Definition
A.Inflammation of the pharynx.
B.Commonly referred to as a sore throat.
Incidence
A.Acute pharyngitis accounts for more than 12 million office and emergency/urgent care visits in the United States annually.
B.Viral pharyngitis occurs most frequently; increased incidence in adult population.
C.Bacterial pharyngitis occurs more frequently in children and adolescents.
1.Particularly the Group A beta-hemolytic streptococci (GAS).
a.Peak incidence occurs in 5 to 15 year age group.
b.Only 5% to 15% of adults present with GAS.
2.Bacterial pharyngitis occurs most frequently in winter and early spring months.
Pathogenesis
A.Infectious.
1.Viral.
a.Adenoviruses and rhinoviruses responsible for most cases of viral pharyngitis.
b.Other causes include.
i.Herpes simplex virus (HSV) 1 and 2.
ii.Coxsackievirus.
iii.Human herpes virus 4 (Epstein–Barr virus [EBV]).
iv.Human herpes virus 5 (cytomegalovirus).
v.HIV.
2.Bacterial.
a.The most important causative agent is the GAS.
i.Severe complications of GAS warrant prompt identification and treatment.
b.Other causes include.
i.Group C streptococci.
ii.Neisseria gonorrhoeae.
iii.Corynebacterium diphtheriae.
iv.Treponema pallidum.
v.Mixed anaerobes.
B.Noninfectious.
1.Allergy.
2.Irritants.
3.Gastrointestinal reflux.
Predisposing Factors
A.Exposure to infectious agents.
1.Bacteria.
2.Viruses.
B.Exposure to allergens.
C.Exposure to environmental irritants.
D.History of gastrointestinal reflux.
E.History of immunosuppression.
Subjective Data
A.Common complaints/symptoms.
1.Sore throat.
2.Difficulty swallowing.
3.Nasal congestion.
4.Sinus tenderness.
5.Cough.
6.Malaise.
7.Headache.
8.Distinguishing features of pharyngitis associated with GAS.
a.Absent cough.
b.Fever.
c.Tonsillar exudates.
d.Anterior cervical lymphadenopathy.
B.Common/typical scenario.
1.Patients typically complain of sore or scratchy throat, fever, and general malaise.
C.Review of systems.
1.Past medical history.
a.Recent illnesses. Determine the onset and duration of symptoms.
i.Abrupt or gradual onset.
ii.Duration longer than 3 weeks unlikely to be pharyngitis.
b.Sick contacts. Determine if the patient or close contacts have any systemic illnesses.
c.Assess the patient for any risk factors.
2.Allergies.
3.Possible occupational exposure history.
4.Travel history.
5.Sexual history.
6.Pertinent systems review.
a.Constitutional.
i.Fever.
ii.Malaise.
b.Head, ear, eyes, nose, and throat (HEENT).
i.Sore throat.
ii.Cough.
iii.Rhinorrhea.
iv.Nasal congestion.
v.Headache.
vi.Sinus tenderness/pain.
c.Integumentary.
i.Rash.
ii.Lesions.
Physical Examination
A.Appearance of pharynx.
1.Pale to red.
2.Mild erythema to profound edema.
3.Vesicular lesions.
a.HSV.
b.Coxsackievirus.
B.Appearance of tonsils.
1.Redness.
2.Edema.
3.Exudates.
a.White (oropharyngeal candidiasis, GAS).
b.Grayish membrane (diphtheria).
C.Lymph nodes.
1.Cervical lymphadenopathy.
2.Tonsillar lymphadenopathy.
D.Integumentary.
1.Scarlatiniform rash may be present in GAS infections.
2.Palatine petechiae may be present in GAS infection.
E.Red flags.
1.Hot potato
voice.
a.Garbled speech due to pharyngeal edema.
b.Suggestive of peritonsillar abscess.
2.Unilateral neck swelling.
3.Difficulties with secretion management.
a.Drooling.
b.Compromised airway.
i.Tonsillar pillars touching.
ii.Kissing tonsils.
4.Uvula deviation.
a.Indicative of peritonsillar abscess.
TABLE 1.1 Modified Centor Criteria
Source: Fine, A. M., Nizet, V., & Mandl, K. D. (2012, June 11). Large-scale validation of the Centor