Association of penicillin-tolerant streptococci with epidemics of streptococcal pharyngitis in closed communities

The association of penicillin-tolerant streptococci with reported epidemics of streptococcal pharyngitis in Israel was studied. The streptococcal strains had been isolated during 11 epidemics of community-acquired pharyngitis and 6 food-borne epidemics of pharyngitis occurring in the last 15 years. Strains were stocked lyophilized. Isolates were defined as tolerant if the MBC/MIC ratio for penicillin was greater than or equal to 32. All 122 group A streptococcal strains isolated during the epidemics of community-acquired infection showed tolerance to penicillin. In contrast, none of the 52 strains from food-borne epidemics (24 group A, 18 group C and 8 group G) was tolerant.

Diagnosis of group A beta-hemolytic streptococcal pharyngitis. Use of antigen detection tests

Early diagnosis and prompt initiation of antibiotic therapy for group A beta-hemolytic streptococcal pharyngitis can shorten the duration of the clinical illness and reduce the period of infectivity. This in turn may expedite a patient's return to school or day care, as well as a parent's return to work. Antigen detection tests are available that can provide a rapid diagnosis of group A beta-hemolytic streptococcal pharyngitis and can facilitate the prompt initiation of antibiotic therapy. In addition, these antigen detection tests can provide a rapid exclusion of group A beta-hemolytic streptococcal pharyngitis and thereby prevent the initiation of unnecessary antibiotics in patients with nonstreptococcal pharyngitis. However, before throat cultures on blood agar plates are totally abandoned and completely replaced by antigen detection tests, a number of additional studies are needed. The consequences of false-negative and false-positive antigen detection tests need to be determined. The accuracy of the antigen detection test as performed in physicians' offices needs to be compared with traditional culture methods performed in physicians' offices and not with an "idealized" standard. Finally, investigations need to be initiated to determine the impact of different antigen detection tests on the revenues and work flow in various practice settings, as well as their direct impact on patient care.

Food-borne streptococcal pharyngitis in a hospital pediatrics clinic

After a potluck luncheon, more than half the staff of a hospital pediatrics clinics became ill. Group A Streptococcus (M precipitin, nontypable; T agglutination type, 8/25; and serum opacity reaction, positive) was isolated from 12 of the 20 ill persons. Food-consumption analysis implicated a rice dressing as the vehicle of transmission. The dressing was prepared by a clinic employee in whom pharyngitis had developed three weeks before the luncheon. This is an unusual outbreak in that the implicated food product was not institutionally or commercially prepared and was not preponderantly composed of milk, eggs, or meat.

Orogenital contact and the isolation of Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum from the pharynx

Men and women who came to clinics in Boston underwent pharyngeal examinations, and pharyngeal specimens were obtained for cultures for Neisseria gonorrhoeae, Mycoplasma hominis, and Ureaplasma urealyticum. Fifty-one (4.9%) of 1,037 participants had gonococcal pharyngeal infection. M. hominis and U. urealyticum were recovered from the pharynges of 149 (14.3%) and 154 (14.8%) of 1,044 participants, respectively. The history of ever having performed fellatio was associated with pharyngeal infection with N. gonorrhoeae (P less than 0.02), M. hominis (P less than 0.05), and U. urealyticum (P less than 0.006). A history of fellatio was also associated with a history of a recent sore throat. There was, however, no association between pharyngeal infection with N. gonorrhoeae, M. hominis, or U. urealyticum and a recent sore throat. Cunnilingus was not associated with symptoms or signs or pharyngitis or with the isolation of gonococci or genital mycoplasmas from the pharynx. The pharyngitis associated with fellatio remains a microbiologic enigma.

Life-threatening pharyngitis caused by herpes simplex virus, type 2

A 21-year-old man who had pharyngitis needed hospitalization for observation of airway patency and for parenteral fluid therapy. Infection with herpes simplex virus, type 2 (HSV-2), was diagnosed on the basis of the finding of significantly increased IgM indirect hemagglutination antibody titers. The pharyngitis appeared to have been contracted by heterosexual orogenital contact (cunnilingus). The results of this case study indicate that HSV-2 infection should be considered in the differential diagnosis in cases of severe pharyngitis in sexually active patients.

Chlamydial pharyngitis?

Among 118 women who were sexual contacts of men with nongonococcal urethritis, the practice of fellatio correlated with symptoms of a sore throat. Oropharyngeal cultures for Chlamydia trachomatis were negative in all women, including 11 women who practiced fellatio and whose partners were known to have nongonococcal urethritis due to C. trachomatis. The study does not support a major role for C. trachomatis as a cause of sore throat in women who practice fellatio.

Epidemic streptococcal sore throat following a community picnic

Following a picnic, nearly half of the persons who attended became ill. Sixty-three of 139 throat cultures were positive for group A beta-hemolytic streptococci. Forty-seven of the positive cultures were available for typing, 34 of which harbored the epidemic strain, group A beta-hemolytic Streptococcus type T-3/13/B3264. This contrasted with two of 204 controls who had not attended, but harbored the epidemic strain. Food preferences and illness rates implicated the potato salad, and from it the epidemic strain was isolated. The attack rate and case-to-infection ratio among those who attended the picnic was significantly greater for persons over 10 years of age. Prompt institution of chemoprophylaxis could possibly have prevented at least 50% of the cases.