F. necrophorum pharyngitis more common than group A streptococcus in university clinic

1. The occurrence of Fusobacterium necrophorum pharyngitis is higher than group A streptococcal (GAS) pharyngitis in university students aged 15-30 years.

2. Clinical presentation and Centor criteria scores for F. necrophorum are similar to GAS.

Evidence Rating Level: 3 (Fair)

Study Rundown: Current clinical guidelines for management of pharyngitis focus on the diagnosis of GAS, but recent European studies have demonstrated that F. necrophorum causes a significant number of pharyngitis cases in adolescents and young adults. Furthermore, it is associated with more morbidity and mortality than streptococcal pharyngitis, specifically Lemierre syndrome. The goal of this study was to determine the prevalence of F. necrophorum and other agents of bacterial pharyngitis in university students aged 15-30 years, as well as compare the clinical presentation of F. necrophorum to streptococcal pharyngitis. F. necrophorum was detected in 20.5% of patients, with group A and group C/G streptococcus found in only 10.3% and 9.0%, respectively. Positive testing for all three bacterial groups was associated with higher Centor scores, supporting the Centor criteria as a predictor model for F. necrophorum, GAS, and non-GAS pharyngitis. The study is limited by single site recruitment, as well as their finding of F. necrophorum in nearly 10% of their asymptomatic controls. Although this study shows the potential importance of F. necrophorum pharyngitis, the clinical applicability is restricted given the lack of a commercially available diagnostic test for F. necrophorum.

Click to read the study today in The Annals of Internal Medicine

Relevant Reading: Infectious Disease Society of America- Strep Pharyngitis Guidelines

In-Depth [cross-sectional study]: A total of 312 students aged 15-30 years presenting to a university health clinic with “sore throat” and 180 asymptomatic students from sites outside the health center were recruited for the study. A PCR assay, developed for the purpose of the study, was used on throat swabs to determine presence of F. necrophorum, GAS, group C or G streptococcus, and Mycoplasma pneumoniae. Clinical information was obtained to calculate Centor scores. Of the 312 students presenting to the clinic, F. necrophorum was present in 64 (20.5%), GAS in 32 (10.3%), and group C or G streptococcus in 28 (9.0%). Of the 64 patients with F. necrophorum, 9 were simultaneously infected with GAS, and 7 with group C or G streptococcus. In the 180 asymptomatic students, F, necrophorum was present in 17 (9.4%), GAS in 2 (1.1%), and group C or G in 7 (3.9%). M. pneumoniae was detected in only 6 of the 312 patients and none of the asymptomatic students. A total of 202 patients (64.7%) and 155 asymptomatic students (86.1%) tested negative for all bacterial groups. Viral causes of pharyngitis were not considered or tested for.

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