BACTERIAL-FLORA IN PATIENTS PRESENTING WITH SORE THROAT IN DUTCH GENERAL-PRACTICE

The bacterial growth in patients presenting with a sore throat was ass ayed and four clinical features were tested in order to reliably diffe rentiate between beta-haemolytic streptococci group A (GABHS) and othe r micro-organisms. For 2 years, 53 general practitioners (GPs) in The Netherlands took throat swabs from all patients, aged 4-60, presenting with a sore throat lasting 14 days or less. Four clinical features: f ever (history), (tonsillary) exudate, anterior cervical lymphadenopath y and absence of cough were registered. In 70% of the 598 patients one or more micro-organisms were cultured from throat specimens. In 48% o f the patients beta-haemolytic streptococci were found (32% group A, 7 % group C, 4% group G, 5% others). Enterobacteriaceae were cultured in 5%, Candida albicans in 5%, Staphylococcus aureus in 4%, various othe rs in 8% of the patients. In 30% of the patients cultures remained neg ative. Of the 270 patients with three or four clinical features, 46% ( 95% Cl, 40-52%) harboured GABHS in their throats, while in 328 patient s with less than three features 21% (95% Cl, 16-25%) were GABHS positi ve. However, this relationship between presence or absence of clinical features and culture result was not found in the youngest age categor y (4-14 years old). Culture results were not related to sex, smoking h abits or the insurance mode of the patient. The clinical relevance of several micro-organisms, other than beta-haemolytic streptococci, rema ins to be determined. The four mentioned signs and symptoms were helpf ul in predicting the probability of GABHS in patients aged 15 years an d older. More negative cultures were seen in the group with less than three clinical features.