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Visualization and Analysis of Pharyngeal Arch Arteries using Whole-mount Immunohistochemistry and 3D Reconstruction
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Group A Streptococcus pharyngitis and pharyngeal carriage: A meta-analysis
Jane Oliver1, Erandi Malliya Wadu1, Nevil Pierse1
1University of Otago Wellington, Newtown, Wellington, New Zealand.
Plos Neglected Tropical Diseases
|March 20, 2018
Summary
Antibiotic treatment for Group A Streptococcus (GAS) pharyngitis is crucial for preventing acute rheumatic fever (ARF). However, unnecessary antibiotic use is common in GAS carriers with viral infections, highlighting the need for accurate prevalence data.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Antibiotic treatment for Group A Streptococcus (GAS) pharyngitis is vital for preventing acute rheumatic fever (ARF).
- Clinical guidelines for GAS pharyngitis treatment vary, leading to potential overuse of antibiotics in asymptomatic GAS carriers with viral infections.
- This review aimed to assess the prevalence of GAS pharyngitis and asymptomatic carriage across diverse settings.
Purpose of the Study:
- To determine the prevalence of GAS-positive pharyngitis and asymptomatic pharyngeal carriage.
- To stratify prevalence estimates by age group, recruitment method, and country income level.
- To inform clinical guidelines regarding antibiotic prescription for GAS pharyngitis.
Main Methods:
- A random-effects meta-analysis was conducted on studies published between 1946 and 2017.
- Prevalence estimates for GAS-positive pharyngitis, serologically-confirmed GAS pharyngitis, and asymptomatic pharyngeal carriage were generated.
- Inclusion criteria required studies to report prevalence data and specify participant symptoms or asymptomatic status.
Main Results:
- GAS-positive pharyngitis prevalence was 24.1% in clinical settings versus 10.0% in active sore throat programs.
- Prevalence was higher in high-income countries (24.3%) compared to low/middle-income countries (17.6%).
- In high-income countries, GAS pharyngitis prevalence was 10.3% and asymptomatic carriage was 10.5% in children; lower carriage (5.9%) was observed in low/middle-income countries.
Conclusions:
- In active sore throat management programs, if GAS detection rates approach asymptomatic carriage rates (6-11%), antibiotic treatment may offer limited benefit.
- The majority of culture-positive individuals in such settings may be asymptomatic carriers, not requiring antibiotics.
- Accurate prevalence data is essential for optimizing antibiotic stewardship in GAS pharyngitis management.
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