Document Detail

Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study.
MedLine Citation:
PMID:  23211183     Owner:  NLM     Status:  MEDLINE    
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.
Paul Little; F D Richard Hobbs; David Mant; Cliodna A M McNulty; Mark Mullee;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of general practice : the journal of the Royal College of General Practitioners     Volume:  62     ISSN:  1478-5242     ISO Abbreviation:  Br J Gen Pract     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-12-05     Completed Date:  2013-12-30     Revised Date:  2014-01-06    
Medline Journal Info:
Nlm Unique ID:  9005323     Medline TA:  Br J Gen Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  e787-94     Citation Subset:  IM    
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MeSH Terms
Anti-Bacterial Agents / therapeutic use*
Cohort Studies
Drug Resistance, Bacterial
Great Britain / epidemiology
Patient Selection
Pharyngitis / drug therapy,  epidemiology,  microbiology*
Prospective Studies
Severity of Illness Index
Streptococcal Infections / drug therapy,  epidemiology,  microbiology*
Streptococcus pyogenes / isolation & purification,  pathogenicity*
Reg. No./Substance:
0/Anti-Bacterial Agents
Paul Little / ; Ian Williamson / ; Mike Moore / ; Mark Mullee / ; Man Ying Edith Cheng / ; James Raftery / ; David Turner / ; Jo Kelly / ; Jane Barnett / ; Karen Middleton / ; Gerry Leydon / ; Richard Hobbs / ; Brendan Delaney / ; Olga Kostopoulou / ; Richard McManus / ; Razia Meer-Baloch / ; David Mant / ; Paul Glasziou / ; Sue Smith / ; Diane Coulson / ; Cliodna McNulty / ; Peter Hawtin /
Comment In:
Evid Based Med. 2013 Dec;18(6):234   [PMID:  23585183 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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