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When What Looks Like Strep Is Something Else

BIRMINGHAM, AL – Severe sore throat in young adults may look like strep throat but, more often than you may suspect, it is something else altogether. And that could be dangerous.

New research published recently in Annals of Internal Medicine suggests that Fusobacterium necrophorum more often causes severe sore throats in young adults than streptococcus. The authors, led by researchers from the University of Alabama at Birmingham (UAB) recommend physicians consider F. necrophorum when treating pharyngitis that worsens in young adults and adolescents.

In the study involving 312 college students at UAB's Student Health Clinic, F. necrophorum was detected in more than 20% of patients with sore-throat symptoms, against with 10% for Group A strep and 9% for Group C or G strep.

"This is the first study in the United States that shows that F. necrophorum causes a significant number of cases of pharyngitis in this young adult population," said lead author Robert M. Centor, MD, professor in the Division of General Internal Medicine in the UAB School of Medicine and the study's lead author. "It is also the first to show that F. necrophorum pharyngitis and streptococcus pharyngitis share similar clinical signs. This study bolsters our understanding that this condition is common in the U.S. and very closely resembles strep throat."

F. necrophorumpharyngitis also is the leading cause of a rare but potentially very dangerous condition known as the Lemierre's syndrome, cautions Centor. The syndrome, which mostly affects adolescents and young adults and is rare in children, often causes long, complex hospitalizations requiring intensive care. In fact, 6% of Lemierre's syndrome patients die.

The syndrome begins with a sore throat, followed by an infected jugular vein after four to five days, according to the report. It also can lead to abscesses in other parts of the body.

More common and deadly prior to the advent of penicillin, Lemierre’s was nearly wiped out by routine antibiotic use. Now that antibiotics are used less often because of resistance fears, the disease has been making a comeback over the last decade.

He argued that F. necrophorum requires the same aggressive diagnosis and treatment at Group A strep, which can cause rheumatic fever, although the lack of rapid test makes it harder to recognize.

"We suspect that many physicians would prescribe antibiotics for patients with F. necrophorum pharyngitis if there were a point-of-care diagnostic test that proved its presence,” Centor said.

Without such a test, he suggested that antibiotics be prescribed to patients who have clinical symptoms and score high on the Centor Score, which measures the likelihood of a bacterial cause of sore throat and is named for him.