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In about a quarter of patients with a sore throat, the disorder is caused by group A streptococcal tonsillopharyngitis. Appropriate treatment of streptococcal tonsillopharyngitis reduces the occurrence of subsequent rheumatic fever, a systemic disease that affects the joints and heart and sometimes the skin, central nervous system, and
Prevalence of Pharyngitis
Sore Throat Pharyngitis
Group A beta-hemolytic streptococcus (GABHS) is responsible for 10-30% of sore throat cases. It typically occurs in patients 5-11 years of age, and it is uncommon in children under 3 years old. Most cases of pharyngitis occur during the colder months. Streptococcal infections usually cold appear in late winter and
In patients who present with pharyngitis, the major goal is to detect GABHS infection because the potentially serious sequelae of rheumatic fever may result. Severe GABHS infections may cause a toxic-shock-like illness (toxic strep syndrome), bacteremia, streptococcal deep tissue infections (necrotizing fascitis), and streptococcal cellulitis.
Etiologic Causes of Sore Throat
Viral. Common cold, influenza, Epstein-Barr virus
Bacterial. Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, anaerobes, Mycoplasma pneumoniae, Candida albicans
Clinical Evaluation of Sore Throat
Presentation. GABHS infection is characterized by sudden onset of sore throat, fever, and tender swollen anterior cervical lymph nodes, typically in a child 5-11 years of age. Headache, nausea and
Cough, rhinorrhea and hoarseness are
Viral infections usually last 5 to 7 days,4 whereas streptococcal infections last slightly longer. Infectious mononucleosis (usually caused by Epstein-Barr virus) may linger for
Physical Examination
Vital signs, especially temperature should be assessed.
Streptococcal infection is suggested by erythema and swelling of the pharynx, enlarged and erythematous tonsils, tonsillar exudate, or
Unilateral inflammation and swelling of the pharynx suggests peritonsillar abscess. Distortion of the posterior pharyngeal wall suggests a retropharyngeal abscess. Corynebacterium diphtheriae is indicated by a dull membrane which
The tympanic membrane should be examined for erythema or a
The neck should be palpated for lymph node enlargement; tender nodes usually occur in an acute infection, whereas nontender enlargement is indicative of chronic infection or
Diagnostic Testing
Rapid streptococcal testing has a specificity of 90% and a sensitivity of 80%; the overall accuracy is 86% . A dry swab should be used to sample both the posterior wall and the tonsillar fossae, especially erythematous or
Diagnostic Approach
Patients presenting with an acute, severe episode of pharyngitis should receive a rapid streptococcal antigen test, and
Antibiotic Therapy
Penicillin G benzathine (Bicillin LA) may be
Another treatment option is use of macrolides. Clarithromycin (Biaxin),
Penicillinase-resistant penicillins, such as dicloxacillin sodium (Dycill, Pathocil), are a