Clinical symptoms and signs in sore throat patients with large colony variant beta-haemolytic streptococci groups C or G versus group A.
BACKGROUND
The role of large colony streptococci groups C or G as pathogen agents in sore throat has been questioned.


OBJECTIVE
To analyse clinical features of patients with large colony streptococci groups C or G compared with patients with group A streptococci (GAS) and with negative cultures.


METHODS
Prospective study of patients with sore throat.


METHODS
Two Norwegian general practices in Stokke and Kongsberg communities with 6500 patients.


METHODS
Frequency of clinical features in the three patient categories including the four Centor criteria (fever, anterior cervical lymphadenopathy, tonsillar exudates, and lack of cough), degree of pain on swallowing, pharyngeal rubor, C-reactive protein (CRP) values, patient age between 3 and 14 years, and duration of symptoms before seeing the doctor. A logistic regression analysis to find independent predictors was performed.


RESULTS
Out of 306 patients with a sore throat, 244 were adults and 62 were children under 10 years old; 40% were men. One hundred and twenty-seven had GAS, 33 had streptococci groups C or G, and 146 had negative throat cultures. Forty-eight per cent of the GAS patients and 45% of the C or G patients met three or four of the Centor criteria. The logistic regression revealed that in patients with GAS considerable pain on swallowing, an age of 3-14 years and a duration of symptoms of < or =3 days or less were significantly associated with GAS infection in addition to the Centor criteria. The same results were found when all streptococci were analysed together, in addition elevated CRP was significant. In patients with streptococci group C or G an elevated CRP-value was significantly associated.


CONCLUSIONS
Patients with tonsillitis caused by streptococcus groups C or G have, to a large extent, the same clinical picture as patients with GAS. Large colony streptococci groups C and G should be considered as throat pathogens in line with GAS.
Lindbaek
Morten
M
Department of general practice and community medicine, University of Oslo, Oslo, Legekontoret, Kongsberg. morten.lindbak@medisin.uio.no
Høiby
Ernst Arne
EA
Lermark
Gro
G
Steinsholt
Inger Marie
IM
Hjortdahl
Per
P
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005194:Family Practice; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009664:Norway / Q000453:epidemiology; D010612:Pharyngitis / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013291:Streptococcus / Q000302:isolation & purification*; D013297:Streptococcus pyogenes / Q000302:isolation & purification