{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:13:55Z","timestamp":1792887235387,"version":"4.5.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009779","name":"Region Kronoberg","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009779","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Diagnosis and treatment of pharyngotonsillitis are commonly focused on group A streptococci (GAS), although the disease is often associated with other pathogens. While the incidence of pharyngotonsillitis is known to vary with season, seasonal variations in the prevalence of potential pathogens are sparsely explored. The aim of this study was to explore any seasonal variations in the use and outcome of rapid antigen detection tests (RADTs) for GAS and throat cultures among patients diagnosed with pharyngotonsillitis in primary care.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We retrieved and combined retrospective data from the electronic medical record system and the laboratory information system in Kronoberg County, Sweden. Primary care visits resulting in a diagnosis of tonsillitis or pharyngitis were included, covering the period 2013\u20132016. The monthly rate of visits was measured, along with the use and outcome of RADTs for GAS and throat cultures obtained on the date of diagnosis. The variations between calendar months were then analysed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We found variations between calendar months, not only in the mean rate of visits resulting in a diagnosis of pharyngotonsillitis (p\u2009&lt;\u20090.001), but in the mean proportion of RADTs being positive for GAS among the diagnosed (p\u2009&lt;\u20090.001), and in the mean proportion of visits associated with a throat culture (p\u2009&lt;\u20090.001). A lower mean rate of visits in August and September coincided with a lower proportion of RADTs being positive for GAS among them, which correlated with a higher proportion of visits associated with a throat culture.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This study suggests that the role of GAS in pharyngotonsillitis in Sweden is less prominent in August and September than during the rest of the year.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06774-5","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T17:02:52Z","timestamp":1635267772000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Seasonal variations in use and outcome of rapid antigen detection tests and cultures in pharyngotonsillitis: a register study in primary care"],"prefix":"10.1186","volume":"21","author":[{"given":"Martin","family":"Andersson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Pallon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olof","family":"Cronberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Sundqvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Hedin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"issue":"1","key":"6774_CR1","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1186\/s12879-016-2018-9","volume":"16","author":"M Tyrstrup","year":"2016","unstructured":"Tyrstrup M, Beckman A, M\u00f6lstad S, Engstr\u00f6m S, Lannering C, Melander E, et al. Reduction in antibiotic prescribing for respiratory tract infections in Swedish primary care\u2014a retrospective study of electronic patient records. BMC Infect Dis. 2016;16(1):709.","journal-title":"BMC Infect Dis"},{"issue":"1","key":"6774_CR2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1080\/02813432.2017.1288680","volume":"35","author":"M Tyrstrup","year":"2017","unstructured":"Tyrstrup M, van der Velden A, Engstrom S, Goderis G, Molstad S, Verheij T, et al. Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, the Netherlands and Sweden: use of European quality indicators. Scand J Prim Health Care. 2017;35(1):10\u20138.","journal-title":"Scand J Prim Health Care"},{"issue":"Suppl 1","key":"6774_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1469-0691.2012.03766.x","volume":"18","author":"C Pelucchi","year":"2012","unstructured":"Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012;18(Suppl 1):1\u201328.","journal-title":"Clin Microbiol Infect"},{"key":"6774_CR4","unstructured":"L\u00e4kemedelsverket (Medical Product Agency Sweden): Faryngotonsilliter i \u00f6ppenv\u00e5rd (Pharyngotonsillitis in open care). 2012. p. 18\u201325."},{"issue":"3","key":"6774_CR5","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1177\/0272989X8100100304","volume":"1","author":"RM Centor","year":"1981","unstructured":"Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Mak. 1981;1(3):239\u201346.","journal-title":"Med Decis Mak"},{"issue":"11","key":"6774_CR6","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1001\/archinternmed.2012.950","volume":"172","author":"AM Fine","year":"2012","unstructured":"Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med. 2012;172(11):847\u201352.","journal-title":"Arch Intern Med"},{"issue":"3","key":"6774_CR7","doi-asserted-by":"publisher","first-page":"263.e1","DOI":"10.1016\/j.cmi.2014.08.020","volume":"21","author":"K Hedin","year":"2015","unstructured":"Hedin K, Bieber L, Lindh M, Sundqvist M. The aetiology of pharyngotonsillitis in adolescents and adults\u2014Fusobacterium necrophorum is commonly found. Clin Microbiol Infect. 2015;21(3):263.e1-7.","journal-title":"Clin Microbiol Infect"},{"issue":"4","key":"6774_CR8","doi-asserted-by":"publisher","first-page":"241","DOI":"10.7326\/M14-1305","volume":"162","author":"RM Centor","year":"2015","unstructured":"Centor RM, Atkinson TP, Ratliff AE, Xiao L, Crabb DM, Estrada CA, et al. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Ann Intern Med. 2015;162(4):241\u20137.","journal-title":"Ann Intern Med"},{"issue":"3","key":"6774_CR9","doi-asserted-by":"publisher","first-page":"149","DOI":"10.3109\/02813439709018506","volume":"15","author":"RK Gunnarsson","year":"1997","unstructured":"Gunnarsson RK, Holm SE, S\u00f6derstr\u00f6m M. The prevalence of beta-haemolytic streptococci in throat specimens from healthy children and adults. Implications for the clinical value of throat cultures. Scand J Prim Health Care. 1997;15(3):149\u201355.","journal-title":"Scand J Prim Health Care"},{"key":"6774_CR10","unstructured":"Statistikmyndigheten SCB (Statistics Sweden): statistical database. http:\/\/www.statistikdatabasen.scb.se\/pxweb\/en\/ssd\/. Accessed 22 Apr 2020."},{"issue":"2","key":"6774_CR11","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1080\/09674845.2007.11732757","volume":"64","author":"JA Amess","year":"2007","unstructured":"Amess JA, O\u2019Neill W, Giollariabhaigh CN, Dytrych JK. A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital. Br J Biomed Sci. 2007;64(2):63\u20135.","journal-title":"Br J Biomed Sci"},{"issue":"10","key":"6774_CR12","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1111\/j.1469-0691.2012.03966.x","volume":"18","author":"CF Christiansen","year":"2012","unstructured":"Christiansen CF, Pedersen L, S\u00f8rensen HT, Rothman KJ. Methods to assess seasonal effects in epidemiological studies of infectious diseases\u2014exemplified by application to the occurrence of meningococcal disease. Clin Microbiol Infect. 2012;18(10):963\u20139.","journal-title":"Clin Microbiol Infect"},{"issue":"3","key":"6774_CR13","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1177\/1403494815618843","volume":"44","author":"I Osika Friberg","year":"2016","unstructured":"Osika Friberg I, Krantz G, M\u00e4\u00e4tt\u00e4 S, J\u00e4rbrink K. Sex differences in health care consumption in Sweden: a register-based cross-sectional study. Scand J Public Health. 2016;44(3):264\u201373.","journal-title":"Scand J Public Health"},{"issue":"5","key":"6774_CR14","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1007\/s00484-015-1072-0","volume":"60","author":"D Herv\u00e1s","year":"2016","unstructured":"Herv\u00e1s D, Herv\u00e1s-Masip J, Ferr\u00e9s L, Ram\u00edrez A, P\u00e9rez JL, Herv\u00e1s JA. Effects of meteorologic factors and schooling on the seasonality of group A streptococcal pharyngitis. Int J Biometeorol. 2016;60(5):763\u20139.","journal-title":"Int J Biometeorol"},{"issue":"6","key":"6774_CR15","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1007\/s10096-021-04157-x","volume":"40","author":"N Mendes","year":"2021","unstructured":"Mendes N, Migu\u00e9is C, Lindo J, Gon\u00e7alves T, Migu\u00e9is A. Retrospective study of group A Streptococcus oropharyngeal infection diagnosis using a rapid antigenic detection test in a paediatric population from the central region of Portugal. Eur J Clin Microbiol Infect Dis. 2021;40(6):1235\u201343.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"7","key":"6774_CR16","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1007\/s10096-014-2052-8","volume":"33","author":"TE Klug","year":"2014","unstructured":"Klug TE. Incidence and microbiology of peritonsillar abscess: the influence of season, age, and gender. Eur J Clin Microbiol Infect Dis. 2014;33(7):1163\u20137.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"3","key":"6774_CR17","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1097\/00007611-198803000-00011","volume":"81","author":"D Hofkosh","year":"1988","unstructured":"Hofkosh D, Wald ER, Chiponis DM. Prevalence of non-group-A beta-hemolytic streptococci in childhood pharyngitis. South Med J. 1988;81(3):329\u201331.","journal-title":"South Med J"},{"key":"6774_CR18","doi-asserted-by":"publisher","first-page":"4739","DOI":"10.2147\/IDR.S279157","volume":"13","author":"M Gajd\u00e1cs","year":"2020","unstructured":"Gajd\u00e1cs M, \u00c1br\u00f3k M, L\u00e1z\u00e1r A, Buri\u00e1n K. Beta-haemolytic group A, C and G streptococcal infections in southern Hungary: a 10-year population-based retrospective survey (2008\u20132017) and a review of the literature. Infect Drug Resist. 2020;13:4739\u201349.","journal-title":"Infect Drug Resist"},{"issue":"5762","key":"6774_CR19","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1136\/bmj.2.5762.624","volume":"2","author":"PW Ross","year":"1971","unstructured":"Ross PW, Chisty SM, Knox JD. Sore throat in children: its causation and incidence. Br Med J. 1971;2(5762):624\u20136.","journal-title":"Br Med J"},{"key":"6774_CR20","unstructured":"Folkh\u00e4lsomyndigheten (Public Health Agency of Sweden): Invasiva grupp A-streptokocker, s\u00e4songsrapport 2016\u20132017.\u00a0https:\/\/www.folkhalsomyndigheten.se\/publicerat-material\/publikationsarkiv\/i\/invasiva-grupp-a-streptokocker---sasongsrapport-2016-2017\/. Accessed 2 Nov 2019."},{"issue":"2","key":"6774_CR21","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/j.cmi.2014.08.019","volume":"21","author":"O Oppegaard","year":"2015","unstructured":"Oppegaard O, Mylvaganam H, Kittang BR. Beta-haemolytic group A, C and G streptococcal infections in Western Norway: a 15-year retrospective survey. Clin Microbiol Infect. 2015;21(2):171\u20138.","journal-title":"Clin Microbiol Infect"},{"issue":"5","key":"6774_CR22","first-page":"347","volume":"93","author":"S Hoffmann","year":"1985","unstructured":"Hoffmann S. The throat carrier rate of group A and other beta hemolytic streptococci among patients in general practice. Acta Pathol Microbiol Immunol Scand B. 1985;93(5):347\u201351.","journal-title":"Acta Pathol Microbiol Immunol Scand B"},{"issue":"4","key":"6774_CR23","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/BF00157398","volume":"9","author":"J Begovac","year":"1993","unstructured":"Begovac J, Bobinac E, Benic B, Desnica B, Maretic T, Basnec A, et al. Asymptomatic pharyngeal carriage of beta-haemolytic streptococci and streptococcal pharyngitis among patients at an urban hospital in Croatia. Eur J Epidemiol. 1993;9(4):405\u201310.","journal-title":"Eur J Epidemiol"},{"issue":"517","key":"6774_CR24","first-page":"615","volume":"55","author":"M Lindbaek","year":"2005","unstructured":"Lindbaek M, H\u00f8iby EA, Lermark G, Steinsholt IM, Hjortdahl P. Clinical symptoms and signs in sore throat patients with large colony variant beta-haemolytic streptococci groups C or G versus group A. Br J Gen Pract. 2005;55(517):615\u20139.","journal-title":"Br J Gen Pract"},{"issue":"12","key":"6774_CR25","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1007\/s10096-016-2757-y","volume":"35","author":"TE Klug","year":"2016","unstructured":"Klug TE, Rusan M, Fuursted K, Ovesen T, Jorgensen AW. A systematic review of Fusobacterium necrophorum-positive acute tonsillitis: prevalence, methods of detection, patient characteristics, and the usefulness of the Centor score. Eur J Clin Microbiol Infect Dis. 2016;35(12):1903\u201312.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"11","key":"6774_CR26","doi-asserted-by":"publisher","first-page":"812","DOI":"10.7326\/0003-4819-151-11-200912010-00011","volume":"151","author":"RM Centor","year":"2009","unstructured":"Centor RM. Expand the pharyngitis paradigm for adolescents and young adults. Ann Intern Med. 2009;151(11):812\u20135.","journal-title":"Ann Intern Med"},{"key":"6774_CR27","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000023","author":"A Spinks","year":"2013","unstructured":"Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2013. https:\/\/doi.org\/10.1002\/14651858.CD000023.","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"6774_CR28","doi-asserted-by":"publisher","first-page":"193","DOI":"10.3109\/02813432.2014.972046","volume":"32","author":"K Hedin","year":"2014","unstructured":"Hedin K, Strandberg EL, Gr\u00f6ndal H, Brorsson A, Thulesius H, Andr\u00e9 M. Management of patients with sore throats in relation to guidelines: an interview study in Sweden. Scand J Prim Health Care. 2014;32(4):193\u20139.","journal-title":"Scand J Prim Health Care"},{"key":"6774_CR29","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1186\/s12875-015-0285-y","volume":"16","author":"H Gr\u00f6ndal","year":"2015","unstructured":"Gr\u00f6ndal H, Hedin K, Strandberg EL, Andr\u00e9 M, Brorsson A. Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat\u2014a qualitative interview study. BMC Fam Pract. 2015;16:81.","journal-title":"BMC Fam Pract"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06774-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06774-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06774-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T17:04:01Z","timestamp":1635267841000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06774-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,26]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6774"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06774-5","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,26]]},"assertion":[{"value":"18 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective study was part of a larger project focusing on the aetiology of pharyngotonsillitis in primary care. It was approved, and informed consent was waived, by the Regional Ethical Review Board, Link\u00f6ping University (Dnr. 2016\/529\u201331). Although personal identification numbers were used in order to match the datasets, these were subsequently anonymized, and no personal EMRs were read during the study. Permissions for data collection were obtained from all the managers of the PHCCs, and the data were stored on servers with restricted access, in compliance with good clinical research practice. Any potential harm to the integrity of the patients was considered negligible, and the data collection had no impact on past or future access to health care.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1104"}}