Primary Care and Population Science, Faculty of Medicine University of Southampton, UK.
Br J Gen Pract. 2012 Nov;62(604):e787-94. doi: 10.3399/bjgp12X658322.
Management of pharyngitis is commonly based on features which are thought to be associated with Lancefield group A beta-haemolytic streptococci (GABHS) but it is debatable which features best predict GABHS. Non-group A strains share major virulence factors with group A, but it is unclear how commonly they present and whether their presentation differs.
To assess the incidence and clinical variables associated with streptococcal infections.
Prospective diagnostic cohort study in UK primary care.
The presence of pathogenic streptococci from throat swabs was assessed among patients aged ≥5 years presenting with acute sore throat.
Pathogenic streptococci were found in 204/597 patients (34%, 95% CI = 31 to 38%): 33% (68/204) were non-group A streptococci, mostly C (n = 29), G (n = 18) and B (n = 17); rarely D (n = 3) and Streptococcus pneumoniae (n = 1). Patients presented with similar features whether the streptococci were group A or non-group A. The features best predicting A, C or G beta-haemolytic streptococci were patient's assessment of severity (odds ratio [OR] for a bad sore throat 3.31, 95% CI = 1.24 to 8.83); doctors' assessment of severity (severely inflamed tonsils OR 2.28, 95% CI = 1.39 to 3.74); absence of a bad cough (OR 2.73, 95% CI = 1.56 to 4.76), absence of a coryza (OR 1.54, 95% CI = 0.99 to 2.41); and moderately bad or worse muscle aches (OR 2.20, 95% CI = 1.41 to 3.42).
Non-group A strains commonly cause streptococcal sore throats, and present with similar symptomatic clinical features to group A streptococci. The best features to predict streptococcal sore throat presenting in primary care deserve revisiting.
咽炎的治疗通常基于被认为与 A 组乙型溶血性链球菌（GABHS）相关的特征，但哪种特征能最好地预测 GABHS 存在争议。非 A 组菌株与 A 组共享主要的毒力因子，但它们的出现频率尚不清楚，其表现是否存在差异也不清楚。
评估与链球菌感染相关的发病率和临床变量。
英国初级保健中前瞻性诊断队列研究。
对年龄≥5 岁、因急性咽痛就诊的患者进行咽喉拭子中致病性链球菌的检测。
在 597 例患者中发现 204 例（34%，95%CI=31%至 38%）患者存在致病性链球菌：33%（68/204）为非 A 组链球菌，主要为 C 群（n=29）、G 群（n=18）和 B 群（n=17）；罕见的为 D 群（n=3）和肺炎链球菌（n=1）。无论链球菌是 A 组还是非 A 组，患者的表现特征相似。预测 A、C 或 G 乙型溶血性链球菌的最佳特征是患者对严重程度的评估（严重咽痛的优势比[OR]为 3.31，95%CI=1.24 至 8.83）；医生对严重程度的评估（严重扁桃体炎 OR 为 2.28，95%CI=1.39 至 3.74）；无剧烈咳嗽（OR 为 2.73，95%CI=1.56 至 4.76）、无鼻塞（OR 为 1.54，95%CI=0.99 至 2.41）；中度或更严重的肌肉疼痛（OR 为 2.20，95%CI=1.41 至 3.42）。
非 A 组菌株常引起链球菌性咽痛，其临床表现与 A 组链球菌相似。预测初级保健中链球菌性咽痛的最佳特征值得重新审视。
