The group A streptococcal carrier state. A reexamination
M. A. Gerber, M. F. Randolph and D. R. Mayo
Department of Pediatrics, University of Connecticut School of Medicine, Farmington.
Streptococcal infection usually is defined as a positive throat culture
with a serologic response to group A beta-hemolytic streptococci, and a
patient with a positive throat culture and no serologic response is a
streptococcal carrier. Studies suggest that streptococcal carriers should
show little clinical response to antibiotic therapy when compared with
patients with true streptococcal infections. Patients with acute
pharyngitis were divided into three groups: group 1--38 patients with
negative throat cultures; group 2--72 patients with a positive throat
culture and a significant rise in streptococcal antibody titers; and group
3--77 patients with positive throat cultures and no significant rise in
streptococcal antibody titers. Patients in group 2 and group 3 had a
comparable and dramatic clinical response to antibiotic therapy that was
considerably greater than the clinical response in the patients in group 1.
These findings raise questions about the appropriateness of using
streptococcal antibody responses to distinguish between the streptococcal
carrier state and a true streptococcal infection.
