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PubMed2006

Effect of tonsillectomy on recurrent sore throats in adults: patients' perspectives.

The aim of this study was to quantify the effect of tonsillectomy on the incidence of sore throats and its co-morbidity in adult patients. One hundred and nineteen adult patients were sent a standard questionnaire regarding their symptoms in the 12 months preceding and following their tonsillectomy. Outcome measures included the incidence of sore throats, total number of days with sore throat, amount of time taken off work or school, and number of visits to the general practitioner (GP). In addition, patients were asked to indicate the duration of their symptoms and whether or not they found the tonsillectomy effective in curing their sore throats. Sixty-six patients (55.5 per cent) returned completed questionnaires. The age of the patients ranged from 16 to 39 years. The mean duration of symptoms was 8.3 years. On average, patients had 8.1 different sore throat episodes, 42 sore throat days, 21.4 days of sore throat related absence from work or school, and 5.9 visits to the GP in the 12 months before their operation. For the 12 months after surgery, these reduced to 0.9 episodes, four days, 2.2 days and 0.6 visits, respectively. This reduction was very significant (p < 0.001, Wilcoxon signed rank test). After their surgery, more than half the patients achieved complete resolution of all the measured parameters mentioned above. Most of the remaining patients achieved at least 50 per cent resolution. Only three patients (4.8 per cent) achieved less than 50 per cent resolution. Ninety-five per cent of the patients found the operation effective in curing their sore throats and were glad they had had surgery. In conclusion, retrospective questionnaire data must be interpreted with some caution, but this study suggests that tonsillectomy is effective in reducing the incidence, duration and co-morbidity of recurrent sore throats in adults; this must be balanced against the post-operative problems in a minority of patients.

Adolescent↗
PubMed2003

Streptococcal throat infections and exacerbation of chronic plaque psoriasis: a prospective study.

BACKGROUND: Guttate psoriasis has a well-known association with streptococcal throat infections but the effects of these infections in patients with chronic psoriasis remains to be evaluated in a prospective study. OBJECTIVES: To determine whether streptococcal throat infections are more common in and can cause exacerbation in patients with chronic psoriasis. METHODS: Two hundred and eight patients with chronic plaque psoriasis and 116 unrelated age-matched household controls were followed for 1 year. At recruitment all patients were examined, their disease severity scored and throat swabs taken. Patients and corresponding controls were then re-examined and tested for streptococcal colonization whenever they reported sore throat or exacerbation of their psoriasis during the study period. RESULTS: The psoriasis patients reported sore throat significantly more often than controls (61 of 208 vs. three of 116, P < 0.0001), and beta-haemolytic streptococci of Lancefield groups A, C and G (M protein-positive streptococci) were more often cultured from the patients than the controls (19 of 208 vs. one of 116, P = 0.003). A significant exacerbation of psoriasis (P = 0.004) was observed only if streptococci were isolated and the patients were assessed 4 days or later after the onset of sore throat. No difference was observed between groups A, C or G streptococci in this respect. CONCLUSIONS: This study confirms anecdotal and retrospective reports that streptococcal throat infections can cause exacerbation of chronic plaque psoriasis. It is concluded that psoriasis patients should be encouraged to report sore throat to their physician and that early treatment of streptococcal throat infections might be beneficial in psoriasis. A controlled trial for assessing potential benefits of tonsillectomy in patients with severe psoriasis should also be considered.

Adolescent↗
PubMed2006

Clinical course of suspected viral sore throat in young adults: cohort study.

OBJECTIVE: To evaluate the natural clinical course of suspected viral sore throat. DESIGN: Prospective cohort study. SETTING: Five military camps in Norway. METHODS: In a randomized placebo-controlled trial comparing the effect of bovine colostrum tablets or placebo on non-streptococcal sore throat in young adults no statistically significant difference in illness duration was found. The participants were thus regarded as one cohort. The authors analysed 10.0 cm visual analogue scales (VAS) scores for 'sickness' and sore throat, using 1.0 cm as a cut-off for recovery. They furthermore explored whether the VAS for sore throat was a good test to discriminate between recovered/not recovered by use of a receiver operating characteristic (ROC) curve. RESULTS: For sore throat, it was found that 51% had recovered by day 6 and 91% had recovered by day 8. Similarly for sickness, 65% had recovered by day 6 and 94% by day 8. The daily VAS scores for 'sickness' and sore throat were highly correlated (p = 0.001). The mean day of recovery from 'sickness' and sore throats (based on VAS scores) was 5.5 and 4.7 respectively and 5.3 based on the dichotomous outcome for throat pain. The ROC curve revealed that a VAS score < 1.0 was the best cut-off point for recovery, with a sensitivity of 0.74 and a specificity of 0.90. CONCLUSION: Almost all the patients had recovered by day 8. A high correlation was found between sickness and sore throat. These data will assist clinicians and others promoting self-care to set realistic expectations regarding recovery from URTI in young adults.

Acute Disease↗
PubMed2005

Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs.

Fusobacterium necrophorum, an anaerobic, Gram-negative rod, has been identified recently as a significant cause of persistent sore throat syndrome (PSTS). This disease is characterised by chronic, recurrent or persistent sore throat, which is believed to respond poorly to penicillin in vivo. The aim of this study is to examine the prevalence of F. necrophorum in all throat swabs received in our diagnostic microbiology department and to compare the results with those for other recognised respiratory pathogens. All throat swabs received in the laboratory over a four-week period were cultured for beta-haemolytic streptococcus groups A, C and G, Corynebacterium diphtheriae, Arcanobacterium haemolyticum and F. necrophorum. Latex agglutination techniques, phenotypic reactions and antibiograms are used to identify these organisms. The age of the patient and the clinical details as stated on the request form were noted. Among a total of 248 samples, 27 were positive for beta-haemolytic streptococcus group A, two were positive for beta-haemolytic streptococcus group C, five were positive for beta-haemolytic streptococcus group G and 24 were positive for F. necrophorum. The most common isolate in the under 20 age group was beta-haemolytic streptococcus group A. In the over 20 age group, F. necrophorum was the pathogen most frequently isolated. A clinical diagnosis of 'sore throat' was most likely to be positive for beta-haemolytic streptococcus group A, a clinical diagnosis of PSTS was most likely to be positive for F. necrophorum and a clinical diagnosis of 'tonsillitis' was equally likely to be caused by beta-haemolytic streptococcus group A or F. necrophorum. beta-haemolytic streptococcus group A was present in 11% of the samples and F. necrophorum was present in 10% of the samples. In total, these two pathogens accounted for 18.5% of throat infections in the sampled group. The results show that F. necrophorum is as significant a cause of throat infection as is beta-haemolytic streptococcus group A. Examination of this provisional data suggests that targeting culture towards these two pathogens may be possible in certain cohorts of patients if more precise clinical data are received from medical staff. However, based on the clinical symptoms routinely provided by clinicians requesting microscopy, culture and sensitivity on throat swabs, F. necrophorum culture is required on all throat swabs received in the laboratory.

Actinomycetaceae↗
PubMed1993

Throat pain and pharyngeal packing: a controlled randomized double-blind comparison between gauze and tampons.

In order to determine whether patients having pharyngeal packing experience more or less post-operative throat pain when tampons were used, 80 patients were randomized into two groups to receive either gauze or tampon pharyngeal packing. A third control group of 40 patients were intubated but did not have any throat packs. Post-operative throat pain was subjectively rated at both 6 hours and at 24 hours by an independent observer. Thirty-eight per cent of patients had moderate or severe throat pain in the gauze group, whilst in the tampon and control groups these amounted to only 15% and 1% respectively. A significantly higher proportion of patients also had a moderate or severe sore throat at 24 hours in the former group. Intubation alone resulted in a sore throat post-operatively in 50% of patients, but 85% of those had a mild sore throat only. No differences in pain ratings in any group could be shown between men or women or between age groupings. Endotracheal intubation often causes post-operative throat pain which is exacerbated by the use of pharyngeal packing. The results presented suggest that tampons are a safe, effective alternative to gauze and result in less severe post-operative throat pain.

Double-Blind Method↗
PubMed1998

Can group A beta haemolytic streptococcal sore throats be identified clinically?

OBJECTIVE: To differentiate the clinical manifestations of a Group A beta haemolytic streptococcal throat infection from viral and other bacterial infections. SETTING: Outpatients' department, Lady Ridgeway Hospital, Colombo. PATIENTS AND METHODS: Children aged 3 to 12 years attending with a sore throat. Throat swabs were taken and relevant details were obtained using a questionnaire. They were examined for significant cervical lymphadenopathy and tonsillar exudate. RESULTS: Group A beta haemolytic streptococci were isolated from 61 (44.5%) throat swabs. Clinical differentiation of Group A beta haemolytic streptococcal sore throats was not possible as none of the symptoms or signs were significantly associated with the presence of this organism. CONCLUSIONS: Group A beta haemolytic streptococcal sore throats cannot be identified clinically, so that throat swabs for culture are necessary in children with sore throat. In the absence of this facility, it is reasonable to treat sore throats in children as for beta haemolytic streptococci.

Child↗
PubMed1998

Towards a better diagnosis of throat infections (with group A beta-haemolytic streptococcus) in general practice.

BACKGROUND: Sore throat is a common complaint in general practice. However, management strategies are not very clear. A better diagnostic procedure is needed to prevent the overuse of antibiotics. AIM: To assess the diagnostic value of a rapid streptococcal antigen detection test in addition to four clinical features in patients with sore throat, using throat culture and antibody titres as reference tests. METHOD: Four clinical features [fever (history) > or = 38.0 degrees C, lack of cough, tonsillar exudate, and anterior cervical lymphadenopathy] were registered in 558 patients aged 4 to 60 years presenting with sore throat of no more than 14 days' duration. A rapid diagnostic test was performed, as well as a throat culture and antibody titres [fourfold increase in anti-streptolysin-O (ASO) and/or anti-deoxyribonuclease B (anti-DNAase B)] in patients aged 11 years and older. RESULTS: Throat cultures were positive for group A beta-haemolytic streptococcus (GABHS) in 33% of the patients. Rapid tests were positive in 24%. Compared with the throat culture, the sensitivity of the rapid test was 65%, the specificity 96%, the positive predictive value 88%, and the negative predictive value 85%. However, for patients with three or four clinical features, the sensitivity of the rapid test was considerably higher at 75%. Children (< or = 14 years) had a slightly raised specificity and raised positive predictive value and prevalence. With the antibody titres as a reference, the rapid test performed as well as the throat culture with regard to its predictive value. CONCLUSION: For the management of patients with sore throat in general practice, a rapid test may have an additional value, especially in patients with a high chance of having GABHS infection. However, as the sensitivity of the test studied is low, tests with a higher sensitivity are needed.

Adolescent↗
PubMed1994

Postoperative sore throat in children and the laryngeal mask airway.

Postoperative sore throat is a minor complaint after general anaesthesia of multifactorial aetiology. The purpose of this study was to compare the effect of the laryngeal mask airway (LMA) and endotracheal tube (ETT) on postoperative sore throat in children. We hypothesized that the incidence of sore throat would be less after the use of the LMA. This was a randomized, single-blind study of 112 patients of age 3 to 12 yr undergoing minor peripheral surgery. The groups were similar, except that airway maintenance was either with an LMA or ETT. After induction of anaesthesia with O2, N2O and halothane, an LMA or ETT was inserted. Anaesthesia was maintained with O2, N2O and halothane. At the end of surgery, the ETT was removed in the operating room before airway reflexes had returned. The LMA was removed after the patient's airway reflexes had returned in the recovery room. On the first postoperative day, the parents were contacted and asked whether or not their child had had a sore throat. If a sore throat had been present, the parents rated the discomfort as mild, moderate or severe. The groups were similar with respect to age, weight, sex and duration of procedure. The overall incidence of sore throat was 9%. The difference between the groups (LMA 13% vs ETT 5%) was not statistically significant. All of the reported sore throats were rated as mild. In conclusion, postoperative sore throats after minor paediatric surgery is uncommon. If it does occur, it is mild and the incidence is unaffected by the choice of an LMA or ETT.

Analgesia↗
PubMed1996

The effect of laryngeal mask cuff pressure on postoperative sore throat incidence.

STUDY OBJECTIVE: To study the effect of laryngeal mask airway (LMA) cuff pressure on the incidence of postoperative sore throat. DESIGN: Prospective, randomized, observational study. SETTING: Operating room of a university hospital. PATIENTS: 200 consecutive adult patients requiring anesthesia for gynecologic procedures. INTERVENTIONS: Anesthesia was induced with thiopental 3-5 mg/kg, fentanyl 2 micrograms/kg, vecuronium bromide 0.05mg/kg, and enflurane 0.8% to 2% and maintained with nitrous oxide and oxygen (65%/35%) and enflurane. MEASUREMENTS AND MAIN RESULTS: In Group 1, cuff pressure measurement was continuously performed until the end of the operation. In Group 2, 5 minutes after induction of anesthesia and 2 minutes after insertion of the LMA, cuff pressure was also continuously observed and reduced to the minimal pressure required for airtightness. In the recovery room, after the operation, patients were questioned for postoperative sore throat 4, 8, and 24 hours after the operation following a scoring protocol (score 0 = no complaints, score 1 = minimal sore throat, score 2 = moderate sore throat, score 3 = severe sore throat: "never a LMA again". Continuous monitoring of cuff pressure revealed a steady increase of pressure (during the first 60 minutes increases of 43 cm H2O) in Group 1. In Group 2, after release of air, cuff pressures were significantly lower through the entire operation when compared with Group 1. In Group 1, 8 patients claimed to have a sore throat (Score 1, n = 4; Score 2, n = 3; Score 3, n = 1). In Group 2, no patient complained of sore throat. CONCLUSIONS: A significant increase in cuff pressure is seen during the first 60 minutes. Three minutes after insertion of the laryngeal mask, cuff pressure can significantly be reduced without any major gas leakage. Postoperative sore throat can be reduced when cuff pressure is continuously monitored and kept on low-pressure values.

Adult↗
PubMed2005

Complaints of sore throat after tracheal intubation: a prospective evaluation.

BACKGROUND AND OBJECTIVE: Sore throat and hoarseness rank, besides pain and nausea, among the most frequent subjective complaints after tracheal intubation for general anaesthesia. Our intention was to determine the incidence of postoperative sore throat from a large sample of patients and thus to identify the most important associated factors. METHODS: We prospectively followed up 809 adult patients who underwent elective surgical interventions and examined their history, the applied anaesthetic techniques, perioperative course and the occurrence, intensity and duration of postoperative throat complaints. The assignment and professional experience of the involved intubators were also assessed. The influence of a multitude of variables on postoperative throat complaints was statistically analysed. RESULTS: Postoperative sore throat was present in 40% overall being significantly higher in female than in male (44% vs. 33%; P = 0.001). The mean pain intensity in the affected patients (n = 323) was 28+/-12 mm on a visual analogue scale where 0 = no pain and 100 = extreme pain. The average duration was 16+/-11 h. Main factors associated with throat complaints were female sex; history of smoking or lung disease, duration of anaesthesia, postoperative nausea, bloodstain on the endotracheal tube and natural teeth. We could find no influence on the occurrence or intensity of throat complaints by the professional assignment or the length of professional experience of the personnel involved. CONCLUSIONS: Postoperative throat complaints frequently arise after tracheal intubation for general anaesthesia in the first 2 postoperative days, but they are of limited intensity and duration.

Adult↗
PubMed2000

Topical tenoxicam from pharyngeal pack reduces postoperative sore throat.

BACKGROUND: One puff of beclomethasone inhaler has been shown to reduce the incidence of sore throat following endotracheal intubation. The aim of this study was to determine the effect of a pharyngeal pack on the incidence of sore throat and whether tenoxicam-impregnated gauze pack significantly influenced the frequency of sore throat. METHODS: Eighty patients undergoing general anaesthesia for elective surgery of the nasal septum were evaluated. The anaesthetist sprayed the upper airway towards the trachea with one puff of beclomethasone inhaler (50 microg) before orotracheal intubation. Patients were randomly assigned to have either a 0.2% tenoxicam- or a 0.9% saline-impregnated gauze pack in the oropharynx during operation. They were evaluated for occurrence and severity of postoperative sore throat by direct questions 12-24 h after surgery. RESULTS: Four patients who experienced any symptoms in the tenoxicam group scored mild sore throat compared to 16 patients in the control group scoring mild, gradually developing moderate or severe sore throat (P<0.01). No drug-related side effects were observed. CONCLUSION: The intraoperative use of a tenoxicam-impregnated gauze pack is effective in reducing moderate or severe postoperative sore throat following the use of throat pack.

Administration, Inhalation↗
PubMed2006

The throat: an important site for MRSA colonization.

In order to evaluate the value of bacterial cultures taken from the throat, 266 patients with MRSA were retrospectively assessed. At the time when MRSA was first detected in the patient, the most frequent sites positive for MRSA were a skin lesion (110 patients, 41%), the anterior nares (109 patients, 41%), and the throat (102 patients, 38%). In 26%, 17%, and 17% of the patients, a skin lesion, the anterior nares, and the throat, respectively, were the only site where MRSA was seen. In 123 patients cultured for MRSA because of a close contact with an already known MRSA patient, 65 patients (53%) were positive for MRSA in their throat and in 40 patients (33%), throat was the only sample site with MRSA at the time when the patient was found to be MRSA positive. 146 of the 266 patients (55%) were colonized with MRSA in the throat any time throughout the period they were MRSA positive. We conclude that throat is an important reservoir for MRSA and that samples taken from the throat should be included in screening patients for MRSA.

Adolescent↗
PubMed2002

Postoperative sore throat after ambulatory surgery.

BACKGROUND: Sore throat is a common complication of anaesthesia that affects patient satisfaction after surgery. METHODS: We studied 5264 ambulatory surgical patients prospectively to determine the patient, anaesthetic, and surgical factors associated with sore throat. RESULTS: In 5264 patients, 12.1% reported a sore throat. Patients with tracheal tube had the greatest incidence, 45.4%, followed by patients with laryngeal mask airway, 17.5%, while patients with a facemask had a lower incidence of sore throat, 3.3%. Female patients had more sore throats than male patients (13.4 vs 9.1%). Airway management had the strongest influence on the incidence of sore throat. Sore throat in ambulatory surgical patients was associated with female sex, younger patients, use of succinylcholine, and gynaecological surgery. CONCLUSION: Airway management, female sex, younger patients, surgery for gynaecological procedure, and succinylcholine predicts postoperative sore throat. Increased awareness of the predictive factors can help to avoid this combination and improve patient satisfaction.

Adolescent↗
PubMed2001

Ibuprofen as a chemesthetic stimulus: evidence of a novel mechanism of throat irritation.

This paper reports a study of the oral and pharyngeal chemesthetic effects of the non-steroidal anti-inflammatory drug (NSAID) ibuprofen [2-(4-isobutylphenyl)propanoic acid], which pilot experiments had indicated produces an unusual sensory irritation of the throat. In experiment 1 subjects swallowed aqueous solutions of ibuprofen prepared with different buffering agents and gave ratings of irritation and taste in the mouth and throat. The results showed that ibuprofen irritates the throat much more than the mouth, and that its quality in the throat is characterized primarily as sting/prick, itch and tickle (often leading to cough). Based upon the results obtained with the different buffering agents, we hypothesized that the sting/prick/itch qualities of throat irritation were pH-dependent. Parametric manipulation of solution pH in experiment 2 confirmed this hypothesis. The same experiment revealed that, in contrast to other oral irritants (e.g. capsaicin and menthol), repeated stimulation caused neither sensitization nor desensitization of throat irritation. In the final experiment we found that ibuprofen's throat irritation could not be modulated by temperature, as it should be if stimulation occurred via capsaicin-sensitive receptors. We therefore conclude that ibuprofen has novel chemesthetic properties, which are not mediated by capsaicin-sensitive (vanilloid) receptors, and that a major component of the throat irritation it produces occurs via a pH-dependent receptor mechanism.

Administration, Oral↗
PubMed1988

Evaluation of the throat culture as a follow-up for an initially negative enzyme immunosorbent assay rapid streptococcal antigen detection test.

In a study of the efficacy of following up an initially negative enzyme immunosorbent assay (EIA) rapid streptococcal antigen detection test with a throat culture, 2 double swabs (4 total) were obtained from 264 pediatric patients with sore throats. Although a throat culture was more specific (97%) than the EIA (89%), the sensitivity (87%) and negative predictive value (97%) of a single EIA was the same as that of a single throat culture. A follow-up throat culture was more accurate than a follow-up EIA. We conclude that the office EIA tested results in more false positives but misses no more true positives than a single throat culture processed by a well-controlled microbiology laboratory. If a follow-up technique is used for an initially negative EIA rapid streptococcal antigen detection test, the throat culture is the superior test and would be equally applicable following an initially negative throat culture or EIA.

Adolescent↗
PubMed1999

Demonstration by a nested PCR for Mycoplasma pneumoniae that M. pneumoniae load in the throat is higher in patients hospitalised for M. pneumoniae infection than in non-hospitalised subjects.

A nested PCR protocol to detect Mycoplasma pneumoniae DNA in throat specimens was developed. An amplification control (AC) template, which is amplified by the same primers as the M. pneumoniae target sequence, was constructed. The assay allowed highly specific and sensitive detection of M. pneumoniae DNA. In all, 305 throat samples, 62 from hospitalised patients and 243 from non-hospitalised subjects, were analysed by the nested PCR. Inhibition of the PCR was observed in 20% of the samples, but was abolished after a 1 in 10 dilution. Throat samples from 5 (8%) of the hospitalised patients and from 7 (3%) of the non-hospitalised subjects were positive for M. pneumoniae DNA. To investigate the relationship between M. pneumoniae load and the severity of disease, the M. pneumoniae load in 10 throat samples from M. pneumoniae-positive subjects was assessed semi-quantitatively by application of the nested PCR to a series of limiting dilutions of nucleic acid extracted from these throat samples. The calculated M. pneumoniae load varied from 20 to 3830 cfu/ml of throat sample. The mean M. pneumoniae load in samples from the hospitalised patients was significantly higher than that in samples from the non-hospitalised subjects. The nested PCR is a useful tool to detect M. pneumoniae DNA in the throat and to study the relationship between the load of M. pneumoniae in throat samples and severity of disease due to M. pneumoniae infection.

Colony Count, Microbial↗
PubMed2005

Effect of additives in lidocaine spray on postoperative sore throat, hoarseness and dysphagia after total intravenous anaesthesia.

BACKGROUND: Laryngo-tracheal lidocaine spray before intubation is associated with an increased risk of postoperative throat problems. Our study investigated the effect of additives contained in lidocaine spray on postoperative sore throat, hoarseness and dysphagia. METHODS: We compared the incidence and severity of postoperative throat complications after laryngo-tracheal application of lidocaine spray (40 mg), lidocaine (40 mg) or normal saline as placebo during laryngoscopy with total intravenous anaesthesia in 122 ASA I-III patients aged 15-87 years in a double-blinded, placebo-controlled study. The incidence and severity of postoperative sore throat, hoarseness and dysphagia were evaluated on the day of and the day after surgery. RESULTS: Sore throat and dysphagia were significantly more severe after lidocaine spray was used than after lidocaine or placebo was used. However, there was no significant difference in the incidence or severity of postoperative sore throat, hoarseness or dysphagia between the lidocaine group and the placebo group throughout the study. CONCLUSION: These results suggest that additives in lidocaine spray, not lidocaine itself, contribute to the increase in postoperative throat problems. Therefore, lidocaine spray should be avoided to prevent these unnecessary complications. Our findings also confirm that laryngo-tracheal lidocaine application does not prevent sore throat, hoarseness or dysphagia after total intravenous anaesthesia.

Adolescent↗
PubMed1968

Bacteriology and clinical significance of hemolytic Haemophilus in the throat.

Hemolytic Haemophilus are rarely isolated in the clinical laboratory, as they do not grow on sheep or human blood-agar alone. On rabbit blood-agar they grow well and are hemolytic, but they grow less well and are not hemolytic on sheep blood-agar with added X and V factors. A survey was made to determine their incidence in pharyngitis. From 28 of 100 sore throats and from 57 of 100 normal throats, only normal bacterial flora were isolated. beta-Streptococci were present in significant numbers in 9 sore and 11 normal throats; staphylococci in 8 sore and 4 normal throats; pneumococci in 20 sore and 11 normal throats; H. influenzae or H. parainfluenzae in 13 sore and no normal throats; hemolytic Haemophilus in 30 sore and 18 normal throats; enteric bacilli in 1 of each; Candida and Neisseria in 2 sore throats each. All of the 33 hemolytic Haemophilus isolates identified to species were H. parahaemolyticus. All were sensitive in vitro to chloramphenicol, erythromycin, and tetracycline; 30 were sensitive to ampicillin and 30 to penicillin, 26 to novobiocin, and 12 to methicillin. H. influenzae, H. parainfluenzae, and H. haemolyticus are indistinguishable by Gram stain morphology, but H. parahaemolyticus is larger than the other three. Hemolytic and nonhemolytic species are indistinguishable by colonial morphology or by nutritional requirements; only hemolysis gives positive differentiation. Nevertheless, only rarely would this be of clinical importance. H. parahaemolyticus apparently may cause pharyngitis, but it is almost always susceptible to penicillin and rarely if ever causes sequelae.

Anti-Bacterial Agents↗