Clinical and Microbiological Evidence for Endemic Pharyngitis Among Adults Due to Group C Streptococci

doi:10.1001/archinte.1990.00390160081017

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Vol. 150 No. 4, April 1990

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Clinical and Microbiological Evidence for Endemic Pharyngitis Among Adults Due to Group C Streptococci

Frederick A. Meier, MD; Robert M. Centor, MD; Leroy Graham, Jr, PhD; Harry P. Dalton, PhD

Arch Intern Med. 1990;150(4):825-829.

Abstract

• Group C β-hemolytic streptococci cause rare epidemicoutbreaks of pharyngitis, but their role in sporadic endemicpharyngitis has been uncertain. We addressed the question ofwhether non–group A β-hemolytic streptococci areassociated with endemic pharyngitis in two ways. First, we comparedrates of isolation from throat swabs of group A, B, C, and Gand ungrouped β-hemolytic streptococci ("culture negative")in adult patients vs those rates in controls. Second, we collectedin standardized form clinical indexes of patients with pharyngitis:signs and symptoms graded for severity, the examining physician'ssubjective estimate of the probability of streptococcal pharyngitis,a logistic regression score predicting streptococcal pharyngitis,and whether antibiotic therapy was prescribed. After collectingdata and cultures on 1425 patients with sore throats and cultureson 284 controls, we found the following: group C streptococciwere isolated significantly more frequently in patients withsore throats than in controls (6% vs 1.4%); four clinical signsand two symptoms distinguished group C–associated pharyngitisas more severe than culture-negative pharyngitis; and six clinicalsigns and one symptom distinguished group C–associatedpharyngitis as less severe than group A pharyngitis. Physicians'subjective estimates, logistic regression scores, and antibiotictreatment all characterized group C–associated pharyngitisas more severe than culture-negative sore throats but less severethan group A pharyngitis. From these data we present the firstdefinitive evidence that group C streptococci are associatedwith endemic pharyngitis, show that clinical presentation distinguishesa group of patients with group C–associated pharyngitisfrom populations with culture-negative sore throats and fromthose with group A pharyngitis. Physicians' response to thatpresentation merits consideration in the context of rapid group-specificdiagnosis of streptococcal pharyngitis by group A antigen tests.

(Arch Intern Med. 1990;150:825-829)

Author Affiliations

From the Departments of Pathology (Drs Meier, Graham, and Dalton) and Internal Medicine (Drs Meier and Centor), Medical College of Virginia, Virginia Commonwealth University, Richmond. Dr Centor was a Teaching and Research Scholar of the American College of Physicians during this project.

Footnotes

Accepted for publication December 5, 1989.

Reprint requests to Box 662, MCV Station, Richmond, VA 23298(Dr Meier).

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