Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- edad infantil o adolescente
- invierno o primavera (en la faringitis bacteriana)
- verano/otoño (en la faringitis por enterovirus)
- rinorrea, congestión nasal, ronquera, úlceras orales y tos (en infección viral)
- dolor de garganta
- exudado faríngeo
- adenopatía cervical
- fiebre
- cefalea
- náuseas, vómitos y dolor abdominal
- Conjuntivitis
- erupción maculopapular (en el sarampión)
- Manchas de Koplik (en el sarampión)
- erupción escarlatiniforme (en la faringitis por estreptococo del grupo A [EGA])
Other diagnostic factors
- actividad o abuso sexual (en infección por VIH, gonorrea o clamidia)
- fracaso del tratamiento con penicilina
- ulceración faríngea (en tularemia)
- membrana faríngea gris (en difteria)
Risk factors
- colonización nasal con estreptococos del grupo A (EGA)
- contacto con personas infectadas por estreptococos del grupo A (EGA)
- actividad sexual o abuso sexual
- ingestión de carnes de animales no domésticos
- huésped inmunocomprometido
- uso de corticosteroides inhalados
- falta de inmunización o fracaso de la vacuna
Diagnostic investigations
1st investigations to order
- prueba rápida de antígenos para estreptococos del grupo A (EGA)
- amplificación del ácido nucleico (mediante la reacción en cadena de la polimerasa) para el estreptococo del grupo A (EGA)
Investigations to consider
- cultivo de exudado faríngeo para estreptococos del grupo A (EGA)
- cultivo o PCR de exudado faríngeo para gonococo o clamidia
- prueba de anticuerpos heterófilos en suero para la infección del virus de Epstein-Barr
Treatment algorithm
todos los pacientes
Contributors
Authors
Jeffrey R. Donowitz, MD
Pediatrician
Pediatric Infectious Diseases
University of Virginia
Charlottesville
VA
Disclosures
JRD declares that he has no competing interests.
Acknowledgements
Dr Jeffrey R. Donowitz would like to gratefully acknowledge Dr William A. Petri, Jr, a previous contributor to this topic.
Disclosures
WAP declares that he has no competing interests.
Peer reviewers
Richard Roberts, MD, JD, FAAFP, FCLM
Professor of Family Medicine
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
RR declares that he has no competing interests.
Remco de Bree, MD, PhD
Otolaryngologist
Head and Neck Surgeon
VU University Medical Center
Amsterdam
The Netherlands
Disclosures
RdB declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America (Archived). Clin Infect Dis. 2012 Nov 15;55(10):e86-102.Full text Abstract
Centers for Disease Control and Prevention. Pharyngitis (strep throat). Jun 2022 [internet publication].Full text
Centers for Disease Control and Prevention. Antibiotic prescribing and use - adult outpatient treatment recommendations. Oct 2017 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Epiglotitis
- Absceso retrofaríngeo, periamigdalino y lateral
- Mononucleosis infecciosa
More DifferentialsGuidelines
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
- Pharyngitis (strep throat)
More GuidelinesPatient information
Dolor de garganta
More Patient information
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