A Complicated Microbiology Diagnosis and Treatment of Tonsillopharyngitis in Pregnancy: A Case Report

Pregnancy is a special period characterized by changes in the immune system as well as alteration of the microbiota predisposing to opportunistic infections, including tonsillopharyngitis. Streptococcus anginosus has numerous virulence factors, and it is associated with a variety of diseases. Being a part of the normal oral microbiota, it can be overlooked as a causative agent of infections in the oral cavity. A clinical case of a 29-year-old pregnant female who was allergic to penicillins and presented with recurrent tonsillopharyngitis has been described. Previous microbiological examinations have not shown any etiologic cause of patient's symptoms. Two species were isolated. S. anginosus and S. oralis were identified using various methods, including nucleotide sequencing. S. anginosus was defined as the causative agent. Both were susceptible to all tested antibiotics. S. anginosus was positive for the duplicated sagA gene, encoding streptolysin S, an important factor of virulence. Based on clinical symptoms, paraclinical tests, immune competence, and characteristics of the strain, a multifactorial evaluation is required to determine whether an opportunist is a causative agent. Moreover, treatment of pregnant patients, particularly with antibiotics, is limited, which leads to therapeutic difficulties.