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Prevalence of key bacterial pathogens among children with pharyngotonsillitis in The Gambia – a case-control study

Nygren, David LU orcid ; Jarju, Sheikh ; Basiru Njai, Mary ; Jagne, Sukai ; Borgström, Martin ; Wasserstrom, Lisa LU orcid ; de Silva, Thushan ; Marks, Michael and Armitage, Edwin (2026) In Journal of Infection 93(2).
Abstract

Objectives: Causes of pharyngotonsillitis in Africa, beyond Streptococcus pyogenes, are poorly understood. We aimed to describe the prevalence of S. pyogenes, Fusobacterium necrophorum, and Streptococcus dysgalacatiae subspecies equisimilis (SDSE) in children in The Gambia and evaluate the usefulness of clinical decision rules, originally developed for S. pyogenes or beta-haemolytic streptococci, for their prediction. Methods: We conducted a case-control study on causes of pharyngotonsillitis in children (0–15 years). Samples from age-matched cases and asymptomatic controls were included from two previous studies in The Gambia, conducted June 2021 to September 2022. Pharyngeal swabs were analysed with multiplex-PCR, targeting S.... (More)

Objectives: Causes of pharyngotonsillitis in Africa, beyond Streptococcus pyogenes, are poorly understood. We aimed to describe the prevalence of S. pyogenes, Fusobacterium necrophorum, and Streptococcus dysgalacatiae subspecies equisimilis (SDSE) in children in The Gambia and evaluate the usefulness of clinical decision rules, originally developed for S. pyogenes or beta-haemolytic streptococci, for their prediction. Methods: We conducted a case-control study on causes of pharyngotonsillitis in children (0–15 years). Samples from age-matched cases and asymptomatic controls were included from two previous studies in The Gambia, conducted June 2021 to September 2022. Pharyngeal swabs were analysed with multiplex-PCR, targeting S. pyogenes, F. necrophorum, and SDSE. Cases and controls were compared, and performance of clinical decision rules evaluated. Results: Only S. pyogenes was more frequently detected among cases (N=376) than controls (n=105) (32% vs. 11%, p<0.0001). No difference was seen for F. necrophorum (9% vs. 10%, p=0.95) or SDSE (11% vs. 14% p=0.19). Clinical decision rules poorly predicted any of the pathogens. Conclusions: S. pyogenes was the only pathogen more prevalent among cases. F. necrophorum was more common in pharyngeal samples from children in The Gambia than previously described in high-income countries, yet neither F. necrophorum or SDSE differed between cases and controls.

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; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Child, Clinical decision rule, Fusobacterium necrophorum, Multiplex PCR, Pharyngitis, Streptococcus dysgalactiaesubspeciesequisimilis, Streptococcus pyogenes, The Gambia, Tonsillitis, Western Africa
in
Journal of Infection
volume
93
issue
2
article number
106787
publisher
W.B. Saunders
external identifiers
  • scopus:105041289368
  • pmid:42269841
ISSN
0163-4453
DOI
10.1016/j.jinf.2026.106787
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/
id
e860b14f-8171-413b-8cd1-17bfa2f029db
date added to LUP
2026-07-23 14:44:20
date last changed
2026-08-06 15:09:17
@article{e860b14f-8171-413b-8cd1-17bfa2f029db,
  abstract     = {{<p>Objectives: Causes of pharyngotonsillitis in Africa, beyond Streptococcus pyogenes, are poorly understood. We aimed to describe the prevalence of S. pyogenes, Fusobacterium necrophorum, and Streptococcus dysgalacatiae subspecies equisimilis (SDSE) in children in The Gambia and evaluate the usefulness of clinical decision rules, originally developed for S. pyogenes or beta-haemolytic streptococci, for their prediction. Methods: We conducted a case-control study on causes of pharyngotonsillitis in children (0–15 years). Samples from age-matched cases and asymptomatic controls were included from two previous studies in The Gambia, conducted June 2021 to September 2022. Pharyngeal swabs were analysed with multiplex-PCR, targeting S. pyogenes, F. necrophorum, and SDSE. Cases and controls were compared, and performance of clinical decision rules evaluated. Results: Only S. pyogenes was more frequently detected among cases (N=376) than controls (n=105) (32% vs. 11%, p&lt;0.0001). No difference was seen for F. necrophorum (9% vs. 10%, p=0.95) or SDSE (11% vs. 14% p=0.19). Clinical decision rules poorly predicted any of the pathogens. Conclusions: S. pyogenes was the only pathogen more prevalent among cases. F. necrophorum was more common in pharyngeal samples from children in The Gambia than previously described in high-income countries, yet neither F. necrophorum or SDSE differed between cases and controls.</p>}},
  author       = {{Nygren, David and Jarju, Sheikh and Basiru Njai, Mary and Jagne, Sukai and Borgström, Martin and Wasserstrom, Lisa and de Silva, Thushan and Marks, Michael and Armitage, Edwin}},
  issn         = {{0163-4453}},
  keywords     = {{Child; Clinical decision rule; Fusobacterium necrophorum; Multiplex PCR; Pharyngitis; Streptococcus dysgalactiaesubspeciesequisimilis; Streptococcus pyogenes; The Gambia; Tonsillitis; Western Africa}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{W.B. Saunders}},
  series       = {{Journal of Infection}},
  title        = {{Prevalence of key bacterial pathogens among children with pharyngotonsillitis in The Gambia – a case-control study}},
  url          = {{http://dx.doi.org/10.1016/j.jinf.2026.106787}},
  doi          = {{10.1016/j.jinf.2026.106787}},
  volume       = {{93}},
  year         = {{2026}},
}