Evidence indicates that the number of beta-hemolytic streptococci found in cultures has great clinical and epidemiologic significance. In those epidemiologic situations where the frequency of streptococcal infections increases so also does the proportion of strongly positive cultures (degree of positivity ratio). This degree of positivity ratio also increases in groups of ill patients in proportion to the importance of streptococci in those illnesses. In the individual patient, significant clinical disease due to the streptococcus, and thus requiring antibiotic therapy, is usually associated with a large number of streptococci in the cultures of that individual. However, in some clinical conditions where direct culture of the infected area is difficult, such as cervical adenitis and unruptured otitis media, a few streptococci may be significant. This is also true in patients with acute glomerular nephritis or rheumatic fever.
Breese BB, Disney FA, Talpey WB, Green JL. Beta-Hemolytic Streptococcal Infection: The Clinical and Epidemiologic Importance of the Number of Organisms Found in Cultures. Am J Dis Child. 1970;119(1):18–26. doi:10.1001/archpedi.1970.02100050020006
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