Bacterial flora in patients presenting with sore throat in Dutch general practice

• Published in: Family practice Vol. 10; no. 4; p. 371
• Main Authors: Dagnelie, C F, Touw-Otten, F W, Kuyvenhoven, M M, Rozenberg-Arska, M, de Melker, R A
• Format: Journal Article
• Language: English
• Published: England 01.12.1993
• Subjects: Adolescent; Adult; Candida albicans - isolation & purification; Child; Child, Preschool; Europe - epidemiology; Family Practice; Female; Gram-Negative Bacteria - isolation & purification; Humans; Male; Middle Aged; Netherlands; Pharyngitis - epidemiology; Pharyngitis - microbiology; Pharynx - microbiology; Prevalence; Staphylococcus aureus - isolation & purification; Streptococcal Infections - epidemiology; Streptococcal Infections - microbiology; Streptococcus - isolation & purification; Streptococcus pyogenes - isolation & purification; Netherlands; Europe
• ISSN: 0263-2136; 1460-2229
• DOI: 10.1093/fampra/10.4.371

The bacterial growth in patients presenting with a sore throat was assayed and four clinical features were tested in order to reliably differentiate between beta-haemolytic streptococci group A (GABHS) and other micro-organisms. For 2 years, 53 general practitioners (GPs) in The Netherlands took throat swabs from all patients, aged 4-60, presenting with a sore throat lasting 14 days or less. Four clinical features: fever (history), (tonsillary) exudate, anterior cervical lymphadenopathy and absence of cough were registered. In 70% of the 598 patients one or more micro-organisms were cultured from throat specimens. In 48% of the patients beta-haemolytic streptococci were found (32% group A, 7% group C, 4% group G, 5% others). Enterobacteriaceae were cultured in 5%, Candida albicans in 5%, Staphylococcus aureus in 4%, various others in 8% of the patients. In 30% of the patients cultures remained negative. Of the 270 patients with three or four clinical features, 46% (95% Cl, 40-52%) harboured GABHS in their throats, while in 328 patients with less than three features 21% (95% Cl, 16-25%) were GABHS positive. However, this relationship between presence or absence of clinical features and culture result was not found in the youngest age category (4-14 years old). Culture results were not related to sex, smoking habits or the insurance mode of the patient. The clinical relevance of several micro-organisms, other than beta-haemolytic streptococci, remains to be determined. The four mentioned signs and symptoms were helpful in predicting the probability of GABHS in patients aged 15 years and older.