title: Beta-haemolytic streptococci isolated from acute sore-throat patients: cause or coincidence? A case-control study in general practice.
abstract: As beta-haemolytic streptococci can be cultured in people with and in those without a sore throat, a case-control study was set up in 43 family practices in The Netherlands. The association was tested between the number of colony counts, specific T/M types and exotoxin genes and an acute sore throat. Duplicate throat swabs were taken from 663 sore-throat patients, selected by clinical criteria, and from 694 healthy controls. They were cultured for beta-haemolytic streptococci by combining several updated laboratory methods. Approximately 40% of the controls and 80% of the patients had beta-haemolytic streptococci-positive cultures. When focusing on cultures with high colony counts, not only group A (46%), but also non-group A streptococci (20%), predominated significantly in adult patients compared with controls. No T/M or exotoxin gene type was significantly more prevalent in patients than in controls. Thus, semiquantitative analysis, but not T/M and exotoxin gene typing, showed an association between beta-haemolytic streptococci and active disease. Groups A, C and G streptococci were found to be potentially pathogenic in adult sore-throat patients, and should be included in the discussion on the use of rapid antigen detection tests and penicillin treatment in primary care.
authors.affiliation: Department of General Practice, University Medical Center Utrecht, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Zwart
authors.forename: G J
authors.initials: GJ
authors.lastname: Ruijs
authors.forename: A P
authors.initials: AP
authors.lastname: Sachs
authors.forename: W J
authors.initials: WJ
authors.lastname: van Leeuwen
authors.forename: J W
authors.initials: JW
authors.lastname: Gubbels
authors.forename: R A
authors.initials: RA
authors.lastname: de Melker
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001426:Bacterial Proteins / Q000235:genetics; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005098:Exotoxins; D005194:Family Practice; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008565:Membrane Proteins / Q000235:genetics; D010612:Pharyngitis / Q000382:microbiology*; D013291:Streptococcus / Q000145:classification / Q000302:isolation & purification*
chemical_list: D001426:Bacterial Proteins; D005098:Exotoxins; D008565:Membrane Proteins; C117980:SpeA protein, Streptococcus pyogenes