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Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis in black and white patients attending a venereal disease clinic.

Pharyngeal colonisation by Neisseria gonorrhoeae and Neisseria meningitidis was studies in 2000 patients attending a venereal disease clinic. Of these patients, 64% were white and 36% were black. The incidence of gonococcal infections was highest in the period from June to August. The incidence of genital or rectal infections or both was higher in the black patients. Pharyngeal colonisation by gonococci was present in 1.3% of the patients. There was no significant associations between pharyngeal colonisation and the pharyngeal symptoms, race, sex, or marital state of the patients. Pharyngeal colonisation was more frequent in patients with gonococcal infections at other sites. However, in 40.7% of the patients with pharyngeal colonisation, the pharynx was the only culture-positive site. There was no significant difference in the auxotypes or in the antibiotic susceptibility of the pharyngeal and the rectal-genital isolates except in the susceptibility to spectinomycin. Our findings do not indicate that gonococci isolated from the pharynx differ significantly from gonococci isolated from rectal or genital sites. It was notable that meningococcal colonisation of the pharynx was significantly more frequent in the white patients. This may be a genetically determined phenomenon.

Adult

Pharyngeal gram stains in the treatment of sore throats.

The use of the direct pharyngeal Gram stain for diagnosis of group A beta-hemolytic streptococcal pharyngitis was evaluated. Seventy-five consecutive out-patients presented with pharyngitis (or high fever in infants) were studied with pharyngeal cultures and Gram stains. Gram stains were read as either positive, negative, or indeterminate for streptococcal pharyngitis. When these predictions were correlated with the resulting culture growth of group A beta-hemolytic streptococci, the predictive value of a throat smear Gram stain was found to be significant (p less than 0.005). There were two false positives and three false negatives. Approximately one third of the smears were in the indeterminate category. Although the Gram stain of a pharyngeal smear was found to be less sensitive than the routine throat culture, the ability to obtain inexpensive rapid microbiological information suggests that the Gram stain can be used as a quick screening procedure.

Adolescent

Adherence of group A streptococci to pharyngeal cells: a role in the pathogenesis of rheumatic fever.

We used an assay in vitro to investigate the possible role of streptococcal adherence to human pharyngeal cells in the pathogenesis of acute rheumatic fever. There was no difference in adherence of rheumatic fever-associated and non-associated strains of group A streptococci to pooled pharyngeal cells of normal people. Likewise, streptococci not associated with rheumatic fever adhered equally well to cells taken from normal people and from patients with rheumatic heart disease. However, the pharyngeal cells of all nine rheumatic heart disease patients tested had increased avidity for adherence for a rheumatic fever-associated strain of streptococcus compared to the pharyngeal cells obtained from age- and sex-matched controls. Increased streptococcal adherence to pharyngeal cells of rheumatic fever-prone patients may play a role in the pathogenesis of rheumatic fever.

Adult

Incidence of invasive group A streptococcal infections and comparison of emm types from invasive infections, pharyngitis, and throat carriage in American Indian communities in the Southwest United States.

BACKGROUND: American Indian/Alaska Native (AI/AN) communities in the US have high rates of group A streptococcal (GAS) infections. We determined the incidence of invasive infections in AI communities in the Southwest and compared emm types from invasive infections, pharyngitis, and throat carriage. METHODS: Activities conducted in the White Mountain Apache Tribal lands (WMA) and Navajo Nation (NN) included active, laboratory-based surveillance for invasive GAS infections (WMA: 2019─2024; NN: 2023─2024; all ages); surveillance for GAS pharyngitis (2023-2024; children 0─17 years); and culture for GAS from oropharyngeal carriage samples (2019 and 2022─2023; children 0─14 years). Emm types were determined by whole-genome sequencing. Annual incidence rates were calculated using Poisson regression. RESULTS: In WMA, age-standardized rates of invasive infections ranged from 80-270/100,000 persons between 2019-2024. Predominant emm types varied (n=74 isolates): 91 (59%) and 49 (32%) in 2019-2020, and 43 (40%) and 53 (30%) in 2023. In NN, rates were 40-60/100,000 persons in 2023-2024; common emm types (n=51) were 53 (28%), 101 (18%), and 12 (16%). In WMA and NN, emm types 1, 12, and 53 predominated in pharyngitis (n=190), and 1, 12, and 91 in throat carriage (n=119). CONCLUSIONS: Rates of invasive GAS infections in these communities were 3-35 times higher than the national US average (12.2/100,000 in 2024). Emm types varied over time with limited overlap in strains from throat carriage or pharyngitis isolates and those from invasive infections. Findings support continuing GAS surveillance and engaging AI/AN communities throughout vaccine development and evaluation.

Indigenous health

Incongruous movements of the velum and lateral pharyngeal walls.

Five patients evaluated via multi-view videofluoroscopy were found to have incongruous movements between the velum and lateral aspects of the pharyngeal walls. All five patients had velopharyngeal insufficiency resulting from either absent lateral pharyngeal wall motion in the presence of velar mobility or absent velar mobility in the presence of lateral pharyngeal wall motion. The data indicates that these valving patterns are not rare phenomena of velopharyngeal valving. Treatment by pharyngeal flap or other methods for velopharyngeal insufficiency must be suited to these peculiar valving patterns based on adequate diagnostic information.

Adult

Articulation skills and oral-nasal resonance in children with pharyngeal flaps.

Longitudinal data on speech sound acquisition and oral-nasal balance were analyzed in 52 children who had had pharyngeal flaps for velopharyngeal incompetency. These data were compared to similar data for a group of 48 children with cleft palates who had not required secondary management. Comparisons were made also between the pre- and post surgical performance of the group who had had pharyngeal flaps. Further comparisons were made between children who had surgery before six years. Analysis of data revealed that the children who required pharyngeal flaps lagged behind the group who did not in the development of acceptable resonance and articulation patterns. Further analysis showed that, for the post-pharyngeal flap group, there was an acceleration in the acquisition of acceptable sound production in the year immediately following surgery. The data suggested that children who had flaps before six years of age made faster gains in the development of articulation and acceptable resonance than did children who were treated after the age of six years.

Age Factors

Life-threatening pharyngitis caused by herpes simplex virus, type 2.

A 21-year-old man who had pharyngitis needed hospitalization for observation of airway patency and for parenteral fluid therapy. Infection with herpes simplex virus, type 2 (HSV-2), was diagnosed on the basis of the finding of significantly increased IgM indirect hemagglutination antibody titers. The pharyngitis appeared to have been contracted by heterosexual orogenital contact (cunnilingus). The results of this case study indicate that HSV-2 infection should be considered in the differential diagnosis in cases of severe pharyngitis in sexually active patients.

Adult

Group B beta-hemolytic streptococci causing pharyngitis.

Group B beta-hemolytic streptococci were isolated from the throats of 49 of 1,110 patients who had pharyngitis. Compared with patients whose throat cultures were negative for beta-hemolytic streptococci, those harboring group B were more likely to have enlarged tonsils (P less than 0.001), exudate (P less than 0.02), and tender enlarged anterior cervical lymph nodes (P less than 0.01). Group B should not necessarily be dismissed as a nonpathogen when identified in the pharynx of patients with exudative pharyngitis; laboratories which report beta-hemolytic streptococcal isolates from the pharynx only as group A or non-group A should be encouraged to perform definitive group identification of all beta-hemolytic isolates to further evaluate the role of other streptococcal groups as the causative agents for pharyngitis.

Adolescent

Oral and pharyngeal cancer in the North-west and West Yorkshire regions of England, and occupation.

Patients with oral or pharyngeal cancer in the two main textile regions of England were matched for age and sex with patients having cancers not known to be associated with textile work. Data were recorded on age, sex, cancer site, and smoking, chewing and drinking habits together with dental and occupational history. There were 102 and 61 matched pairs of males and 52 and 60 matched pairs of females in the North-west and West Yorkshire regions respectively. There were significantly (P less than 0.05) more textile workers in the cases compared with their matched controls for only the females in the North-west. No particular type of textile work occurred more frequently for the cases than the controls in all four matched comparisons. Only for the males in the North-west were there significant differences (P less than 0.05) in the proportions of textile workers in the three cancer sites of the tongue, mouth and pharynx. These results do not confirm the association between textile work and oral or pharyngeal cancer found by the mortality study of Moss and Lee (1974). The results for the association between oral or pharyngeal cancer and smoking, drinking, chewing and wearing of dentures are discussed.

Adult

Streptococcal pharyngitis: diagnosis by gram stain.

Group A beta-hemolytic streptococci were isolated from 49 (10.4%) of 472 patients with pharyngitis. Throat culture results, interpreted by five observers of varying experience, showed the mean sensitivity, specificity, and predictive value of a positive Gram-stained smear of pharyngeal secretions as 73%, 96%, and 71%. Assignment to a high-risk group by clinical algorithm gave sensitivity, specificity, and predictive value of only 45%, 83%, and 23%. The Gram-stained smear is the most accurate method of early diagnosis of streptococcal pharyngitis.

Adolescent

A comprehensive study of pharyngeal flap surgery: tailor made flaps.

Three methods of pharyngeal flap surgery were analyzed with multiview videofluoroscopy and nasopharyngoscopy at least six months post-operatively. It was found that, by varying the type of insertion of the flap into the palate, post-operative flap width could be "tailored" to the size of the gap in the velopharyngeal sphincter. The value of varying flap width according to gap size was assessed by analyzing speech results in 60 patients specifically assigned for narrow, moderate, or wide flaps. Results show a marked improvement in the effectiveness of pharyngeal flap surgery when operations are prescribed according to the degree of lateral pharyngeal wall motion seen pre-operatively.

Cineradiography

Quantitative throat-swab culture in the diagnosis of streptococcal pharyngitis in children.

A striking difference in the detection of a heavy growth of Streptococcus pyogenes in throat swabs taken from 1054 children with pharyngitis compared with those from 462 normal children was demonstrated when a standardised technique of quantitative culture was used. In patients with pharyngitis 71% of the isolates were heavy whereas a heavy culture was obtained in only 1-7% of healthy children. Also, a significant correlation between the clinical observations suggestive of streptococcal pharyngitis and the results of culture was confined to those patients whose throat swabs yielded a heavy growth of streptococci. It is concluded that bacteriological examination is of value as a diagnostic test only when the results of culture are quantitatively assessed.

Age Factors

Pharyngeal flora in ambulatory alcoholic patients: prevalence of gram-negative bacilli.

The pharyngeal flora of a group of ambulatory alcoholic patients was studied and compared with the pharyngeal flora of a control group. Sixty-eight patients were studied, 34 alcoholics and 28 controls. Of the alcoholic patients, 59% had Gram-negative bacilli in their pharyngeal flora, while 14% of the control group had the same organisms. There were no differences in Gram-positive cocci colonization between the groups. Klebsiella pneumoniae was the most frequent isolate (40%) and the Klebsiella-Enterobacter group accounted for 76% of the isolates. Colonization rates of greater than 10 colony forming units/ml were found in 43% of the alcoholic patients. The high prevalence and higher colonization rates of Gram-negative bacilli in alcoholic patients might explain the higher incidence of Gram-negative bacillary pneumonia among alcoholics.

Adult

Pharyngeal hypoplasia in Treacher Collins syndrome.

Examination of 11 patients with Treacher Collins syndrome (TCS), with the use of multiple-view videofluoroscopy and nasopharyngoscopy of the pharynx, disclosed marked narrowing of the airway. In several patients, the pharynx was less than 1 cm in width at its most narrow point. It is thought that reduced airway in TCS may help to explain the frequent reports of neonatal death associated with the syndrome. Pharyngeal narrowing was found throghout the entire vertical height of the pharynx in all 11 patients. Pharyngeal hypoplasia is probably responsible for reported difficulties in intubating patients with TCS for endotracheal anesthesia and for respiratory complications after palatoplasty and pharyngoplasty. Pharyngeal hypoplasia is considered to be a primary feature of the syndrome and may aid in its diagnosis.

Adolescent

Bacterial adherence to pharyngeal cells in smokers, nonsmokers, and chronic bronchitics.

Selective adherence to host mucosal surfaces is probably a requirement for colonization and infection by bacteria. Since pharyngeal colonization may be an important determinant in the pathogenesis of pneumonia, we studied the adherence of 10 different bacteria to pharyngeal cells obtained from nonsmokers, smokers, and chronic bronchitics. Various patterns of adherence among the different groups of subjects were found. Young healthy smokers had increased adherence of Streptococcus pneumoniae type I and, to a lesser extent, S. pneumoniae type III and Staphylococcus aureus when compared with nonsmokers. Middle-aged smokers with a long history of chronic bronchitis had significantly increased adherence only of untypable Haemophilus influenzae when compared with age-matched nonsmokers. The acquisition of pneumococcal pneumonia by smokers and the role of nontypable Haemophilus species in chronic bronchitis may be determined, in part, by bacterial adherence to pharyngeal cells.

Adult

[On the physiopathologic reactions of pharyngeal tonsil from the clinical standpoint (author's transl)].

On the basis of personal experiences the authors isolate two forms of pharyngeal tonsil hypertrophy: a physiological and a pathological one. The first one corresponds to the requirements of the organism which is not completely mature immunologically, it may be quite considerable but causes no disturbances in breathing through the nose or in the function of Eustachian tubes. The pathological hypertrophy of pharyngeal tonsil is due to a parenchymal inflammation caused by viruses with a typical pathogenesis. The authors describe six diagnostic criterias of the pathological hypertrophy of pharyngeal tonsils. Using these criter as they analysed 100 cases of adenotomy from the year 1969 and they have found that in only 38 cases the operation was done for pathological hypertrophy while in 62 cases hypertrophy was physiologic. Adentomy gives good results in cases of pathological hypertrophy but in cases of physiologic hypertrophy it may cause adverse results.

Adenoidectomy

The pharyngeal effect of partial nasal obstruction.

The case histroy and cinematoradiographic findings of a baby with partial nasal obstruction are presented. This infant's restriction to air entry at the nose led to severe airway obstruction during inspiration by a forward movement of the posterior pharyngeal wall and backward movement of the tongue and lower jaw. At the height of inspiration, there was total airway occlusion in the pharynx. These events can be explained by the pressure drop that takes place behind a restriction if air is sucked through it forcibly from an area of atmospheric pressure. Studies of postpalatal pressures in adults and infants demonstrate such a drop in pressure during nasal breathing if the nose is partly obstructed. If the adult or infant is able to respond to the diminished nasal airway by mouth breathing, there is no postpalatal pressure drop. It is suggested that partial nasal obstruction in a sleeping obligatory nasal-breathing infant could result in a sucking back of the tongue over the larynx in this "cafe coronary" type of situation. This could be the mechanism of the obstructive type of apnea recorded by Steinschneider, and of the asphyxial type of death that is suggested by autopsies on some "cot death" victims. This hypothesis is consistent with the frequency of infection of rhinitis and pharyngitis in victims of sudden infant death syndrome and with the seasonal incidence. Prevention of this obstructive type of apnea would depend on the recognition of infants showing inspiratory and expiratory changes in pharyngeal airway size as can be seen externally by the movements in the carotid triangle of the neck and confirmed by roentgenography or cinematoradiography.

Adult

Streptococcal pharyngitis therapy. A comparison of two erythromycin formulations.

The recommended dosage of erythromycin, without regard to the formulation prescribed, for children with streptococcal pharyngitis is 30 to 40 mg/kg/day. We previously reported an acceptable streptococcal eradication rate among patients with pharyngitis treated with erythromycin estolate, 20 mg/kg/day. In this study, an extension of the earlier one, the efficacy of this same dosage of erythromycin estolate was compared with a 40 mg/kg/day dosage of erythromycin ethylsuccinate. Streptococcal eradication rates were nearly identical in the two groups of patients. The efficacy of erythromycin estolate at a dosage lower than that recommended for children is most likely explained on pharmacologic grounds: better absorption and higher levels in serum and tissue than those achieved with other erythromycin formulations. It seems rational to calculate required dosages of erythromycin on the basis of the formulation being administered.

Antibodies, Bacterial