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Group C Streptococcus, F. necrophorum common in patients with acute pharyngitis
Fusobacterium necrophorum and group C Streptococcus were common in patients with acute pharyngitis, particularly in young adults, according to research published in Annals of Family Medicine.
“Whether this is clinically important remains to be determined; it depends on whether they are merely colonizing the pharynx or are pathogens,” Christian Marchello, MS, MT (ASCP) and Mark H. Ebell, MD, MS, of the department of epidemiology and biostatistics at the University of Georgia, wrote.
Marchello and Ebell conducted a systematic review of 16 studies identified in MEDLINE. They stratified the studies by type: laboratory-based studies of throat swabs and prospective studies of patients with sore throats.
They found that in laboratory-based studies, the prevalence of group C Streptococcus was 6.6% (95% CI, –1 to 14.2) and the prevalence of F. necrophorum was 18.8% (95% CI, 6.5-31.1). In primary care patients with sore throats, group C Streptococcus prevalence was 6.1% (95% CI, 3.1-9.2), while F. necrophorum prevalence was 19.4% (95% CI, 14.7-24.1). Overall, occurrence of group C Streptococcus was 6.1% (95% CI, 3.2-9) and F. necrophorum was 18.9% (95% CI, 10.5-27.2).
Researchers wrote that group C Streptococcus, F. necrophorum and group A Streptococcus have similar signs and symptoms in patients with pharyngitis, but it is unknown whether they are pathogenic and if treating all three would be beneficial.
“The argument for detection and treatment is threefold. While group C Streptococcus is not a cause of rheumatic fever, this is an exceedingly rare complication of group A Streptococcus, and treatment solely for that purpose is not cost-effective,” Marchello and Ebell wrote. “Treatment of all three infections, however, may reduce the duration of symptoms, decrease the likelihood of spread (particularly in communal living settings such as universities), and for F. necrophorum it has may prevent rare complications such as peritonsillar abscess and Lemierre’s syndrome. It is premature, however, to recommend antibiotic treatment for these pathogens.”
Marchello and Ebell said further studies that contain randomized, controlled trials of treatment would help determine if treatment is advantageous to patients. - by Janel Miller
Disclosures: The researchers report no relevant financial disclosures.
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This is a review of a collection of 16 heterogenous studies describing the incidence of isolation of group C streptococcus and Fusobacterium necrophorum in patients with acute pharyngitis. Unfortunately, the authors are severely limited by the study design that is a purely retrospective data analysis of disparate patient populations and clinical information. Therefore, no practical conclusions regarding treatment can be made, nor even a statement about the importance of their results can be definitively stated. This study was not designed to assess the benefit or even the results of treatment or patient outcome, as the populations being looked at were not analyzed or randomized for this type of analysis. Plus, the major benefit for treating group A beta hemolytic "strep" throats in younger patients is NOT symptom relief but is the prevention of rheumatic heart disease, a condition which is not associated with either of the two bacteria identified in these studies.
The old adages ’further research is needed’ and ’prospective randomized studies are indicated’ were never more correct. No change in clinical practice should occur as a result of this study.