Sore throat may be a sign of serious illness in young adults

Sore throat may be a sign of a bacterial infection in young adults between the ages of 15 and 30, even if they test negative for strep, according to a paper being published in Annals of Internal Medicine.

Recent European studies suggest that Fusobacterium necrophorum (F. necrophorum) is to blame for at least 10 percent of pharyngitis cases in adolescents and adults. This is concerning because F. necrophorum may cause peritonsillar abscess and life-threatening internal jugular thrombophlebitis. The prevalence of F. necrophorum in the US is unknown and current guidelines for managing pharyngitis focus mostly on group A streptococcal infection.

Researchers studied 312 patients aged 15 to 30 presenting with a sore throat and 180 asymptomatic students at a student health clinic to estimate the prevalence of F. necrophorum compared with other agents of bacterial pharyngitis in this population. The authors developed an objective tool to calculate a Centor score based on fever history; lack of cough; swollen, tender lymph nodes and tonsils. Patients with scores of 2 to 4 were nearly two times as likely to have bacterial pathogens as patients with Centor scores of 0 or 1. F. necrophorum was detected in 20.5 percent of patients with sore throat symptoms and 9.4 percent of asymptomatic patients, and was found to be the most common bacterial agent of pharyngitis.

The author of an editorial wrote that pharyngitis guidelines do not need to be revised due to the findings of this study, but say that physicians should use the Centor scoring criteria so that they are not overcomplicating pharyngitis diagnosis and treatment.

Research: The Clinical Presentation of Fusobacterium-Positive and Streptococcal-Positive Pharyngitis in a University Health Clinic: A Cross-sectional Study, R.M. Centor, T.P. Atkinson, A.E. Ratliff, L. Xiao, D.M. Crabb, C.A. Estrada, M.B. Faircloth, L. Oestreich, J. Hatchett, W. Khalife, and K.B. Waites, Annals of Internal Medicine, doi: 10.7326/M14-1305, published 16 February 2015.

Editorial: Sore Throat: Avoid Overcomplicating the Uncomplicated, J.A. Linder, Annals of Internal Medicine, doi: 10.7326/M14-2899, published 16 February 2015.