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Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study

Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study
Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study
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
0960-1643
787-794
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Hobbs, F.D. Richard
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Mant, David
d2e30212-70ec-48c9-b80a-a45cf4bcc46e
McNulty, Cliona A.M.
c82aedfc-4ced-4231-8d7a-06e0d1592b26
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Moore, M.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Hobbs, F.D. Richard
0935e839-463a-436b-b66f-f99679d6839a
Mant, David
d2e30212-70ec-48c9-b80a-a45cf4bcc46e
McNulty, Cliona A.M.
c82aedfc-4ced-4231-8d7a-06e0d1592b26
Mullee, Mark
fd3f91c3-5e95-4f56-8d73-260824eeb362
Moore, M.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Leydon, Geraldine
c5cdaff5-0fa1-4d38-b575-b97c2892ec40

Little, Paul, Hobbs, F.D. Richard, Mant, David, McNulty, Cliona A.M., Mullee, Mark, Moore, M. and Leydon, Geraldine (2012) Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study. British Journal of General Practice, 62 (604), 787-794. (doi:10.3399/bjgp12X658322). (PMID:23211183)

Record type: Article

Abstract

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

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Published date: 2012
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 347576
URI: http://eprints.soton.ac.uk/id/eprint/347576
ISSN: 0960-1643
PURE UUID: c2e171ae-e575-42cc-bb79-8af08034b246
ORCID for M. Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Geraldine Leydon: ORCID iD orcid.org/0000-0001-5986-3300

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Date deposited: 25 Jan 2013 11:39
Last modified: 26 Nov 2021 02:49

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Contributors

Author: Paul Little
Author: F.D. Richard Hobbs
Author: David Mant
Author: Cliona A.M. McNulty
Author: Mark Mullee
Author: M. Moore ORCID iD

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