Acute sore throat and Fusobacterium necrophorum in primary healthcare: a systematic review and meta-analysis

• Published in: BMJ open 2021-06, Vol.11 (6), p.e042816-e042816
• Main Authors: Malmberg, Stefan, Petrén, Susanna, Gunnarsson, Ronny, Hedin, Katarina, Sundvall, Pär-Daniel
• Format: Article
• Language: English
• Subjects: Allmän medicin; Allmänmedicin; Anti-Bacterial Agents; Anti-Bacterial Agents - therapeutic use; Antibiotics; Asymptomatic; Bias; Clinical Medicine; diagnostic microbiology; Epidemiology; Family Medicine; Fusobacterium necrophorum; General practice / Family practice; HIV Infections; Humans; Infections; infectious diseases; Infectious Medicine; Infektionsmedicin; Klinisk medicin; Medical and Health Sciences; Medical diagnosis; Medicin och hälsovetenskap; Meta-analysis; Oto-rino-laryngologi; Otorhinolaryngology; Pharyngitis; Pharyngitis - epidemiology; primary care; Primary Health Care; Streptococcus pyogenes; Systematic review; therapeutic use
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-042816

PurposeThe main objective of this review was to describe and quantify the association between Fusobacterium necrophorum (FN) and acute sore throat in primary healthcare (PHC).MethodsIn this systematic review and meta-analysis, we searched Scopus and PubMed for case–control studies reporting the prevalence of FN in patients attending primary care for an uncomplicated acute sore throat as well as in healthy controls. Only studies published in English were considered. Publications were not included if they were case studies, or if they included patients prescribed antibiotics before the throat swab, patients with a concurrent malignant disease, on immunosuppression, having an HIV infection, or patients having another acute infection in addition to a sore throat. Inclusion criteria and methods were specified in advance and published in PROSPERO. The primary outcome was positive etiologic predictive value (P-EPV), quantifying the probability for an association between acute sore throat and findings of FN in the pharynx. For comparison, our secondary outcome was the corresponding P-EPV for group A Streptococcus (GAS).ResultsPubMed and Scopus yielded 258 and 232 studies, respectively. Removing duplicates and screening the abstracts resulted in 53 studies subsequently read in full text. For the four studies of medium to high quality included in the meta-analysis, the cumulative P-EPV regarding FN was 64% (95% CI 33% to 83%). GAS, based on data from the same publications and patients, yielded a positive EPV of 93% (95% CI 83% to 99%).ConclusionsThe results indicate that FN may play a role in PHC patients with an acute sore throat, but the association is much weaker compared with GAS.