Role of group C beta-hemolytic streptococci in pharyngitis: epidemiologic study of clinical features associated with isolation of group C streptococci.

All Lancefield group C beta-hemolytic streptococci isolated over 12 months from college students with clinical pharyngitis and age-matched healthy controls were identified. Clinical features of upper respiratory tract infection and pyogenic pharyngitis as well as colony counts were tabulated for each patient according to throat culture results. Of 1,480 patients, Lancefield group C Streptococcus equisimilis was isolated from 45 (3%) patients and Streptococcus anginosus ("Streptococcus milleri") was isolated from 164 (11.1%) patients. Patients from whom S. equisimilis was isolated had clinical features more suggestive of pyogenic infection than did patients from whom S. anginosus was isolated. Colony counts on primary throat culture plates from patients from whom S. equisimilis and Streptococcus pyogenes were isolated were higher than those from patients from whom S. anginosus was isolated. This study presents epidemiologic evidence supporting a role for S. equisimilis in causing pharyngeal infection and for S. anginosus as representing part of the normal oropharyngeal flora.