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Prevalence of key bacterial pathogens among children with pharyngotonsillitis in The Gambia - a case-control study

D Nygren1, S Jarju2, M Basiru Njai2

  • 1Division of Infection Medicine, Lund University, Lund, Sweden; Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden.

The Journal of Infection
|June 10, 2026
PubMed

Insights

Streptococcus pyogenes was the only pathogen more common in Gambian children with pharyngotonsillitis. Fusobacterium necrophorum and SDSE were not associated with illness, and clinical rules were poor predictors.

Area of Science:

  • Pediatric infectious diseases
  • Microbiology
  • Epidemiology

Background:

  • Pharyngotonsillitis in African children is poorly understood beyond Streptococcus pyogenes.
  • Limited data exists on Fusobacterium necrophorum and Streptococcus dysgalacatiae subspecies equisimilis (SDSE) in this population.

Purpose of the Study:

  • To determine the prevalence of S. pyogenes, F. necrophorum, and SDSE in Gambian children with pharyngotonsillitis.
  • To evaluate the effectiveness of clinical decision rules for predicting these pathogens.

Main Methods:

  • A case-control study involving children aged 0-15 years in The Gambia.
  • Analysis of pharyngeal swabs using multiplex-PCR for S. pyogenes, F. necrophorum, and SDSE.
  • Comparison of pathogen prevalence between cases and age-matched asymptomatic controls.

Main Results:

  • S. pyogenes was significantly more prevalent in cases (32%) than controls (11%).
  • No significant difference in prevalence was observed for F. necrophorum (9% vs. 10%) or SDSE (11% vs. 14%) between cases and controls.
  • Clinical decision rules demonstrated poor predictive performance for all tested pathogens.

Conclusions:

  • S. pyogenes is the primary bacterial cause of pharyngotonsillitis in this pediatric population in The Gambia.
  • While F. necrophorum was more common than previously reported in high-income countries, it was not associated with pharyngotonsillitis in this study.
  • Neither F. necrophorum nor SDSE showed a significant association with pharyngotonsillitis in Gambian children, and current clinical decision rules are not useful for their prediction.
Abstract

Keywords:
ChildClinical decision ruleFusobacterium necrophorumMultiplex PCRPharyngitisStreptococcus dysgalactiae subspecies equisimilisStreptococcus pyogenesThe GambiaTonsillitisWestern Africa

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