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LetterCorrespondence

Re: Role of Non-Group A Streptococci in Acute Pharyngitis

Robert M. Centor
The Journal of the American Board of Family Medicine May 2010, 23 (3) 423; DOI: https://doi.org/10.3122/jabfm.2010.03.090267
Robert M. Centor
MD
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To the Editor: Jeffrey Tiemstra and Rosita L. F. Miranda1 have added important data concerning the diagnosis and management of acute pharyngitis. Like previous investigators, they found that a significant percentage of adolescents and young adults presenting with acute pharyngitis grow streptococci from a group other than group A strep, which is the classic concern.

Most other articles on this subject have focused on group C and group G streptococci. I doubt that clinical presentation of group B resembles the clinical presentation of group C. In unpublished data, we did not find group B patients having such a presentation. Zwart also found that only A, C, and G caused pharyngitis.2 Therefore, I would suggest that the authors look carefully at the distribution of clinical indicators in group B compared with group A and group C.

The Tiemstra article also shows that in practice (rather than in prospective studies) the sensitivity of the group A strep rapid test was only 75%. One can postulate several reasons for a difference in rapid test sensitivity from prospective studies. Just to suggest 2 possibilities: (1) sampling errors might occur more often in practice or (2) there may be publication bias for higher sensitivity studies.3

Like Zwart's classic 2000 BMJ study on treatment, the authors find a high probability of either group A or non-group A strep in patients having high pharyngitis scores.3 That article supports a clinical improvement from antibiotics for group C strep pharyngitis. In that article adults (ages 15–60) experienced a 2-day symptom improvement if they had group A pharyngitis and a 1-day symptom improvement if they had group C pharyngitis.

The addition of headache to the pharyngitis scores, although understandable, makes comparison of this study to previous studies more difficult.

A note of caution: these findings probably apply to the adolescent/young adult age group and not pre-adolescents. Previous studies have shown that non-group A infections occur commonly in college health populations but not pre-adolescents.

Congratulations for continuing the documentation that adolescent and adult pharyngitis is more complex than deciding whether the patient has group A strep.

Notes

  • The above letter was referred to the author of the article in question, who offers the following reply.

References

  1. ↵
    Tiemstra J, Miranda RLF. Role of non-group A streptococci in acute pharyngitis. J Am Board Fam Med 2009; 22: 663–9.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    Zwart S, Ruijs GJ, Sachs AP, van Leeuwen WJ, Gubbels JW, de Melker RA. Beta-haemolytic streptococci isolated from acute sore-throat patients: cause or coincidence? A case-control study in general practice. Scand J Infect Dis 2000; 32: 377–84.
    OpenUrlCrossRefPubMed
  3. ↵
    Zwart S, Sachs AP, Ruijs GJ, Gubbels JW, Hoes AW, de Melker RA. Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults. BMJ 2000; 320: 150–4.
    OpenUrlAbstract/FREE Full Text
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The Journal of the American Board of Family Medicine: 23 (3)
The Journal of the American Board of Family Medicine
Vol. 23, Issue 3
May-June 2010
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Re: Role of Non-Group A Streptococci in Acute Pharyngitis
Robert M. Centor
The Journal of the American Board of Family Medicine May 2010, 23 (3) 423; DOI: 10.3122/jabfm.2010.03.090267

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Re: Role of Non-Group A Streptococci in Acute Pharyngitis
Robert M. Centor
The Journal of the American Board of Family Medicine May 2010, 23 (3) 423; DOI: 10.3122/jabfm.2010.03.090267
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