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This investigation aims to assess the effectiveness of PCR-based detection versus conventional methods for identifying Group A and Non-Group A streptococci in tonsillitis patients.

January 18, 2026Open Access

PCR-based detection reveals threefold underdiagnoses of Group A Streptococcus and Pathogenic Non-Group A Streptococci Predominance in Iraqi Tonsillitis Patients

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This investigation aims to assess the effectiveness of PCR-based detection versus conventional methods for identifying Group A and Non-Group A streptococci in tonsillitis patients.
Conducted a prospective cross-sectional study involving 250 tonsillitis patients and 25 healthy controls.
Utilized PCR targeting the spy1258 gene alongside traditional culture methods for BHS identification.
Performed statistical analyses including chi-square testing and logistic regression.
PCR identified Group A Streptococcus in 62.7% of culture-positive specimens, compared to only 22.9% by culture methods.
Achieved 100% sensitivity and specificity with PCR diagnostics.
Pathogenic potential was noted in Non-Group A streptococci, with over 42% of infections showing elevated anti-streptolysin O titers.

Resumen

Background Beta-hemolytic streptococci (BHS) constitute a significant etiology of tonsillitis and rheumatic heart disease (RHD), affecting approximately 55 million individuals and causing 360,000 deaths annually worldwide. In the Middle East and North Africa region, RHD prevalence reaches 389 per 100,000 population, though diagnostic inadequacies may obscure the true disease burden. This investigation compared polymerase chain reaction (PCR)-based detection with conventional culture-based methods for BHS identification in Iraqi tonsillitis patients and assessed associated clinical, immunological, and systemic dissemination parameters. Methods A prospective cross-sectional study included 250 tonsillitis patients at Ramadi General Hospital, Iraq (April 2020–January 2025) and 25 healthy controls. Diagnostics comprised throat culture with Lancefield serogrouping, bacitracin testing, and PCR targeting the spy1258 gene. Blood specimens underwent PCR for systemic bacterial detection. Statistical analyses included chi-square testing, logistic regression, and diagnostic accuracy calculations. Results PCR detected Group A Streptococcus (GAS) in 52 of 83 (62.7%) culture-positive specimens, whereas Lancefield serogrouping identified only 19 (22.9%), representing a statistically significant threefold detection disparity (p

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