Pharyngitis

Chapter 36 Pharyngitis



William V. Raszka




ETIOLOGY



What Are the Common Causes of Pharyngitis?


Pharyngitis, or inflammation of the pharynx, is a frequent complication of upper respiratory tract infections. The principal bacterial organism that causes pharyngitis is Streptococcus pyogenes, although Mycoplasma, Neisseria gonorrhoeae, and Arcanobacterium haemolyticum may cause infections in adolescents. Viruses, however, cause the vast majority of pharyngeal infections. Some viruses, particularly Epstein-Barr virus (EBV) and adenovirus, also commonly cause exudative pharyngitis, a condition in which tonsils and pharynx have a white exudate and inflammation. Distinguishing viral causes from S. pyogenes is important, because untreated S. pyogenes tonsillopharyngeal infection may lead to nonsuppurative complications such as acute rheumatic fever.



EVALUATION



How Do Viral and Streptococcal Pharyngitis Differ?


Patients with viral pharyngitis and streptococcal pharyngitis may present with similar signs and symptoms. Generally, viral pharyngitis begins gradually, often associated with rhinorrhea and other signs of upper respiratory tract infection. Streptococcal pharyngitis usually has a more sudden onset and higher fever than most viral illnesses, with the notable exception of EBV infection. In addition, headache, sore throat, and abdominal upset often accompany strep infection, but not cough or rhinorrhea. The likelihood that the patient may have streptococcal tonsillopharyngitis is highest if pharyngeal pain is associated with fever but without cold symptoms; age younger than 2 years decreases the likelihood. Patients with streptococcal pharyngitis usually have prominent pharyngeal erythema, palatal petechiae, tonsillar exudates, and tender anterior cervical lymph nodes. A rapid antigen test or culture of the tonsils or pharynx that is positive for group A β-hemolytic streptococci (GABHS) confirms the diagnosis.



How Do I Detect Viral Causes of Pharyngitis?


Although many patients with viral pharyngitis present with nonspecific findings, some have features characteristic of specific infections. Herpangina, a Coxsackie virus infection, is associated with vesiculoulcerative lesions on the soft palate. Patients with EBV infection (“mononucleosis”) may be difficult to distinguish from those with streptococcal pharyngitis based on the history and physical examination. They often complain of sore throat, malaise, and fever. Physical examination reveals diffuse lymphadenopathy, particularly of the anterior and posterior cervical chains, exudative pharyngitis, and splenomegaly. Laboratory findings in patients with EBV infection include atypical lymphocytosis and mild hepatic transaminase changes. In children older than 5 years, a positive IgM heterophile antibody test (Monospot) is highly suggestive of EBV infection. Specific EBV titers can confirm the diagnosis in children of all ages.

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Jun 19, 2016 | Posted by in PEDIATRICS | Comments Off on Pharyngitis

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