The anatomical area of involvement in streptococcal infections and the carrier state.

Questions concerning the precise anatomical location, the numbers and bacteriologic characteristics of hemolytic streptococci in streptococcal infections and in the carrier state are in need of clarification. This paper is a report of a study of these questions. The time-honored diagnostic aid for streptococcal infections is the practice of swabbing the posterior pharyngeal wall, the tonsils or nasal passages, culturing the mucous or exudate on the swab and identifying the bacteria that subsequently grow. The presence of characteristic symptoms and signs of pharyngitis or tonsillitis with a throat culture positive for group A hemolytic streptococci plus a significant rise in streptococcal antibodies is evidence that the patient has had a streptococcal infection. In the absence of symptoms and signs, a carrier state is assumed to exist, although carriers may have a significant rise in streptococcal antibodies."2 The cultures do not furnish any information regarding the exact anatomical site or extent of bacterial growth, whether it be the tonsils, the posterior oropharynx, the nasopharynx, or the posterior nares. In addition there is incomplete information concerning which histologic structures are involved, lymphoid tissue, mucous membrane or other tissues, or the microscopic anatomical location of streptococci during the carrier state or infection. Bacteria originating in the turbinates, the nasal mucosa, the sinuses, or the nasopharynx, if they are not taken up by leucocytes, may be swept backward in the mucous coat into the oropharynx by cilia of the lining (pseudostratified, ciliated epithelium) so that this locus becomes a disposal area for the whole upper respiratory tract. Hemolytic streptococci recovered here may have originated in locations extending from the nasal mucosa to the oropharynx.