Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • child or adolescent age
  • winter or spring season (in bacterial pharyngitis)
  • summer/fall season (in enteroviral pharyngitis)
  • rhinorrhea, nasal congestion, and cough (in viral infection)
  • sore throat
  • pharyngeal exudate
  • cervical adenopathy
  • fever >98.6°F (37°C)
  • headache
  • nausea, vomiting, and abdominal pain
  • conjunctivitis (in measles)
  • maculopapular rash (in measles)
  • Koplik spots (in measles)
  • scarlatiniform rash (in group A Streptococcus [GAS] pharyngitis)

Other diagnostic factors

  • sexual activity or abuse (in HIV, gonorrheal, or chlamydial infection)
  • treatment failure of penicillin
  • pharyngeal ulceration (in tularemia)
  • pharyngeal gray membrane (in diphtheria)

Risk factors

  • nasal colonization with group A Streptococcus (GAS)
  • GAS-infected contact
  • sexual activity or abuse
  • ingestion of nondomestic meats
  • immunocompromised host
  • use of inhaled corticosteroids
  • lack of immunization or vaccine failure
  • irradiation

Diagnostic investigations

1st investigations to order

  • rapid antigen test for group A Streptococcus (GAS)
Full details

Investigations to consider

  • culture of throat swab for group A Streptococcus (GAS)
  • culture of throat swab for gonococcus or chlamydia
  • serum monospot for Epstein-Barr virus infection
  • PCR for group A Streptococcus (GAS)
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Pediatrician

Pediatric Infectious Diseases

Children’s Hospital of Richmond

Virginia Commonwealth University

Richmond

VA

Disclosures

JRD declares that he has no competing interests.

Dr Jeffrey R. Donowitz would like to gratefully acknowledge Dr William A. Petri, Jr, a previous contributor to this monograph. WAP declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Family Medicine

University of Wisconsin School of Medicine and Public Health

Madison

WI

Disclosures

RR declares that he has no competing interests.

Otolaryngologist

Head and Neck Surgeon

VU University Medical Center

Amsterdam

The Netherlands

Disclosures

RdB declares that he has no competing interests.

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