriage in American Indian communities in the Southwest United States.

BACKGROUND: American Indian/Alaska Native (AI/AN) communities in the US have high rates of group A streptococcal (GAS) infections. We determined the incidence of invasive infections in AI communities in the Southwest and compared emm types from invasive infections, pharyngitis, and throat carriage. METHODS: Activities conducted in the White Mountain Apache Tribal lands (WMA) and Navajo Nation (NN) included active, laboratory-based surveillance for invasive GAS infections (WMA: 2019─2024; NN: 2023─2024; all ages); surveillance for GAS pharyngitis (2023-2024; children 0─17 years); and culture for GAS from oropharyngeal carriage samples (2019 and 2022─2023; children 0─14 years). Emm types were determined by whole-genome sequencing. Annual incidence rates were calculated using Poisson regression. RESULTS: In WMA, age-standardized rates of invasive infections ranged from 80-270/100,000 persons between 2019-2024. Predominant emm types varied (n=74 isolates): 91 (59%) and 49 (32%) in 2019-2020, and 43 (40%) and 53 (30%) in 2023. In NN, rates were 40-60/100,000 persons in 2023-2024; common emm types (n=51) were 53 (28%), 101 (18%), and 12 (16%). In WMA and NN, emm types 1, 12, and 53 predominated in pharyngitis (n=190), and 1, 12, and 91 in throat carriage (n=119). CONCLUSIONS: Rates of invasive GAS infections in these communities were 3-35 times higher than the national US average (12.2/100,000 in 2024). Emm types varied over time with limited overlap in strains from throat carriage or pharyngitis isolates and those from invasive infections. Findings support continuing GAS surveillance and engaging AI/AN communities throughout vaccine development and evaluation.

Indigenous health↗
PubMed1996

Throat microflora in breastfed and formula-fed infants.

Most bacterial infections are caused by organisms that are already colonizing the host, and these infections commonly originate at site of the gastrointestinal and respiratory tracts. However, little attention has been focused on the indigenous microflora of the respiratory tract in the infant. We studied the throat microflora of healthy breastfed and formula-fed infants. The incidence of pathogenic bacterial isolation from breastfed infants (1 out of 23) was lower relative to infants fed formula (5 out 14). The dominant bacteria in the throat flora isolated in both breastfed and formula-fed infants were alpha-haemolytic Streptococcus and gamma Streptococcus. These results suggest that breastmilk may be effcacious in preventing the growth of pathogenic bacteria in the throat.

Bacteria↗
PubMedDate not supplied

Sore throats in adolescents.

The approach to the adolescent with sore throat requires few diagnostic tools: an accurate history, a good physical examination and the ability to perform simple laboratory tests such as complete blood count, a test for heterophile antibody and a throat culture. The majority of adolescent patients with a sore throat require only symptomatic relief for what is probably a short lived viral infection of the upper respiratory tract.

Adolescent↗
PubMed1997

Erythromycin resistance of group A streptococci from throat samples is related to age.

BACKGROUND: Factors associated to increased antimicrobial resistance among bacterial pathogens have been widely discussed and need to be evaluated. In Finland resistance to erythromycin in group A streptococci has become an important problem among outpatients. The aim of this study was to investigate whether occurrence of erythromycin resistance among group A streptococci isolated from noninvasive infections correlates with the patients' age and sex. METHODS: Group A streptococci isolated from 10 162 patients were tested for erythromycin resistance in 21 regional microbiologic laboratories located throughout Finland. The age of every patient and the sex of 8121 (80%) patients were known. The statistical significance of the association between the patients' age or sex and the occurrence of erythromycin resistance in group A streptococci, isolated from throat swab samples (8568 isolates) or pus samples (1594 isolates), was measured by logistic regression analysis. RESULTS: When erythromycin resistance of the isolates was regressed with the patients' age and sex, the age of the patient was a clearly significant predictor for the throat isolates (beta coefficient = -0.0114, SD 0.0029, observed value of t test statistic = -3.89, P = 0.0001) but not for the pus isolates. The odds ratio for age was 0.99 with a 95% confidence interval of 0.98 to 0.99. Thus the expected risk of erythromycin resistance on a group A streptococcal throat isolate decreased with increasing age by 1% per year. No significant association between the patients' sex and the occurrence of erythromycin resistance was found. CONCLUSIONS: Significant differences may exist between different age groups in the frequency of antibiotic-resistant isolates among outpatients, perhaps caused by differences in antibiotic prescribing. Thus overall resistance levels do not necessarily represent all age groups, especially children.

Adolescent↗
PubMed2005

Acute guttate psoriasis patients have positive streptococcus hemolyticus throat cultures and elevated antistreptococcal M6 protein titers.

To further study the role of Streptococci hemolyticus infection and streptococcal M6 protein in the pathogenesis of acute guttate psoriasis, streptococcal cultures were taken from the throats of 68 patients with acute guttate psoriasis. PCR technique was applied to detect M6 protein encoding DNA from those cultured streptococci. Pure M6 protein was obtained by Sephacry/S-200HR and Mono-Q chromatography from proliferated Streptococcus hemolyticus. Antistreptococcal M6 protein titers were measured in the serum of patients with acute guttate psoriasis, plaque psoriasis and healthy controls by ELISA. A high incidence of Streptococcus hemolyticus culture was observed in the guttate psoriatic group compared with the plaque psoriasis and control groups. Fourteen strains of Streptococcus hemolyticus were cultured from the throats of 68 acute guttate psoriasis patients. Of these, 5 strains contain DNA encoding the M6 protein gene as confirmed by PCR technique. More than 85% purification of M6 protein was obtained from Streptococcus pyogenes. Applying our pure M6 protein with the ELISA methods, we found that the titer of antistreptococcal M6 protein was significantly higher in the serum of guttate psoriasis patients than in the control or plaque psoriasis groups (P < 0.01). We verified that patients of acute guttate psoriasis have a high incidence of Streptococcus hemolyticus in their throats and raised titers of antistreptococcal M6 protein in their sera.

Adolescent↗
PubMed2004

The throat flora and its mitogenic activity in patients with Kawasaki disease.

The etiology of Kawasaki disease (KD) remains unknown, although some infectious organism has been suggested as the cause. Recent studies suggest that some bacterial toxins with superantigen activity are involved in its pathogenesis, but no specific bacterial toxin has yet been identified. Throat swabs for bacterial culture were obtained from 21 patients with KD and 20 with other febrile illnesses as controls. Mitogenic activity in culture supernatants obtained from individual bacterial strains was measured by lymphocyte proliferation assay. Sixty-one bacterial strains were isolated from KD patients, and 62 strains from control patients. There was no apparent difference in bacterial species in the throat flora between KD patients and febrile controls. Moreover, total and individual mitogenic activity of strains from KD patients was no greater than that of strains from febrile controls. The bacterial superantigen activity of throat flora may not play a major role in the pathogenesis of KD.

Adolescent↗
PubMed1990

Postoperative sore throat. A comparison after premedication with papaveretum/hyoscine or temazepam.

A randomised double-blind trial was conducted to study the use of two commonly used premedication regimens and the subsequent incidence of sore throat. Fifty adult patients who underwent routine surgery were anaesthetised in a standard fashion after premedication with papaveretum and scopolamine or temazepam, and interviewed after operation to assess the presence of sore throat. A significantly higher incidence of sore throat was associated with the use of papaveretum and scopolamine.

Adult↗
PubMed1987

No increased incidence of postoperative sore throat after administration of suxamethonium in endotracheal anaesthesia.

Sixty patients were divided into two groups (A and B) of 30 patients each to investigate the effect of using suxamethonium in endotracheal anaesthesia on the incidence of postoperative sore throat. The patients were anaesthetized with thiopentone, fentanyl, droperidol, N2O and pancuronium. Before endotracheal intubation with a Mallinckrodt lo-pro-tube, patients in Group A were given pancuronium, whereas patients in Group B were given suxamethonium. There was no difference in the incidence or severity of sore throat 20-30 h postoperatively between the two groups (P = 0.5). The type 2 error (beta) was low (the risk of overlooking a "true" difference in incidence of 0.20 was calculated to be 0.04). These results contradict those of a recent study, which demonstrated an increased incidence of postoperative sore throat following the use of suxamethonium in mask anaesthesia.

Adolescent↗