Group A beta-hemolytic streptococcal pharyngitis: current clinical concepts.

The classic triad of fever, pharyngeal exudate and tender anterior cervical adenopathy is present in only 15 percent of cases of group A beta-hemolytic streptococcal pharyngitis. Since clinical findings are unreliable, a rapid streptococcal test or a throat culture should be performed to confirm the diagnosis. A positive rapid test immediately identifies group A beta-hemolytic streptococcus and may help encourage patients to complete the course of antibiotics. However, a negative rapid test does not definitively rule out this organism and should be followed by a throat culture. Early antibiotic therapy reduces the duration of pharyngitis, minimizes transmission and lessens complications such as acute rheumatic fever and abscess. A 10-day course of oral penicillin or an intramuscular injection of penicillin G benzathine is recommended. Erythromycin is recommended for patients who are allergic to penicillin.

Establishing a student health all-appointment system: making the transition from a walk-in approach.

The authors offer a process for critically evaluating a walk-in system for patient and care provider satisfaction, for developing goals for a new patient flow system, and for designing and implementing an appointment system at a student health center. Their suggestions are based on their recent experience in making the transition from a walk-in approach to an all-appointment system in the general medicine division of the university's student health service. They give specifics of the appointment system established at their facility, including an explanation of the weekly appointment schedule, the monthly duty schedule, and a strong triage system. Key areas for consideration in converting to an all-appointment system, such as reeducational techniques for various staffing responsibilities and strategies for marketing a new system to patients, are outlined in detail.

Latex agglutination testing directly from throat swabs for rapid detection of beta-hemolytic streptococci from Lancefield serogroup C.

A latex agglutination method for the rapid detection of beta-hemolytic streptococci from Lancefield serogroup C in throat swabs from 403 university students with symptomatic pharyngitis was evaluated. Compared with culture, the rapid test was poorly sensitive (34.4%) but very specific (98.4%) in detecting group C beta-hemolytic streptococci. The sensitivity of the rapid test improved with an increasing quantity of growth on culture.

Association of group C beta-hemolytic streptococci with endemic pharyngitis among college students.

Throat cultures were performed throughout 2 school years to determine whether non-group A beta-hemolytic streptococci (NGA BHS) could be isolated more frequently in 232 college students who had symptomatic pharyngitis than from 198 age-matched controls with noninfectious problems. Duplicate throat swabs were inoculated onto plates that contained sheep blood agar, one plate being incubated in a 5% CO2 atmosphere and the other in an anaerobic environment. The BHS were grouped using latex agglutination. Among the NGA BHS, only those from group C were isolated significantly more often among the patients compared with the controls (26% vs 11%). Quantitative colony counts of isolates of group C BHS were generally higher among patients than controls. Patients with group C BHS had fever, exudative tonsillitis, and anterior cervical adenopathy significantly more frequently than did patients who had throat cultures that were negative for group C BHS. Group C BHS were epidemiologically associated with endemic pharyngitis in this college student population.