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PubMed2006

Recovering streptococci from the throat, a practical alternative to direct plating in remote tropical communities.

Throat swabs are regarded as the "gold standard" for diagnosing streptococcal pharyngitis and for surveillance research. Culturing throats in remote tropical settings is logistically difficult, and these settings are commonly burdened by high rates of streptococcal disease. The survival of streptococci on swabs may depend on whether they are of "throat" or "skin" type, as determined by emm pattern typing. The aims of this study were to compare the recovery rates of beta-hemolytic streptococci (BHS) using three different transport methods and to determine whether the recovery rates correlated with the emm pattern type. Monthly duplicate throat swabs were taken from occupants of selected households in three remote Aboriginal communities. Paired swabs were separated and handled in one of three ways: (i) direct inoculation onto culture media with cold-box transport (plated), (ii) sealed in a bag with a silica gel desiccant and cold-box transport (desiccant), and (iii) transport at ambient temperature and humidity (ambient). emm pattern typing was done by standard methods. Over 23 months, 4,842 throat swabs were taken, and 4,122 were paired. BHS were recovered on 11.5% of the 4,842 occasions (group A, 4.5%; group C, 1.7%; group G, 5.4%). Results from paired swabs showed the plated method was superior to desiccant and desiccant was better than ambient. Pooled data indicated that plated and desiccant were equivalent, and both were significantly better than ambient. There was no correlation between the emm pattern type and recovery of group A streptococci by different methods. In tropical and remote settings, cold-box transport with desiccant and subsequent inoculation of culture plates in the laboratory is a practical alternative to direct plating.

Bacteriological Techniques↗
PubMed1999

A clinical and serological comparison of group A versus non-group A streptococcal reactive arthritis and throat culture negative cases of post-streptococcal reactive arthritis.

OBJECTIVE: To identify clinical and serological differences of patients with reactive arthritis after infection with Lancefield group A beta-haemolytic streptococci (GAS), compared with non-group A-that is, group C or G streptococci (NGAS:GCS/GGS), and a group of culture negative or unidentified streptococci (GUS). METHODS: A prospective study of consecutive patients with reactive arthritis after serologically or culture confirmed infection with beta-haemolytic streptococci, presenting to the outpatient department of rheumatology from January 1992 until January 1998. Alternative causes for reactive arthritis were excluded. Main outcome measures were clinical and serological characteristics including antistreptolysine-O (ASO) and antideoxyribonuclease-B (antiDNase-B) antibody titres. RESULTS: 41 patients (female/male ratio 22/19; mean (SD) age 38 (13) years) with reactive arthritis were included. Culture of throat swab was positive in 13 cases (32%): 6 (15%) GAS, 7 NGAS (17%), that is, 5 (12%) GCS, 2 (5%) GGS. In 28 cases throat culture remained negative resulting in a group of unidentified streptococci; antibiotic pre-treatment had been given by the general practitioner in 18 cases (64%). Arthritis was non-migratory, the number of arthritic joints in GAS and NGAS was similar, whereas in NGAS patients fewer joints were involved than in GUS: mean (SEM) 36 swollen joint index: 3.3 (1.0) in NGAS v 5.6 (1.0) in GUS (p<0.005); 28 swollen joint index: 2.9 (1.0) in NGAS v 4.3 (0.8) in GUS (p<0.05). Extra-articular manifestations-that is, erythema nodosum/ multiforme, AV conduction block or hepatitis-were observed after GAS or GUS infection, but not after NGAS infection. ASO and/or antiDNase-B rose significantly in all patients. The maximal titres for ASO and antiDNase-B in 41 PSRA patients were: mean (SEM) 1242 (232) U/l and 890 (100) U/l respectively; the maximal ASO titres were similar in the three groups: mean (SEM) 1125 (185) in GAS, 625 (160) in NGAS (GAS v NGAS: p=0.17), and 1430 (320) U/l in GUS (NGAS v GUS: p=0.10). AntiDNase-B titres were: mean (SEM) 1075 (180) in GAS, 375 (105) in NGAS (GAS v NGAS: p<0.01), and 995 (125) U/l in GUS (NGAS v GUS: p<0.005). ASO: antiDNase-B ratios were: mean (SEM) 0.89 (0.21) in GAS, 2.60 (0.76) in NGAS (GAS v NGAS: p<0.05), and 1.43 (0.28) in GUS (NGAS v GUS: p=0.12). CONCLUSION: Post-streptococcal reactive arthritis occurs not infrequently. Differentiation of PSRA based on the causative streptococcal strain is frequently thwarted by negative throat cultures. Sometimes extra-articular manifestations are present that exclude NGAS as the causative organism. Serologically, lower antiDNase-B titres may be indicative for primary NGAS infection; the ASO/antiDNase-B ratio may be of additive value for differentiation in cases of a negative throat culture: the higher ASO/antiDNase-B ratios suggesting primary NGAS infection. In reactive arthritis, serological monitoring consisting of a simultaneous titration of antiDNase-B and ASO, seems to be of clinical importance to trace GAS induced cases, especially when throat cultures remain negative.

Adult↗
PubMed2000

Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults.

OBJECTIVE: To assess whether treatment with penicillin for three days and the traditional treatment for seven days were equally as effective at accelerating resolution of symptoms in patients with sore throat compared with placebo. DESIGN: Randomised double blind placebo controlled trial. SETTING: 43 family practices in the Netherlands. PARTICIPANTS: 561 patients, aged 15-60 years, with sore throat for less than seven days and at least three of the four Centor criteria-that is, history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate. 142 patients were excluded for medical reasons and 73 needed penicillin. INTERVENTIONS: Patients were randomly assigned to penicillin V for seven days, penicillin V for three days followed by placebo for four days, or placebo for seven days. MAIN OUTCOME MEASURES: Resolution of symptoms in the first week, eradication of bacteria after two weeks, and recurrences of sore throat after two, four, and six months. RESULTS: Symptoms resolved 1.9 and 1.7 days earlier in patients taking penicillin for seven days than in those taking penicillin for three days or placebo respectively. Symptoms resolved 2.5 days earlier in patients with group A streptococci and 1.3 days earlier in patients with high colony counts of non-group A streptococci. 23 (13%) of the placebo group had to be given antibiotics later in the week because of clinical deterioration; three developed a peritonsillar abscess. The eradication rate for group A streptococci was 72% in the seven day penicillin group, 41% in the three day penicillin group, and 7% in the placebo group. Sore throat recurred more often in the three day penicillin group than in the seven day penicillin or placebo groups. CONCLUSION: Penicillin treatment for seven days was superior to treatment for three days or placebo in resolving symptoms of sore throat in patients with group A streptococcal pharyngitis and, possibly, in those with non-group A streptococcal pharyngitis.

Adolescent↗
PubMed2002

Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat.

OBJECTIVE: To assess the effectiveness of tailored interventions to implement guidelines for urinary tract infections in women and sore throat. DESIGN: Unblinded, cluster randomised pretest-post-test trial. SETTING: 142 general practices in Norway. PARTICIPANTS: 72 practices received interventions to implement guidelines for urinary tract infection and 70 practices received interventions to implement guidelines for sore throat, serving as controls for each other. 59 practices in the urinary tract infection group and 61 practices in the sore throat group completed the study. Outcomes were measured in 16 939 consultations for sore throat and 9887 consultations for urinary tract infection. INTERVENTIONS: Interventions were developed to overcome identified barriers to implementing the guidelines. The main components of the tailored interventions were patient educational material, computer based decision support and reminders, an increase in the fee for telephone consultations, and interactive courses for general practitioners and practice assistants. MAIN OUTCOME MEASURES: Changes in rates of use of antibiotics, laboratory tests, and telephone consultations. RESULTS: Patients in the sore throat group were 3% less likely to receive antibiotics after the intervention. Women with symptoms of urinary tract infection in the intervention group were 5.1% less likely to have a laboratory test ordered. No significant differences were found between the groups for the other outcomes. Large variation was found across the included practices in the rates of antibiotic prescription, use of laboratory tests and telephone consultations, and in the extent of change for all three outcome measures. CONCLUSIONS: Passively delivered, complex interventions targeted at identified barriers to change had little effect in changing practice.

Adolescent↗
PubMed2003

Penicillin for acute sore throat in children: randomised, double blind trial.

OBJECTIVE: To assess the effectiveness of penicillin for three days and treatment for seven days compared with placebo in resolving symptoms in children with sore throat. DESIGN: Randomised, double blind, placebo controlled trial. SETTING: 43 family practices in the Netherlands. PARTICIPANTS: 156 children aged 4-15 who had a sore throat for less than seven days and at least two of the four Centor criteria (history of fever, absence of cough, swollen tender anterior cervical lymph nodes, and tonsillar exudate). Interventions Patients were randomly assigned to penicillin for seven days, penicillin for three days followed by placebo for four days, or placebo for seven days. MAIN OUTCOME MEASURES: Duration of symptoms, mean consumption of analgesics, number of days of absence from school, occurrence of streptococcal sequelae, eradication of the initial pathogen, and recurrences of sore throat after six months. RESULTS: Penicillin treatment was not more beneficial than placebo in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A streptococci. In the groups randomised to seven days of penicillin, three days of penicillin, or placebo, one, two, and eight children, respectively, experienced a streptococcal sequela. CONCLUSION: Penicillin treatment had no beneficial effect in children with sore throat on the average duration of symptoms. Penicillin may, however, reduce streptococcal sequelae.

Acute Disease↗
PubMed2004

Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial.

OBJECTIVE: To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy. DESIGN: Open, randomised controlled trial. SETTING: 21 general hospitals and three academic centres in the Netherlands. PARTICIPANTS: 300 children aged 2-8 years requiring adenotonsillectomy. INTERVENTION: Adenotonsillectomy compared with watchful waiting. MAIN OUTCOME MEASURES: Episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life. RESULTS: During the median follow up period of 22 months, children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group (difference -0.21, 95% confidence interval -0.54 to 0.12), 0.56 throat infections per person year compared with 0.77 (-0.21, -0.36 to -0.06), and 5.47 upper respiratory tract infections per person year compared with 6.00 (-0.53, -0.97 to -0.08). No clinically relevant differences were found for health related quality of life. Adenotonsillectomy was more effective in children with a history of three to six throat infections than in those with none to two. 12 children had complications related to surgery. CONCLUSION: Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or adenotonsillar hypertrophy.

Adenoidectomy↗
PubMed2004

Does benzydamine hydrochloride applied preemptively reduce sore throat due to laryngeal mask airway?

Sore throat is a common postoperative complaint. We investigated whether preemptive benzydamine hydrochloride (BH) treatment could prevent sore throat due to a laryngeal mask airway (LMA) cuff inflated with air. One-hundred ASA status I-II patients who underwent general anesthesia were randomly divided into two groups. In the first group, four puffs of BH were applied to the pharynx 30 min before the operation and 5 min before the induction of anesthesia. Distilled water with a similar bottle was applied with the same protocol in the second group. Anesthetic induction was provided with propofol and fentanyl. The pressure of the LMA cuff inflated with room air was measured after the first adjustment and after 30, 60, and 90 min of inflation in both groups. At the end of operation, the LMA was removed after the recovery of spontaneous breathing. After the operation, patients were asked about sore throat symptoms at the first, second, and fourth hours. There were no significant differences between groups for cuff pressures, cuff volumes, analgesic doses, or operation times. However, sore throat symptoms were significantly less severe for the BH group during both resting and swallowing. In conclusion, preemptive topical BH may decrease the incidence of sore throat due to LMA use.

Adult↗
PubMed1988

Relationship between throat feather-color pattern and photodependency of testicular function in the athens randombred control line of Japanese quail.

The relationship between throat feather-color and testicular regression and recrudescence under short photoperiods of 6 hr light (L):18 h dark (D) was examined in the Athens randombred control line of Japanese quail. In contrast to earlier studies, no differences were found in testicular regression when quail with brick red, mixed red and white, central red surrounded by white, or all white throat feathers were shifted from a photoperiod of 16L:8D to one of 6L:18D. The cloacal protuberance areas (CPA) of all groups ranged between 1.81 +/- .09 and 1.90 +/- .19 cm2 while birds were housed on the long photoperiod. Cloacal protuberance areas of all groups were markedly reduced after 3 wk of exposure to 6L:18D. Testes weights of all groups ranged between 46.7 and 54.8 mg after 3 wk of exposure to the short photoperiod. In a second experiment, cloacal foam gland development of males of the four throat feather patterns was examined during 26 wk after changing the photoperiod from 16L:8D to 6L:18D. Foam glands of all groups regressed within 3 wk of exposure to 6L:18D. Glands of birds with brick red throats or mixed red and white feathers recrudesced by 11 wk under the short photoperiod. Foam glands of birds with white throats or a band of white surrounding a patch of red did not show recrudescence at 11 or 14 wk but did so by 26 wk.

Animals↗
PubMed1999

[Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator].

Many clinical reports have described postoperative hoarseness and sore throat after general anesthesia. In most cases, these symptoms were attributed to high pressure of the endotracheal tube cuff. The recommended cuff pressure is less than 25 mmHg, as excessive pressure produces ischemia of the tracheal mucosa. However, within the safe pressure range, postoperative hoarseness and sore throat are still often observed. In this study, one hundred and ninety patients of ASA classes I or II were allocated randomly to two groups, low cuff pressure group (< 15 mmHg) or high cuff pressure group (15-25 mmHg), using continuous monitoring with a cuff pressure gauge. We investigated the incidence of postoperative hoarseness and sore throat at 24 hours after intubation and on the seventh postoperative day. The incidence of postoperative hoarseness and sore throat was significantly decreased in the low pressure group at 24 hours after intubation as compared with the high pressure group, but there was no significant difference between the two groups on the seventh postoperative day. These results suggest that keeping the cuff pressure under 15 mmHg can prevent postoperative hoarseness or sore throat at 24 hours after intubation, and that a cuff pressure gauge is thought to be one of the indispensable monitors during anesthesia.

Adult↗
PubMed1999

[Sore throat consultation--what is the value of a treatment guideline?].

OBJECTIVE: To investigate the possibility of rationalizing the management of sore throat in the doctor's office with the aid of appropriate guidelines. PATIENTS AND METHODS: Part 1 was designed as a retrospective study involving two comparative groups: A1 under the care of general practitioner (GP) A, and B1 under the care of GP B. Part 2 was designed as a randomized prospective study involving two comparative groups and intervention: A2 under the care of GP A with no intervention, and B2 treated by GP B with intervention. The study was conducted in the group practice of the two GPs, located in a middle-sized town. Guidelines for the differential management of sore throat was developed. An overall total of 1010 patients with sore throat were divided into 4 groups, and their epidemiological data, care criteria (throat swabs, antibiotics) and effectiveness criteria (success rate, relapses) evaluated statistically using the Instat Guide program to identify guideline-influenced effects. RESULTS: No significant differences were to be seen between the three groups receiving routine care. In the guideline-oriented group, however, significant changes were observed (P < 0.01): more frequent identification of viral pharyngitis in comparison with other underlying clinical causes, a decrease in the frequency of throat swabs from 32% to 7%, and a decrease in the use of antibiotics from 51% to 31%, with the success and relapse rates remaining virtually unchanged. CONCLUSION: The implementation of the guidelines results in the avoidance of unnecessary diagnostic measures and the overuse of antibiotics, while ensuring high-quality care and a high level of feasibility in the day-to-day work of the doctor's office.

Adolescent↗
PubMed2000

An evaluation of the management of patients with sore throats by practice nurses and GPs.

BACKGROUND: Practice nurses are increasingly involved in the management of minor illnesses in primary care. However, there has been little work published that evaluates the quality of the service they offer to patients. In our practice (semi-rural, 14,000 patients) a nursing triage system for minor illnesses has been established since 1992. AIM: To compare the quality of management of sore throats by practice nurses and general practitioners (GPs) in a routine nursing triage system. METHOD: An observational study assessing all patients over the age of two years presenting over a six-month period (February-August 1997) to either the practice nurse or GP with a sore throat as the chief presenting complaint. Patients were followed up at five to seven days by a researcher and recovery rates, analgesic requirements, reconsultation rates, and satisfaction rates were recorded. Patients who were still symptomatic at five to seven days were followed up again at 28 days and outcomes recorded. RESULTS: A total of 44% of patients consulted the practice nurse and 56% consulted the GP. Severity of presenting illness was similar in the two groups. The number of patients whose sore throats had settled, reconsultation rates, antibiotic prescription, and dissatisfaction rates were the same for both groups. However, the patients consulting the nurse had a more favourable outcome on indices such as patients' perception of being back to normal health (64% versus 53%) and median number of days for the sore throat to settle (four versus five). Nurses tended to see younger patients (mean age = 22.5 years versus 28.3 years) and more patients seeing the practice nurse recalled receiving advice about home remedies (76% versus 54%). CONCLUSION: Practice nurses can establish a safe and effective service for treatment of sore throats in a time-restricted triage system.

Adult↗
PubMed2003

[Diagnosis and treatment in 45 patients with Hashimoto's thyroiditis associated with throat symptoms].

OBJECTIVE: To assess the diagnosis and treatment in the patients complaining of throat discomfort that resulted from Hashimoto's thyroiditis (HT). METHOD: Forty-five patients were reported for their clinical dates, 17 had abnormal sensation of pharynx, 5 stabbing feeling, 10 compressive feeling, 7 dry feeling, 6 sore throat. The pharyngeal symptoms were accompanied with hoarseness in 4. Thyroid uptake of 99mTc scan showed abnormal in 37 and normal in 8. Serum T3, T4 level was abnormal in 33 and normal in 12. Serum TSH level was abnormal in 26. Antithyroid antibodies estimated in 32 patients detected positive titers of TMAb and TGAb in 21 (66%) and in 18 (56%), respectively. Thirty were diagnosed as having HT by thyroid fine-needle aspiration biopsy (FNAB), 7 Hashimoto's hyperthyroidism. Tab. Thyroids were administrated to the patients at the period of euthyroidism or hypothyroidism and Propylthiouracilum to the ones at the period of hyperthyroidism. RESULT: Thirty-two patients received the follow-up for six months, throat symptoms disappeared in 27 and improved in 5. CONCLUSION: Abnormal sensation of pharynx and hoarseness as well as sore throat play an important role in symptomatology of HT. Medicine therapy may make the patients with HT free of throat symptoms.

Adolescent↗
PubMed1992

Subclinical group A streptococcal throat infection in school children.

Seven hundred and forty nine apparently healthy school children aged 5-15 years were investigated for throat infection with Group A streptococci (GAS) during December 1990 to May 1991. The prevalence of beta hemolytic streptococci (BHS) was 18.8%; most organisms belonged to Group A streptococci (13.7%). The prevalence of BHS in throat was significantly higher (p < .001) in girls as compared to boys. Immune response to extracellular antigens was studied in 53 children who had GAS strain in their throat, 54.7% had elevated titers of antistreptolysin O or antideoxyribonuclease B or both indicating subclinical infection with GAS. Thus it is recommended that serological examinations should be done along with throat culture to identify subclinical Group A streptococcal throat infection.

Adolescent↗
PubMed1992

The quality of a laboratory test in general practice: the throat swab example.

AIM: To measure the repeatability, the flow of information, and the data entry error of the throat swab test from a suburban general practice. METHOD: A prospective study of consecutive patients seen in routine consultation for a sore throat as their primary complaint. Repeated throat swabs were taken for each patient. Carbon copies of routine laboratory forms were collected. RESULTS: The kappa statistic for reproducibility of the throat swab test was 0.63 (95% CI 0.50-0.77). In 5.8% of patients, one swab was positive and the other negative. Information took one day or less to travel to and from the laboratory for 25.7% of patients with a beta-haemolytic streptococcal growth compared to the 9.9% of patients with no growth (chi 2 = 6.17, p < 0.02). The laboratory received 53% of the swabs on the day they were taken. Delays in getting the swabs to the laboratory occurred when swabs were taken in the afternoon session or on weekends. Monday morning gave the quickest return. Data entry errors were found on 15.9% of patient forms. CONCLUSION: The quality of the throat swab test needs improvement in the suburban general practice context.

Clinical Laboratory Techniques↗
PubMed2003

[Discovery of Chlamydia trachomatis in the throat during diagnosis of secondary syphilis in an HIV+ patient].

INTRODUCTION: Chlamydia trachomatis (CT) pharyngitis has rarely been described in the literature. Studies in the last decade have shown a prevalence of less than 5%, with more women than men infected in the pharynx. Among homosexual men, only one study, conducted more than 5 years ago, detected the presence of CT in the throat (in one patient out of 13 tested). OBSERVATION: A 33 year-old homosexual man consulted for cutaneous lesions on the palms and the chest. Infected by HIV, he was taking antiretroviral therapy but no antibiotic prophylaxis. He admitted practising unprotected (insertive and receptive) fellatio with unknown partners. The lesions were those of secondary syphilis but the location of the chancre remained unknown. An enlarged screening for sexually transmitted infections detected the presence, through molecular amplification, of CT in the throat without further localisation (urethra, anus). After intramuscular injection of Extencillin and an 8-day-regimen of cycline, CT was no longer detected in the throat. The course of HIV infection did not appear modified by this infectious episode. COMMENTS: According to a review of the literature, the 4 most recent studies have not revealed CT in the throat of homosexuals although the bacteria was detected in the urethra of 3 to 4% of them. Chlamydia trachomatis is more frequently detected in the genital tract rather than the pharynx of women also screened in various localisations. These results must be tempered by the participant recruitment methods, diagnostic methods used, sample size and history of recent antibiotherapy. The pharyngeal mucosa might be less receptive to CT than the urethral mucosa. Association of CT pharyngitis with syphilis or its occurrence during HIV infection are not documented. The molecular amplification technique detects CT in the throat with sensitivity and specificity. A one-week regimen of cycline can cure this pharyngitis. Cost-effectiveness of screening for pharyngeal CT has not yet been assessed in persons 'at risk'.

Adult↗
PubMedDate not supplied

[Comparative analysis of clinical and laboratory methods for diagnosing streptococcal sore throat].

OBJECTIVES: Diagnosis and correct treatment of group A streptococcal sore throat is important particularly to prevent non-suppurative sequelae. Clinical findings continue to be used to differentiate streptococcal infection from viral sore throat. The American Academy of Pediatrics recommends that streptococcal sore throat diagnosis should always be performed by microbiological identification methods. The aim of this study is to evaluate the accuracy of clinical diagnosis in comparison with culture and rapid test. METHODS: Children aged 2 to 13 years who had received a clinical diagnosis of sore throat and sought treatment at the pediatric emergency unit of São Paulo Santa Casa were evaluated and those with clinical signs or viral infection were excluded. Clinical findings were recorded and swabs were taken for group A Streptococcus cultures and a Streptococcus rapid test. RESULTS: The culture was positive in 96 (24.4%) of the 376 children evaluated. The presence of petechiae, purulent exudate and painful tonsils were more likely to occur in children with positive streptococcus cultures, however they exhibited low diagnostic accuracy. The doctors' subjective evaluation failed to identify 21% of positive cases and antibiotics were prescribed in 47% of negative cases, compared with 3 and 6%, respectively, for the rapid test. CONCLUSIONS: A microbiologic method is necessary for the correct prescription of antibiotics in children with streptococcal sore throat.

Adolescent↗
PubMed2005

Clinical symptoms and signs in sore throat patients with large colony variant beta-haemolytic streptococci groups C or G versus group A.

BACKGROUND: The role of large colony streptococci groups C or G as pathogen agents in sore throat has been questioned. AIM: To analyse clinical features of patients with large colony streptococci groups C or G compared with patients with group A streptococci (GAS) and with negative cultures. DESIGN OF STUDY: Prospective study of patients with sore throat. SETTING: Two Norwegian general practices in Stokke and Kongsberg communities with 6500 patients. METHOD: Frequency of clinical features in the three patient categories including the four Centor criteria (fever, anterior cervical lymphadenopathy, tonsillar exudates, and lack of cough), degree of pain on swallowing, pharyngeal rubor, C-reactive protein (CRP) values, patient age between 3 and 14 years, and duration of symptoms before seeing the doctor. A logistic regression analysis to find independent predictors was performed. RESULTS: Out of 306 patients with a sore throat, 244 were adults and 62 were children under 10 years old; 40% were men. One hundred and twenty-seven had GAS, 33 had streptococci groups C or G, and 146 had negative throat cultures. Forty-eight per cent of the GAS patients and 45% of the C or G patients met three or four of the Centor criteria. The logistic regression revealed that in patients with GAS considerable pain on swallowing, an age of 3-14 years and a duration of symptoms of < or =3 days or less were significantly associated with GAS infection in addition to the Centor criteria. The same results were found when all streptococci were analysed together, in addition elevated CRP was significant. In patients with streptococci group C or G an elevated CRP-value was significantly associated. CONCLUSION: Patients with tonsillitis caused by streptococcus groups C or G have, to a large extent, the same clinical picture as patients with GAS. Large colony streptococci groups C and G should be considered as throat pathogens in line with GAS.

Adolescent↗
PubMed1990

[Sore throat: an analysis of medical management in a community clinic].

The diagnostic approach to sore throat and its treatment by 7 doctors was studied in 692 community clinic patients. Redness of the throat, the commonest clinical feature in all age groups, was present in 88%. The prevalence of other clinical findings varied in the different age groups. 54% of the patients, most of whom were less than 13 years old, were treated initially with antibiotics. Most of the physicians prescribed penicillin V (average, 8.4 days). From 11 (13%) of the throat cultures taken from children under the age of 4, beta hemolytic streptococci (BHS) were grown. Based on throat cultures, antibiotics had been given unnecessarily in 53% of those in whom it was initially prescribed, and wrongly withheld in 10% of those who initially did not receive them. This study reveals an urgent need for a rapid and accurate method of detecting BHS in patients with sore throat.

Adolescent↗