title: Concurrent influenza A and group A beta-hemolytic streptococcal pharyngotonsillitis.
abstract: OBJECTIVE
  A concurrent group A beta-hemolytic Streptococcus (GABHS)-influenza virus pharyngotonsillitis (PT) is generally not considered in diagnoses, even though mixed bacterial-viral infections are common in other respiratory tract infections. This report describes our experience in diagnosing a potential mixed GABHS-influenza virus PT in children.
  
  
  METHODS
  Acute and convalescent antistreptolysin O (ASO) and anti-DNase B titers were obtained from 12 children with acute PT and clinical presentation that suggested viral infection, and in whom both rapid influenza A virus and rapid GABHS tests were positive.
  
  
  RESULTS
  The children did not receive any antimicrobial therapy, and all recovered from their acute PT within 2 to 5 days and were all asymptomatic upon their return visit 3 to 4 weeks later. GABHS was recovered from 2 of the children on their return visit. However, ASO and anti-DNase B titers were not elevated in these individuals. The ASO and anti-DNase B titers determined in the first serum samples were less than the age-adjusted normal values for all of the children. However, these titers rose by at least two-dilution (0.2 logarithm) in the convalescent sera as compared with the acute ones in 4 of the 12 children (33%). One of the 8 children who had no increase in ASO and anti-DNase B titers had an acute GABHS PT 5 months later. One-year follow-up of all of the children showed no anomalies.
  
  
  CONCLUSIONS
  This report is the first to describe a concomitant GABHS and influenza A virus PT, as evident by increased ASO and anti-DNase B titers in a third of the patients who had both of these organisms detected in their upper airways.
authors.affiliation: Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Brook
authors.forename: Alan E
authors.initials: AE
authors.lastname: Gober
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009980:Influenza A virus; D007251:Influenza, Human / Q000150:complications*; D008297:Male; D010612:Pharyngitis / Q000150:complications* / Q000382:microbiology; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis; D013297:Streptococcus pyogenes; D013997:Time Factors; D014069:Tonsillitis / Q000150:complications* / Q000382:microbiology