Fusobacterium Pharyngitis May Be As Serious As Strep Throat

Robert M Centor, MD, MACP Chair ACP Board of Regents Regional Dean, UAB Huntsville Regional Medical Campus Huntsville, AL 35801 Professor, General Internal Medicine UAB Birmingham, AL 35294-3407 MedicalResearch.com Interview with:
Robert M Centor, MD, MACP
Chair ACP Board of Regents
Regional Dean, UAB Huntsville Regional Medical Campus
Huntsville, AL 35801
Professor, General Internal Medicine
UAB Birmingham, AL 35294-3407

Medical Research: What is the background for this study? What are the main findings?

Dr. Centor: European researchers have shown that Fusobacterium necrophorum, an obligate gram-negative anaerobe, likely causes approximately 10% of young adult pharyngitis. This same organism is the major cause of peritonsillar abscess in the age group (and this age group has the highest rate of peritonsillar abscess). The organism also causes around 80% of the Lemierre Syndrome. We knew of no US data evaluating the role of this bacteria as a cause of pharyngitis. The European studies also did not report the signs and symptoms of Fusobacterium pharyngitis.

Medical Research: What is the background for this study? What are the main findings?

Dr. Centor: In our college health population, Fusobacterium necrophorum caused more pharyngitis then did group A strep. Clinically, the patients with Fusobacterium necrophorum pharyngitis had the same signs and symptoms as the strep pharyngitis patients. This suggests that the previously develop Centor score identifies bacterial pharyngitis, and not just strep pharyngitis.

Medical Research: What should clinicians and patients take away from your report?

Dr. Centor: We believe that we should consider Fusobacterium pharyngitis as seriously as strep pharyngitis. Patients should understand that if they get no antibiotics that they should be aware of the following warning signs (or red flags) – worsening symptoms (routine pharyngitis should improve quickly, over 2-3 days), night sweats or rigors (these suggest bacteremia), or unilateral neck swelling. Given the sensitivities of strep and Fusobacterium, if the clinician plans to give empiric antibiotics, he/she should use penicillin (or a penicillin derivative) and not use a macrolide.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Centor: We need a series of confirmatory studies. We need to develop a point-of-care test for Fusobacterium necrophorum.

Citation:

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

Robert M. Centor, MD; T. Prescott Atkinson, MD, PhD; Amy E. Ratliff, MLS; Li Xiao, PhD; Donna M. Crabb, MT (ASCP); Carlos A. Estrada, MD, MS; Michael B. Faircloth, MD; Lisa Oestreich, DO; Jeremy Hatchett, MD; Walid Khalife, PhD; and Ken B. Waites, MD

Ann Intern Med. 2015;162(4):241-247. doi:10.7326/M14-1305

).push({});

Tags:
,