Trends in Group A Streptococcus Pharyngitis and Co-Infection with Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Observational Study
Abstract
1. Introduction
2. Materials and Methods
Variable | Overall | ① Pre-COVID-19 Social Period (January 2019–April 2020) | ② Restricted Social Period (May 2020–April 2023) | ③ Post-Restriction Period (May 2023–December 2024) | p-Value (① vs. ②, ② vs. ③, ① vs. ③) |
---|---|---|---|---|---|
Positivity rate (%) | 463/4837 (9.6) | 137/1197 (11.4) | 169/2398 (7.0) | 157/1242 (12.6) | <0.001 (0.000015, <0.001, 0.459) |
Age (mean ± SD, years) | 28.0 ± 17.2 | 27.8 ± 16.5 | 33.1 ± 14.3 | 22.6 ± 18.9 | <0.001 (0.0029, <0.001, 0.013) |
Male (%) | 278 (60.0) | 81 (59.1) | 107 (63.3) | 90 (57.3) | 0.52 (0.48, 0.31, 0.81) |
Children aged <15 years (%) | 117 (25.3) | 34 (24.8) | 9 (5.3) | 74 (47.1) | <0.001(<0.001, <0.001, 0.00010) |
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
COVID-19 | coronavirus disease 2019 |
GAS | group A Streptococcus |
GAS-P | group A Streptococcus pharyngitis |
NPIs | non-pharmaceutical interventions |
PCR | polymerase chain reaction |
RSV | respiratory syncytial virus |
SARS-CoV-2 | severe acute respiratory syndrome coronavirus 2 |
SD | standard deviation |
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Category | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
---|---|---|---|---|---|---|
GAS-positive cases (pediatric cases) | 97 (23) | 98 (13) | 43 (3) | 57 (1) | 92 (42) | 76 (35) |
SARS-CoV-2 testing among GAS-positive cases (pediatric cases tested) | 0 (0) | 21 (0) | 5 (0) | 42 (1) | 43 (3) | 40 (5) |
Co-infection cases: GAS and SARS-CoV-2 (pediatric co-infections) | 0 (0) | 0 (0) | 0 (0) | 7 (0) | 6 (1) | 1 (0) |
Characteristics | |
---|---|
Total patients | 14 |
Age (mean ± SD) | 34.4 ± 17.7 |
Sex (male/female) | 7/7 |
History of COVID-19 | 2 |
Immunodeficiency | 0 |
Number of COVID-19 vaccine doses | |
≥2 | 10 |
None | 4 |
Days from onset (mean ± SD, [range]) | 1.5 ± 1.2 [0–4] |
Symptoms | |
Fever | 14 (100%) |
Sore throat | 12 (85.7%) |
Cough | 7 (50%) |
Headache | 6 (42.9%) |
Malaise | 6 (42.9%) |
Arthralgia | 4 (28.6%) |
Nasal discharge | 3 (21.4%) |
Muscle pain | 2 (14.3%) |
Nasal congestion | 2 (14.3%) |
Chills | 2 (14.3%) |
Nausea | 2 (14.3%) |
Vital signs | |
Body temperature (mean ± SD, [range]) | 38.4 ± 1.2 °C [37.1–40.0] |
Pulse oximetry oxygen saturation (mean ± SD, [range]) | 98.0 ± 1.0% [97–99] |
Systolic blood pressure (mean ± SD, [range]) | 122.5 ± 16.9 [90–149] |
Heart rate (mean ± SD, [range]) | 97.1 ± 15.5 [72–120] |
Laboratory and imaging data | |
White blood cell count (/μL) | 5812.5 ± 660.0 [4400–6600] |
Neutrophil count (/μL) | 4342 ± 911 [3089–5316] |
Lymphocyte count (/μL) | 954 ± 542 [180–1401] |
C-reactive protein (mg/dL) | 2.0 ± 1.5 [0.6–4.0] |
SARS-CoV-2 PCR (Ct values) | 20.2 ± 4.3 [15.2–29.4] |
Pneumonia findings on chest imaging/patients who underwent imaging (%) | 1/5 (20%) |
Clinical course and treatment | |
Hospitalized/outpatient cases | 3/11 |
Treatment | Regimen Details (Number of Patients) |
Antibiotics only (nine patients) | AMPC/CVA (5), CAM (2), ABPC/SBT (1), CFPN-PI (1) |
Antibiotics + antiviral agents (five patients) | CCL + ensitrelvir (2), AMPC/CVA + molnupiravir (1), ABPC/SBT + CAM + remdesivir (1), ABPC/SBT + nirmatrelvir (1) |
Outcomes | Recovery: 14/14 (100%) |
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© 2025 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Takahashi, H.; Satake, Y.; Shimizu, S.; Fujihara, S.; Takano, S.; Fukasawa, S.; Park, K.; Toba, N.; Yano, T.; Nagamatsu, H.; et al. Trends in Group A Streptococcus Pharyngitis and Co-Infection with Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Observational Study. Medicina 2025, 61, 937. https://doi.org/10.3390/medicina61050937
Takahashi H, Satake Y, Shimizu S, Fujihara S, Takano S, Fukasawa S, Park K, Toba N, Yano T, Nagamatsu H, et al. Trends in Group A Streptococcus Pharyngitis and Co-Infection with Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Observational Study. Medicina. 2025; 61(5):937. https://doi.org/10.3390/medicina61050937
Chicago/Turabian StyleTakahashi, Hidenori, Yugo Satake, Saori Shimizu, Satomi Fujihara, Syunsuke Takano, Suzuko Fukasawa, Kaeyong Park, Naoya Toba, Takahiko Yano, Hiroki Nagamatsu, and et al. 2025. "Trends in Group A Streptococcus Pharyngitis and Co-Infection with Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Observational Study" Medicina 61, no. 5: 937. https://doi.org/10.3390/medicina61050937
APA StyleTakahashi, H., Satake, Y., Shimizu, S., Fujihara, S., Takano, S., Fukasawa, S., Park, K., Toba, N., Yano, T., Nagamatsu, H., Hirose, R., Toyama-Kousaka, M., Ota, S., Morikawa, M., & Shinkai, M. (2025). Trends in Group A Streptococcus Pharyngitis and Co-Infection with Severe Acute Respiratory Syndrome Coronavirus 2: A Retrospective Observational Study. Medicina, 61(5), 937. https://doi.org/10.3390/medicina61050937