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Fewer Symptoms Occur in Same-Serotype Recurrent Streptococcal Tonsillopharyngitis
Lucia H. Lee, MD;
Elia Ayoub, MD;
Michael E. Pichichero, MD
Arch Otolaryngol Head Neck Surg. 2000;126:1359-1362.
Background Most patients with acute rheumatic fever report no antecedent pharyngitis.
Objective To determine the clinical and microbiological characteristics of recurrent group A  -hemolytic streptococcal (GABHS) tonsillopharyngitis.
Design Prospective randomized trial.
Subjects Symptoms were recorded and throat cultures were obtained at 4 to 6, 18 to 21, and 32 to 35 days following the start of treatment. A subset of 60 patients with subsequent GABHS episodes occurring were evaluated for a 0.2-or greater log rise in either antistreptolysin O or anti–deoxyribonuclease B titer to confirm a bona fide recurrence.
Results Sixteen (27%) of 60 patients had recurrent GABHS tonsillopharyngitis of the same serotype that occurred 21 days or longer following the onset of the initial GABHS infection and was associated with a 0.2- or greater log rise in either antistreptolysin O or anti–deoxyribonuclease B titer, indicating bona fide recurrent infection; these recurrences all occurred within 55 days. Fewer patients with recurrent GABHS pharyngitis of the same serotype had headache (P = .02), sore throat (P = .006), fever (P = .008), pharyngeal erythema (P<.001), pharyngeal edema (P<.001), pharyngeal exudate (P = .04), and adenitis (P = .03) compared with the initial episode. Chills, stomachache, scarlatina, tonsillar enlargement, and palatal petechiae were similar for both episodes.
Conclusions Fewer symptoms occur during recurrent GABHS pharyngitis of the same serotype compared with the initial infection. These patients may be less likely to seek physician attention, yet their infections put them at risk for sequelae.
From the Food and Drug Administration, Rockville, Md (Dr Lee); the Department of Pediatrics, University of Florida, Gainesville (Dr Ayoub); and the Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY (Dr Pichichero).
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