Sore Throat

Published on 23/03/2015 by admin

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Last modified 23/03/2015

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CHAPTER 24 Sore Throat

Magdy W. Attia, MD, Yamini Durani, MD

1 How do you define acute pharyngitis, tonsillitis, and pharyngotonsillitis?

Acute pharyngitis is an infection of the tonsils or the pharynx. Pharyngitis, tonsillitis, and pharyngotonsillitis are interchangeable terms often used to describe the clinical diagnosis of sore throat regardless of the etiology.

2 What is the incidence of pharyngitis in children?

The exact incidence of pharyngitis is not known. It is, however, the second most common diagnosis in children 1–15 years of age in the ambulatory setting.

4 How can I distinguish throat infections caused by these viruses?

The signs and symptoms often overlap between different causes of throat infection. Some helpful diagnostic clues are as follows:

When pharyngitis is associated with conjunctivitis, the diagnosis of pharyngoconjunctival fever secondary to adenovirus is highly likely.

The presence of ulcerative lesions on an erythematous base on the posterior palate is associated with coxsackie A virus, a condition known as herpangina. Another variant of coxsackie pharyngitis is hand, foot, and mouth disease. Small vesiculopustular lesions or shallow ulcers are seen on the soft palate, palms, and soles.

The association of significant cervical or generalized adenopathy and hepatosplenomegaly is highly suspicious for infectious mononucleosis due to Epstein-Barr virus or, less commonly, cytomegalovirus.

5 Which bacterial pharyngitis is the most common?

Streptococcus pyogenes, also known as group A β-hemolytic streptococcus (GABHS), is the most common bacterium causing pharyngitis in children. It is implicated in as many as 20–30% of all cases of pharyngitis in children. Other bacterial causes of sore throats (group C β-hemolytic streptococci, group G β-hemolytic streptococci, Mycoplasma pneumoniae, Neisseria gonorrhoeae) are much less common and almost irrelevant to everyday practice.

6 Why is it important for clinicians to diagnose and treat GABHS pharyngitis?

Antibiotic treatment of GABHS pharyngitis prevents rheumatic fever and suppurative complications. In addition, early treatment of GABHS pharyngitis shortens the course of the disease and reduces transmission to contacts.

7 Can rheumatic fever occur after a skin GABHS infection or after non-GABHS pharyngitis?

No. It is only known to occur after GABHS pharyngitis.

8 List the suppurative complications of GABHS.

These include peritonsillar cellulitis or abscess (quinsy), retropharyngeal abscess, cervical adenitis, otitis media, and sinusitis.

9 What are other important complications of GABHS infections? Does treatment of GABHS prevent these complications?

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