The Clinical Presentation of Fusobacterium-Positive and Streptococcal-Positive Pharyngitis in a University Health Clinic

• DOI: 10.7326/m14-1305
• Publication Date: 2015-02-16T23:31:08Z
• Authors: Robert M. Centor; T. Prescott Atkinson; Amy E. Ratliff; Li Xiao; Donna M. Crabb; Carlos A. Estrada; Michael B. Faircloth; Lisa Oestreich; Jeremy Hatchett; Walid Khalife; Ken B. Waites
• Keywords: Adult; Male; Adolescent; Streptococcus pyogenes; Student Health Services; Streptococcus; Pharyngitis; Real-Time Polymerase Chain Reaction; United States; 3. Good health; Mycoplasma pneumoniae; Young Adult; 03 medical and health sciences; Cross-Sectional Studies; Fusobacterium necrophorum; 0302 clinical medicine; Streptococcal Infections; Asymptomatic Diseases; Pneumonia, Mycoplasma; Fusobacterium Infections; Prevalence; Humans; Female

Pharyngitis guidelines focus solely on group A β-hemolytic streptococcal infection. European data suggest that in patients aged 15 to 30 years, Fusobacterium necrophorum causes at least 10% of cases of pharyngitis; however, few U.S. data exist.To estimate the prevalence of F. necrophorum; Mycoplasma pneumoniae; and group A and C/G β-hemolytic streptococcal pharyngitis and to determine whether F. necrophorum pharyngitis clinically resembles group A β-hemolytic streptococcal pharyngitis.Cross-sectional.University student health clinic.312 students aged 15 to 30 years presenting to a student health clinic with an acute sore throat and 180 asymptomatic students.Polymerase chain reaction testing from throat swabs to detect 4 species of bacteria and signs and symptoms used to calculate the Centor score.Fusobacterium necrophorum was detected in 20.5% of patients and 9.4% of asymptomatic students. Group A β-hemolytic streptococcus was detected in 10.3% of patients and 1.1% of asymptomatic students. Group C/G β-hemolytic streptococcus was detected in 9.0% of patients and 3.9% of asymptomatic students. Mycoplasma pneumoniae was detected in 1.9% of patients and 0 asymptomatic students. Infection rates with F. necrophorum, group A streptococcus, and group C/G streptococcus increased with higher Centor scores (P < 0.001).The study focused on a limited age group and took place at a single institution. Asymptomatic students-rather than seasonal control participants-and a convenience sample were used.Fusobacterium necrophorum-positive pharyngitis occurs more frequently than group A β-hemolytic streptococcal-positive pharyngitis in a student population, and F. necrophorum-positive pharyngitis clinically resembles streptococcal pharyngitis.University of Alabama at Birmingham and the Justin E. Rodgers Foundation.