Article Figures & Data
Figures
- Figure 1
Process used to identify articles from initial search to final decision
- Figure 2
Forest plot of Group C streptococcus prevalence in sore throats in the outpatient and laboratory-based setting, sorted by prevalence
I2 = 97.28; PCR = polymerase chain reaction
- Figure 3
Forest plot of Fusobacterium necrophorum prevalence in sore throats in the outpatient and laboratory-based setting, sorted by prevalence
I2 = 98.71; PCR = polymerase chain reaction
Tables
- Table 1
Characteristics of Studies Reporting the Prevalence of Group C beta hemolytic Streptococcus and Fusobacterium necrophorum
Author, Year (Country) Population Age Settinga Years of Data Collection Diagnostic Method Group C Streptococci Lindbaek et al,4 2005 (Norway) Adults and children with sore throat for <7 d and no recent antibiotic presenting to GP. Mean 23.9 y; 244 adults, 62 children <10 y Primary care 2000–2002 Culture Fretzayas et al,17 2009 (Greece) Children with pharyngitis and no recent antibiotics presenting to an outpatient clinic. Mean 6.5 y, range 4 y–14 y Primary care 2006 Culture Little et al,5 2012 (England) Adults and children presenting to a GP with sore throat for <14 d as the primary symptom. ≥5 y; 11% were 5 y–9 y Primary care 2007–2008 Culture Cohen et al,18 2012 (France) Children with pharyngitis and no recent antibiotics presenting to their pediatrician. Mean 6.1 y, range 3 y–5 y Primary care 2008–2010 Culture Llor et al,19 2009 (Spain) Adults presenting to GP with acute pharyngitis and ≥2 Centor criteria. Mean 30.6 y, range ≥14 yr Primary care 2007–2008 Culture Calvino et al,20 2014 (Spain) Adults presenting to an outpatient health center with pharyngitis and all 4 Centor criteria. Mean 28.5 y, range 18 y–51 y Primary care 2010–2012 Culture Fusobacterium necrophorum Ludlam et al,21 2009 (United Kingdom) Two groups: 411 students, of whom 85 had a sore throat, and 103 patients presenting to a GP with sore throat. University students: median 20 y, range 18 y–39 y
GP patients: median 26 y, range 2 y–77 yPrimary care 2005–2006 PCR Bank et al,16 2010 (Denmark) All throat swabs submitted to a regional laboratory from primary care practice during 2 mo. Median 20 y, range 0 y–57 y Laboratory-based 2009 PCR Bank et al,22 2013 (Denmark) All throat swabs submitted to a regional laboratory from primary care practices for patients age 15 y–24 y. Range 15 y-24 y Laboratory-based 2007–2009 Culture Both pathogens Aliyu et al,23 2004 (United Kingdom) Random sample of 100 throat swabs submitted by primary care physicians during 7 mo. Mean 25 y, range 5 mo-79 y Laboratory-based 2003 Culture Batty et al,24 2005 (United Kingdom) All throat swabs received during a 4 wk period. 1 y–47 y Laboratory-based 2005 Culture Amess et al,10 2007 (United Kingdom) All throat swabs received during 6 mo. <1 y to 88 y Laboratory-based 2004–2005 Culture Jensen et al,25 2007 (Denmark) All throat swabs received during 7 mo from patients with a diagnosis consistent with tonsillitis or pharyngitis. Range 18 y–32 y Laboratory-based 2005–2006 PCR Eaton et al,26 2014 (United Kingdom) All throat swabs received during 1 y. Not reported; largely 10 y–49 y Laboratory-based 2011–2012 Culture Hedin et al,27 2015 (Sweden) Adults presenting to a GP with acute pharyngo-tonsillitis. Median 33 y, range 15 y–48 y Primary care 2011–2012 Culture Centor et al,7 2015 (United States) Adults with sore throat presenting to a college health center. Mean 22.3 y, range 15 y–30 y Primary care 2013–2014 PCR GP = general practitioner; PCR = polymerase chain reaction.
↵a Primary care includes outpatient generalist clinics such as general practice, family medicine, general internal medicine, and pediatrics.
- Table 2
Prevalence of Signs and Symptoms in Patients With Pharyngitis Associated With Group A streptococcus, Group C streptococcus, and Fusobacterium necrophorum
Symptom or Sign Percentage With this Sign or Symptom Group A
streptococcusGroup C
streptococcusF necrophorum Cervical adenopathy4,5,7 71–91 82–93 66 Absence of cough4,5,7 67–90 63–80 62 Fever4,5,7 29–80 47–76 38 Tonsillar exudates4,5,7 25–52 24–56 34 Redness in pharynx4 88 79 NT Pain on swallowing4 57 36 NT Duration ≤3 d5 70 64 NT Severely inflamed tonsils5 30 38 NT Absence of runny nose5 71 76 NT NT = not tested.
The Article in Brief
Prevalence of Group C Streptococcus and Fusobacterium Necrophorum in Patients With Sore Throat: A Meta-Analysis
Mark H. Ebell , and colleagues
Background Although most cases of sore throat are viral, some are caused by Group A beta-hemolytic streptococci bacteria. Two other bacteria may also cause sore throat: Group C beta-hemolytic streptococcus and Fusobacterium necrophorum. This analysis of existing research evaluates the prevalence of these two pathogens in the outpatient primary care setting.
What This Study Found Group C beta-hemolytic streptococcus and Fusobacterium necrophorum are common in patients with sore throat. Analysis of 16 studies reveals overall prevalences of Group C streptococcus and F necrophorum were 6 percent and 19 percent, respectively, in patients presenting with sore throat in primary care.
Implications
- Future research is needed to determine whether these bacteria cause disease in patients with sore throat and whether antibiotics reduce the duration of symptoms, the likelihood of complications, or the spread to others.
Supplemental Appendixes 1-2
Supplemental Appendixes
Files in this Data Supplement:
- Supplemental data: Appendixes 1-2 - PDF file
