INTRODUCTION
Acute tonsillitis and pharyngitis are the most common clinical illnesses produced by group A streptococcus (GAS) bacteria. Untreated patients may develop purulent complications, including otitis media, sinusitis, peritonsillar and retropharyngeal abscesses, and cervical adenitis. The significance of streptococcal respiratory tract infection is related particularly to its acute morbidity and nonsuppurative sequelae, ie, acute rheumatic fever and acute glomerulonephritis.1 2 Saudi Arabia occurs in young children and in a form more severe than in the western world.3 3 4 5 6 7 8 9 Saudi Arabia on the GAS carrier rate or infection. This paper serves as a pilot study of the rate of GAS infection and carrier rate among children less than 12 years old from the same neighbourhood in the city of Makkah, Saudi Arabia .
METHODOLOGY
Throat swabs were obtained from 73 children visiting a pediatric outpatient clinic complaining of sore throat and fever of more than 38.5°C and diagnosed as tonsillitis and pharyngitis. The age range of the children was 1 to 12 years (mean age of 7 years). Similarly, swabs were obtained from 465 primary school children whose ages ranged from 6 to 12 years (mean age of 9 years) who lived in the neighborhood of the clinic. The pediatrician and the nurse of the clinic took the swabs of the children attending the clinic. The swabs were put in transport media and sent immediately to the laboratory. A team of specialists and residents from the Departments of Pediatrics and Microbiology at Umm Al-Qura University-Makkah took the throat swabs from the school children. They were put in transport media, plotted and cultured immediately. The organisms were isolated and identified according to standard laboratory methods.10
RESULTS
Group A streptococcus bacteria was positive in 29 patients (40%) of children with tonsillitis and pharyngitis. The cultures were positive for GAS in 15 carriers (3%) out of 465 healthy school children (Table 1 ). GAS in the 29 children with tonsillitis and pharyngitis was sensitive to penicillin G in 14(48%), erythromycin 27(93%), and to cefaclor in 28(96%) (Table 2 ).
Table 1: Prevalence of GAS among children with tonsillitis, pharyngitis and healthy children
Table 2: GAS sensitivity to antibiotics in patients with tonsillitis and pharyngitis.
DISCUSSION
This study shows a low carrier rate of GAS in healthy Saudi children compared to studies from some developing and neighboring countries. However, the occurrence of GAS among children with tonsillitis and pharyngitis is 40%. Al-Mazrou from Saudi Arabia reported an increase in the severity and invasiveness of GAS infection.11 12 13 Saudi Arabia . A large study across the Kingdom showed a high prevalence of rheumatic fever of 0.3 per 1000 and the prevalence of chronic rheumatic heart disease of 2.8 per 1000, giving an overall rate of 3.1 per 1000 school children 6-15 years old.14 Saudi Arabia . Al-Ghamdi et al reported 5.6% resistance of GAS to penicillin in eastern Saudi Arabia .15 16 – 18
Resistance of more than 50% in our study is a cause for alarm. We recommend routine throat swabs for children with tonsillitis, pharyngitis and high fever and appropriate treatment of GAS positive cases. There is a need for a large-scale study in Saudi Arabia to assess the carrier rate of GAS, its sensitivity to penicillin G, and the magnitude of nonsuppurative sequelae of GAS infection.
ACKNOWLEDGMENT
We would like to extend our sincere thanks to Dr. Nassim Khan and the team of residents for their assistance in collecting the samples of the school children.
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