Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- criança ou adolescente
- inverno ou primavera (na faringite bacteriana)
- estação do verão/outono (na faringite enteroviral)
- rinorreia, congestão nasal, rouquidão, úlceras orais e tosse (em infecção viral)
- faringite
- exsudato faríngeo
- adenopatia cervical
- febre
- cefaleia
- náuseas, vômitos e dor abdominal
- conjuntivite
- exantema maculopapular (no sarampo)
- manchas de Koplik (no sarampo)
- erupção cutânea escarlatiniforme (na faringite por estreptococo do grupo A [GAS])
Other diagnostic factors
- atividade ou abuso sexual (em infecção por vírus da imunodeficiência humana [HIV], gonorreia ou clamídia)
- fracasso na resposta a um tratamento com penicilina
- ulceração faríngea (em tularemia)
- membrana cinza faríngea (na difteria)
Risk factors
- colonização nasal com Streptococcus do grupo A (GAS)
- contato infectado por GAS
- atividade ou abuso sexual
- ingestão de carne não doméstica
- hospedeiro imunocomprometido
- uso de corticosteroides inalatórios
- ausência de imunização ou fracasso vacinal
Diagnostic tests
1st tests to order
- teste rápido de antígeno para estreptococo do grupo A (GAS)
- teste de amplificação de ácido nucleico (via reação em cadeia da polimerase) para estreptococos do grupo A (GAS)
Tests to consider
- cultura de swab de garganta para Streptococcus do grupo A (GAS)
- cultura ou reação em cadeia da polimerase de swab da garganta para gonococo ou clamídia
- monoteste sérico para infecção pelo vírus Epstein-Barr
Treatment algorithm
todos os 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
- Epiglotite
- Abscesso retrofaríngeo, peritonsilar e lateral
- Mononucleose 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
Faringite
More Patient information
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