International Journal of Otorhinolaryngology

2020; 6(1): 6-9

http://www.sciencepublishinggroup.com/j/ijo
doi: 10.11648/j.ijo.20200601.12
ISSN: 2472-2405 (Print); ISSN: 2472-2413 (Online)

Study of Factors Associated with Acute Pharyngitis

Kadidiatou Doumbia-singare1, *, Fatogoma Issa Kone1, Lassine Dienta2, Samba Karim Timbo1,
Naouma Cisse1, Djibril Samake3, Boubacary Guindo1, Lamine Traore1, Siaka Soumaoro1,
N’Faly Konate1, Kassim Diarra1, Mohamed Amadou Keita1, Alhousseini A. G. Mohamed1
1
Department of Surgery, University of Gabriel Toure, Bamako, Mali
2
Regional hospital of Mopti, Bamako, Mali
3
Reference Health Center V, Bamako, Mali

Email address:
*
Corresponding author

To cite this article:

Kadidiatou Doumbia-singare, Fatogoma Issa Kone, Lassine Dienta, Samba Karim Timbo, Naouma Cisse, Djibril Samake, Boubacary
Guindo, Lamine Traore, Siaka Soumaoro, N’Faly Konate, Kassim Diarra, Mohamed Amadou Keita, Alhousseini A. G. Mohamed. Study of
Factors Associated with Acute Pharyngitis. International Journal of Otorhinolaryngology. Vol. 6, No. 1, 2020, pp. 6-9.
doi: 10.11648/j.ijo.20200601.12

Received: January 6, 2020; Accepted: January 20, 2020; Published: February 1, 2020

Abstract: Introduction: acute pharyngitis is found in children as well as in adults. The peak incidence is between 5 and 15
years. The responsible germs are of viral or bacterial origin; the group A hemolytic beta streptococcus haunts this condition.
Objective: Study the factors associated with acute pharyngitis in the ENT department of the CHU Gabriel TOURE in Bamako.
Methods: A descriptive and analytical prospective study was conducted from August 30, 2015 to August 30, 2016. The study
population consisted of patients admitted to the ENT department of the CHU Gabriel Touré in Bamako for acute pharyngitis.
Data was collected using a questionnaire during the interview and physical examination. They were entered using Epi Data
software version 3.01 and analyzed using R 3.1.2 software. Results: We collected 234 cases of pharyngitis between August 30,
2015 and August 30, 2016. The sex ratio (F / M) was 1.32. The mean age was 28.21 ± 14.20 years. The majority of patients
presented with erythematous angina (81%). The group A hemolytic beta streptococcus was the predominant germ (58%). The
active antibiotics on the germ were penicillin, amoxicillin, and cephalosporin. This germ was associated with erythematous
angina and the risk was 3.99, CI (1.88-8.45). Complications were noted in 7 patients (3%) upon admission, including 1 case of
cervical cellulitis and 6 cases of palatine tonsil phlegmon. No deaths have been recorded. Conclusion: The aspect of the
palatine tonsil does not allow to evoke a viral or bacterial etiology from where the interest to carry out a bacteriological
examination in particular the culture which could orient a bacterial etiology and help the practitioner to rationalize the
indication of antibiotic therapy.
Keywords: Pharyngitis, Culture, Germs, Treatment, Mali

glomerulonephritis, acute GNA), local

1. Introduction (perithygealphlegmon, bacterial adenitis, retropharyngeal
Acute pharyngitis also called acute angina is an abscess) and general (sepsis). These complications are post-
inflammation of the lining of the pharynx less than 15 days streptococcal (rheumatic fever, RAA, glomerulonephritis,
old [1]. It is found in children as well as in adults [2-4]. The acute GNA), local (periamydalianphlegmon, bacterial
peak of incidence is between 5 and 15 years [5]. The germs adenitis, retropharyngeal abscess) and general (sepsis).
responsible are of viral or bacterial origin [1, 4, 5]. The group In Mali, despite advances in antibiotic therapy, these
A beta-hemolytic streptococcus (SGA) remains the first complications are still common.
bacteria in question (25 to 40%). Pharyngitis can progress to Therapeutic management requires the identification of the
life-threatening complications [6, 7]. These complications are bacterial presence with a view to antibiotic therapy adapted
post-streptococcal (rheumatic fever, RAA, to germs. This is based on performing a throat swab for direct
 International Journal of Otorhinolaryngology 2020; 6(1): 6-9 7

examination and culture. The rapid diagnostic test (RDT) is 3. Results

also recommended when it is positive, this confirms the
etiology at SGA [1, 8-11]. We have identified 234 cases of pharyngitis in 1 year.
The identification of the germ is difficult in our context The mean age was 28.21 ± 14.20 years. The extreme ages
justifying probabilistic antibiotic therapy. This could be were 2 and 75, with a median of 29.
explained by difficulties related to sampling (insufficient The majority of patients were over 30 years of age (42%).
equipped laboratories, financial inaccessibility to The series included 133 female patients (57%) and 101
microbiological examination of patients). male patients (43%) with a sex ratio (F / M) of 1.32.
The percentage of germs responsible for this disease is As for symptoms, dysphagia was predominant (94%).
unknown in Mali, as are the antibiotics active on the germs. The mean duration of symptom progression was 5 days
Faced with these situations, we undertook a study on the with extremes of 1 and 15 days.
factors associated with forms of acute pharyngitis in order to The mean duration of symptom progression was 5 days
find out the bacterial ecology of acute pharyngitis which is with extremes of 1 and 15 days.
necessary to guide ENT practitioners towards the judicious Angina was macroscopically erythematous in 81% of
use of antibiotic therapy. This will reduce resistance to germs cases and erythematato-pultacea in 19% of cases.
and complications. Bacteriologically: Group A Streptococci have been
isolated in 58% of cases. The amoxicillin-clavulanic acid
combination was the most active antibiotic on the germ
2. Patients and Methods (61%). The average duration of antibiotic therapy was 8, 66
This is a descriptive and analytical prospective study with days with extremes of 5 and 10 days.
the ENT and head and neck surgery department of the The evolution was marked by complications 7 cases (3%)
Gabriel Toure teaching hospital in Bamako, Mali. It was including 1 case of cervical cellulitis and 6 cases of peri-
carried out over a period of 1 year from August 30, 2015 to tonsillaryphlegmon. These complications were observed
August 30, 2016. We included in this study all the files of upon admission of patients. There were no deaths.
patients admitted for acute pharyngitis. We did not include In bivariate analysis, Table 1 shows the links between
the files of patients who received antibiotic treatment before erythematous angina and the signs.
the first consultation and of patients who did not benefit from Table 1. Link between erythematous appearance and signs.
a pharyngeal sample (these were mainly pusillanimous
children). Erythematous angina
Variables P value
We noted for each file: Presente n (%) absent n (%)
1. The quantitative variables (age, duration of evolution) Pharyngeal pain
we determined the mean, the standard deviation, the Yes 178 (94) 41 (93)
0,67
No 11 (6) 4 (9)
extremes.
Fever
2. Qualitative variables (sex, location, symptoms of
Yes 78 (42) 26 (57,8)
pharyngitis, history of acute pharyngitis, local and 0,06
No 111 (58) 19 (42,2)
general complications, macroscopic appearance of the
Erache
palatine tonsil, identified germ, antibiotics active on the Yes 34 (18) 10 (22,2)
germ, evolution under treatment) we determined their 0,27
No 155 (82) 35 (77,8)
frequencies.
The bivariate analysis was carried out with software R. Erythematous angina was statistically significant with
The dependent variable was the erythematous and fever (p = 0.06).
erythematato-pultaceous aspect of acute pharyngitis. The Group A streptococcus was the most frequently
tests used were those of CHI2 or Fisher depending on their encountered germ in erythematous angina and the link was
applicability conditions. The confidence interval was 95%, statistically significant (p = 0.003).
and the difference considered significant if p was less than In multivariate analysis, a complete model was constructed
0.05. only with the variables having a p < 0.05.
The multivariate analysis was done with software R. The
modeling of pharyngitis was done by logistic regression.
Table 2. Results of the determinants of erythematous angina on the qualitative variables in multivariate analysis.

Variables Crude OR (95%CI) Adj. OR (95%CI) P (Wald's test)

FIEVER: no vs yes 0.51 (0.27, 0.99) 0.44 (0.21, 0.91) 0.026
COMPLICATION: no vs yes 0.03 (0,0.3) 0.03 (0,0.24) 0.001
StreptococcusA: no vs yes 2.8 (1.43, 5.48) 3.99 (1.88, 8.45) < 0.001

Patients who do not have Streptococcus A are 3.99 times develop erythematous angina. Those who do not have a fever
more likely not to develop erythematous angina. are 2.27 times less likely to not develop erythematous angina.
Uncomplicated patients are 0.03 times more likely not to
8 Kadidiatou Doumbia-singare et al.: Study of Factors Associated with Acute Pharyngitis

4. Discussion than that recommended by other authors 24-48 hours [1, 3, 4,

13]. The culture has a sensitivity and specificity of 90-95%
Acute angina is a frequent pathology, we received 234 (3, 4.5). It allowed germ isolation in 76% and Group A
cases in 1 year on the other hand Gorge N et al received Streptococcus represented 58%. On the other hand, for
23130 cases in 1 year [12]. Benouda et al out of 697 pharyngeal samples, the culture
The average age of the patients was 28.21 years. The only isolated Group A Streptococcus in 65 cases, ie 9.3% [4].
highest frequency of angina was found in patients over 30 For Regoli M et al, the TDR was 98% specific and the
years of age (42%) while it was 11% in patients between the culture was 97%, the difference between the two tests was
ages of 1 and 10 years. However, this difference was not not statistically significant [2].
statistically significant (p = 0.52). Angina may progress to loco-regional suppurative
On the other hand, other studies have reported that the complications (peri-tonsillaryphlegmon, retropharyngeal
peak of angina was at the age group 5 and 15 years and these abscess, cervical adenitis, cervical cellulitis) and post-
authors did not find an association between age and angina (p sterptococcal syndromes (acute glomerulonephritis, acute
= 0.06) [4.5]. rheumatic fever, chorea Sydenham) [1, 3, 4, 14]. We noted
The usual clinical signs of angina are fever, odynophagia, complications with peri-tonsillaryphlegmon type in 7 patients
dysphagia, cough, lymphadenopathy, redness of the pharynx upon admission. These complications can occur even after
sometimes associated with white spots. The dominant well-administered antibiotic treatment for angina. The
symptom was odynophagia (94%). Although common, it was preventive treatment of antibiotics on the occurrence of these
not significantly associated with erythematous angina (p = complications is not well established [3, 5, 6, 13]. Among
0.6) and erythematato-pultacea (p = 1). This symptom is these 7 cases, the SGA was isolated in 5 patients. These
classic regardless of the type of angina [1, 2]. complications were attributed to the SGA. This result is in
As for fever, it was associated with erythematous angina contradiction with that of George N et al who had noted 13
(OR = 0.44; CI = 0.21, 0.91) and erythematato-pultacea (OR cases of peri-tonsillaryphlegmon which were not related to
= 2.27; CI = 1.12, 4.58). We share the same observation with SGA in 953 patients with acute pharyngitis [12].
literature. Antibiotic treatment of angina is not systematic, due to the
An examination of the oropharynx makes the clinical prevalence of viral etiology. The most frequently used
diagnosis of angina. It makes it possible to distinguish on the antibiotics are: penicillin, aminopenicillins, betalactamase
appearance of the oropharynx from erythematous or inhibitors, cephalosporins, macrolides [5, 6, 12]. Several
erythematato-pultaceous, pseudo-membranous, ulcerative authors agree to suggest penicillin as the antibiotic of choice
and ulcerative-necrotic, finally vesicular angina [1, 2, 7]. [2-4, 13]. In the present study 86% of the patients received an
Erythematous angina was predominant (81%) followed by antibiotic before the bacteriological result and the
erythemaro-pultacea angina (16%) as reported in the combination amoxicillin – clavulanic acid was the most used
literature (1, 3). These two aspects do not prejudge the antibiotic 61% and the duration of the treatment was 8-10
bacterial or viral etiology [1, 3, 10, 11]. days.
Among the germs found in the present study, group A The number 3 antibiotic family was the most active 67%
hemolytic beta streptococcus (SGA) was the most frequent on the germs involved in erythematous angina and
(58%). This rate was lower than that reported by Bouskraoui erythematato-pultacea. It included penicillin, the
M et al who isolated 65 group A hemolytic beta streptococci aminopenicillin and beta-lactamase inhibitor, the Macrolides,
in 697 samples, ie 9.1% [3]. was the most active 67% on the germs involved in
We did not note a significant difference between the erythematous and erythematato-pultacea. Nazgoul A et al in
frequency of these two aspects and age (p = 0.33) while for their series of 200 cases of GBS in children reported that this
other authors the data differ (25-40% for children against 10- germ was sensitive to amoxicillin 36.2%, to cephalosporins
25% for adults) [4, 12]. 38.7% and to macrolides 26.2% [15].
These two aspects (erythematosus and erythematato- The outcome was favorable in all patients. We did not
pultaceae) do not prejudge the bacterial or viral etiology. notice a recurrence.
Strep throat can be erythematous or erythematato-pultacea [1,
3, 13].
Group A hemolytic beta streptococcus was associated with 5. Limits
erythematous angina (OR = 3.99; CI = 1.88, 8.45). On the Information reported by parents about symptoms is often
other hand, it was not associated with erythematato-pultacea insufficient when it comes to children who cannot express
angina (p = 0.29). themselves properly.
The identification of the germ is based on the culture of The interpretations of our results must take into account
the pharyngeal sample and the practice of the rapid above all the quality of the sample which is not always easy
diagnostic test (RDT). Culture is only indicated if the RDT is in children. The conditions of transport of the samples and
negative and there are risk factors for rheumatic fever (RAA) the storage of the swabs in the cold can also influence the
[1, 3, 13]. The unavailability of the TDR led us to culture the results.
samples with a waiting time of 72 hours. This time is longer
 International Journal of Otorhinolaryngology 2020; 6(1): 6-9 9

6. Conclusion streptococcal pharyngotonsillitis in children and adolescents:

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