Acute pharyngitis is hallmarked by acute onset of sore throat; the absence of cough, nasal congestion and discharge suggests a bacterial aetiology.
Rapid antigen detection tests allow immediate point-of-care assessment of group A Streptococcus (GAS) pharyngitis.
The goal of treatment of GAS is to prevent acute rheumatic fever, reduce the severity and duration of symptoms, and prevent transmission.
Acute pharyngitis is generally a self-limited condition with resolution within two weeks. Infected individuals are not, however, immune to reinfection with most aetiological pathogens.
The only situation in which antibiotic prophylaxis to prevent GAS infections is recommended is for individuals with a history of rheumatic fever.
Acute pharyngitis is characterised by the rapid onset of sore throat and pharyngeal inflammation (with or without exudate). Absence of cough, nasal congestion, and nasal discharge distinguishes bacterial from viral aetiologies. It can be caused by a variety of viral and bacterial pathogens, including group A Streptococcus (GAS), as well as fungal pathogens (Candida). Bacterial pharyngitis is more common in winter (or early spring), while enteroviral infection is more common in the summer and autumn. Generally a self-limited condition with resolution within two weeks.
History and exam
- presence of risk factors
- child or adolescent age
- winter or spring season (in bacterial pharyngitis)
- summer/autumn season (in enteroviral pharyngitis)
- rhinorrhoea, nasal congestion, and cough (in viral infection)
- sore throat
- pharyngeal exudate
- cervical adenopathy
- fever >37°C (98.6°F)
- nausea, vomiting, and abdominal pain
- conjunctivitis (in measles)
- maculopapular rash (in measles)
- Koplik spots (in measles)
- scarlatiniform rash (in group A Streptococcus [GAS] pharyngitis)
Pediatric Infectious Diseases
Children’s Hospital of Richmond
Virginia Commonwealth University
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 topic.
Professor of Family Medicine
University of Wisconsin School of Medicine and Public Health
RR declares that he has no competing interests.
Head and Neck Surgeon
VU University Medical Center
RdB declares that he has no competing interests.
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